House Passes Bills that Address Infections Related to the Opioid Epidemic

6/13/2018

Statement of the Infectious Diseases Society of America, the HIV Medicine Association and the Pediatric Infectious Diseases Society 

Contact: IDSA: Jennifer Morales This email address is being protected from spambots. You need JavaScript enabled to view it.

PCI Public Relations (312) 558-1770 This email address is being protected from spambots. You need JavaScript enabled to view it.

The U.S. House of Representatives voted overwhelmingly last night to approve the Eliminating Opioid-Related Infectious Disease Act and the Substance Use Disorder Loan Repayment Act of 2018. The Infectious Diseases Society of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society strongly support these bills. They will expand surveillance of infections (including HIV, hepatitis B and C, endocarditis, and other communicable health threats) associated with substance use disorders, authorize provider training to coordinate care for both infectious diseases arising from substance use and addiction, and provide loan repayment for health professionals caring for patients with substance use disorders (including those treating related infections).

As Societies with more than 12,000 infectious diseases, pediatric, and HIV physicians, IDSA, HIVMA, and PIDS made recommendations reflected in the Eliminating Opioid-Related Infectious Diseases Act, including the addition of endocarditis, a heart valve infection, to the list of infections related to the opioid epidemic. Not currently under national surveillance, endocarditis in most cases is a severe, acute illness requiring hospitalization that is different from viral infections associated with injection drug use such as HIV and hepatitis C virus (HCV).  For HIV and HCV, individuals can live with the conditions for years before prominent symptoms occur requiring acute care and engagement with the medical system. Surveillance or monitoring of endocarditis and other bacterial infections will lead to more timely identification of injection drug-related outbreaks. We also strongly support the provider training component of the bill and are pleased that the bill now recognizes the importance of training and care coordination for infectious diseases and addiction to help ensure better patient outcomes.

The Substance Use Disorder Loan Repayment Act will address the need for a trained health workforce sufficient to detect, control and deliver coordinated care for infections with an escalating incidence as a result of increasing injecting drug use. Compared to five years ago there are 20 percent fewer physicians entering training programs for infectious diseases and HIV medicine, raising great concern about shortfalls in expertise exactly when most needed. This bill will help to attract the diversity of healthcare providers necessary to provide prevention, care, and treatment services to individuals with substance use disorders, including infectious diseases and HIV providers.

These bills are part of a package of legislation passed by the House yesterday to address the opioid crisis, and the effort reflects a bipartisan commitment to confronting the combined public health threats of the growing opioid epidemic and the outbreaks of infectious diseases the crisis has fueled. We urge the U.S. Senate to advance these measures so that they may rapidly become law.

The SECURE -- Securing Experts to Control, Understand, and Respond to Emergencies -- Act (HR 5998), a bill that would establish Epidemic Intelligence Service student loan repayment at the Centers for Disease Control and Prevention, was introduced today by Rep. Jan Schakowsky (D-IL). This bill would represent a critical step in strengthening the infectious diseases public health workforce by allowing medical school loan repayment for physicians participating in the CDC’s two-year public health emergency preparedness and response fellowship program.
 
While similar programs at NIH and HRSA’s National Health Service Corps offer loan repayment to encourage careers in biomedical research and patient care in underserved communities, that opportunity does not now exist for careers in public health preparedness and response. HR 5998 would fill this gap.
 
IDSA was instrumental in developing this proposal, and is urging its passage. PIDS is assisting IDSA in spreading the word to our members.  Please take two minutes now to ask your representative to co-sponsor HR 5998.
 

Dinny was Professor of Community Paediatrics from late 1995, as well as a highly experienced specialist in Pediatric Infectious Diseases with many years of service to Starship (and previously Princess Mary Hospital), Kidz First/Middlemore Hospital and the University of Auckland since 1977. She was hugely respected as an academic researcher in the field both in New Zealand and internationally with over an impressive portfolio of publications. Dinny was an international expert in Rheumatic Fever and instrumental in researching and developing successful school based prevention programs which are a testament to her passion and persistence in developing timely access to quality health services on behalf of our children.

From 2002, when meningococcal disease was at epidemic levels, Dinny worked tirelessly at the national and international level in developing a vaccine and then setting up and leading clinical trials culminating in mass MeNZB vaccination program in 2004 -2008. Dinny was a champion in involving local communities and schools from the start. Her passion to reduce the inequitable burden of infectious diseases in our child community is an example to us all and will be her lasting legacy. Her career achievements will have touched many generations of New Zealand children as well as pediatricians who benefited from her wisdom and teaching.

This news will be a shock to many, as it has been to us. Her passion, leadership, and tenacity to improve the health of disadvantaged children will be sorely missed and remembered with great fondness - moe mai ra e te rangatira.

We send our love and condolences to her husband John, children William and Harry, and their families

Kua hinga te tōtara i Te Waonui a Tāne.
A mighty tōtara has fallen in the forest of Tāne.

Pediatric infectious diseases is an exciting, rewarding, and intellectually stimulating specialty, as well as one that is critical to maintaining good health in children and adolescents. Despite these characteristics, however, there are concerns that too few young physicians are entering the field to meet growing needs.

A new commentary published in JPIDS examines the looming shortage of physicians pursuing pediatric ID, factors behind the problem, and possible solutions to address it. Drawing on physician surveys, recent ID fellowship program match results, and perceptions of both compensation trends and available employment opportunities, the commentary describes the current state of the specialty and implications for the future. Led by Janet R. Gilsdorf, MD, of the University of Michigan Medical School and a past president of PIDS, the commentary authors also suggest ways forward. These include a list of practical steps pediatric ID physicians should take at their own institutions today to attract medical students and residents to the field.

Additional authors of the new commentary, “Pediatric Infectious Diseases Meets the Future,” are Paul Spearman, MD, of Cincinnati Children’s Hospital Medical Center; Janet A. Englund, MD, of the University of Washington in Seattle; Tina Q. Tan, MD, of Northwestern University Feinberg School of Medicine in Chicago; and Kristina A. Bryant, MD, of the University of Louisville School of Medicine.

Prevalence of Pertussis Antibodies in Maternal Blood, Cord Serum, and Infants from Mothers With and Those Without Tdap Booster Vaccination During Pregnancy in Argentina

Fallo AA et al. Journal of the Pediatric Infectious Diseases Society, Volume 7, Issue 1, 19 February 2018, Pages 11–17, https://doi.org/10.1093/jpids/piw069

Pertussis-related morbidity and mortality are highest among infants. In 2012, the Advisory Committee on Immunization Practices recommended Tdap vaccination for all US pregnant women during their third trimester, irrespective of their immunization status. Few studies have evaluated the optimal time for immunizing pregnant women. A study by Fallo and colleagues examined the kinetics of pertussis toxin immunoglobulin G levels (IgG-PT) among infants born to mothers immunized with the Tdap vaccine during pregnancy in Buenos Aires, Argentina.

Healthy pregnant women (aged 18-44) who delivered a singleton child at a public hospital and had not received a Tdap vaccine since 6 years of age were enrolled from 2011 to 2012 (n=99); women who delivered their child at the same center and received a Tdap vaccination were recruited from 2013 to 2014 (n=105). The control group was healthy non-pregnant women aged 18-44 (n=69). Women with current or chronic medical conditions and women with antibody levels suggestive of recent pertussis infection were excluded, along with newborns with a birth weight <2000 g. There were no significant differences in demographics or exposure to household children/adolescents among the three groups of subjects. The mothers received their Tdap vaccine at, on average, 13.2–36.6 weeks.

Paired maternal and umbilical cord blood samples were collected at the time of delivery, processed and frozen at −20°C until blind testing at the Argentina National Reference Center. IgG-PT level was measured using a Centers for Disease Control and Prevention–validated specific pertussis IgG enzyme-linked immunosorbent assay (ELISA). Purified pertussis toxin (Protein Express, Inc, Cincinnati, OH) was used as the positive control. The assay was calibrated to the World Health Organization international reference standard, 06/140. The lower limit of quantification was 1 ELISA unit (EU)/mL. In each assay, values lower than 1 EU/mL were assigned a value of 0.5 EU/mL.

IgG-PT concentration of >20 EU/mL at birth is considered “seropositive” with ≥5 EU/mL defined as the protective level.   In this study nonpregnant women had significantly higher concentrations of IgG-PT than the pregnant women who were not vaccinated (IgG-PT GMCs were 14.4 EU/mL (95% CI, 10.2–20.1 EU/mL; range, 2.7–85.5 EU/mL) and 9.8 EU/mL (95% CI, 8–12.1 EU/mL; range, 0.5–68.1 EU/mL respectively; p=0.03); 16 (16.1%) of the pregnant women had an IgG-PT level of <5 EU/mL.  Lower antibody level among non-vaccinated pregnant women was thought to be due to the immune modulation observed during pregnancy. At birth, the mothers with and without a Tdap vaccine had serum IgG-PT geometric mean concentrations (GMCs) of 35.1 and 9.8 ELISA units (EU)/mL, respectively (P < .0001); cord blood GMCs were 51.3 and 11.6 EU/mL, respectively (P < .0003); cord blood IgG-PT levels were <5 EU/mL in 2.9% and 16.1% respectively (P < .001). There was a linear correlation in IgG-PT levels between paired mother and cord serum samples. The IgG-PT level was <5 EU/mL in 3 (2.9%) of 105 immunized mothers and 33 of 105 (31.4%) had a level of <20 EU/mL. 2 of 105 (1.9%) cord samples had an IgG-PT level of <5 EU/mL.  Vaccination timing had no impact on maternal or cord serum levels; however, there were lower antibody levels at delivery in mothers vaccinated before 20 weeks of gestation. No correlation was found between cord IgG-PT concentrations and maternal age or infant birth weight.

Cord blood IgG-PT levels were higher than those of maternal serum. Placental antibody transference efficiencies (the ratio of cord blood GMC to maternal GMC) were 1.46 and 1.18 for mothers with and those without a Tdap vaccination, respectively. 

After birth, the investigators analyzed the IgG-PT kinetics in newborns born to immunized mothers.  The IgG-PT GMCs were 17.7 EU/mL in 36 infants in their first month of life and 11.6 EU/mL in 32 infants in their second month of life, representing decreases of 76% and 63.5%, respectively, from cord sample levels. This decay was earlier than that suggested by Van Savage et al.  (1) and predicted by Eberhardt et al (2). Therefore, the investigators proposed that an antibody level higher than 20 EU/mL at birth was desirable.  All infants with a IgG-PT GMC higher than 20 EU/mL at birth had a level of >5 EU/mL at 2 months of age; however, 20 of 105 (19%) had a cord level of <20 EU/mL.  No infants in this study developed pertussis. Figure 3 shows the decay of IgG-PT in infants during their first 1 and 2 months of life. 

The authors concluded that infants born to immunized mothers had significantly higher antibody levels during the first 2 months of life, and suggested that more prospective studies to determine the optimal timing of Tdap vaccination during pregnancy.

References

5/21/2018

The Ebola outbreak in the Democratic Republic of Congo announced May 8 has highlighted meaningful advances as well as critical needs that continue in the wake of the epidemic across Sierra Leone, Guinea and Liberia that ended two years ago. Because of an immediate response by the World Health Organization and partners to the confirmation of one case in the remote rural Bikoro health zone, mobile laboratories are in operation, 14 cases have been confirmed, and contact tracing as well as community engagement are underway. People who have been potentially exposed to the virus will receive a promising, investigational Ebola vaccine. All of this represents remarkable progress, due to investments in science, in practice, and in the recognition that solidarity is essential to effective infectious disease interventions globally. WHO officials Friday cited the swiftness, collaboration, and coordination of the response so far among the reasons that the outbreak does not now meet their criteria for declaring a Public Health Emergency of International Concern.

But the challenges remain formidable, with the remoteness of the region where the first cases were discovered, and the vulnerability of neighboring communities, cities and nations, posing a daunting combination of obstacles to the response, and risk of international spread. The identification of four cases in Mbandaka, a city of 1.2 million people, confirms the urgency of closing gaps in resources and capacities that fuel the spread Ebola. For those reasons, the WHO committee will revisit the threats posed by this advancing outbreak.

It is essential now to take stock of what needs to be done, not just to reach, diagnose, and care for those who have been affected by this outbreak, and to contain its spread, but to improve future responses, and prevent future threats from Ebola and other diseases. Funding allocated by Congress in 2014 to support responses to the outbreak in West Africa have gone a long way toward supporting the enhanced global health security needed to accomplish those goals. Continued investments in global health security and biomedical research are essential to maintaining the momentum now underway. On the same day the Ebola outbreak in the Democratic Republic of Congo was announced, however, the White House made its own announcement, of a proposal to rescind $252 million of funding supporting USAID’s global health security efforts.

As organizations of more than 12,000 infectious diseases, pediatric infectious diseases and HIV physicians, as well as infection prevention specialists, the Infectious Diseases Society of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society and the Society for Healthcare Epidemiology of America offer our solidarity, support, and expertise to the outbreak response in the Democratic Republic of Congo. We urge Congress to support those efforts as well, by rejecting White House rescission proposals and by basing robust funding for global health security and biomedical research on the realities reflected in the current Ebola outbreak.

Paul Auwaerter, MD, MBA, President IDSA
Melanie Thompson, MD, Chair HIVMA
Paul Spearman, MD, FPIDS, President PIDS
Keith Kaye, MD, MPH, FSHEA

Contact
IDSA: Jennifer Morales This email address is being protected from spambots. You need JavaScript enabled to view it. 
PCI Public Relations (312) 558-1770 This email address is being protected from spambots. You need JavaScript enabled to view it. 


05/10/2018 

The Infectious Diseases Society of America, the HIV Medicine Association the Pediatric Infectious Diseases Society and the Society for Healthcare Epidemiology of America call on Congress to reject legislative attempts, including House Resolution 3 introduced Wednesday evening, that advance the Trump administration’s rescissions package. The resolution and the administration proposal both undercut future budget deals, thus endangering critical investments in public health, treatment and biomedical research programs, including activities to combat infectious diseases.

HR 3 mirrors the administration’s proposal by rescinding $7 billion in budget authority for the State Children’s Health Program. Such a cut would dramatically reduce resources available to House and Senate appropriators as they determine funding for vital health programs, including infectious disease and HIV domestic and global programs at the National Institutes of Health, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the State Department, and USAID.

HR 3 also follows the administration’s proposal to rescind $252 million of USAID funding for combating Ebola and other emerging infectious disease threats through the Global Health Security Agenda. This is deeply concerning to the members of IDSA, HIVMA, PIDS and SHEA. The most recent outbreak of Ebola in the Democratic Republic of Congo, announced by the World Health Organization on the same day, highlights the shortsightedness of the proposal, as well as the urgency of efforts to build capacities to detect, prevent, and respond to infectious disease outbreaks where they originate.

Congress recognized this priority by directing part of the remaining emergency funding allocated in response to the 2013-to-2016 Ebola outbreak in West Africa to global health security programs in the omnibus funding bill for fiscal year 2018. The funding supports surveillance, laboratory capacity, and public health workforce strengthening in countries with limited public health resources. It is essential to averting future devastating outbreak impacts like those caused by the Ebola crisis across three West African countries, and to protecting the health of Americans at home and abroad. Funding for global health security strengthening activities is available through September 2019 – the administration’s attempt to rescind remaining funding would impact the ability of USAID to stop outbreaks at their source.

HR 3 also would undermine efforts to combat the critical and growing global health threat of antimicrobial resistance, with cuts to funding that supports health provider training to prevent health care associated infections and expanded surveillance of drug-resistant bacteria. In addition, a proposed $148 million rescission of funds allocated to the Animal and Plant Health Inspection Service at the Department of Agriculture threatens efforts to address disease outbreaks from re-emerging diseases, including the avian influenza.
Ultimately the outcomes of the rescission package announced by the administration Tuesday and echoed in HR 3 will not be savings, but added costs, when the effects of infectious diseases abroad, and failures to stop them at their source, come home.

Contact: IDSA: Jennifer Morales This email address is being protected from spambots. You need JavaScript enabled to view it.
PCI Public Relations (312) 558-1770 This email address is being protected from spambots. You need JavaScript enabled to view it.

Paul Auwaerter, MD, MBA, President IDSA
Melanie Thompson, MD, Chair HIVMA
Paul Spearman, MD, FPIDS, President PIDS
Keith Kaye, MD, MPH, FSHEA

IDSA and HIVMA guide legislation responding to opioid ID impacts

As key Committees in Congress turned their attention to the opioid crisis, IDSA and HIVMA ensured their legislation addressed the intersection of infectious diseases and substance use disorders, as well as the need to build ID and HIV provider capacity into the response.

The Senate Health, Education, Labor and Pensions Committee modified its Opioid Crisis Response Act in response to IDSA/HIVMA recommendations to include infective endocarditis in addition to viral hepatitis and HIV in new surveillance activities and to include clinicians caring for patients with infectious diseases related to substance use in new loan repayment opportunities through the National Health Service Corps. Because of our advocacy, the bill also now authorizes infectious diseases testing through comprehensive opioid recovery centers that would be created under the bill. The HELP Committee approved this important legislation on April 24, and the full Senate is expected to consider it this summer. Read More.

May 15 webinar to offer advocacy tips
 
IDSA, HIVMA, and PIDS have scheduled an advocacy webinar on ways to engage policymakers at home and in Washington, DC-and you're invited. In addition to practical tips on building relationships with elected officials as well as their staff members, and conducting productive meetings, IDSA and HIVMA member advocates will share their experiences with members of Congress, discuss the ways that advocacy can make a difference, and take questions. Read More.

Educate policymakers on 340B and ID/HIV

In January 2018, the Centers for Medicare and Medicaid Services reduced 340B reimbursement for Medicare Part B drugs to some participating hospitals, potentially cutting support for services provided to uninsured and underinsured patients at these facilities. In addition, Congressional members have indicated an interest in making changes to the program with similar bills being introduced in the House and Senate that would put a moratorium on new participating hospital sites and impose new data reporting requirements. Read More.

IDSA & HIVMA weigh in as House begins work on FY 2019 federal funding bills 

As lawmakers confront a White House budget plan proposing deep cuts to research, public health and global health programs, and consider their priorities for the year to come, IDSA and HIVMA leaders are weighing in. 

HIVMA board member Dr. Marwan Haddad testified April 26 at the House Appropriations Labor, Health and Human Services, and Education subcommittee public witness hearing on the need to increase funding for Ryan White Part C clinics and to leverage Ryan White clinics in responding to national opioid epidemic. His testimony can be found onlineRead More.

The 5th Annual St. Jude-PIDS Pediatric Transplant ID Symposium entitled “Bench to Bedside” was held at the Marlo Thomas Center, St. Jude Children’s Research Hospital in Memphis, TN, on March 9, 2018, with over 160 attendees present. The symposium featured excellent talks by amazing faculty, as well as case presentations, oral abstracts and poster sessions, and 3 clinical breakout sessions discussing bacterial, fungal, and donor question issues.

The morning sessions included lectures on transplant immunology by Allan Kirk, MD, PhD, Duke University School of Medicine; HHV-6 in the transplant recipient by Danielle Zerr, MD, MPH, Seattle Children’s Hospital; cell therapy with genetically modified T cells by Stephen Gottschalk, St. Jude Children’s Hospital, vaccines in transplant patients by Klara Posfay-Barbe, MD, MS, University Hospitals of Geneva, and NIH transplant for primary immmunodeficiencies by Alexandra Freeman, MD, NIH, NIAID. This was followed by a poster session (with a good lunch!) and a session on biomarkers for post-transplant lymphoproliferative disorders by Olivia Martinez, PHD, Stanford University School of Medicine, and three challenging cases in Transplant ID. These cases included a challenging case of CMV resistance and children presenting with RSV and rhinovirus infection pretransplant, which were discussed by panelists Klara Posfay-Barbe, Danielle Zerr, and Michael Green. Following selected oral abstracts by Joy Hazleton, MD, PhD, from University of Colorado and William Muller, MD, PhD, from Northwestern University Feinberg School of Medicine, we had breakout sessions discussing interesting and challenging cases in immunocompromised hosts including evaluation of risk for donor-derived infecitons. Finally, research presentations and proposals by the PIDS Transplant Research Network showing results of multicenter research on respiratory viruses in solid organ transplant recipients (Lara Danziger-Isakov), C. difficile (Gabriela Maron, MD), and a proposed CMV immune biomarker study (Michael Green and Daniel Dulek) were presented and discussed.

The Organizing Committee, Lara Danziger-Isakov, Janet Englund, Brian Fisher, Hayley Gans, Betsy Herold, Gabriela Maron, and Elaine Tuomanen, would like to thank St. Jude and PIDS staff for helping with this meeting. A supplement for JPIDS is being planned featuring some of the topics discussed at this meeting as well as selected abstracts.

SAVE THE DATE: 6th Annual St. Jude-PIDS Pediatric Transplant ID Symposium will be held on March 7, 2019 at the Marlo Thomas Center at St. Jude Children’s Research Hospital. Suggestions for topics for next year’s meeting are welcome – click here to submit your suggestions!

My wife will say that it is when she first knew that I would specialize in pediatric ID. During my final year of medical school in Memphis, I attended the John Erskine Lecture at St. Jude Children’s Research Hospital and I was hooked. Over the last two decades, I have attended nearly every St. Jude/PIDS Pediatric ID Research Conference and each year I am equally enamored by the breadth and depth of research within our field.

The conference is intended to showcase field leading infectious diseases research, highlight luminaries in our field, and honor those whose work transcends disciplines, as with the annual John Erskine Lecture. The meeting focuses principally on basic discovery, with this year’s frontier lecturers ranging from the molecular evolution of Enterococci, to systems serology, HIV therapeutics, and new approaches to S. aureus. As the first morning concluded, Dan Portnoy, PhD, an expert in Listeria pathogenesis was honored as the John Erskine Lecturer in Infectious Diseases.

The afternoon was filled with original research presentations by PIDS Fellowship Award recipients and meeting participants, including a poster presentation and wine/cheese reception. The evening concluded with dinner at the newly renovated National Civil Rights Museum.

The second day of the meeting included insights into RSV pathogenesis and a deeper look into vaccine regulatory considerations, presented by this year’s Luminary in Pediatric Infectious Diseases, Dr. Larry Pickering. These were followed by career development presentations, career pathway talks, and breakout sessions focused on K-awards, loan repayment, grant writing, and understanding how jobs are created. This latter portion is one of the unique aspects of the meeting and follows a 3-year curriculum developed by members of the PIDS Research Committee.

The meeting enjoyed record attendance this year, with over 220 participants. We remain deeply grateful for the generous support that St. Jude provides year after year and for their leadership and organizational commitment to this meeting.

We encourage you to attend next year’s meeting, which will be held March 8-9, 2019. Registration will open in November and we encourage you to attend. Suggestions for topics for next year’s meeting are welcome – click here to submit your suggestions! If you are a fellow, limited funds are available for travel stipends that can offset the cost of travel. The 2019 meeting promises to be a great opportunity for faculty, fellows, residents, and students to attend the only PIDS-specific meeting in the US.

We look forward to seeing you in Memphis next year!

C. Buddy Creech, MD, MPH
Chair, PIDS Research Committee
PIDS Secretary-Treasurer

Each year, the St. Jude / PIDS Pediatric Infectious Disease Research Conference includes a series of career development presentations. These sessions are planned based on changes in the field and feedback from our members and attendees. At the 2018 St. Jude / PIDS Pediatric Infectious Disease Research Conference, we presented a breakout session on “Unlocking the Black Box of Pediatric ID FTEs” to empower our residents, fellows and junior faculty in negotiating academic positions. In this session, participants and session leaders Kari Simonsen and Stephanie Stovall discussed the meaning of Full Time Employment in our field, and some of the potential opportunities for building a career of your own design.

The session began with explaining the concept of “Full Time Equivalents” and the most common elements of FTE in pediatric infectious careers, including clinical, educational, research, administrative and service FTE allocations. Understanding the variations in how clinical FTE is defined and allocated across practice settings including large and small academic centers, community hospitals, and private practice were discussed.  Comparing clinical FTE allocations across settings requires consideration of hospital size, practice setting, team complement, and support staff resources. Niche clinical expertise including the role of the Pediatric Transplant, HIV, and/or Immunocompromised host expert is also an important potential distinguishing characteristic when demonstrating expertise in the field of clinical Pediatric ID.  The concept of clinical productivity targets as measured by wRVUs (work-based Relative Value Units) was introduced, and the need to understand how these productivity targets may be incorporated into discussions of FTE, or included in compensation metrics.

Most pediatric infectious disease physicians consider education a key component of our role as clinicians and scientists. In defining an academic position, there is an important distinction between time spent educating learners during clinical activities versus having an explicit role as an educator.  We navigated the discussion of having clearly defined FTE for a titled position (Pediatric Clerkship Director, Residency Director, Fellowship Director) and that these titles should come with an expectation of FTE allocation, guaranteed salary support for this time and effort, as well as anticipated demonstration of outcomes in education for the role.

As we discussed Administrative or Service FTE, we included important aspects of practice management such as Division Chief, or Clinical Service Chief, and hospital-based positions such as Directorships of Medical Microbiology, Antimicrobial Stewardship, or Hospital Epidemiology. These titled roles are of critical importance to hospitals and health systems, and should provide both FTE allocation and guaranteed salary support.

Protected time for research is essential for success as a physician scientist. We strategized initial negotiation of protected time and expansion of that FTE allocation through extramural funding sources. As with the other elements of FTE, success in a research career requires consideration of other support such as funds, personnel, space and equipment in addition to FTE. It is also important to define what is necessary and expected for success on a physician-scientist career path at each institution, versus what is a reasonable offer or expectation for someone anticipating a career as a clinician educator or primarily in a clinical role.

A better understanding of the building blocks of professional time allocation empowers fellows and junior faculty identify and negotiate a position that is best suited for long term success and professional fulfillment. The St. Jude / PIDS Pediatric Research Conference provides a valuable opportunity to ask peers, mentors, and others in the field questions such as these to build a rewarding career in pediatric infectious disease.

 

For those who were able to stay until the very end of the St. Jude/PIDS conference, attendees were treated to one of the newest elements in this annual meeting, the Global Health session. The goal is to address the increasing interest in global health among pediatric infectious diseases specialists and engage the large entourage of international infectious disease experts who attend the course as part of the St. Jude Global Academy Infectious Diseases Training Seminar.

To begin, we heard from two pediatric infectious diseases leaders who have created successful and rewarding careers in global health. Dr. Edwin Asturias explained how his specialty training in infectious diseases and his desire to improve public health in his home country of Guatemala led him to pursue research in vaccine preventable illnesses in Guatemala. He told a fascinating story of the history of oral polio virus vaccination in Latin America. Next, Dr. Fernando Polack briefly told his story of leaving his home country of Argentina for training and beginning his career and then return to Argentina to build a successful research career. Dr. Polack offered his top ten key lessons for succeeding for physician-scientists who leave their home country for training and plan to return and pursue an academic career. We have summarized the top ten list here.

At the end of the session, the group divided into teams for a competitive but lively game of infectious disease jeopardy. Categories included “picture perfect” (photographs of pathogens or pathognomonic presentations), “defenseless” (infections of the immunocompromised) and “new menaces” (emerging pathogens). The questions covered infections throughout the world, so specialists from the United States and abroad were essential for each team’s success.

  1. Train formally and intensely. Fellowship can greatly enhance your clinical skills, but it will often be up to you to make your research experience an opportunity to acquire real tools to think for yourself. And this may be your only chance to do it for free.
  2. Do not leave the US as soon as you graduate from fellowship. Beyond clinical duties, the roles of faculty and fellows are very different. The most important assets – such as writing successful applications for funding, interpreting how to communicate your work orally and in writing, networking- may not be obvious to you during fellowship. And you need to learn them well (at least to a certain extent) before you migrate to regions where you may be unable to find mentors to help you. In other words, if you were to visit the Queen of England, you can be smarter than Einstein but will look like a fool if you ignore the protocol.
  3. Have a plan. Do not leave without a plan that sounds reasonably logical and safe to other international scientists. Be cognizant that different people may look at your plans from different angles, even at times from the wrong angle. Be smart in selecting your advisors.
  4. Understand your environment. Do not allow homesickness to blind you into the dangerous belief that all will be easy and wonderful upon returning. The better trained and more experienced you are (while relatively young), the smoother your re-insertion in terms of creating a safe zone for yourself.
  5. Be quick to recognize challenges and solve them creatively. Do not be stubborn. If you detect a menace, be quick to act and find solutions. While the developing world is often full of unpredictable challenges, people are often more flexible to alternative solutions (in part because everybody does more than one thing to survive and therefore nothing is as ”fixed” as in industrialized nations). Always have an alternative plan in hand.
  6. Do not delude yourself. Most extraordinary promises will never materialize. Given that research programs can be less structured than in the industrialized world, people’s genuine hopes for participating in novel experiences may lead them to promise you fabulous returns for your efforts: hundreds of participants for an observational study that turn out to be 5 subjects, incredible samples that were lost years ago, etc. Be rational when using this information to plan your efforts.
  7. Never negotiate the quality and standards of your work. You are into this to be first class scientists. Not to be pat in the back by the President. Your eyes should always be set in your academic colleagues worldwide, never to lose reference.
  8. Be smart selecting your questions. The logic of funding for the developing world is different from that for industrialized countries, and often even different from the logic of funding for US investigators conducting research in developing countries from the US. Know the players and keep them in mind when planning your program.
  9. Enjoy your impact. It is not a minor achievement to succeed in science from a satellite country. Stop once in a while to feel good about recognition in reputed academic forums, to wonder whether you may be a factor of change in your community’s health status, and to marvel when your trainees succeed.
  10. Groom the next generation. Then your work will take root and multiply.

 

04/25/18

The Infectious Diseases Society of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society commend House and Senate panels approving legislation this week that demonstrated a commitment to confronting the opioid crisis comprehensively and effectively. As societies comprising more than 12,000 infectious diseases, pediatric and HIV physicians, we deeply appreciate provisions in the bills responding to the escalating incidence of infections including HIV, hepatitis C, hepatitis B, bacterial endocarditis and other communicable health threats that accompany the epidemic of opioid use and other addictive substance use disorders. Testing and treatment for infections transmitted through injection drug use must be integrated into responses to the opioid epidemic to avert some of the most serious consequences of this crisis.

The bills put forward by the Senate HELP Committee and the House Health Subcommittee of the Committee on Energy and Commerce recognize that responses to the opioid crisis must address accompanying threats to individual and public health. The Senate Opioid Crisis Response Act and the House Eliminating Opioid Related Infectious Disease Act both address needs for expanded and coordinated surveillance of infections associated with substance use disorders. The inclusion, in both bills, of surveillance of infective endocarditis, represents an important and urgently needed advance. Rates of this serious heart valve infection, which generally requires costly inpatient care, are increasing dramatically among young people who inject drugs, but there is currently no system for monitoring it.

Both the Senate Committee and House Subcommittee also recognize the need for a ready, trained and sufficient health workforce to detect, control and deliver coordinated care for the infections that accompany the opioid epidemic. The Senate Committee bill and the Substance Use Disorder Workforce Loan Repayment Act, approved by the House Health Subcommittee would provide loan repayment for clinicians whose primary role is caring for patients with substance use disorder, including treating infectious diseases associated with substance use. These bills address a significant factor leading to fewer physicians pursuing training in infectious diseases and HIV care, at a time when the need for that expertise is increasing. In addition, the House Eliminating Opioid Related Infectious Disease Act also authorizes provider training to coordinate care for infectious diseases and addiction.

The Senate bill also addresses demonstrated needs for expanded access to interventions critical to addressing and treating substance use disorders and infectious diseases among individuals who inject drugs. A provision that includes testing for diseases commonly associated with substance use disorders in Comprehensive Opioid Recovery Centers will ensure that individuals with viral hepatitis and HIV will be diagnosed faster, leading to more prompt treatment that will improve their health outcomes and help stop transmission. Provisions easing restrictions on access to medication assisted treatment for substance use disorder will help optimize use of a proven intervention that can reduce opioid-related deaths by half.

We applaud the panels for the leadership they have shown in confronting the combined public health threats of the growing opioid epidemic and the infectious diseases that continue to spread in its wake. The needs noted in their bills will continue until the resources, policies, healthcare access and workforce are in place to address all the health impacts of the opioid crisis. We strongly support these bills and urge our legislators to move forward swiftly to bring them to fruition to make a difference in the many communities across the country confronting these devastating epidemics.

Contact

IDSA: Jennifer Morales This email address is being protected from spambots. You need JavaScript enabled to view it.

PCI Public Relations (312) 558-1770 This email address is being protected from spambots. You need JavaScript enabled to view it.

Paul Auwaerter, MD, MBA, President IDSA

Melanie Thompson, MD, Chair, HIVMA Board of Directors

Paul Spearman, MD, FPIDS, President PIDS

World Immunization Week from April 24-30 gives us the opportunity to celebrate one of the greatest achievements of modern medicine. Safe and effective vaccines that protect individuals against diphtheria, hepatitis B, measles, mumps, pertussis, rubella, human papilloma virus, and polio have drastically limited the incidence of these serious, sometimes life-threatening diseases in many parts of the world. Immunizations against infectious diseases that cause severe illness, disability and death save from 2 million to 3 million lives annually and prevent the spread of infections that can be resistant to treatments. This week also is a time to reflect on the public health benefits of immunization, with high rates of vaccination across communities providing indirect protection through herd immunity for populations including very young children, pregnant women, and people with weakened immune systems who cannot be vaccinated. Across the U.S. and globally, universal access to vaccines is critical to their optimal effectiveness. Gaps in coverage anywhere can pose threats of re-emerging diseases, particularly among the most vulnerable populations everywhere.

This year, World Immunization Week brings reminders that globally, vaccine coverage remains far from adequate. Currently, 19.5 million children lack access to basic vaccines against diphtheria-tetanus-pertussis and remain vulnerable to these preventable yet potentially deadly infectious diseases. And, while measles vaccinations have prevented more than 20 million deaths since the turn of this century, making that vaccine one of the most cost-effective investments in public health, measles remains one of the leading causes of death worldwide among children under five.

While the United States has made significant progress toward eliminating vaccine-preventable diseases among children, coverage continues to lag for adolescents and adults.  Every year, more than 50,000 adults in the U.S. die from vaccine-preventable illnesses. Annually, the U.S. spends $26.5 billion treating four vaccine-preventable illnesses in adults—influenza, shingles, pertussis and pneumococcal disease. In addition, ill-informed policies allowing personal belief-based exemptions for childhood immunization requirements have contributed to depressed vaccination rates in some communities, followed by predictable measles outbreaks. Travelers continue to bring measles into the U.S. where, upon reaching communities where significant numbers of people remain unvaccinated, the disease spreads.

The Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society for Healthcare Epidemiology of America support universal immunization of children, adolescents, and adults, based on current scientific evidence and according to the recommendations and standards established by the National Vaccine Advisory Committee, the U.S. Centers for Disease Control and Prevention, and the CDC’s Advisory Committee on Immunization Practices. For CDC’s advisory committee to recommend a vaccine, the vaccine must demonstrate significant patient benefit and very low risk. To secure approval from the Food and Drug Administration, vaccines are often required to present more rigorous safety and efficacy data than drugs or devices. We strongly encourage states to enact and enforce laws requiring all children without medical contraindications to be fully immunized as a requirement for school or daycare. We support robust funding for CDC immunization programs that help ensure access to immunizations and respond to outbreaks of vaccine-preventable diseases. We also support improved Medicare coverage of vaccines and increased investment in vaccine registries or immunization information systems across the lifespan to increase uptake of recommended vaccines, including for pneumococcal disease, shingles and influenza for at-risk adults, including elderly individuals. We recognize the importance of policies requiring vaccination among healthcare workers to protect their health and that of their vulnerable patients.

We call on policymakers to continue investments in vaccine research and development needed to bring new and improved vaccines, including a universal influenza vaccine, to market, and to remain invested in ensuring the availability of these critical public health tools.

Contact

IDSA: Jennifer Morales This email address is being protected from spambots. You need JavaScript enabled to view it.

PCI Public Relations (312) 558-1770 This email address is being protected from spambots. You need JavaScript enabled to view it.

PIDS: Terri Christene Phillips, MSA This email address is being protected from spambots. You need JavaScript enabled to view it.

SHEA: Kristy Weinshel This email address is being protected from spambots. You need JavaScript enabled to view it.

Paul Auwaerter, MD, MBA, President IDSA

Paul Spearman, MD, FPIDS, President PIDS

Keith Kaye, MD, MPH, FSHEA

 

IDSA, SHEA and PIDS Announce Inaugural LEAP Fellowship Awardees 

IDSA, SHEA and PIDS are pleased to announce the first awardees of the Leadership in Epidemiology, Antimicrobial Stewardship, and Public health (LEAP) Fellowship. Currently in its inaugural year, the LEAP Fellowship is a $100,000 training award competitively granted to four promising young infectious diseases physicians. Funded by the Centers for Disease Control and Prevention, this fellowship aims to foster the next generation of Infectious Diseases leaders in public health, hospital epidemiology and antimicrobial stewardship, giving them the hands-on experience they’ll need to lead and collaborate across these disciplines of healthcare.

Awardees:

  • Milner Staub, MD, Vanderbilt University
    Leap Fellowship Project: An Assessment of Outpatient Antimicrobial Prescription Across Tennessee Based on Practice Location, Specialty and Provider
  • Dana Pepe, MD, Yale School of Medicine
    Leap Fellowship Project: Expanding Utilization of Targeted Assessment for Prevention (TAP) Strategy in Connecticut
  • Gabriella Andujar Vazquez, MD, Tufts Medical Center
    LEAP Fellowship Project: Enhanced Support for Long Term Care Facilities Participating in a Massachusetts Department of Public Health Antimicrobial Stewardship Initiative
  • Jennifer Blumenthal, MD, Boston Children’s Hospital
    LEAP Fellowship Project: Assessing and Optimizing the Utility of the Massachusetts Statewide Antibiogram

The LEAP Fellowship will commence July 1, 2018 and last one year. The Fellowship is for early career infectious diseases physicians - those in their second or third year of fellowship or up to two years post fellowship.

Societal Leadership Weighs In:

IDSA : “I am proud that we have partnered with SHEA and PIDS along with the CDC who is sponsoring LEAP so that infectious disease fellows or early career clinical ID physicians may gain experience and tools to foster collaboration between academic institutions and public health departments. With antimicrobial resistance a more pressing concern then ever, we wish the awardees success during their fellowship and look to their future for inspired leadership in stewardship, epidemiology and public health.” – Paul Auwaerter, MBA, MD, FIDSA, President of IDSA

SHEA : “The ability to effectively share knowledge and experience among professionals in public health, infection prevention and antibiotic stewardship and to form fruitful collaborative partnerships is critical in improving patient care and reducing antimicrobial resistance. By offering research support and professional opportunities, the Leadership in Epidemiology, Antimicrobial Stewardship, and Public health (LEAP) Fellowship will help to train future leaders in healthcare epidemiology. We are extremely excited to join IDSA and PIDS in awarding these inaugural LEAP Fellowships,” – Keith Kaye, MD, MPH, president of SHEA

PIDS : “The LEAP fellowships recognize outstanding young ID physicians who are poised to become leaders in public health, hospital epidemiology and antimicrobial stewardship. The Pediatric Infectious Diseases Society (PIDS) is excited to be a part of the inaugural LEAP fellowship awards, and would like to congratulate the four awardees. This is an area of great importance to the future of ID and to the health of our nation.”– Paul W. Spearman, MD, FPIDS

For more information on the LEAP Fellowship, please contact, Michele Wagner, MPH, LEAP Fellowship Project Manager at This email address is being protected from spambots. You need JavaScript enabled to view it.. For more information from CDC, please contact Karima Hunter, Project Manager at This email address is being protected from spambots. You need JavaScript enabled to view it..

On behalf of the National Foundation for Infectious Diseases (NFID), the latest NFID Call to Action: Improving Healthcare Personnel Immunization Rates, addressing how to best optimize practices that will lead to improved immunization rates among healthcare personnel. The recommendations in this Call to Action are based upon the discussions at a November 2017 Summit convened by NFID which included representatives from professional healthcare organizations active in infection prevention and control, occupational health, and immunization.

It is well recognized that vaccination is among the most cost-effective clinical preventive services currently available in the US. In looking specifically at healthcare personnel (HCP), vaccination efforts have been shown to reduce or eliminate the spread of disease to prevent illness among patients served and to reduce the need for medical visits, missed days of work, productivity loss, and medical errors. Those benefits are identified throughout the 2011 US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommendations for HCP immunization.
 
How PIDS Members Can Get Involved

Upcoming Complimentary NFID Webinar 

Thursday, April 5, 2018 at 12:00 PM ET

Improving Healthcare Personnel (HCP) Immunization Rates

Join NFID Medical Director William Schaffner, MD; Ruth M. Carrico, PhD, NP, CIC, University of Louisville; and Patricia A. Stinchfield, RN, MS, CPNP, CIC, Children’s Minnesota, for engaging presentations on specific strategies and best practices to increase HCP immunization in various healthcare settings. 

At the conclusion of this activity, participants will be able to:

• Review the current US recommendations for healthcare personnel and immunization rates

• Understand issues, challenges, and opportunities that may impact HCP immunization acceptance

• Discuss best practices and practical strategies to increase HCP immunization rates in various healthcare settings

There is no fee to participate in this activity but pre-registration is required: https://cc.readytalk.com/r/58ofavyuv6x7&eom.