Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2020/10/news-scan-oct-30-2020
News Scan for Oct 30, 2020
UTI telemedicine antibiotic prescribing; ICE detention center outbreaks; Polio in 7 countries
Filed Under:
Varicella; Antimicrobial Stewardship; Childhood Vaccines; Influenza, General; Mumps; Polio
Telemedicine linked to more appropriate antibiotic prescribing for UTIs
Telemedicine visits for urinary tract infections (UTIs) were associated with more appropriate antibiotic prescribing and decreased use of diagnostic and follow-up resources than virtual visits, according to the results of a primary care network study published yesterday in Infection Control and Hospital Epidemiology.
The retrospective cohort study, conducted at Mercy Health Physician Partners, a primary care network in western Michigan with 44 outpatient sites and one virtual visit platform, compared guideline-concordant antibiotic prescribing among adult women diagnosed as having an uncomplicated UTI during an office visit or a virtual visit in 2018. The researchers looked at antibiotics prescribed, duration of therapy, and patient outcomes. Guideline-concordant therapy was assessed based on the network's antimicrobial stewardship program guidelines.
A total of 350 women were included in the study, with 175 in each group. There was no difference in the rate of antibiotic prescribing between the two groups, but a guideline-concordant antibiotic was more commonly prescribed during virtual visits compared with office visits (74.9% vs 59.4%; P = .002). Guideline-concordant duration of therapy was also more common in the virtual-visit group (100% vs 53.1%; P < .001).
Patients treated through virtual visits were also less likely to have a urinalysis (0% vs 97.1%; P < .001) or urine culture ordered (0% vs 73.1%; P < .001) and were less likely to have an unplanned revisit within 7 days (5.1% vs 18.9%; P < .001).
The authors of the study attribute the more appropriate prescribing in part to a fixed drop-down menu of antibiotic choices for virtual visits, which is based on national guidelines and includes a corresponding fixed dose and duration for each antibiotic. "These results add further support to the growing evidence surrounding virtual visits as a tool to improve antibiotic prescribing in the outpatient setting," they wrote.
Oct 29 Infect Control Hosp Epidemiol abstract
Chickenpox, mumps, flu spike at US migrant detention centers
A JAMA research letter yesterday revealed large, sustained outbreaks of potentially life-threatening vaccine-preventable diseases among involuntarily held migrants in dozens of US Immigration and Customs Enforcement (ICE) detention centers, highlighting the need for vaccination programs in the high-risk migrant population.
The Jan 2017 to Mar 2020 study gathered ICE electronic health record system data from 22 facilities, revealing 1,280 cases of flu, 1,052 cases of varicella (chickenpox), and 301 cases of mumps in 79 separate outbreaks—some occurring year-round. Fifteen of the 22 centers reported at least one outbreak—defined as 3 or more linked cases.
Varicella and mumps are relatively rare in the general population, and flu outbreaks typically circulate only seasonally. One facility recorded a 33-month varicella outbreak, with most cases in unvaccinated adults, who are predisposed to more severe disease. The same facility also reported year-round flu transmission. Waning immunity for mumps is common, so adult migrants remain susceptible even if previously vaccinated, the authors note.
Crowding, poor health conditions, under-immunization, and limited access to vaccines create high-risk environments for infectious disease in ICE detention centers. The authors suggest that case numbers underestimate the true number of infections, as they do not include undiagnosed cases, and data were limited to 22 centers with ICE electronic health record systems—a small subset of the 315 US detention facilities.
Two Texas facilities were overrepresented in case counts, with 44.7% of all infections occurring at the South Texas Family Residential Center and 16.5% at the Port Isabel Service Processing Center. The number and duration of outbreaks suggest that transfers between centers are to blame. "Typically, migrants are detained, held for a few days, then moved to another center," lead author Nathan C. Lo, MD, PhD, said in a University of California-San Francisco (UCSF) news release.
"These numbers are pretty shocking," said Lo. "They suggest this vulnerable population is being placed at very high risk for these infections while being detained," he added.
"We should change policy to offer vaccines that can minimize preventable suffering," Lo argued.
Oct 29 JAMA research letter
Oct 29 University of California San Francisco news release
Seven countries report more vaccine-derived polio cases
Seven countries—Pakistan and six African nations—reported more polio cases this week, all involving circulating vaccine-derived poliovirus type 2 (cVDPV2), the Global Polio Eradication Initiative (GPEI) said in its latest update.
Pakistan reported cases from three different provinces (Balochistan, Punjab, and Sindh), bringing its total for the year to 80.
In Africa, Cameroon reported two more cVDPV2 cases, both from Extreme Nord region, raising its total for 2020 to seven. Chad reported eight more cases, including seven from Logone Oriental and one from Moyen Chari, boosting its number to 77 this year, from two different outbreaks.
Ivory Coast reported three more cases from three different provinces, putting its total at 66 for 2020. In the Democratic Republic of Congo (DRC), four cVDPV2 cases were detected, one each in Equateur and Kinshasa provinces and two in Maindombe, increasing the number to 60 so far. Mali reported 15 more cases from five different locations, three of them from the capital city Bamako, putting its total at 26 for the year. And finally, South Sudan reported nine more cases from three different states, pushing its total to 12, all linked to an ongoing outbreak in Chad.
Oct 29 GPEI update
News Scan for Oct 30, 2020
UTI telemedicine antibiotic prescribing; ICE detention center outbreaks; Polio in 7 countries
Filed Under:
Varicella; Antimicrobial Stewardship; Childhood Vaccines; Influenza, General; Mumps; Polio
Telemedicine linked to more appropriate antibiotic prescribing for UTIs
Telemedicine visits for urinary tract infections (UTIs) were associated with more appropriate antibiotic prescribing and decreased use of diagnostic and follow-up resources than virtual visits, according to the results of a primary care network study published yesterday in Infection Control and Hospital Epidemiology.
The retrospective cohort study, conducted at Mercy Health Physician Partners, a primary care network in western Michigan with 44 outpatient sites and one virtual visit platform, compared guideline-concordant antibiotic prescribing among adult women diagnosed as having an uncomplicated UTI during an office visit or a virtual visit in 2018. The researchers looked at antibiotics prescribed, duration of therapy, and patient outcomes. Guideline-concordant therapy was assessed based on the network's antimicrobial stewardship program guidelines.
A total of 350 women were included in the study, with 175 in each group. There was no difference in the rate of antibiotic prescribing between the two groups, but a guideline-concordant antibiotic was more commonly prescribed during virtual visits compared with office visits (74.9% vs 59.4%; P = .002). Guideline-concordant duration of therapy was also more common in the virtual-visit group (100% vs 53.1%; P < .001).
Patients treated through virtual visits were also less likely to have a urinalysis (0% vs 97.1%; P < .001) or urine culture ordered (0% vs 73.1%; P < .001) and were less likely to have an unplanned revisit within 7 days (5.1% vs 18.9%; P < .001).
The authors of the study attribute the more appropriate prescribing in part to a fixed drop-down menu of antibiotic choices for virtual visits, which is based on national guidelines and includes a corresponding fixed dose and duration for each antibiotic. "These results add further support to the growing evidence surrounding virtual visits as a tool to improve antibiotic prescribing in the outpatient setting," they wrote.
Oct 29 Infect Control Hosp Epidemiol abstract
Chickenpox, mumps, flu spike at US migrant detention centers
A JAMA research letter yesterday revealed large, sustained outbreaks of potentially life-threatening vaccine-preventable diseases among involuntarily held migrants in dozens of US Immigration and Customs Enforcement (ICE) detention centers, highlighting the need for vaccination programs in the high-risk migrant population.
The Jan 2017 to Mar 2020 study gathered ICE electronic health record system data from 22 facilities, revealing 1,280 cases of flu, 1,052 cases of varicella (chickenpox), and 301 cases of mumps in 79 separate outbreaks—some occurring year-round. Fifteen of the 22 centers reported at least one outbreak—defined as 3 or more linked cases.
Varicella and mumps are relatively rare in the general population, and flu outbreaks typically circulate only seasonally. One facility recorded a 33-month varicella outbreak, with most cases in unvaccinated adults, who are predisposed to more severe disease. The same facility also reported year-round flu transmission. Waning immunity for mumps is common, so adult migrants remain susceptible even if previously vaccinated, the authors note.
Crowding, poor health conditions, under-immunization, and limited access to vaccines create high-risk environments for infectious disease in ICE detention centers. The authors suggest that case numbers underestimate the true number of infections, as they do not include undiagnosed cases, and data were limited to 22 centers with ICE electronic health record systems—a small subset of the 315 US detention facilities.
Two Texas facilities were overrepresented in case counts, with 44.7% of all infections occurring at the South Texas Family Residential Center and 16.5% at the Port Isabel Service Processing Center. The number and duration of outbreaks suggest that transfers between centers are to blame. "Typically, migrants are detained, held for a few days, then moved to another center," lead author Nathan C. Lo, MD, PhD, said in a University of California-San Francisco (UCSF) news release.
"These numbers are pretty shocking," said Lo. "They suggest this vulnerable population is being placed at very high risk for these infections while being detained," he added.
"We should change policy to offer vaccines that can minimize preventable suffering," Lo argued.
Oct 29 JAMA research letter
Oct 29 University of California San Francisco news release
Seven countries report more vaccine-derived polio cases
Seven countries—Pakistan and six African nations—reported more polio cases this week, all involving circulating vaccine-derived poliovirus type 2 (cVDPV2), the Global Polio Eradication Initiative (GPEI) said in its latest update.
Pakistan reported cases from three different provinces (Balochistan, Punjab, and Sindh), bringing its total for the year to 80.
In Africa, Cameroon reported two more cVDPV2 cases, both from Extreme Nord region, raising its total for 2020 to seven. Chad reported eight more cases, including seven from Logone Oriental and one from Moyen Chari, boosting its number to 77 this year, from two different outbreaks.
Ivory Coast reported three more cases from three different provinces, putting its total at 66 for 2020. In the Democratic Republic of Congo (DRC), four cVDPV2 cases were detected, one each in Equateur and Kinshasa provinces and two in Maindombe, increasing the number to 60 so far. Mali reported 15 more cases from five different locations, three of them from the capital city Bamako, putting its total at 26 for the year. And finally, South Sudan reported nine more cases from three different states, pushing its total to 12, all linked to an ongoing outbreak in Chad.
Oct 29 GPEI update