Turkey Links

We at the Ye Olde Humble Controversies Blog (YOHCB) wish you a safe and happy Thanksgiving. We have lots to be thankful for including the many tireless state and federal partners in infection prevention, fantastic infection preventionists, colleagues across many clinical disciplines and our readership. Thank you!

While you are out and about or gathered around a turkey or television, you might want to browse these studies/posts which we haven't covered yet. Just promise that you won't read any while driving, OK?

Links:

1) Stephan Harbarth's group has published in BMJ Open a surgical patient sub-study under MOSAR comparing the impact of (1) enhanced hand hygiene promotion (2) universal MRSA screening and decolonization  or (3) risk-factor based, targeted MRSA screening and enhanced hand hygiene in 10 hospitals encompassing 33 surgical wards. This quasi-experimental study found that neither intervention alone reduced monthly MRSA clinical culture rates. However, the combined intervention (3) was associated with a 12% reduction in monthly clinical cultures.

2) The CDDEP Blog has a new post by Stan Deresinksi covering Antibiotic Stewardship Programs and Education. Stanford's antimicrobial stewardship program has just posted an online course covering appropriate antimicrobial use.

3) Think Like an Anthropologist (HBR). Even though this is a business-oriented article, I think its points are generalizable to health-related administrative data. Key portion of the article: "efforts are typically driven by econometricians, computer scientists, and IT technicians—the people who are expert in database management. They understand digital information, but they don’t always understand how to get from information to meaning. So they boil the data down to percentages, treating random comments (and pictures of people with foil on their legs) as noise. But if you want meaning, you have to think like an anthropologist."

4) Marin Schweizer and colleagues from CDDEP recently published an study in ARIC looking at whether clinicians prescribed antibiotics based on national MRSA or local MRSA data. Clinicians appeared to prescribe linezolid and clindamycin based on national MRSA data but not local data suggesting that providing better local antibiogram data might help with outpatient antimicrobial stewardship efforts.

5) There's a really nice paper in Pediatrics that explores the importance of clustering of unvaccinated patients in the recent California pertussis epidemic. It appears that non-medical exemptions may be contributing significantly to the spread of pertussis. h/t Melissa W

6) There's a new study in PLoS Medicine that recalculated the mortality associated with pandemic 2009 H1N1. This study found mortality to be ten times prior low estimates but in line with a typical influenza season. NPR covered the study. h/t Jonathan Eisen

7) The physician at the center of a Las Vegas clinic Hepatitis C outbreak received a life sentence. h/t Daniel Sexton

8) Finally, we have nothing to worry about. The dragonfly's nano-tech black silicon will eliminate those nasty bacteria. It'll even kill spores.  h/t Judy Stone

Turkey: Best recipe (h/t MO Wright)

Photo Credit: Bob Evans

Epidemiological surveillance testing is a waste

Only last month, we posted on the Washington state pertussis outbreak. Back then, there were 640 reported cases through March.  A month later there are 1284 total cases, up from 128 the prior year.  To me, these seem like important data. For one, we've used them to sound the alarm over low vaccination rates.  Now an article in today's NY Times highlights the impact that state budget woes have had on the public health infrastructure and how this has blunted the epidemic response.

Skagit County's (pop: 117,000) top medical officer, ER doc Dr. Howard Leibrand, has some choice words for pertussis testing, which I've pasted below:

If the signs are there, he said — especially a persistent, deep cough and indication of contact with a confirmed victim — doctors should simply treat patients with antibiotics. The pertussis test can cost up to $400 and delay treatment by days. About 14.6 percent of Skagit County residents have no health insurance, according to a state study conducted last year, up from 11.6 percent in 2008. 

“There has been half a million dollars spent on testing in this county,” Dr. Leibrand said late last week. “Do you know how much vaccination you can buy for half a million dollars?” And testing, he added, benefits only the epidemiologists, not the patients. “It’s an outrageous way to spend your health care dollar.” 

Since antibiotic overuse has no cost or downsides from a public health perspective and we don't need to understand the scope of the epidemic, this is probably cool.

Image source: www.healthheritageresearch.com

Why is the public health community losing to Jenny McCarthy?

There is word of a huge pertussis epidemic in the state of Washington. So far this year, there have been 640 reported cases through March compared to 94 cases during the same period in 2011. If my math is correct, that's a 649% increase, which is quite possibly more than even Apple's stock increased over the same period.* Per a report in the Seattle Times, if the trend continues, this would equal an outbreak not seen since the 1940's! The article also contains a telling anecdote describing a mother who passed pertussis to her one-month old infant, who turned blue and had to spend a week in the ICU and a month in the hospital.

This outbreak isn't limited to Washington. In 2010, whooping cough killed 10 infants and infected over 9,000 in California, which was the state's worst outbreak in 60 years.

Why is this happening?  I won't go into all of the reasons, as we've had plenty of posts on the topic over the years. I'll just refer you to Red Sox fan and PLoS co-founder Michael Eisen's tweet from yesterday. In an earlier tweet he mentioned that 34% of the parents in his daughter's school don't fully vaccinate their kids.  I agree that this is all Jenny McCarthy's fault and anyone who listens to her or gives her a voice.  It is clear that after years of neglect, the public health community is so weak that it can't even compete with Jenny 'Effin' McCarthy.

*By law, nothing is allowed a larger percent increase than Apple's stock.

Pertussis outbreak

The LA Times reports today that pertussis activity in California has reached epidemic levels. To date this year, there have been over 900 confirmed cases with an additional 600 cases under investigation. Five deaths in infants have been reported.