The Senate Health, Education, Labor and Pensions Committee yesterday voted to advance a vote on President Donald Trump's nominee to lead the US Centers for Disease Control and Prevention (CDC)—Susan Monarez, PhD—to a full Senate vote, Politico reported.

Monarez was appointed acting director in January, but the CDC has been without a director since late March, when the White House withdrew its original nominee, David Weldon, MD, and named Monarez as the nominee. Weldon was deemed to not have the votes needed to pass Senate confirmation.

Party-line vote amid concerns about Kennedy influence

Her approval came along party lines, 12 to 11. Bill Cassidy, MD, (R-LA), who chairs the committee, said Monarez is committed to improving transparency at the CDC and properly communicating health guidance, which he said is especially important against the backdrop of reemerging health threats such as measles.

However, Democrats raised concerns about Monarez standing by while Health and Human Services Secretary Robert F. Kennedy Jr. spreads misinformation about vaccines.

Monarez previously served as deputy director of the Advanced Research Projects Agency for Health within HHS and has held several other roles in government, including with the Office of Science and Technology Policy and the National Security Council, both within the executive branch.

Her work has included strategies to combat antimicrobial resistance, and Monarez has led projects to use artificial intelligence and machine learning to improve health outcomes. 

So far there is no vote scheduled in the full Senate to finalize Monarez's confirmation.

A new randomized clinical trial conducted at three US emergency departments (EDs) concludes that screening all adults for hepatitis C virus (HCV) testing identifies significantly more cases than screening based on individual patient risk, although low proportions sought treatment.

Researchers in Denver; Baltimore; and Jackson, Mississippi, randomly assigned 147,498 patients to receive nontargeted HCV screening or risk-based screening, with 18 months of follow-up. 

Screening is critical because most HCV infections cause no symptoms and thus go undetected, the authors noted. EDs "have been a focus of screening efforts, as they serve large numbers of at-risk patients who commonly do not access health care elsewhere," they wrote. 

The team published their findings yesterday in JAMA.

Low percentages followed up

Relative to targeted HCV screening, nontargeted screening found a significantly higher incidence of HCV infections (relative risk, 1.34). Nontargeted screening of 73,847 patients led to 9,867 (13.4%) tested for HCV, yielding 154 new diagnoses. Targeted screening of 73,651 patients identified 23,400 (31.8%) high-risk patients, resulting in 4,640 (6.3%) patients tested and 115 diagnoses. 

The substantial decrease in patients who went from diagnosis to SVR12 highlights an urgent need for innovative models of HCV treatment.

Yet only small percentages of patients with diagnoses sought follow-up care (19.5% nontargeted and 24.3% targeted), started direct-acting antiviral (DAA) treatment (15.6% and 17.4%, respectively), completed DAA treatment (12.3% and 12.2%), and achieved a sustained virologic response by 12 weeks (SVR12; 9.1% and 9.6%).

"The substantial decrease in patients who went from diagnosis to SVR12 highlights an urgent need for innovative models of HCV treatment," the researchers concluded.

In an editor's note, Preeti Malani, MD, MSJ, of the University of Michigan, and Stephen Schenkel, MD, MPP, of the University of Maryland, pointed out that while the difference between the screening approaches met the threshold for statistical significance, the nontargeted approach offered HCV testing to three times as many patients and tested more than double the number for a relatively small absolute difference in diagnoses and similar treatment outcomes. 

"From a practical standpoint, both approaches likely brought logistical challenges to already busy EDs and represented substantial, and potentially nongeneralizable, commitment in the 3 participating EDs," they wrote.

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