Top Infectious Disease News of the Week—July 1, 2018
JUL 06, 2018 | CONTAGION® EDITORIAL STAFF
#5: Biodefense World Summit Coverage—Biodetection Technologies
Last week, Bethesda, Maryland hosted the 3-day Biodefense World Summit during which experts from around the world gathered to discuss everything from food safety to point-of-care (POC) testing. We know that from the hospital to an emergency treatment center at the epicenter of an outbreak, POC testing is critical for rapid diagnoses and medical interventions. In fact, such efforts can be life-saving, which makes their presence in biodefense efforts that much more critical. Two such presentations discussed the potential for early diagnostic testing for certain infectious diseases, as well as the application of POC for more emergent, biological event situations.
The first presentation, "Far-forward early diagnosis of biothreat agents," by Charles Young (Johns Hopkins Applied Physics Laboratory) raised a question many of us have been asking; how can we improve the diagnosis of an infectious disease through earlier detection?
Shortening the rabies pre-exposure prophylaxis (PrEP) regimen is both effective and safe, a recent study published online in Clinical Infectious Diseases shows.
“In healthy adults, ID [intradermal] administration of a double dose of 0.1 ml of HDCV [human diploid cell culture rabies vaccine] over two-visits (day 0 and day 7) was safe and not inferior to the single-dose three-visit schedule,” writes Patrick Soentjens, MD, PhD, from the Institute of Tropical Medicine, Antwerp, Belgium, and colleagues.
According to the authors, rabies is a neglected global challenge, with a case fatality rate approaching 100%.
As a consequence, PrEP is a key component of rabies prevention and is recommended by the World Health Organization (WHO) for anyone at high risk of exposure to the virus because of their occupation, travel, or residence in a rabies-endemic area with poor access to timely and adequate PEP.
#3: Four in 10 Antibiotic Prescriptions for Acute Respiratory Infections Are Unnecessary
Antibiotics are most commonly prescribed for one clinical category—acute respiratory infections—but these illnesses are most often viral. In a new study, a team of researchers examines antibiotic prescribing during influenza season, with the objective of identifying targets for reducing inappropriate prescribing.
Acute respiratory infections mostly occur from infections such as the common cold, which can be caused by about 200 viral pathogens. These viruses include rhinovirus, parainfluenza, adenovirus, and Respiratory syncytial virus, and cannot be treated with an antibiotic. Symptoms of these infections include congestion, runny nose, sore throat, and cough, and may last up to 14 days. The Centers for Disease Control and Prevention (CDC) notes that treating such a respiratory infection with an antibiotic does not resolve or shorten the duration of illness, and may also increase a patient’s risk of developing an antibiotic-resistant infection. At least 2 million individuals experience infections from antibiotic-resistant bacteria each year, leading to 23,000 deaths. Yet, as many as half of all outpatient antibiotic prescriptions are unnecessary.
#2: In South, Patients with HIV Face Additional Hurdles
New research makes the case that HIV disparities are not only dependent on individual actions and socioeconomic factors, but also on geography.
The study looked at outcomes for patients with HIV in 11 cities, 5 in southern states and 6 in non-southern states. Those in the southern states had lower rates of viral suppression and a higher likelihood of having CD4+ cell counts below 200 cells/µl. Southern patients were also less likely to be connected with regular HIV care, something the investigators suggested was linked with less robust social safety nets in those states.
“This study among hospitalized HIV-infected participants across 11 sites in the United States found that while participants living in southern sites had lower rates of problematic drug and alcohol use, they were less likely to report care engagement and more likely to have worse HIV outcomes,” wrote Morgan M. Philbin, PhD, MHS, and colleagues. Dr. Philbin is an assistant professor of sociomedical sciences at Columbia University.
#1: Suicide Poses a Complicated Risk in Those with Infectious Diseases
A diagnosis of an infectious disease can be devastating for patients. Even as more effective treatments become available for infections such as HIV and hepatitis C, patients who receive a positive diagnosis must prepare for significant life changes and new burdens.
As physicians struggle to keep up with the latest treatments and therapeutic research, a growing body of evidence is highlighting another problem closely tied to infectious disease: suicide.
The first half of this month (June) was marked by a pair of high-profile suicides, prompting a national discussion about risk factors and prevention. When it comes to infectious diseases, suicide is a major problem, but one that is difficult to address because its cause is difficult to isolate.
“It gets very messy and hard to pinpoint an exact cause [of suicide],” said Travis Salway, PhD, a post-doctoral fellow at the University of British Columbia’s School of Population and Public Health and the British Columbia Centre for Disease Control.
The problem can be related to psychological and psychiatric factors, stress, pain, and chemistry. And sometimes, it can even be linked to the treatment for the underlying infection.
Though the issue is complicated, the statistics are clear. Salway’s research, which focuses on health disparities for LGBT individuals, found that nearly 1 in 4 (22%) gay and bisexual men who are HIV-positive reported suicidal ideation within the past year. Five percent of respondents to Salway’s survey reported a suicide attempt within the past year.
Another 2010 study found that although suicide rates dropped significantly among the HIV-positive population after the introduction of highly active antiretroviral therapy (HAART), the HIV-positive suicide rate was still 3 times higher than the general population.
However, the issue of suicidality among patients with infectious diseases is not just an HIV story.
Reports have shown increases in depression and suicidality among patients with hepatitis C (HCV) infections, and among those who received interferon therapy.
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