NEWS SCAN: Endangered public health funding, MRSA in kids, Tdap safety in seniors, Haiti cholera plan, injection infection prevention

Nov 29, 2012

Past CDC directors push Congress to protect public health funding
Six former directors of the US Centers for Disease Control and Prevention (CDC) recently posted a letter on the political news Web site Politico urging Congress to invest in public health and protect the funding from budget cuts, which could be severe, especially if lawmakers allow automatic cuts to take place in January. A July report from Sen Tom Harkin, D-Ia., who chairs the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, projected that the sequestration cuts, which were included in a bipartisan bill in August 2011 to raise the national debt limit, would cut more than $48 million in fiscal year 2013 funding from a federal grant program that helps states boost their public health preparedness. The former CDC directors said the agency's swift response to the fungal meningitis outbreak helped save lives and required the work of 300 staffers, plus numbers of personnel from state and local health departments. In addition, global threats such as novel coronavirus and H5N1 avian flu are just a plane ride away, they noted. "We know that we cannot afford to shortchange our frontline protection against these emerging and ongoing domestic and global health threats," the group wrote. They emphasized that they served on both sides of the political aisle and that ensuring that the CDC is well funded is not a partisan issue.
Nov 27 Politico letter
Jul 27 CIDRAP News story "Senator says automatic cuts would hurt preparedness grants"

MRSA colonization increases in pediatric patients
Colonization with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), a risk factor for hospital-onset infections, is becoming more prevalent among children admitted to pediatric intensive care units (ICUs), say  the results of a study from Children's Hospital Boston published today in Infection and Immunity. The researchers retrospectively identified 495 of 15,295 (3.2%) children as having been colonized with MRSA on admission to the hospital's ICUs from 2001 to 2009. While the proportion of patients colonized with MRSA did not change significantly over the study period (P = 0.82), the proportion of children with MRSA spa type 1, staphylococcal cassette chromosome mec type IV, and genes that encoded Panton–Valentine leukocidin increased to maximums in 2009 of 36.1% (P < 0.001), 54.2% (P = 0.03), and 28.9% (P  =  0.003), respectively. The susceptibility of infections to non-beta-lactam antibiotics also increased over the period (P values <0.001). According to the authors, "The increasing prevalence of CA-MRSA colonization in paediatric ICUs has the potential to increase the risk of hospital-onset CA-MRSA infections in this vulnerable population."
Nov 29 Infect Immunol abstract

Tdap safety study reassuring for seniors
The tetanus, diphtheria, and acellular pertussis (Tdap) vaccine has a good safety profile in adults ages 65 and older, a group that has been targeted to reduce the pertussis burden not only in themselves but in babies who are too young to be immunized, according to a research group from Kaiser Permanente Southern California. Their study in Clinical Infectious Diseases included 119,573 seniors from seven US health maintenance organizations who received the vaccine from January 2006 through December 2010. Little is known about the safety of the vaccine in older people, because they weren't included in prelicensure studies. Over the past several years, though, the indications for Tdap have broadened based on increased cases, and in 2010 federal advisors recommended those 65 and older to receive one dose of Tdap instead of the tetanus and diphtheria (Td) vaccine, if they hadn't received Tdap vaccine before. Investigators compared adverse events in those who received Tdap versus Td vaccine during the same period. They found only a small increased risk of adverse events, mainly injection-site reaction, within 6 days of Tdap vaccination, but it was no different than the level seen for the Td vaccine.
Nov 28 Clin Infect Dis abstract
Nov 29 Infectious Diseases Society of America press release

Global health groups craft cholera elimination plan for Hispaniola
Global health officials will soon unveil a comprehensive plan to eliminate cholera from Haiti and the Dominican Republic at a cost of $2.2 billion over 10 years, the Associated Press (AP) reported yesterday. Jordan Tappero, MD, MPH, who directs the Health Systems Reconstruction Office for the CDC's Center for Global Health, said the plan will be released in a week or two and will spell out efforts supported by the CDC, the Pan American Health Organization (PAHO), and the United Nations Children's Fund (UNICEF). The AP report said the plan will be the biggest yet to develop Haiti's almost nonexistent water and sanitation system, which experts say is one of the keys to eliminating cholera. It's not clear how the strategy would be funded, but the next step is to seek international donors. Maryanne Sharp, a Haiti project manager for the World Bank, told the AP that the World Bank plans to contribute $5 million in unspent funds. A shorter-term goal is to move cholera treatment from tent facilities to hospitals to use hospital workers and reduce the stigma of cholera treatment, Sharp said.
New resources target injection-related infections
In a move to drive down the number of injection-related infections, the CDC and its partners yesterday released new resources for clinicians, including a PowerPoint training presentation, a video, posters, brochures, and a digital press kit. In a blog post, the CDC said safe injections are a minimum expectation in any healthcare setting, yet it continues to investigate outbreaks linked to injection errors. For example, since 2001 more than 150,000 patients have been affected by unsafe injection practices, according to background materials from the CDC. Of 48 outbreaks during that time, 21 involved hepatitis B or C and 27 were caused by different bacteria, most of which led to invasive bloodstream infections. Lapses in infection control practices that can lead to injection-linked infections include reusing needles, syringes, or single-dose vials. The CDC and its partners in the Safe Injection Practices Coalition (SIPC) have been promoting awareness of the problem and its solutions through a "One and Only" campaign since 2009. The CDC said the goal of the new materials is to make it easier for healthcare workers to learn and train others about safe injection practices.
Nov 28 CDC blog post
CDC digital press kit
Nov 28 SIPC statement

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