The story of two little pigs

Not surprisingly, flu was a major topic of the IDSA meeting. I'll be writing a full article about the information presented, but in the meantime, a funny story from the CDC about pigs and H1N1. The first two cases of the novel flu were identified in kids in Southern California last April. Both children had been in contact with pigs, so the CDC wanted to determine whether the swine had been the source of the flu.

The 9-year-old girl had visited pigs at the state fair, but when the authorities went there, they found that the pigs had been butchered. The 10-year-old boy had met his pig on a leash at the San Diego Zoo, and when the CDC went to test that pig, they ran into a legal tussle with the zoo. So, concluded CDC expert Dan Jernigan, MD, "This is the story of two pigs--one had been slaughtered, and one had a lawyer."

Labels: H1N1, infectious disease, swine flu

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posted by Stacey Butterfield at 10:37 AM   0 Comments

The vaccine that went away.

You could almost think of it as part of the positive publication bias that almost all conference session are about things we do have, whether they're diseases, drugs, or dilemmas.

The IDSA session "Why is there no vaccine for Lyme disease?" bucked that trend. Experts reviewed why the Lymerix vaccine (on the market from 98-02) didn't work out. Problems included that the vaccine wasn't approved for kids, who are one of the highest risk groups, and it required multiple shots to acheive good (80%) effectiveness. Because of these factors (and others), the CDC gave it an underwhelming recommendation and uptake was limited. Protest, on the other hand, was serious and involved class action lawsuits claiming an association with arthritis that was never proven by the evidence.

Therefore, it's not surprising that no manufacturer has come up with a new vaccine, the experts said, but it is a "public health disaster" according to Stanley Plotkin, MD. Parts of the U.S. (like the Northeast) have a high prevalence of Lyme disease and residents who could benefit from a vaccine. Some are so eager for a vaccine that they've asked vets to give them the USDA-approved dog vaccine, Greg Poland reported.

Yet the only work on a Lyme disease vaccine (which hasn't gotten as far as human testing yet) is being done in Europe by Baxter. Europeans are less hostile to the concept and public attitude is really the factor that will determine whether the U.S. ever gets a vaccine, the experts concluded. "At least with Lyme disease, the advocacy groups are a lot more influential than we are," said CDC's C. Ben Beard. "Without their support, it's doubtful that vaccination would be successful."

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posted by Stacey Butterfield at 9:11 AM   0 Comments

Infectious tidbits

More hot stuff in infectious disease, this time from Bennett Lorber, MD. Dr. Lorber reviewed an array of recent research yesterday at IDSA. Here's the super-condensed version of his conclusions:

It's pretty clear that acid-suppressive medications are increasing the risk of pneumonia, and thereby causing excess hospital deaths, so they should not be prescribed so broadly. "We need to tell our medicine and hospital colleagues that acid-suppression should be a carefully considered decision," Dr. Lorber told the infectious disease docs.

Prescribing prophylactic antibiotics before catheter removal, on the other hand, is supported by new evidence. A recent trial found a NNT of 6 to prevent symptomatic infection. "We don't like this idea, but it's a pretty good study," Dr. Lorber said.

However, if you're trying to prevent infections after cardiac surgery, there's not enough evidence to justify putting patients on a statin before the procedure. A recent cohort study found that statins weren't associated with reduced post-op infections.

And finally, if you suspect a prosthetic joint infection, tell the lab to hold on to the specimen for at least 2 weeks, because a recent study showed that about a quarter of bacteria grown in cultures didn't show up until after a week had passed.

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posted by Stacey Butterfield at 1:00 PM   0 Comments

It's a party! Bring your own alcohol (gel).

I learned about a new holiday today at IDSA. The WHO has declared May 5 to be hand-hygiene day. I'd suggest that we all celebrate by washing our hands, but apparently the point is that health care workers should be cleaning their hands all the time--specifically at 5 moments in the patient encounter. (See, 5 moments for the cinco de Mayo.)

This international effort is trying to make hand hygiene "easy, convenient and even sexy," according to Didier Pittet, MD. The project is very country-specific--in some developing countries, they're teaching how to make your own hand gel, while in others the focus is on humorous education to improve compliance. The importance of localizing humor was made clear by a French cartoon of a germ on a couch that Dr. Pittet presented. "Dr. Freud, in this hospital, it's become impossible to cause infections anymore," the germ said. It sure wouldn't win the ACP Internist/Hospitalist cartoon caption contest.

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posted by Stacey Butterfield at 12:49 PM   0 Comments

The fact that it is almost Halloween is purely coincidental.

At an IDSA session on "What's hot in infectious disease," John Bartlett, MD, updated us on the risks of bat bites. Apparently (surprising as this sounds), it's easy to be bitten by a bat without noticing, and a fair number of bats are rabid.

Therefore, standard protocol (at least in Canada, I'm not sure if this also applies to the U.S.) was "If you wake up and see a bat in the bedroom, you should be considered for rabies prophylaxis." Some Canadian researchers were suspicious of the cost-effectiveness of this recommendation, so they did a study of 36,000 people. They asked how many of them had either had contact with a bat or seen one in a bedroom, and then calculated the cost of providing rabies prophylaxis.

Turns out that just the therapy--not even counting clinician time--would cost $2 billion per rabies case prevented if you treated all the bedroom encounters, and $48 million each if you treated just the people who had contact. Canadian policy was revised based on these calculations, and the results appear to confirm the projections, Dr. Bartlett said. "The epidemic of rabies has not been found."

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posted by Stacey Butterfield at 6:38 PM   0 Comments

Get your darn flu shot!

The press conference I attended today at the Infectious Disease Society of America's annual meeting had a clear message and it was pretty much a more polite version of this post's title.

Researchers presented data showing that flu vaccination of pregnant women (seasonal, not pandemic, by the way) makes their babies less likely to be premature, small or admitted to the hospital for flu early in their lives. So, such vaccinations would solve the problem of not having a vaccination for newborns and achieve the cost-effectiveness of protecting two people with one shot. The scientists expressed hope that their findings would increase the currently "dismal" rates of expectant-mother vaccination. "If they're not doing it for themselves, maybe they'll do it for their babies," said Marietta Vasquez, MD.

I wouldn't count on it, based on the results presented about vaccination attitudes among hospital workers. The one-hospital survey found that plenty of health care workers, and even some physicians, believe that flu vaccines aren't safe and could give you the flu. In addition, many of them were not aware that one can transmit the flu without having symptoms. Depressing.

On the bright side, even though vaccine expert Paul Offit, MD, termed his part of the press conference a "mini-rant," he actually had some positive news to offer. "The pendulum is starting to swing the other way," he said. Concerns from parents of immunocompromised kids and the refusal by some docs to see unvaccinated children, among other factors, are putting the anti-vaccine troops on the defense, he thinks.

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posted by Stacey Butterfield at 5:04 PM   3 Comments

ACP Master speaks his mind on H1N1 vaccines for health care workers

Following studies on Canadian and Hong Kong health workers unsure about getting vaccinated for H1N1, William Schaffner, MACP, now questions whether American health workers will, as well.

"There isn't a doubt that it's a severe challenge," Dr. Schaffner told MSNBC. "It's primarily a patient safety issue."

He's not only a Master of the College but also chairman of the infectious diseases division at Vanderbilt University in Nashville, and is in a position to encourage others. Clinical trials for it appear safe, he said, and health care workers should protect themselves and their patients.

"It's a professional and ethical responsibility of every health care worker to be vaccinated," he said.

Labels: flu, H1N1, infectious disease, swine flu, vaccination

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posted by Ryan DuBosar at 4:00 PM   1 Comments

More health workers unsure about H1N1 vaccination

In a follow-up to Tuesday's post that found Canadian health workers might refuse an H1N1 vaccine during a pandemic, another report finds about half of Hong Kong's health workers would refuse the swine flu vaccine. According to the BMJ, when the World Health Organization raised the H1N1 flu alert level to 5 in May, only 47.9% of 2,255 Hong Kong surveyed health workers were willing to get vaccinated, up from 28.4% surveyed a few months prior. An accompanying editorial in BMJ gently encourages vaccination while quelling fears of potential harms from vaccination.

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posted by Ryan DuBosar at 12:11 PM   0 Comments

Health workers, public may refuse H1N1 vaccines

Health care workers will balance the risks of H1N1 flu against the novelty of vaccines developed to combat it, according to research published in Emerging Health Threats Journal.

Canadian researchers conducted 11 focus groups (eight community groups and three for health care workers) in Vancouver asking participants how willing they would be to accept a new vaccine in case of a pandemic. They found that respondents were reluctant to get vaccinated against an illness they perceived as mild.

"Participants were very concerned that in a pandemic, a vaccine would be brought to market without sufficient testing for safety," researchers wrote. Many among all 11 focus groups believed that hand washing, social distancing or a good diet conferred protection. In the words of one health care worker: "A lot, well all of us probably practice basic body, blood, fluid precautions, right? ... So, we're equipped in that way to handle new diseases. We know how to protect ourselves. At least we think we do."

Similarly, health care workers are balancing the severity of the disease vs. any potential risk in a new vaccine. One health care worker told researchers: "Information would be key and I'd have to weigh the cost and the benefit of ... I'd have to know what would be the implications of getting the disease. And what would be the implications of getting the vaccine."

Meanwhile, a panel of U.S. presidential advisors finds looked at a plausible planning scenario--not a prediction--that H1N1 could infect 60 million to 120 million Americans (20%-40% of the population), killing 30,000 to 90,000 people. And the Washington Post looks at history for a lesson from the flu outbreak of 1957.

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posted by Ryan DuBosar at 11:59 AM   4 Comments

TB and drugs: A double whammy

Nearly one-fifth of U.S. tuberculosis patients abuse drugs or alcohol, which is a problem in and of itself. But the substance abuse also makes it harder to treat the TB, according to a release from a new study in Archives of Internal Medicine.

TB patients are more likely to be substance abusers than to be recent immigrants, infected with HIV, homeless or working at a high-risk job, the study found. Substance abusers with TB, but without HIV, were almost twice as likely to have a contagious form of TV than non-abusers, and women substance abusers were more than twice as likely to fail treatment.

Why is this? Substance abusers may not get routine medical treatment, so they are less likely to be detected early. Since TB often spreads faster as the disease progresses, these undetected substance abusers would be more contagious, study authors said. And they may be harder to treat because of weakened immune systems.

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posted by Jessica Berthold at 3:12 PM   0 Comments

Don't drink the water

ACP Internist's latest cover article describes the potential environmental impact of disposing of drugs down the drain and into the water supply. I ran into this problem after getting a bad series of eye, ear and sinus infections over the holidays.

I worked my way through all the antibiotics as prescribed, but those aren't the problem anyway, said Christian Daughton, PhD, Chief of the Environmental Chemistry Branch at the EPA's National Exposure Research Laboratory in Las Vegas. He told ACP Internist that antibiotics in drinking water occur only at parts-per-trillion range, which is probably a moot concern for creating bacterial resistance.

My main problem is all that leftover pseudoephedrine. I didn't mix well with the pills and didn't finish them. And, while I was looking through my medicine cabinet to throw them out, I found a family's worth of expired prescriptions and over-the-counter meds so old that I can't even remember buying them. If I dispose of them improperly, I'm making sure my neighbors don't get headaches, fevers, sore throats, cramps, coughs, stuffiness, gas, bloating or warts.

I'm supposed to mix it all with kitty litter, but I don't have a cat. If I did, I'd probably need more pseudoephedrine. I drink coffee and thought I'd found a conscience-free way of throwing them out with used grounds, but Dr. Daughton said, "The recommendation to mix drugs with kitty litter or coffee is not without controversy."

To top it all off, only one of the pill bottles is recyclable in my borough. It's not just me getting sick, it's the planet.

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posted by Ryan DuBosar at 11:35 AM   0 Comments

Work areas can be breeding ground for C-diff

A study in the February issue of the American Journal of Infection control found that the surfaces in hospital rooms are often contaminated with spores, even outside of Clostridium difficile infection isolation rooms. Of the 105 non-isolation rooms studied, researchers discovered that 17 (16%) were contaminated with toxin-producing C-diff.

The study also looked at surfaces in hospital work areas and equipment such as oximetry devices and electrocardiogram machines. They found that 23% were contaminated, including 31% in physician work areas, 10% in nurse work areas, and 21% on portable pieces of equipment.

Commenting on his blog, Kevin MD said the study reinforces the importance of old-fashioned soap-and-water handwashing. "Alcohol-based sanitizers aren't effective in killing the spores."

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posted by Janet Colwell at 9:47 AM   0 Comments

Sleep it off--avoiding the common cold

A study from researchers in Pittsburgh caught my attention for two reasons. First, the conclusion of the study: more and better sleep reduces the odds of getting a cold.

Researchers interviewed 153 healthy volunteers for 14 days about how many hours they slept and their sleep efficiency (the percentage of time in laying bed compared to the time actually asleep). Then volunteers then took nasal drops containing a rhinovirus and were followed for colds.

Volunteers averaging less than 7 hours of sleep a night were 2.94 times more likely to catch a cold than those with 8 hours or more. Those with 92% efficiency were 5.50 times more likely to get a cold than those with 98% or more efficiency.

That's astounding by itself. Less relevant but still prevalent in my mind is that 153 people volunteered to catch a cold. They got $800 for their time and trouble. I just got over a nasty cold and would pay that much to not get another one.

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posted by Ryan DuBosar at 11:45 AM   0 Comments

Sermo launches flu tracker

Sermo, the online social network for physicians, has launched its own flu tracking system that it says improves on those offered by the CDC, Google and Harvard Medical. Whereas other sites aggregate content from online searches and lab result reports, Sermo says its tracker is based on input from actual physicians and updated in real-time. After logging in, physicians can exchange geographically based clinical observations instantly.

According to Sermo, the site's analysis of each flu outbreak is based on:
Patient breakdown for vaccinated vs. not vaccinated
Age distribution - which age is most affected
Symptom breakdown - which symptoms are presenting more than others
Voracity of outbreak - how many per day/week/month, etc.

Physician members of Sermo (registration is free for MDs and DOs) can link directly to the flu tracker after signing in.

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posted by Janet Colwell at 11:00 AM   0 Comments

Googling the flu

The datameisters at Google say they can track potential flu epidemics two weeks earlier than the CDC by tracking people's searches for flu information online.

Google's non-profit arm, Google.org, is trying to apply its heft as the most popular search engine to tackle poverty, renewable energy and small-business growth. And now, they're applying the power of the millions of global users looking for health data to track the flu.

According to Google's blog, millions of users around the world search for online health information weekly. There are more flu-related searches during flu season, more allergy-related searches during allergy season, and more sunburn-related searches during the summer. A pattern emerges when all the flu-related search queries from each state and region are added together, Google says.

To test their hypothesis, Google compared search queries with CDC data to find out which searches occured during flu season, and then extrapolated that frequency provides an estimate how much flu is circulating. They used last year's flu season as a test and now claim to have accurately estimated flu levels one to two weeks faster than published CDC reports across the nine U.S. surveillance regions.

Additional details are available in a draft manuscript and a later version has been accepted in Nature.

Labels: epidemiology, flu, infectious disease

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posted by Ryan DuBosar at 9:09 AM   0 Comments

New CDC testing recommendations for Hep B

The CDC just issued new testing recommendations for chronic Hep B virus infection, which affects more than 1 million in the U.S.

In addition to testing all pregnant women, infants born to infected mothers, household contacts and sex partners of infected individuals, and people with HIV, providers should now test:

• People born in Asia, Africa, and other regions with 2% or higher prevalence of chronic HBV infections. (It was formerly 8% prevalence)
• Men who have sex with men and injection drug users.
• People with abnormal liver function tests not explained by other conditions
• People who require immunosuppressive therapy

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posted by Jessica Berthold at 10:13 AM   0 Comments