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    <recommendedItem id="20100101_19_106"
                     title="IOM Urges Action on Hepatitis"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/Hepatitis/tb/17916?impressionId=1265782690083"
                     
      &lt;p&gt;The public health community is not doing enough to deal with hepatitis B and C, according to the Institute of Medicine (IOM).&lt;/p&gt;
&lt;p&gt;The viruses are under-recognized public health problems that require more resources for prevention and control, according to a 14-member IOM committee chaired by R. Palmer Beasley, MD, of the University of Texas School of Public Health in Houston.&lt;/p&gt;
&lt;p&gt;The report urged the CDC, which commissioned the assessment, to increase awareness of the issue among the healthcare community and the general population, improve surveillance, and better integrate hepatitis services.&lt;/p&gt;
&lt;p&gt;The CDC &quot;supports the Institute of Medicine&apos;s call for an intensified national response to viral hepatitis in the U.S.,&quot; Kevin Fenton, MD, PhD, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a statement.&lt;/p&gt;
&lt;p&gt;&quot;The nation must recognize viral hepatitis as a severe health threat that affects millions of Americans.&quot;&lt;/p&gt;
&lt;p&gt;Up to 2% of the U.S. population lives with a chronic hepatitis B or C infection, according to the IOM report, making the infections more common than HIV/AIDS.&lt;/p&gt;
&lt;p&gt;However, many do not know they&apos;re infected until they develop long-term problems, such as liver cancer or liver disease.&lt;/p&gt;
&lt;p&gt;In 2008, the IOM gathered experts to assess the status of prevention and control efforts. The committee concluded that neither the healthcare community nor the general public were aware of the seriousness of hepatitis B and C as a public health problem.&lt;/p&gt;
&lt;p&gt;&quot;This insufficient understanding about chronic viral hepatitis can contribute to continued transmission, missed opportunities for early diagnosis and medical care, and poor health outcomes in infected people,&quot; the report stated.&lt;/p&gt;
&lt;p&gt;To improve the situation, the committee members said, the CDC should work with key stakeholders to develop educational programs for healthcare and social service providers and design outreach and education programs for the general public.&lt;/p&gt;
&lt;p&gt;In addition, better hepatitis services are needed, the report stated, particularly for those most at risk, including individuals born in countries where the viruses and injection-drug users are common.&lt;/p&gt;
&lt;p&gt;&quot;Comprehensive viral hepatitis services should have five core components: outreach and awareness, prevention of new infections, identification of infected people, social and peer support, and medical management of chronically infected people,&quot; the report read.&lt;/p&gt;
&lt;p&gt;The general population should have access to screening for hepatitis, as well, the committee concluded. It recommended that publicly-funded health insurance programs mandate hepatitis screening as a part of preventive care.&lt;/p&gt;
&lt;p&gt;For injection-drug users in particular, hepatitis prevention programs should include access to sterile needles and drug-preparation equipment, hepatitis B vaccination, and counseling to reduce alcohol use and secondary transmission, according to the report.&lt;/p&gt;
&lt;p&gt;The IOM also made the following recommendations regarding hepatitis B vaccination: &lt;ul&gt; &lt;li&gt;All full-term infants born to women with hepatitis B should receive the first dose of hepatitis B vaccine in the delivery room as soon as they are stable and washed. The CDC&apos;s Advisory Committee on Immunization Practices currently recommends administering the first dose within 12 hours of birth.&lt;/li&gt; &lt;li&gt;All states should mandate starting the hepatitis B vaccine series before a child can begin school.&lt;/li&gt; &lt;li&gt;Additional federal resources should be used to increase the rate of hepatitis B vaccination among at-risk adults, which is only about 50%.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_622"
                     title="Tamiflu-Resistant H1N1 Flu Virus Prevalence Increasing"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/13072?impressionId=1265782690083"
                     
      ATLANTA, March 2 -- More than 12% of H1N1 influenza A infections in the U.S. last season were resistant to oseltamivir (Tamiflu) and the prevalence appears to be rising dramatically, according to a team of CDC-led researchers.
              &lt;br&gt;&lt;br&gt;Moreover, the resistant strains appear no less virulent, debunking earlier suggestions that oseltamivir resistance would make the virus less dangerous.
              &lt;br&gt;&lt;br&gt;Those findings emerged from a study of 1,155 H1N1 isolates from the 2007-2008 season by Nila J. Dharan, M.D., of the CDC, and colleagues from that agency and from several state public health laboratories, and reported online in the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;Mid-season data reported in February 2008 showed oseltamivir resistance on the rise generally among all flu virus serotypes. (See: &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/8385&quot; target=&quot;blank&quot;&gt;Resistance to Oseltamivir (Tamiflu) Grows Higher&lt;/a&gt;) 
              &lt;p&gt; 
              &lt;p&gt;Dr. Dharan examined records of 274 individual infections with H1N1 viruses, including 99 showing oseltamivir resistance.
              &lt;p&gt; 
              &lt;p&gt;&quot;We found no significant difference in our comparison of the clinical symptoms and outcomes of untreated patients with oseltamivir-resistant and oseltamivir-susceptible influenza A(H1N1) infections,&quot; the researchers wrote.
              &lt;p&gt; 
              &lt;p&gt;One exception was that fewer hospitalizations were seen among those with resistant strains (2% versus 8%, &lt;em&gt;P&lt;/em&gt;=0.005).
              &lt;p&gt; 
              &lt;p&gt;But virtually identical percentages of untreated patients took medications for fever and missed work or school, the researchers found.
              &lt;p&gt; 
              &lt;p&gt;Among patients who received antiviral agents, illness severity and outcomes were also similar.
              &lt;p&gt; 
              &lt;p&gt;Of 47 patients with resistant strains who received oseltamivir, five were hospitalized and four died.
              &lt;p&gt; 
              &lt;p&gt;Patient factors including demographics and flu vaccination history did not affect the likelihood of contracting oseltamivir-resistant H1N1 strains.
              &lt;p&gt; 
              &lt;p&gt;Dr. Dharan and colleagues also determined that rates of oseltamivir usage within a state did not correlate with the prevalence of resistant strains.
              &lt;p&gt; 
              &lt;p&gt;Of 22 states analyzed, only one had records of high oseltamivir usage (as measured by filled prescriptions) and high proportions of resistant strains, whereas four had high drug usage and low rates of resistant infection. Six states had relatively low levels of oseltamivir use and high rates of resistant infection.
              &lt;p&gt; 
              &lt;p&gt;The researchers also noted that early surveillance data for the current season have suggested that more than 90% of H1N1 viruses -- the most common now in circulation -- are resistant to oseltamivir. (See: &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/12747&quot; target=&quot;blank&quot;&gt;Mild Flu Season So Far May Still Have Punch&lt;/a&gt;)
              &lt;p&gt; 
              &lt;p&gt;In an accompanying editorial, David M. Weinstock, M.D., and Gianna Zuccotti, M.D., both from Harvard, said the study helps &quot;dispel the notion that oseltamivir resistance compromises virulence.&quot;
              &lt;p&gt; 
              &lt;p&gt;They also pointed to a small Dutch study, also reported online this week in &lt;em&gt;JAMA&lt;/em&gt;, suggesting that one particular oseltamivir resistant strain may be even deadlier than normal for H1N1 viruses.
              &lt;p&gt; 
              &lt;p&gt;&quot;The widespread belief that oseltamivir would retain activity against epidemic influenza strains has crumbled,&quot; Drs. Weinstock and Zuccotti wrote.
              &lt;p&gt; 
              &lt;p&gt;They added that this should not be surprising, given that a variety of studies have shown rising resistance to the drug beginning in the 2006-2007 season.
              &lt;p&gt; 
              &lt;p&gt;&quot;For now, the best tools to mitigate influenza infection are tried-and-true -- vaccination, social distancing, hand washing, and common sense,&quot; they concluded.
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;No external funding for the study was reported.
              &lt;p&gt; 
              &lt;p&gt;No potential conflicts of interest were reported.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
           
    </recommendedItem>
    <recommendedItem id="20090101_19_649"
                     title=""
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/PublicHealth/tb/13103?impressionId=1265782690083"
                     
      
    </recommendedItem>
    <recommendedItem id="20090101_19_836"
                     title="Hospitals &apos;Share&apos; One in Five Patients"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/InfectionControl/tb/13254?impressionId=1265782690083"
                     
      SAN DIEGO, March 19 -- Hospitals &quot;share&quot; about 22% of their patients with other institutions over the course of a year, a researcher said here.
              &lt;br&gt; 
              &lt;br&gt;But only about one patient in nine is directly transferred from one facility to another, and hospitals may not know much about the rest, according to Susan Huang, M.D., of the University of California Irvine.
              &lt;br&gt; 
              &lt;br&gt;The finding, based on analysis of admission and discharge records in California&apos;s Orange County, has implications for controlling the spread of drug-resistant pathogens, Dr. Huang said at the annual meeting of the Society for Healthcare Epidemiology of America.
              &lt;br&gt; 
              &lt;br&gt;In times past, patients were often admitted to a single hospital for relatively long stays, but healthcare delivery today is increasingly complex, Dr. Huang told reporters before her oral presentation.
              &lt;br&gt; 
              &lt;br&gt;&quot;Hospitals don&apos;t live in isolation,&quot; she said, and &quot;may not know who they&apos;re sharing patients with.&quot;
              &lt;p&gt; 
              &lt;p&gt;&quot;A hospital might think they&apos;re largely sharing patients with hospital B, but in reality they&apos;re sharing most of their patients with hospitals C and D,&quot; she said.
              &lt;p&gt; 
              &lt;p&gt;To begin to clarify the picture, she and her colleagues analyzed records from the 31 acute care hospitals in Orange County, which is home to some three million people.
              &lt;p&gt; 
              &lt;p&gt;In California, most hospital admissions and discharges are tagged with a unique encrypted identifier, which allowed the researchers to track how many patients were discharged and then readmitted within a year, either to the first institution or to another.
              &lt;p&gt; 
              &lt;p&gt;In 2005, Dr. Huang said, 239,456 patients were admitted to the hospitals for a median stay of three days.
              &lt;p&gt; 
              &lt;p&gt;Hospitals shared at least one patient with a median of 28 other hospitals, she said, but little of that occurred by direct patient transfer. Among those discharged, more than one in five patients were readmitted to a median of two hospitals in the subsequent year, with a median time to readmission of 23 days.
              &lt;p&gt; 
              &lt;p&gt;Over the whole set of hospitals, Dr. Huang said, there was a nexus of shared patients whose proportions were surprisingly high. When using a threshold of 10 shared patients, she said, hospitals &quot;exposed&quot; 30% of other county hospitals within five months and 50% within 10 months.
              &lt;p&gt; 
              &lt;p&gt;In other words, she said, &quot;we found that within five months every hospital in the county, on average, exposed 30% of other country hospitals to 10 of their patients.&quot;
              &lt;p&gt; 
              &lt;p&gt;Understanding what she called &quot;traffic patterns&quot; has implications for the control of outbreaks of such dangerous pathogens as methicillin-resistant &lt;em&gt;Staphylococcus aureus&lt;/em&gt;, she said.
              &lt;p&gt; 
              &lt;p&gt;The numbers might be even more impressive if the study was restricted to large tertiary hospitals, said Neil Fishman, M.D., of the University of Pennsylvania, the society&apos;s president-elect, who moderated a press conference at which the data was presented.
              &lt;p&gt; 
              &lt;p&gt;Patients are often admitted to those hospitals for special procedures, but will seek additional care at local institutions closer to their homes, he said.
              &lt;p&gt; 
              &lt;p&gt;&quot;We&apos;re learning more and more about what we don&apos;t know,&quot; he said, &quot;and we don&apos;t know what happens to patients when they leave a hospital.&quot;
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was supported by the University of California Irvine and the NIH. Dr. Huang made no disclosures.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
         
    </recommendedItem>
    <recommendedItem id="20090101_19_874"
                     title="Novel Program Cuts MRSA"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/InfectionControl/tb/13379?impressionId=1265782690083"
                     
       SAN DIEGO, March 23 -- An infection control program with a novel behavioral approach called &quot;positive deviance&quot; sharply reduced the incidence of methicillin-resistant &lt;em&gt;Staphylococcus aureus&lt;/em&gt; (MRSA), a researcher said here.
              &lt;br&gt; 
              &lt;br&gt;In three hospitals, the incidence density of MRSA was reduced by up to 62% after the multipronged intervention was introduced, according to John Jernigan, M.D., of the CDC.
              &lt;br&gt; 
              &lt;br&gt;There was also a trend toward reductions in methicillin resistance, Dr. Jernigan said during a late-breaking presentation here at the annual meeting of the Society for Healthcare Epidemiology of America.
              &lt;p&gt; 
              &lt;p&gt;&quot;Reports of successful multicenter interventions to reduce endemic antimicrobial resistance problems among U.S. hospitals are extremely rare,&quot; Dr. Jernigan said.
              &lt;p&gt; 
              &lt;p&gt;&quot;These extremely encouraging findings add to a growing body of evidence that hospitals can make a difference in their endemic MRSA rates,&quot; he added.
              &lt;p&gt; 
              &lt;p&gt;The intervention -- involving the Billings Clinic in Billings, Mont., the Albert Einstein Medical Center in Philadelphia, and the University of Louisville Hospital in Louisville -- had three standard elements:
              &lt;p&gt; 
              &lt;table style=&quot;font-size:12px;&quot;&gt;
                &lt;tr&gt;&lt;td valign=&quot;top&quot;&gt;&lt;li&gt;&lt;/li&gt;&lt;/td&gt; &lt;td&gt;Active surveillance testing for MRSA in selected intensive care units&lt;/td&gt;&lt;/tr&gt;
                &lt;tr&gt;&lt;td valign=&quot;top&quot;&gt;&lt;li&gt;&lt;/li&gt;&lt;/td&gt; &lt;td&gt;Contact precautions for MRSA carriers&lt;/td&gt;&lt;/tr&gt;
                &lt;tr&gt;&lt;td valign=&quot;top&quot;&gt;&lt;li&gt;&lt;/li&gt;&lt;/td&gt; &lt;td&gt;Hand hygiene promotion&lt;/td&gt;&lt;/tr&gt;
              &lt;/table&gt;
              &lt;p&gt; 
              &lt;p&gt;The novel element was a method called &quot;positive deviance,&quot; which encourages staff to use existing resources and collaborate to solve problems.
              &lt;p&gt; 
              &lt;p&gt;One example, Dr. Jernigan said, came from Albert Einstein Medical Center, where a patient escort suggested a new way to dispose of soiled gloves and gown -- a method now used throughout the facility.
              &lt;p&gt; 
              &lt;p&gt;The staff member reduced the transmission threat posed by the garments by quickly sliding out of the gown -- turning it inside out during the process -- and rolling it into a tight ball with his hands still protected by gloves.
              &lt;p&gt; 
              &lt;p&gt;He then stripped off one glove while holding the wadded-up gown, so that the glove -- now inside out -- was wrapped around the gown. Finally, he repeated the process with the other glove, so that any contaminated surfaces were safely tucked and the garments could be disposed of safely.
              &lt;p&gt; 
              &lt;p&gt;Such innovations -- combined with the other standard practices -- led to the observed reductions in MRSA incidence density, Dr. Jernigan said.
              &lt;p&gt; 
              &lt;p&gt;They show that &quot;hospitals can make an important difference in antimicrobial resistance even at a time when the availability of new antibiotics has stagnated,&quot; he declared.
              &lt;p&gt; 
              &lt;p&gt;The three hospitals started their interventions in 2007. To assess the effects, the researchers looked at clinical microbiology results for all inpatient areas generated between Jan. 1, 2005 and Sept. 30, 2008.
              &lt;p&gt; 
              &lt;p&gt;MRSA cases were defined by positive clinical (nonsurveillance) cultures from patients with no MRSA-positive cultures in the previous year, Dr. Jernigan said.
              &lt;p&gt; 
              &lt;p&gt;Accounting for preintervention trends, interrupted time series regression analysis showed a significant (at &lt;em&gt;P&lt;/em&gt;=0.0008) intervention-associated reduction in MRSA incidence density across the three hospitals. Incidence density is defined as the number of cases divided by person-time of observation.
              &lt;p&gt; 
              &lt;p&gt;As well, Dr. Jernigan said, over 20 months of postintervention observation, the three hospitals reduced MRSA incidence density by 26%, 31%, and 62%. The pooled trend was significant at &lt;em&gt;P&lt;/em&gt;&lt;0.0001.
              &lt;p&gt; 
              &lt;p&gt;A trend toward intervention-associated reduction in methicillin resistance across hospitals did not reach statistical significance. However, the three facilities each saw reductions in methicillin resistance in the postintervention period (7%, 15%, and 28%) and the pooled trend was significant at &lt;em&gt;P&lt;/em&gt;&lt;0.02, Dr. Jernigan reported.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; The researchers did not report any study support or conflicts.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
        
    </recommendedItem>
</recommendedContent>