CDC releases core elements for prescribing outpatient antibiotics The Centers for Disease Control and Prevention (CDC) issued new recommendations for antibiotic prescribing in outpatient settings in an effort to help reduce the spread of drug-resistant infections, improve patient safety and lower the cost of health care. According to the CDC, at least 2 million people each year in the U.S. acquire serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections. At least 23,000 people die each year as a direct result of these antibiotic-resistant infections. The CDC recommendations, "Core Elements of Outpatient Antibiotic Stewardship," provides clinicians and facilities involved in outpatient care—including primary care clinics, emergency departments, specialty clinics, community pharmacies, and retail health and urgent care clinics—strategies to improve antibiotic prescribing and reduce unnecessary antibiotic use. Antibiotic stewardship programs are designed to coordinate interventions to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy and route of administration. The California Medical Association Foundation's Alliance Working for Antibiotic Resistance Education (AWARE) project has also developed a free mobile app containing clinical guidelines for appropriate antibiotic use. The AWARE Compendia mobile app provides easy access to the project's Adult and Pediatric Acute Respiratory Tract Infection Guidelines. The app is frequently updated to ensure accurate, timely information. The AWARE app is available on Android and iPhone devices. To download, search “AWARE Toolkit” in the Google Play or iTunes stores. To read the CDC report, click here. November 22, 2016 General Antibiotic Resistance, AWARE, CDC, CMA Foundation (CMAF), Public Health 0 0 Comment Read More »
Prepare for Zika transmission in the U.S. with August 10 webinar The Centers for Disease Control and Prevention (CDC) and the American Medical Association (AMA) are hosting an important one-hour webinar next week focused on transmission of the Zika virus in the United States. The webinar will be next Wednesday, August 10, 2016, at 4 p.m. PT. All interested parties are invited to participate in this free webinar. CDC Medical Epidemiologist Susan Hills will present an update on the epidemiological and clinical aspects of the current outbreak. CDC Medical Officer Kiran Perkins, M.D., MPH, will present on the implications for pregnant women, including CDC's updated interim clinical guidance, before fielding questions from webinar participants. To register for this webinar, click here. For more information on Zika, visit www.cdc.gov/Zika, or AMA’s Zika Virus Resource Center. August 5, 2016 General Centers for Disease Control and Prevention, Public Health, Webinars, Zika Virus, CDC 0 0 Comment Read More »
CDC urges aggressive screening of pregnant women for Zika The Centers for Disease Control and Prevention (CDC) is urging physicians to be more aggressive in screening pregnant women for the Zika virus. The new guidance comes amid growing concerns about Zika, which, if contracted by pregnant women, can result in severe birth defects — including microcephaly, which stunts children’s brain development. It has also been implicated in miscarriages and diseases like Guillain-Barre, a neurological disorder that causes temporary paralysis. The CDC update recommends that all pregnant women in the United States and its territories should be “assessed for possible Zika virus exposure” whenever they get a prenatal care visit. Physicians are also being urged to test for the virus if a pregnant woman or her sexual partner have traveled to an area where the virus was actively spreading. Previously, Zika testing was only recommended if they were also showing symptoms — CDC is now recommending testing even in the absence of symptoms. Zika has been spreading in many Latin American and South American countries, along with Puerto Rico. Public health experts warn it could reach the continental United States by summer’s end. Epidemiologists are investigating two cases in Florida in which local mosquitoes may have transmitted the virus. Another key part of the new CDC guidelines emphasizes that both symptomatic and asymptomatic pregnant women should be screened within two weeks of the date of possible Zika exposure with PCR, a DNA-based test. If the PCR test is negative, or an at-risk pregnant woman misses that initial two-week window, the CDC calls for screening with a test that searches for antibodies to the virus. That test, which is effective for as long as 12 weeks after exposure, is considered a less reliable indicator and has drawn some criticism because it can generate false positives. Click here to read the CDC guidelines. August 5, 2016 General Centers for Disease Control and Prevention, Public Health, Zika Virus, CDC, Infectious Diseases 0 0 Comment Read More »
CDC warns of multistate outbreak of B. cepacia possibly tied to liquid docusate The Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration issued a joint warning for a multistate outbreak of Burkholderia cepacia infections (also known as B. cepacia complex). To date, 47 B. cepacia cases have been confirmed from health care facilities in five states. Reports of possible cases from additional states are currently being investigated. CDC has confirmed that two samples of unused oral liquid docusate product received from one of the affected hospitals have tested positive for B. cepacia complex. B. cepacia is a gram-negative bacterium found in soil and moist environments that is known to cause various types of infections, including catheter-associated infections and respiratory tract infections in hospitalized patients. Although healthy individuals are not affected in most cases, those who are immunocompromised are at particular risk, as are patients with chronic respiratory illnesses, especially those with cystic fibrosis. Infections caused by B. cepacia are often resistant to multiple antibiotics and can be life-threatening. In light of the organism's high level of transmissibility, health care facilities should apply stringent infection control measures in the presence of infection. Pending further investigation, CDC recommends that clinicians not use any liquid docusate product as a stool softener or for any other medical purpose. Additional testing is being conducted to determine if bacteria from the docusate samples match the outbreak strains. For more information on the infection outbreak, see the CDC website. July 14, 2016 General Centers for Disease Control and Prevention, Infectious Diseases, Public Health, CDC 0 0 Comment Read More »
CDPH publishes FAQ on ordering and interpreting Zika lab tests The California Department of Public Health (CDPH) Viral and Rickettsial Diseases Laboratory has published an FAQ designed to answer providers’ frequently asked questions about ordering and interpreting Zika laboratory tests and tests for other flaviviruses. Because the way Zika test results are applied to clinical care is rapidly changing, CDPH published this document to clarify the Centers for Disease Control and Prevention’s most recent recommendations. Additionally, the FAQ addresses the current limitations of commercial laboratory testing for Zika in California. To read the FAQ, click here. If you have additional questions about Zika virus testing and interpretation, contact CDPH at JeocUser43@cdph.ca.gov. For more information on the Zika virus, see the CDPH website. July 14, 2016 General CDC, Department of Public Health, Zika Virus, Blood Testing 0 0 Comment Read More »
CDC issues clinical guidelines for possible congenital Zika virus infection The Centers for Disease Control and Prevention (CDC) has issued interim guidelines for health care providers in the evaluation, testing and management of infants with possible congenital Zika virus infection. The guidelines, developed in conjunction with the American Academy of Pediatrics, were published in the January 26 issue of the Morbidity and Mortality Weekly Report. Zika virus is a mosquito-borne infectious disease primarily transmitted by Aedes mosquitoes. These mosquitoes, which also transmit dengue and chikungunya viruses, are found throughout much of the Americas, including parts of the United States. The Brazil Ministry of Health is currently investigating the possible association between Zika virus and a reported increase in the number of babies born with microcephaly. Microcephaly is a condition where a baby’s head is much smaller than expected, and may include a range of other problems depending upon the severity of the condition. About 1 in 5 people infected with Zika virus become symptomatic. Characteristic clinical findings are acute onset of fever, rash, joint pain, and/or red eyes. Other commonly reported symptoms include myalgia and headache. Clinical illness is usually mild with symptoms lasting for several days to a week. Severe disease requiring hospitalization is uncommon and case fatality is low. However, there have been cases of Guillain-Barre syndrome reported in patients following suspected Zika virus infection. The CDC advises that when an infant is born with microcephaly or intracranial calcifications to a mother who was potentially infected with Zika virus during pregnancy, the infant should be tested for Zika infection. In addition, further clinical evaluation and laboratory testing is recommended for the infant. The mother should also be tested for a Zika virus infection, if this testing has not already been performed during pregnancy. An ophthalmologic evaluation, including retinal examination, should occur during the first month of life, given reports of abnormal eye findings in infants with possible congenital Zika virus infection. For infants with any positive or inconclusive test findings for Zika virus infection, health care providers should report the case to the state or local health department and assess the infant for possible long-term sequelae. This includes a repeat hearing screen at age 6 months, even if the initial hearing screening test was normal, because of the potential for delayed hearing loss as has been described with other infections such as cytomegalovirus. For infants with microcephaly or intracranial calcifications who have negative results on all Zika virus tests performed, health care providers should evaluate for other possible etiologies and treat as indicated. Under the CDC guidelines, pediatric health care providers are advised to work closely with obstetric providers to identify infants whose mothers were potentially infected with Zika virus during pregnancy based on their travel history or residence in an area with Zika virus transmission and to review fetal ultrasounds and maternal testing for Zika virus infection. No local transmission of Zika infections has occurred in California, according to the California Department of Public Health (CDPH). Zika infections in California have been documented only in persons who were infected while traveling outside the United States. While the risk for transmission of Zika, chikungunya or dengue viruses is still low in California, infected travelers coming back to California can transmit these viruses to Aedes mosquitoes that bite them. This may lead to additional people becoming infected if they are then bitten by those mosquitoes. To read the full guidelines, click here. While there has been no occurrence of Zika transmission in California, CDPH will be holding a conference call for health care providers on Wednesday, February 10, from 9-10 a.m. The call will provide information and updates about the Zika virus, and give providers the opportunity to ask questions. To join the conference call dial (866) 216-6835 FREE and key 839641 the participant passcode. Questions about the conference call can be directed to Cheryl Starling, (916) 324-0336 or cheryl.starling@cdph.ca.gov. Contact: Samantha Pellon, (916) 551-2887 or spellon@cmanet.org. Call Send SMS Call from mobile Add to Skype You'll need Skype CreditFree via Skype February 1, 2016 General Public Health, CDC, Centers for Disease Control and Prevention 0 0 Comment Read More »
CDC says flu vaccine better match for 2015 The Centers for Disease Control and Prevention (CDC) announced that the flu shot available to the public this year is a much better match for the flu virus that is expected to circulate during this year's flu season. Last season’s vaccine did not protect against a particular strain of H3N2 flu virus – known as the "Switzerland variant” – causing the vaccine's effectiveness rate against the H3N2 strain to be only about 13 percent. In an effort to get it right in 2015, scientists scrutinized 199 flu specimens collected in the United States and elsewhere between May 24 and Sept. 5. The majority of those specimens were H3N2 viruses and all were built in a way that should make them vulnerable to this year’s vaccines, according to the CDC’s latest Morbidity and Mortality Weekly Report (MMWR). In the United States, annual influenza vaccination is recommended for all persons aged 6 months and older who do not have contraindications. Manufacturers of the vaccine expect this season to see the largest supply of influenza vaccine distributed in the United States during one season with the exception of the 2009 pandemic. To see the CDC MMWR on flu vaccine for 2015, click here. September 23, 2015 General Centers for Disease Control and Prevention, Flu, Vaccination, CDC, Immunization 0 0 Comment Read More »
CDC encourages antiviral treatment for influenza With a poorly matched influenza vaccine and influenza activity high across much of the country, the Centers for Disease Control and Prevention (CDC) is urging physicians to prescribe antiviral drugs to patients who are very ill with flu-like symptoms, particularly those over age 65 and those at high risk of complications from the virus. According to the California Department of Public Health (CDPH), flu activity in California is beginning to increase. The first influenza death in the state of a person under the age of 65 for the 2014-2015 season was confirmed last week. CDC Director Thomas Frieden, M.D., said in a conference call last week that if administered in the first 48 hours of exposure antiviral drugs can impact the length and severity of patients’ illness. Because antivirals are most effective if administered in the first 48 hours, the CDC urges that they be prescribed for high risk patients with flu-like symptoms, even before ordering tests to confirm the virus. Physicians are also encouraged to continue vaccinating patients against the flu, even though early reports indicate the vaccine is not well matched to this year’s strain. “Flu activity is beginning to increase statewide, including reports of hospitalizations and severe disease,” said California’s State Health Officer Ron Chapman, M.D. “We are early on in what could be a severe flu season, and I encourage everyone who has not yet gotten a flu vaccination to do so. The influenza vaccine remains the most effective way to protect yourself from the flu.” For more information on the use of antivirals to treat influenza, see the updated CDC Influenza Antiviral Medications: Summary for Clinicians. For more information on influenza activity in California, see the CDPH website. January 22, 2015 General Centers for Disease Control and Prevention, Flu, Influenza, Public Health, CDC 0 0 Comment Read More »
Congress passes a number of health care provisions in the current budget Congress narrowly passed a $1.1 trillion federal budget that will fund most of the federal government through September 2015. Below is a summary of key health care provisions in the bill. Within the bill, Congress expressed concern that there had not been adequate opportunity for public comment on bundling of surgical codes in the final rule of the Medicare Physician Fee Schedule. The budget bill says that the appropriate methodology has not been tested to ensure that patient care and patient access are not negatively impacted and ponderous administrative burdens placed on providers. It asks the Centers for Medicare and Medicaid Services (CMS) to reconsider that fee schedule provision. The budget includes $5.4 billion of emergency funding to prepare for and respond to the Ebola outbreak. The National Institutes of Health will received $30.3 billion (an increase of $150 million), including $283 million for Ebola-related research. CMS receives no increase in funding over last year ($3.6 billion). The Centers for Disease Control and Prevention (CDC) will receive money to combat prescription drug abuse around the country. Twenty million dollars has been set for prevention of drug abuse and another $12 million has been included under the Substance Abuse and Mental Health Services Administration for the states to expand treatment services for drug addiction. This funding is also expected to support activities to establish or expand prescription drug monitoring databases of physicians writing prescriptions for opiates and pharmacists filling prescriptions. The bill looks at the Medicare Recovery Audit Contractors (RAC) and how audits may be reducing patient access to care. The bill directs CMS to provide education to providers on error reduction. It also asks the agency to develop procedures to reduce backlogs of claims and hearings and asks CMS to provide education to RAC contractors to improve the accuracy of their audits. The bill urges the Office of the National Coordinator for Health Information Technology to decertify electronic health records products that block the sharing of information and to certify only those products that meet current meaningful use program standards. December 16, 2014 General, Medicare Advocacy, Federal Legislation, Medicare, Prescription Drugs, CDC, Ebola, Recovery Audit Contractor 0 0 Comment Read More »
CDPH publishes quarantine guidelines for travelers at risk of contracting or spreading Ebola The California Department of Public Health (CDPH) yesterday published statewide guidelines for quarantining individuals with suspected cases of Ebola and those who are at high risk of contracting or spreading the disease. These rules are consistent with the Centers for Disease Control and Prevention (CDC) guidelines and include a mandatory 21-day quarantine for any travelers who had contact with an Ebola patient, whether or not the travelers are showing symptoms. However, the state said it would allow local health authorities to enforce the order on a “case-by-case” basis, with varying levels of restriction and monitoring, from monitoring with no movement restrictions to isolation, based on the risk assessment. The quarantine order will apply to anyone who has traveled from an Ebola affected area (Liberia, Guinea and Sierra Leone) or who has had contact with someone with a confirmed case of the virus. The quarantine orders will be issued and supervised by county health officers on a case-by-case basis. “Not everyone who has been to an Ebola affected area should be considered high risk,” Dr. Chapman said. “This order will allow local health officers to determine, for those coming into California, who is most at risk for developing this disease, and to contain any potential spread of infectious disease by responding to those risks appropriately.” Currently federal Customs and Border Protection (CBP) and the Centers for Disease Control Services’ (CDC) Division of Global Migration and Quarantine are screening travelers coming to California from the three West African countries at U.S. ports-of-entry. All returning travelers are asked about possible risk exposures and recent history of signs and symptoms of Ebola. Travelers are also checked for fever. According to the CDPH, it receives daily lists from the CDC with contact information for all travelers who were screened through this process and whose final destination is California. The CDPH sends the information on the same day to the local health department at the traveler’s final destination. Local health departments are responsible for actively monitoring the individual twice a day for symptoms of Ebola. In California, local health officers already had the authority to order quarantine of people who may have an infectious disease that threatens public health. This order, however, will ensure consistent application across the state of quarantine for high risk individuals in order to control risks from Ebola. To read the CDPH's quarantine guidance, click here. November 5, 2014 General Ebola, Infectious Diseases, Public Health, CDC 0 0 Comment Read More »
