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/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F9df2ad2c2110dcb557b3509394a82fffa533dc8b-8043x5362.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F9df2ad2c2110dcb557b3509394a82fffa533dc8b-8043x5362.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="fill" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="object-contain" loading="lazy"/></noscript></span></a></div><div class="border-t-gray-100 border-t-2 flex-auto py-2 "><span class="text-sm text-gray-500 py-2">November 22nd 2024</span><div class="py-3"><a class="lg:text-[20px] text-[19px] font-[500]" href="/view/in-room-air-purifiers-could-impact-rsv-incidence-among-older-adults">In-Room Air Purifiers Could Impact RSV Incidence Among Older Adults</a></div><div class="pb-2"><div><span class="text-md "><span class="mr-1 italic">By </span><a class="mr-1 text-sky-800 hover:text-primary" href="/authors/kennedy-ferruggia"><i>Kennedy Ferruggia</i></a></span></div></div><a href="/view/in-room-air-purifiers-could-impact-rsv-incidence-among-older-adults"><a href="/view/in-room-air-purifiers-could-impact-rsv-incidence-among-older-adults"><p class="mt-1 text-gray-800 text-[13px] line-clamp-6 text-hidden">Use of in-room air purifiers with HEPA-14 filters did not result in a significant reduction of acute respiratory infections.</p></a></a></div></div><div class="flex-wrap w-[60%] flex "><a class="flex w-[50%] flex-col sm:pl-[35px] pl-[20px] pb-[35px] " href="/view/community-pharmacies-hold-key-role-in-protecting-older-adults-from-rsv"><div class="w-full lg:h-[134px] h-[100px] relative bg-default-logo-background "><span 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href="/view/community-pharmacies-hold-key-role-in-protecting-older-adults-from-rsv"><p class="line-clamp-4 text-hidden font-[500]">Community Pharmacies Hold Key Role in Protecting Older Adults From RSV</p></a></div><div class="py-2"><div><span class="text-md "><span class="mr-1 italic">By </span><a class="mr-1 text-sky-800 hover:text-primary" href="/authors/pearl-steinzor"><i>Pearl Steinzor</i></a></span></div></div></div></a><a class="flex w-[50%] flex-col sm:pl-[35px] pl-[20px] pb-[35px] " href="/view/rsv-vaccine-proven-effective-in-reducing-rsv-related-hospitalizations"><div class="w-full lg:h-[134px] h-[100px] relative bg-default-logo-background "><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:absolute;top:0;left:0;bottom:0;right:0"><img alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="fill" 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style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="lg:object-cover object-contain " loading="lazy"/></noscript></span></div><div class="border-t-gray-100 border-t-2 pt-2 pb-2 flex-auto "><a href="/view/rsv-vaccine-proven-effective-in-reducing-rsv-related-hospitalizations"><span class="text-sm text-gray-500">November 15th 2024</span></a><div><a class="text-[14px]" href="/view/rsv-vaccine-proven-effective-in-reducing-rsv-related-hospitalizations"><p class="line-clamp-4 text-hidden font-[500]"> RSV Vaccine Proven Effective in Reducing RSV-Related Hospitalizations</p></a></div><div class="py-2"><div><span class="text-md "><span class="mr-1 italic">By </span><a class="mr-1 text-sky-800 hover:text-primary" href="/authors/kennedy-ferruggia"><i>Kennedy Ferruggia</i></a></span></div></div></div></a><a class="flex w-[50%] flex-col 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href="/view/impact-of-rsv-on-hospitalizations-in-us-adults-prior-to-vaccine-introduction"><span class="text-sm text-gray-500">November 14th 2024</span></a><div><a class="text-[14px]" href="/view/impact-of-rsv-on-hospitalizations-in-us-adults-prior-to-vaccine-introduction"><p class="line-clamp-4 text-hidden font-[500]">Impact of RSV on Hospitalizations in US Adults Prior to Vaccine Introduction</p></a></div><div class="py-2"><div><span class="text-md "><span class="mr-1 italic">By </span><a class="mr-1 text-sky-800 hover:text-primary" href="/authors/pearl-steinzor"><i>Pearl Steinzor</i></a></span></div></div></div></a><a class="flex w-[50%] flex-col sm:pl-[35px] pl-[20px] pb-[35px] " href="/view/sti-epidemic-may-be-slowing-cdc-data-suggests"><div class="w-full lg:h-[134px] h-[100px] relative bg-default-logo-background "><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:absolute;top:0;left:0;bottom:0;right:0"><img alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="fill" class="lg:object-cover object-contain " style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Ff7e04cbc83dfad74d8bdb0df2c82f0d80ff4f7ea-4160x2981.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Ff7e04cbc83dfad74d8bdb0df2c82f0d80ff4f7ea-4160x2981.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, 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respiratory syncytial virus (RSV) vaccine indicated for adults younger than 50 years. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/gsk-s-arexvy-vaccine-shows-strong-efficacy-against-rsv-in-older-adults"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/8287ab160a0fbc0fb0436cd45688b013079d9da4-5568x3712.jpg?fit=crop&auto=format" alt="RSV vaccine vial with syringe - Respiratory syncytial virus shot | MargJohnsonVA - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 23rd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/gsk-s-arexvy-vaccine-shows-strong-efficacy-against-rsv-in-older-adults">GSK's Arexvy Vaccine Shows Strong Efficacy Against RSV in Older Adults</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/sophia-abene">Sophia Abene </a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/gsk-s-arexvy-vaccine-shows-strong-efficacy-against-rsv-in-older-adults"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The vaccine proved a cumulative efficacy of 62.9% against respiratory syncytial virus (RSV)-related lower respiratory tract disease in older adults over 3 seasons.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/clinical-outcomes-mortality-risk-factor-of-rsv-influenza-in-hospitalized-adults"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/914ff0d685eec8a3466fd62232069866af1601e0-6048x4024.jpg?fit=crop&auto=format" alt="respiratory infection. | Image credit: Kateryna - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/clinical-outcomes-mortality-risk-factor-of-rsv-influenza-in-hospitalized-adults">Clinical Outcomes, Mortality Risk Factor of RSV, Influenza in Hospitalized Adults</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/clinical-outcomes-mortality-risk-factor-of-rsv-influenza-in-hospitalized-adults"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Study explores the clinical manifestations, risk factors, and 90-day mortality outcomes in adults hospitalized with RSV or influenza across Europe. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/identifying-post-discharge-care-needs-among-adults-hospitalized-with-rsv"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/bf5b1a057ebf6e9e6eaebe4464fc4d028ebbd11d-5109x3682.jpg?fit=crop&auto=format" alt="Nurse prepares oxygen mask in hospital, conceptual image - Felipe Caparrós - stock.adobe.com.jpeg" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 9th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/identifying-post-discharge-care-needs-among-adults-hospitalized-with-rsv">Identifying Postdischarge Care Needs Among Adults Hospitalized With RSV</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/identifying-post-discharge-care-needs-among-adults-hospitalized-with-rsv"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Study compares immediate post-discharge care requirements for respiratory syncytial virus (RSV), influenza, acute myocardial infarction, and stroke. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/predictors-of-poor-outcomes-in-patients-with-myasthenia-gravis-and-covid-19"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/0c0602a3e61e6c7fec1f15f7992bd5a412d5737b-1280x918.jpg?fit=crop&auto=format" alt="COVID-19 virus | Image credit: phonlamaiphoto - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 6th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/predictors-of-poor-outcomes-in-patients-with-myasthenia-gravis-and-covid-19">Predictors of Poor Outcomes in Patients With Myasthenia Gravis and COVID-19</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/kimberly-rath-pharmd">Kimberly Rath, PharmD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/predictors-of-poor-outcomes-in-patients-with-myasthenia-gravis-and-covid-19"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Researchers identify certain predictive factors that impact the prognosis of patients with myasthenia gravis and COVID-19 infection. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/adult-rsv-hospitalizations-clinical-characteristics-risk-factors-for-severe-outcomes"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/d1024943b40e0b87ca36ca1c2a1de913f336757d-7360x4912.jpg?fit=crop&auto=format" alt="Blood sample tube for RSV test. | Image credit: JUN LI - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 4th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/adult-rsv-hospitalizations-clinical-characteristics-risk-factors-for-severe-outcomes">Adult RSV Hospitalizations: Clinical Characteristics, Risk Factors for Severe Outcomes</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/adult-rsv-hospitalizations-clinical-characteristics-risk-factors-for-severe-outcomes"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new study highlights risk factors for hospitalization and severe illness among adults with respiratory syncytial virus (RSV) receiving care through the emergency department. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-7"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/vaccine-hesitancy-persists-despite-understanding-vaccination-effectiveness-survey-finds"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/651979e967732302bc0515a7214e69a43e7305af-5568x3712.jpg?fit=crop&auto=format" alt="Vaccine booster concept faded background | MargJohnsonVA - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 30th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/vaccine-hesitancy-persists-despite-understanding-vaccination-effectiveness-survey-finds">Vaccine Hesitancy Persists Despite Understanding Vaccination Effectiveness, Survey Finds</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/vaccine-hesitancy-persists-despite-understanding-vaccination-effectiveness-survey-finds"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Survey reveals gaps in vaccination intentions for flu, COVID-19, respiratory syncytial virus, and pneumococcal disease.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/ziresovir-reduces-bronchiolitis-in-infants-hospitalized-with-rsv"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/8982487b80a63a05d577527e4421ad42c493ff65-5760x3840.jpg?fit=crop&auto=format" alt="Baby on nebulizer | Image credit: zilvergolf - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 27th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/ziresovir-reduces-bronchiolitis-in-infants-hospitalized-with-rsv">Ziresovir Reduces Bronchiolitis in Infants Hospitalized With RSV</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/ziresovir-reduces-bronchiolitis-in-infants-hospitalized-with-rsv"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Ziresovir reduces respiratory syncytial virus (RSV) symptoms and viral load in infants, offering hope for an effective treatment.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/over-half-of-us-infants-infected-with-rsv-in-first-year-of-life-study-finds"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/b39cf66640c8ff15a639876c186bb4d34e9d608a-1200x724.jpg?fit=crop&auto=format" alt="Mother holding newborn baby | Image credit: kieferpix -stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 25th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/over-half-of-us-infants-infected-with-rsv-in-first-year-of-life-study-finds">Over Half of US Infants Infected With RSV in First Year of Life, Study Finds</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/over-half-of-us-infants-infected-with-rsv-in-first-year-of-life-study-finds"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">More than half of healthy term infants born in the United States are infected with respiratory syncytial virus (RSV) during their first year of life, with significant hospitalization and illness rates observed. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/new-rsv-vaccine-is-likely-cost-effective-for-older-adults-study-finds"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/d1024943b40e0b87ca36ca1c2a1de913f336757d-7360x4912.jpg?fit=crop&auto=format" alt="Blood sample tube for RSV test. | Image credit: JUN LI - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 17th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/new-rsv-vaccine-is-likely-cost-effective-for-older-adults-study-finds">New RSV Vaccine Is Likely Cost-Effective for Older Adults, Study Finds </a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/new-rsv-vaccine-is-likely-cost-effective-for-older-adults-study-finds"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Respiratory syncytial virus (RSV) vaccination in adults aged 60 years and older may be cost-effective in preventing illness, hospitalizations, lost quality of life, and deaths, according to one study. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/rsv-vaccine-shows-high-effectiveness-against-hospitalization-in-older-adults"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/afdddf86fe0622e5fc70995c72690bc4ab020a82-5568x3712.jpg?fit=crop&auto=format" alt="RSV swab test with negative result | Image credit: MargJohnsonVA - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 4th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/rsv-vaccine-shows-high-effectiveness-against-hospitalization-in-older-adults">RSV Vaccine Shows High Effectiveness Against Hospitalization in Older Adults</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/rsv-vaccine-shows-high-effectiveness-against-hospitalization-in-older-adults"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The first real-world study highlights benefits for adults aged 60 years and older who receive the respiratory syncytial virus (RSV) vaccine. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/sixty-percent-of-adults-over-50-unaware-of-rsv-risks-survey-reveals"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/8287ab160a0fbc0fb0436cd45688b013079d9da4-5568x3712.jpg?fit=crop&auto=format" alt="RSV vaccine vial with syringe - Respiratory syncytial virus shot | MargJohnsonVA - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 30th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/sixty-percent-of-adults-over-50-unaware-of-rsv-risks-survey-reveals">Sixty Percent of Adults Over 50 Unaware of RSV Risks, Survey Reveals</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/sixty-percent-of-adults-over-50-unaware-of-rsv-risks-survey-reveals"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new survey highlights lack of awareness about respiratory syncytial virus (RSV) among older adults, posing increased health risks for those with chronic conditions.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-13"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/top-5-causes-of-death-on-the-first-labor-day-fueled-by-harsh-working-life"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/d371af69ebdedd234f72dc3ae26634da61af7672-600x446.jpg?fit=crop&auto=format" alt="Top 5 Causes of Death on the First Labor Day Fueled by Harsh Working Life" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 30th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/top-5-causes-of-death-on-the-first-labor-day-fueled-by-harsh-working-life">Top 5 Causes of Death on the First Labor Day Fueled by Harsh Working Life</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/mary-caffrey">Mary Caffrey</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/top-5-causes-of-death-on-the-first-labor-day-fueled-by-harsh-working-life"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Infectious diseases were the leading causes of death on the first Labor Day, just ahead of a major epidemiological shift that brought both vaccines to fight these deadly ailments but also the rise of cigarette smoking.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/impact-of-new-york-state-s-paid-family-leave-on-infant-respiratory-infections"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/2b525b872ada82fab21abfb9daab0cfa5eb60491-5500x3667.jpg?fit=crop&auto=format" alt="Young child sneezing | Image credit: kornnphoto - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 29th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/impact-of-new-york-state-s-paid-family-leave-on-infant-respiratory-infections">Impact of New York State's Paid Family Leave on Infant Respiratory Infections</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/impact-of-new-york-state-s-paid-family-leave-on-infant-respiratory-infections"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">An 18% reduction in acute care encounters for respiratory tract infections among infants 8 weeks or younger was identified following the implementation of New York's paid family leave policy.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/pediatric-primary-care-emergency-visits-for-rsv-vary-greatly-worldwide"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/c4606827cae8d897f05cae39b21fd0290370c851-1280x853.jpg?fit=crop&auto=format" alt="Pediatrics | Image Credit: © Viacheslav Yakobchuk - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/pediatric-primary-care-emergency-visits-for-rsv-vary-greatly-worldwide">Pediatric Primary Care, Emergency Visits for RSV Vary Greatly Worldwide</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/christina-mattina">Christina Mattina</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/pediatric-primary-care-emergency-visits-for-rsv-vary-greatly-worldwide"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A recent study estimates the prevalence of primary care and emergency department visits by young children to treat respiratory syncytial virus (RSV), finding that the rates vary widely by country.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/struggling-to-find-a-summer-covid-19-vaccine-updated-shots-are-coming-soon"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/01db29bc5ed4350d89959cf6274d468beeac5c96-4872x3112.jpg?fit=crop&auto=format" alt="COVID-19 vaccine | neirfy - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/struggling-to-find-a-summer-covid-19-vaccine-updated-shots-are-coming-soon">Struggling to Find a Summer COVID-19 Vaccine? Updated Shots Are Coming Soon</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/struggling-to-find-a-summer-covid-19-vaccine-updated-shots-are-coming-soon"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Spotty vaccine supplies have consumers searching for protection as the FDA prepares to approve updated COVID-19 shots.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/who-declares-another-mpox-global-emergency-what-americans-should-know"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/45e0554a02d30605f2fd179d9a509050a005222e-6000x4000.jpg?fit=crop&auto=format" alt="World Health Organization | Image credit: hectorchristiaen – stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 20th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/who-declares-another-mpox-global-emergency-what-americans-should-know">WHO Declares Another Mpox Global Emergency—What Americans Should Know</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/hayden-e-klein">Hayden E. Klein</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/who-declares-another-mpox-global-emergency-what-americans-should-know"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The current outbreak stems from the clade I strain of mpox, different from the clade II strain that caused the 2022 global health emergency.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/new-at-home-syphilis-test-has-potential-to-save-lives-and-money"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/e36866eec432f57d8afad15c85099072f90b9265-1200x738.jpg?fit=crop&auto=format" alt="Icon repping sexual health | Image Credit: stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 19th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/new-at-home-syphilis-test-has-potential-to-save-lives-and-money">New At-Home Syphilis Test Has Potential to Save Lives and Money</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/new-at-home-syphilis-test-has-potential-to-save-lives-and-money"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">CDC data from 2021 show the lifetime cost of treating syphilis to be $1190.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-19"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/pfizer-reports-positive-phase-3-results-for-rsv-vaccine-in-immunocompromised-adults"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/8c603bc886ceaf5fc8d5e459402107c9425262d1-6000x4000.jpg?fit=crop&auto=format" alt="Pfizer | Image credit: jetcityimage - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 15th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/pfizer-reports-positive-phase-3-results-for-rsv-vaccine-in-immunocompromised-adults">Pfizer Reports Positive Phase 3 Results for RSV Vaccine in Immunocompromised Adults</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/pfizer-reports-positive-phase-3-results-for-rsv-vaccine-in-immunocompromised-adults"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The respiratory syncytial virus (RSV) vaccine shows strong immunogenicity and safety in immunocompromised adults, study finds. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/updated-acip-guidelines-rsv-vaccine-for-adults-aged-60-years-and-older"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/afc3ab09f3a5266315ad5159fd1386f8ff959787-6600x4400.jpg?fit=crop&auto=format" alt="Headquarters of the CDC | Imaged credit: Tada Images - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 7th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/updated-acip-guidelines-rsv-vaccine-for-adults-aged-60-years-and-older">Updated ACIP Guidelines: RSV Vaccine for Adults Aged 60 Years and Older</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/updated-acip-guidelines-rsv-vaccine-for-adults-aged-60-years-and-older"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">CDC’s Advisory Committee on Immunization Practices (ACIP) revises respiratory syncytial virus (RSV) vaccination guidelines to prioritize older adults and those at higher risk of severe disease.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/part-2-addressing-migrant-workers-vulnerability-to-hiv"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a165a8045737460f8a4e51a858da4b26c2e858dc-3750x2000.png?fit=crop&auto=format" alt="Musarrat Perveen | Image Credit: CARAM Asia" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 7th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/part-2-addressing-migrant-workers-vulnerability-to-hiv">Part 2: Addressing Migrant Workers' Vulnerability to HIV</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/part-2-addressing-migrant-workers-vulnerability-to-hiv"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">In part 1 of this interview, Musarrat Perveen, regional coordinator at Coordination of Action Research on AIDS and Mobility in Asia (CARAM Asia), explained the research she presented at the 25th International AIDS Conference and the disparities migrant workers continue to encounter in HIV care.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/severe-covid-19-illness-linked-to-prior-respiratory-syncytial-viral-infection-study-finds"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/651979e967732302bc0515a7214e69a43e7305af-5568x3712.jpg?fit=crop&auto=format" alt="Vaccine booster concept faded background | MargJohnsonVA - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 6th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/severe-covid-19-illness-linked-to-prior-respiratory-syncytial-viral-infection-study-finds">Severe COVID-19 Illness Linked to Prior Respiratory Syncytial Viral Infection, Study Finds</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/severe-covid-19-illness-linked-to-prior-respiratory-syncytial-viral-infection-study-finds"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">New research highlights the increased risk of severe COVID-19 in individuals previously infected with respiratory syncytial virus (RSV).</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/part-1-addressing-migrant-workers-vulnerability-to-hiv"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a165a8045737460f8a4e51a858da4b26c2e858dc-3750x2000.png?fit=crop&auto=format" alt="Musarrat Perveen | Image Credit: CARAM Asia" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">Published: August 5th 2024 | Updated: August 4th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/part-1-addressing-migrant-workers-vulnerability-to-hiv">Part 1: Addressing Migrant Workers' Vulnerability to HIV</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/part-1-addressing-migrant-workers-vulnerability-to-hiv"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">We spoke with Musarrat Perveen, regional coordinator at Coordination of Action Research on AIDS and Mobility in Asia (CARAM Asia), who advocates at regional and global levels for policy reform of discriminatory practices that put migrant workers at risk of HIV and AIDS.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/cbt-group-sessions-ease-distress-in-older-patients-living-with-hiv"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/65a3eac0cd3b340a361b9caaf9ab99d5ab3aef6a-1200x675.jpg?fit=crop&auto=format" alt="Jacklyn D. Foley, PhD, MS" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 1st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/cbt-group-sessions-ease-distress-in-older-patients-living-with-hiv">CBT Group Sessions Ease Distress in Older Patients Living With HIV</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/cbt-group-sessions-ease-distress-in-older-patients-living-with-hiv"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">This research presented at AIDS 2024 shows that cognitive behavioral therapy (CBT) groups help to fill an unmet need among older persons living with HIV: to overcome the age-related health disparities this group experiences from being in long-term care and improve their health outcomes. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-25"></div></div></div><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/assessing-the-economic-burden-of-rsv-associated-hospitalizations-among-us-adults"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/ec5d7f3ca4327cf6946c47b72824c06b31815c29-7680x4320.jpg?fit=crop&auto=format" alt="RSV vaccine | Peter Hansen - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">July 31st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/assessing-the-economic-burden-of-rsv-associated-hospitalizations-among-us-adults">Assessing the Economic Burden of RSV-Associated Hospitalizations Among US Adults</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/assessing-the-economic-burden-of-rsv-associated-hospitalizations-among-us-adults"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Researchers estimate the financial impact of respiratory syncytial virus (RSV) in cardiorespiratory hospitalizations using MarketScan data and CDC viral positivity rates. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/what-we-re-reading-social-media-regulations-merck-s-antibody-based-rsv-vaccine-drug-shortages-continue"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/43a26cd2cd6a291365b4c989b3a7ac9474195aa7-1000x523.png?fit=crop&auto=format" alt="What We’re Reading: Social Media Regulations; Merck’s Antibody-Based RSV Vaccine; Drug Shortages Hit a New High" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">July 23rd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/what-we-re-reading-social-media-regulations-merck-s-antibody-based-rsv-vaccine-drug-shortages-continue">What We’re Reading: Social Media Regulations; Merck’s Antibody-Based RSV Vaccine; Drug Shortages Continue</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/ajmc-staff">AJMC Staff</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/what-we-re-reading-social-media-regulations-merck-s-antibody-based-rsv-vaccine-drug-shortages-continue"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Efforts to regulate social media for youth face resistance; MK-1654 meets key goals in mid-to-late stage trial; active drug shortages remain above 300 for sixth consecutive quarter.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/rsv-testing-among-infants-with-bronchiolitis-is-increasing-study-shows"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/afdddf86fe0622e5fc70995c72690bc4ab020a82-5568x3712.jpg?fit=crop&auto=format" alt="RSV swab test with negative result | Image credit: MargJohnsonVA - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">July 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/rsv-testing-among-infants-with-bronchiolitis-is-increasing-study-shows">RSV Testing Among Infants With Bronchiolitis Is Increasing, Study Shows </a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/rsv-testing-among-infants-with-bronchiolitis-is-increasing-study-shows"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Despite rising trends in respiratory syncytial virus (RSV) testing, more outpatient testing is needed for accurate RSV surveillance. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/what-we-re-reading-aca-plans-protection-resistant-hospital-infections-kamala-harris-stance-on-health-care-policy"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/43a26cd2cd6a291365b4c989b3a7ac9474195aa7-1000x523.png?fit=crop&auto=format" alt="What We’re Reading: ACA Plans Protection; Resistant Hospital Infections; Kamala Harris’s Stance on Health Care Policy" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">July 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/what-we-re-reading-aca-plans-protection-resistant-hospital-infections-kamala-harris-stance-on-health-care-policy">What We’re Reading: ACA Plans Protection; Resistant Hospital Infections; Kamala Harris’ Stance on Health Care Policy</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/ajmc-staff">AJMC Staff</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/what-we-re-reading-aca-plans-protection-resistant-hospital-infections-kamala-harris-stance-on-health-care-policy"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">New rules aim to curb insurance brokers and protect consumers; data highlights surge in post-pandemic hospital-onset infections; President Biden’s decision to step down highlights Harris’ stance on health care reform and equity.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/nirsevimab-reduces-risk-of-rsv-associated-bronchiolitis-study-finds"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/beb07b8f2b1f611720288b570adf1c1ab9c7bc65-6016x4016.jpg?fit=crop&auto=format" alt="Mom makes inhalation of the child, holding hands | Image credit: komokvm - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">Published: July 18th 2024 | Updated: July 18th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/nirsevimab-reduces-risk-of-rsv-associated-bronchiolitis-study-finds">Nirsevimab Reduces Risk of RSV-Associated Bronchiolitis, Study Finds </a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/nirsevimab-reduces-risk-of-rsv-associated-bronchiolitis-study-finds"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The effectiveness of nirsevimab therapy shows promise against respiratory syncytial virus (RSV)–associated bronchiolitis in a real-world setting. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/risk-of-long-covid-has-declined-largely-due-to-vaccination"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/41329cf7faa4b4958d788e5fd9d7805a95c33fd4-1280x720.jpg?fit=crop&auto=format" alt="Doctor giving senior woman vaccine | Image credit: stock.adobe.com - Konstantin Yuganov" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">July 17th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/risk-of-long-covid-has-declined-largely-due-to-vaccination">Risk of Long COVID Has Declined, Largely Due to Vaccination</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/laura-joszt">Laura Joszt, MA</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/risk-of-long-covid-has-declined-largely-due-to-vaccination"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Over the course of the pandemic, the risk of developing long COVID after a COVID-19 infection decreased, largely due to vaccination.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div><div class="w-full text-center flex justify-center pb-24"><a class="px-4 py-2 border-y border-r bg-primary text-white" href="/compendium/infectious-disease?page=1">1</a><a class="px-4 py-2 border-y border-r " href="/compendium/infectious-disease?page=2">2</a><a class="px-4 py-2 border-y border-r " href="/compendium/infectious-disease?page=3">3</a><a class="px-4 py-2 border-y border-r " href="/compendium/infectious-disease?page=4">4</a><a class="px-4 py-2 border-y border-r " href="/compendium/infectious-disease?page=5">5</a><a class="px-4 py-2 border-y border-r " href="/compendium/infectious-disease?page=6">6</a><a class="px-4 py-2 border-y border-r " href="/compendium/infectious-disease?page=7">7</a><a class="px-4 py-2 border-y border-r " href="/compendium/infectious-disease?page=8">8</a><div class="px-4 py-2 border-y border-r">...</div><a class="px-4 py-2 border-y border-r" href="/compendium/infectious-disease?page=10">10</a><a class="px-4 py-2 border-y border-r" href="/compendium/infectious-disease?page=2">></a></div></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div 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","published":"2024-09-25T16:19:36.089Z","updatedOn":null,"contentCategory":{"name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory"},"authors":[{"displayName":"Pearl Steinzor","url":"pearl-steinzor"}],"factCheckAuthors":null,"url":"over-half-of-us-infants-infected-with-rsv-in-first-year-of-life-study-finds","thumbnail":{"alt":"Mother holding newborn baby | Image credit: kieferpix -stock.adobe.com","asset":{"_type":"reference","_ref":"image-b39cf66640c8ff15a639876c186bb4d34e9d608a-1200x724-jpg"},"_type":"mainImage"}},{"summary":"Respiratory syncytial virus (RSV) vaccination in adults aged 60 years and older may be cost-effective in preventing illness, hospitalizations, lost quality of life, and deaths, according to one study. ","published":"2024-09-17T20:27:22.069Z","_id":"c95ec27d-bfec-4680-ba12-574a03d16e80","title":"New RSV Vaccine Is Likely Cost-Effective for Older Adults, Study Finds ","url":"new-rsv-vaccine-is-likely-cost-effective-for-older-adults-study-finds","authors":[{"displayName":"Pearl Steinzor","url":"pearl-steinzor"}],"factCheckAuthors":null,"thumbnail":{"_type":"mainImage","alt":"Blood sample tube for RSV test. | Image credit: JUN LI - stock.adobe.com","asset":{"_type":"reference","_ref":"image-d1024943b40e0b87ca36ca1c2a1de913f336757d-7360x4912-jpg"}},"updatedOn":null,"contentCategory":{"_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z"}},{"factCheckAuthors":null,"url":"rsv-vaccine-shows-high-effectiveness-against-hospitalization-in-older-adults","thumbnail":{"_type":"mainImage","alt":"RSV swab test with negative result | Image credit: MargJohnsonVA - stock.adobe.com","asset":{"_ref":"image-afdddf86fe0622e5fc70995c72690bc4ab020a82-5568x3712-jpg","_type":"reference"}},"summary":"The first real-world study highlights benefits for adults aged 60 years and older who receive the respiratory syncytial virus (RSV) vaccine. ","published":"2024-09-04T15:00:00.000Z","updatedOn":null,"contentCategory":{"_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z"},"_id":"32da2b13-32f2-4a90-b15b-29b9ad794d40","title":"RSV Vaccine Shows High Effectiveness Against Hospitalization in Older Adults","authors":[{"displayName":"Pearl Steinzor","url":"pearl-steinzor"}]},{"title":"Sixty Percent of Adults Over 50 Unaware of RSV Risks, Survey Reveals","thumbnail":{"_type":"mainImage","alt":"RSV vaccine vial with syringe - Respiratory syncytial virus shot | MargJohnsonVA - stock.adobe.com","asset":{"_ref":"image-8287ab160a0fbc0fb0436cd45688b013079d9da4-5568x3712-jpg","_type":"reference"}},"summary":"A new survey highlights lack of awareness about respiratory syncytial virus (RSV) among older adults, posing increased health risks for those with chronic conditions.","updatedOn":null,"authors":[{"displayName":"Pearl Steinzor","url":"pearl-steinzor"}],"factCheckAuthors":null,"_id":"11847272-19e1-418c-b640-a43d83c28aac","url":"sixty-percent-of-adults-over-50-unaware-of-rsv-risks-survey-reveals","published":"2024-08-30T17:19:21.189Z","contentCategory":{"_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z"}},{"thumbnail":{"_type":"mainImage","caption":"An immigrant child working in New York City, around 1900. | Image credit: National Park Service","asset":{"_ref":"image-d371af69ebdedd234f72dc3ae26634da61af7672-600x446-jpg","_type":"reference"}},"title":"Top 5 Causes of Death on the First Labor Day Fueled by Harsh Working Life","url":"top-5-causes-of-death-on-the-first-labor-day-fueled-by-harsh-working-life","published":"2024-08-30T12:00:00.000Z","updatedOn":null,"contentCategory":{"_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2"},"authors":[{"displayName":"Mary Caffrey","url":"mary-caffrey"}],"factCheckAuthors":null,"_id":"ef969043-cc7e-41d9-8ba8-bed216a16d3d","summary":"Infectious diseases were the leading causes of death on the first Labor Day, just ahead of a major epidemiological shift that brought both vaccines to fight these deadly ailments but also the rise of cigarette smoking."},{"_id":"86848142-3412-4dd1-aedd-be2894359d72","url":"impact-of-new-york-state-s-paid-family-leave-on-infant-respiratory-infections","summary":"An 18% reduction in acute care encounters for respiratory tract infections among infants 8 weeks or younger was identified following the implementation of New York's paid family leave policy.","factCheckAuthors":null,"title":"Impact of New York State's Paid Family Leave on Infant Respiratory Infections","thumbnail":{"_type":"mainImage","alt":"Young child sneezing | Image credit: kornnphoto - 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Updated Shots Are Coming Soon","url":"struggling-to-find-a-summer-covid-19-vaccine-updated-shots-are-coming-soon","thumbnail":{"_type":"mainImage","alt":"COVID-19 vaccine | neirfy - stock.adobe.com","asset":{"_ref":"image-01db29bc5ed4350d89959cf6274d468beeac5c96-4872x3112-jpg","_type":"reference"}},"updatedOn":null},{"factCheckAuthors":null,"contentCategory":{"name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory"},"title":"WHO Declares Another Mpox Global Emergency—What Americans Should Know","url":"who-declares-another-mpox-global-emergency-what-americans-should-know","thumbnail":{"_type":"mainImage","alt":"World Health Organization | Image credit: hectorchristiaen – stock.adobe.com","asset":{"_ref":"image-45e0554a02d30605f2fd179d9a509050a005222e-6000x4000-jpg","_type":"reference"}},"summary":"The current outbreak stems from the clade I strain of mpox, different from the clade II strain that caused the 2022 global health emergency.","published":"2024-08-20T13:44:00.000Z","updatedOn":null,"authors":[{"displayName":"Hayden E. Klein","url":"hayden-e-klein"}],"_id":"ea61b3c5-1bdd-4891-9df0-e2ea8760dc5d"},{"_id":"57f70af6-4daf-4858-8ab7-1d56642b1d0f","published":"2024-08-19T16:38:42.861Z","updatedOn":null,"authors":[{"displayName":"Maggie L. 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","published":"2024-08-15T22:30:08.052Z","authors":[{"displayName":"Pearl Steinzor","url":"pearl-steinzor"}]},{"summary":"CDC’s Advisory Committee on Immunization Practices (ACIP) revises respiratory syncytial virus (RSV) vaccination guidelines to prioritize older adults and those at higher risk of severe disease.","published":"2024-08-07T14:49:47.320Z","updatedOn":null,"contentCategory":{"_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles"},"authors":[{"displayName":"Pearl Steinzor","url":"pearl-steinzor"}],"_id":"97cb59a1-cdc8-489b-91e6-255025610e85","title":"Updated ACIP Guidelines: RSV Vaccine for Adults Aged 60 Years and Older","url":"updated-acip-guidelines-rsv-vaccine-for-adults-aged-60-years-and-older","thumbnail":{"_type":"mainImage","alt":"Headquarters of the CDC | Imaged credit: Tada Images - stock.adobe.com","asset":{"_ref":"image-afc3ab09f3a5266315ad5159fd1386f8ff959787-6600x4400-jpg","_type":"reference"}},"factCheckAuthors":null},{"_id":"f05f011b-d7b5-48f6-a6e6-478c200ccc29","title":"Part 2: Addressing Migrant Workers' Vulnerability to HIV","updatedOn":null,"contentCategory":{"_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh"},"authors":[{"displayName":"Maggie L. 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Having said that, I’d like to get some final words of wisdom about ","_key":"1487654a8ed1"},{"_type":"span","marks":["em"],"text":"Clostridioides difficile","_key":"1ca6b7a20449"},{"marks":[],"text":" and recurrent ","_key":"d236f40e7341","_type":"span"},{"_type":"span","marks":["em"],"text":"C diff","_key":"3d4757f94fe5"},{"_type":"span","marks":[],"text":" infections, whether it’s therapy, treatment, prevention, etc, from each of you. I’ll start with Dr Gerding.","_key":"7f78a5c6ec61"}],"_type":"block"},{"_type":"block","style":"normal","_key":"6bebd032474c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"858aa023cfba0"}]},{"markDefs":[],"children":[{"text":"Dale N. 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We need to be patient.","_key":"a84a53e574d05","_type":"span"}],"_type":"block","style":"normal","_key":"43606d18d72a"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"054d7c14f44b0"}],"_type":"block","style":"normal","_key":"201a0ce9de9e"},{"markDefs":[],"children":[{"_key":"4ee3b2d3c1090","_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:"},{"_type":"span","marks":[],"text":" Dr Abdallah?","_key":"4ee3b2d3c1091"}],"_type":"block","style":"normal","_key":"950968147407"},{"children":[{"_type":"span","marks":[],"text":"","_key":"eecece8e63dc0"}],"_type":"block","style":"normal","_key":"83a415fdeb63","markDefs":[]},{"_type":"block","style":"normal","_key":"166be0b09efa","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Karina Abdallah, PharmD:","_key":"7f262da746be0"},{"_type":"span","marks":[],"text":" I second that. We’re looking at the pipeline of treatments from the payer side of things, making sure that we’re ready to quickly address any changes in the landscape, any new covered items. We’re looking for data and new FDA-approved therapies that are going to be proven to be efficacious and safe. Ultimately, we can take those data and show that it can lead to overall cost of care reduction with less recurrence, along with a better patient experience. With that and some coordination among our thought leaders, both in the GI [gastrointestinal] and ID [infectious disease] spaces, as well as larger health systems, we can make this better in the future. We’re looking to do that together with a strong partnership.","_key":"7f262da746be1"}]},{"_type":"block","style":"normal","_key":"23ef18700bc4","markDefs":[],"children":[{"_key":"d678950b752d0","_type":"span","marks":[],"text":""}]},{"style":"normal","_key":"5faac6384baa","markDefs":[],"children":[{"text":"Neil Minkoff, MD:","_key":"71899fc6533f0","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":" Dr Stephens?","_key":"71899fc6533f1"}],"_type":"block"},{"markDefs":[],"children":[{"text":"","_key":"50d4f6bcea300","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"a4df5cb54050"},{"style":"normal","_key":"f886ebe938e6","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Kevin U. Stephens, Sr. MD, JD:","_key":"daf273f884760"},{"_type":"span","marks":[],"text":" Yes, thank you again. This was a very good panel. I thank all of you for your thoughts and considerations. It’s very interesting. I’d like to focus on the big picture. Many times, we get stuck in little silos. Our health care delivery system as we know it today is still fragmented to a certain degree. The big picture is not just the total cost of care. We have to look at the patient’s quality of life, if they’re back at work, their family life, their caregivers, and their support system at home. We have to look at the whole continuum of care, not just in the episodic treatment of CDI [","_key":"daf273f884761"},{"_type":"span","marks":["em"],"text":"C diff","_key":"daf273f884762"},{"_type":"span","marks":[],"text":" infection], but how this fits into that whole picture.","_key":"daf273f884763"}],"_type":"block"},{"style":"normal","_key":"0badaefc6c98","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"00da541d7a0f0"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"564ed13953350","_type":"span","marks":[],"text":"To the degree that we can put all of this together, the key is having the total picture, having the complete health care delivery system that will include cost, research, and new drugs and modalities. But more importantly, how does this affect the patient in terms of that quality of life and outcomes? That’s what I would say."}],"_type":"block","style":"normal","_key":"6dbfcef22109"},{"style":"normal","_key":"66fe5eef634e","markDefs":[],"children":[{"marks":[],"text":"","_key":"438a56e07a5c0","_type":"span"}],"_type":"block"},{"_key":"a94d863614f9","markDefs":[],"children":[{"text":"Neil Minkoff, MD:","_key":"35afa3434e4d0","_type":"span","marks":["strong"]},{"_key":"35afa3434e4d1","_type":"span","marks":[],"text":" Dr Allegretti, you get the final word."}],"_type":"block","style":"normal"},{"_key":"700c69236903","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"0dace829bca40"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Jessica Allegretti, MD, MPH:","_key":"344dbe0233370"},{"_type":"span","marks":[],"text":" Wonderful. I agree with all of my fellow panelists. We have a lot of work to do, but this is an exciting space to be in right now. We need safe FDA-approved therapies for our patients that we can access. One of the biggest challenges right now is accessing therapies that we know are effective. In the big picture, as we just pointed out, primary prevention is going to be key, as well as antibiotic stewardship. How can we protect our patients much earlier as opposed to at their fifth or sixth episode, which is where the focus is now? We’re addressing the crisis at hand with these multiply recurrent patients. But in the big picture, we absolutely need primary prevention. 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Stephens, Sr, JD, MD ","_createdAt":"2021-03-26T18:46:58Z","_rev":"cl0eFhNBuAbCzwFmJiuVjo","_type":"author","_id":"d0f8309e-9564-4d57-97bd-b7647bff33e9","_updatedAt":"2021-03-26T18:46:58Z"},{"_createdAt":"2021-11-18T17:06:07Z","_rev":"Yi2bn4k8OtohOHqwyceISd","_type":"author","_id":"f6cf33a7-e2b4-46ca-bc1b-e4ae630748a0","_updatedAt":"2021-11-18T17:06:07Z","url":{"current":"karina-abdallah-pharmd","_type":"slug"},"displayName":"Karina Abdallah, PharmD"}],"is_visible":true,"_id":"df5ab67f-e1ea-4205-a281-bf9615841c68","_type":"article","internalTag":["clostridium difficile infection","c. diff infection","recurrent clostridium difficile infection","recurrent CDI"],"title":"Evolving Medical Policies and Unmet Needs in C. Diff Infection Management","_updatedAt":"2022-01-12T21:00:57Z","documentGroupMapping":[{"_ref":"a0c82c66-4eed-4b01-9909-154a617990cb","_type":"reference","_key":"168f885ada5c"}],"body":[{"_type":"video","videoID":"6281516490001","source":"brightcove","_key":"4cc42b180718"},{"style":"normal","_key":"0f845843f25b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"700f97b1579d"}],"_type":"block"},{"markDefs":[],"children":[{"text":"Transcript:","_key":"6dbdb2164b11","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"3219537ab3e0"},{"_type":"block","style":"normal","_key":"d5b720f77cfc","markDefs":[],"children":[{"_key":"5f86b7abd37d","_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:"},{"_type":"span","marks":[],"text":" Let me ask this question. We’ve talked a lot about what’s going on in this space. We’ve talked about some of the different medications, the difficulty of treatment, recurrence, and when to accelerate to a higher level of treatment. I want to open this up to everybody: What’s the biggest unmet need in recurrent ","_key":"559489070aac"},{"text":"Clostridioides difficile","_key":"72fd1c2a3ef5","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" infection, whether it’s your coverage policy or your practice? What do you think would be the best thing for us to address?","_key":"69992f6e64a0"}]},{"_type":"block","style":"normal","_key":"8d0246dcecf4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ff225dec4fa30"}]},{"markDefs":[],"children":[{"text":"Jessica Allegretti, MD, MPH:","_key":"ca71a5cd313a0","_type":"span","marks":["strong"]},{"marks":[],"text":" In the big picture, the best thing we could do for patients long term is primary prevention. If we can prevent ","_key":"ca71a5cd313a1","_type":"span"},{"_type":"span","marks":["em"],"text":"C diff","_key":"ca71a5cd313a2"},{"_type":"span","marks":[],"text":" from even happening, then we don’t have to worry about recurrent ","_key":"ca71a5cd313a3"},{"text":"C diff","_key":"ca71a5cd313a4","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":". That includes things like vaccines and some of these primary preventive agents. Or when patients are going into the hospital and getting on broad spectrum antibiotics, how can we prevent that subsequent ","_key":"ca71a5cd313a5"},{"_key":"ca71a5cd313a6","_type":"span","marks":["em"],"text":"C diff"},{"_type":"span","marks":[],"text":" infection? That’s probably the biggest unmet need and the most exciting place to be working to prevent this from happening at all.","_key":"ca71a5cd313a7"}],"_type":"block","style":"normal","_key":"ded132d02e34"},{"_key":"86fdee91cc0a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7db7d005bb020"}],"_type":"block","style":"normal"},{"style":"normal","_key":"6f93e5508f51","markDefs":[],"children":[{"_key":"8f4709b337970","_type":"span","marks":[],"text":"That being said, in lieu of that, we need more effective therapies to treat and eradicate recurrent "},{"_type":"span","marks":["em"],"text":"C diff","_key":"8f4709b337971"},{"_type":"span","marks":[],"text":" to ultimately result in decolonization and not keep these patients in a vulnerable microbiome space, if you will. I’m very pleased and excited to see all these novel microbiome therapeutics being studied.","_key":"8f4709b337972"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1ccadad7cf080"}],"_type":"block","style":"normal","_key":"b4b18d6ea2de"},{"style":"normal","_key":"35ad96d5f062","markDefs":[],"children":[{"marks":[],"text":"We need FDA-approved therapies. I’m a true believer in FMT [fecal microbiota transplantation]. Obviously, I believe in the safety and efficacy of that product. It’s never going to be FDA approved. That’s quite clear to all of us. In lieu of that, we need products that we can use that are effective and safe. From my perspective, that’s what we need right now.","_key":"a08482e7b7e50","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"413743009b500","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"3648ae1346ac"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:","_key":"e77861909a6a0"},{"marks":[],"text":" Any others?","_key":"e77861909a6a1","_type":"span"}],"_type":"block","style":"normal","_key":"5d572adc1a94"},{"style":"normal","_key":"a93f1490debc","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"22ddd81b33950"}],"_type":"block"},{"_type":"block","style":"normal","_key":"dff535e38f8c","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dale N. Gerding, MD:","_key":"206b18c4f1490"},{"_type":"span","marks":[],"text":" I agree. Primary prevention is where we need to be. There’s 1 vaccine pending; we’ve been waiting a long time for the announcement. One has already failed. But there are other modalities coming that will also be effective in primary prevention if we can establish those methodologies. However, those are still in the research stage.","_key":"206b18c4f1491"}]},{"_key":"4edd02ed58ac","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"80cece733e250"}],"_type":"block","style":"normal"},{"_key":"748298f8bc49","markDefs":[],"children":[{"marks":[],"text":"But in the case of preventing recurrence, we need a safe, effective, and cost-effective way to prevent ","_key":"414075bb29030","_type":"span"},{"text":"C diff","_key":"414075bb29031","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" recurrences that you can use with the first episode. We need to get on top of this as soon as it occurs the first time, because the real need here is to prevent patients from having any recurrences at all. We’re focused on multiple recurrences because they’re devastating to people, both emotionally and physically.","_key":"414075bb29032"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"","_key":"0602e69401fb0"}],"_type":"block","style":"normal","_key":"ffc32edc21fc","markDefs":[]},{"_key":"cfe3ec011352","markDefs":[],"children":[{"text":"We also need to find the means to develop treatment agents that will prevent recurrence with the first episode. One of the big barriers right now is the cost of these preventive agents. Everything we’ve talked about so far has been more expensive than standard therapies. You’re trying to weigh the benefit of those more expensive therapies against their acquisition cost. We need something that works well, is safe, and doesn’t cost a whole lot.","_key":"1f6cd86faed70","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"","_key":"d5cb204ee2e40"}],"_type":"block","style":"normal","_key":"c7d1ff6b6391","markDefs":[]},{"style":"normal","_key":"e23a92e3aaed","markDefs":[],"children":[{"marks":["strong"],"text":"Neil Minkoff, MD:","_key":"2e6814cc90320","_type":"span"},{"_type":"span","marks":[],"text":" You just defined the holy trinity.","_key":"2e6814cc90321"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d00cb2f9e9500"}],"_type":"block","style":"normal","_key":"75a91b074009"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Kevin U. Stephens, Sr. MD, JD:","_key":"57c18eb749030"},{"_key":"57c18eb749031","_type":"span","marks":[],"text":" Absolutely. That’s right on point, because obviously it’s a balancing system, and you have to figure out outcomes vs cost vs patient satisfaction. To answer your question about what we need, we need more studies, research, randomized studies that show the effectiveness and cost-benefit, or CBAs [cost-benefit analyses], as we call it. That can help push us to better decisions, particularly as a payer."}],"_type":"block","style":"normal","_key":"270dac5a1882"},{"_type":"block","style":"normal","_key":"7b9b86bf7ca2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8de289e73a540"}]},{"markDefs":[],"children":[{"_key":"4edc5af1b8ae0","_type":"span","marks":["strong"],"text":"Karina Abdallah, PharmD:"},{"_type":"span","marks":[],"text":" I agree. Our unmet needs are FDA approval and new agents. Even if we don’t get Dr Gerding’s full wish list with lower cost, at least proven success. The ability to prove that being proactive will ultimately bring down not only the cost but also improve patient experience. Earlier on, Dr Allegretti took us through what a horrible experience this can be, not only for the patient but for their family. It’s important to bring in that whole picture. Dr Stephens earlier also mentioned behavioral health. Maybe even bringing that under the behavioral health umbrella and connecting it with nursing case management on the payer side. Most payers have a good, strong force of nursing case management. Maybe connecting that with hospital discharges, that can be an unmet need as well that we touched on a little.","_key":"4edc5af1b8ae1"}],"_type":"block","style":"normal","_key":"fb876d3d2862"},{"_key":"68726b033311","markDefs":[],"children":[{"text":"","_key":"58990f40c6ca0","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"It’s about being as proactive as we can and not only looking at the recurrent ","_key":"33a03bbd91d00"},{"_type":"span","marks":["em"],"text":"C diff","_key":"33a03bbd91d01"},{"_type":"span","marks":[],"text":" population. Some quick statistics: before Medicare Advantage, a third of the primary cases end up in recurrence. It’s important to target the primary cases and be as proactive as possible, tracking what their risk factors are and what therapies they’re on. Are they following up with GI [gastrointestinal] or ID [infectious disease] physicians to manage their care all the way through? Connecting any coordination that we can do between the payer, health system, facility, and even at home for the patients is key.","_key":"33a03bbd91d02"}],"_type":"block","style":"normal","_key":"5a7e947aebcc","markDefs":[]},{"children":[{"text":"","_key":"f98ed2563cb1","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"8a4c94929931","markDefs":[]},{"children":[{"_type":"span","marks":["strong","em"],"text":"Transcript edited for clarity.","_key":"24b5f17aa742"}],"_type":"block","style":"normal","_key":"827f872eccf1","markDefs":[]}],"updatedOn":null,"contentCategory":{"_updatedAt":"2020-04-03T20:03:44Z","_createdAt":"2020-04-03T20:03:44Z","_rev":"Yw6MEKZDMdk6hC2JCPjfiB","_type":"contentCategory","name":"Videos","_id":"ee14ccb3-3542-4414-9046-927be1198c76"},"summary":"Panelists review unmet needs in clostridium difficile infection management and consider how medical policies are evolving to address them."},{"_type":"article","summary":"Shared insight on the process to gain access to fecal microbiota transplant for patients with clostridium difficile infection.","taxonomyMapping":[{"cmeType":"per","_createdAt":"2021-06-25T13:33:00Z","_type":"taxonomy","_id":"ac19e76a-0661-476c-b098-97d507cb4992","summary":[{"_type":"block","style":"normal","_key":"27c49744cbbf","markDefs":[],"children":[{"_key":"68847f532bcb0","_type":"span","marks":[],"text":"The "},{"_type":"span","marks":["em"],"text":"AJMC® ","_key":"68847f532bcb1"},{"_type":"span","marks":[],"text":"Infectious Disease compendium is a comprehensive resource for news and interviews about the viruses, bacteria, fungi, and parasites that create illness and outbreaks.","_key":"68847f532bcb2"}]}],"identifier":"infectious-disease","perKeywordMapping":["Pediatrics","Family Medicine","Health Equity Diversity \u0026 Inclusion"],"_updatedAt":"2023-11-03T18:19:57Z","parent":{"_ref":"297fa3d1-5216-46eb-bf51-66c5f77c3c8a","_type":"reference"},"_rev":"J9E0v654gKdSlGLhTDCtmK","name":"Infectious Disease"}],"_createdAt":"2021-12-08T22:07:42Z","factCheckAuthorMapping":null,"seoTag":["clostridium difficile infection","c. diff infection","recurrent clostridium difficile infection","recurrent CDI","fecal microbiota transplantation","FMT","FMT approval","indications for FMT","barriers to FMT "],"documentGroupMapping":[{"_ref":"a0c82c66-4eed-4b01-9909-154a617990cb","_type":"reference","_key":"3b3fd05ada2c"}],"body":[{"videoID":"6281514851001","source":"brightcove","_key":"2513c81b10d6","_type":"video"},{"_type":"block","style":"normal","_key":"1bea8f7f4a2d","markDefs":[],"children":[{"marks":[],"text":"","_key":"5feade93bbe8","_type":"span"}]},{"_type":"block","style":"normal","_key":"9f87ab3e6171","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Transcript:","_key":"963bcf47f37e"}]},{"markDefs":[],"children":[{"text":"Neil Minkoff, MD:","_key":"dfcc0d8ada11","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":" Let me ask a question to the whole group. I’m not trying to cause a rift between our panelists here, but Dr Allegretti or Dr Gerding, do you have difficulty getting procedures approved? Is your clinical judgment tracking along with the medical policies of the payers?","_key":"26e8783947b6"}],"_type":"block","style":"normal","_key":"5c8e50d0b52c"},{"_type":"block","style":"normal","_key":"18736aab9e5b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ac1aee1de44d0"}]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Jessica Allegretti, MD, MPH:","_key":"2eab000e5d500"},{"_key":"2eab000e5d501","_type":"span","marks":[],"text":" I’m fortunate in that I’m well versed in this space. I have a lot of support in my clinic and I’ve worked with payers to get complex therapies for a long time, so I understand to an extent what needs to be documented and how that process needs to go to make it a bit easier on myself and my patients. Not everybody has those resources or that background knowledge."}],"_type":"block","style":"normal","_key":"048f7c39c7a0"},{"_type":"block","style":"normal","_key":"f17d6ea42e62","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"162bd45fc5df0"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"That being said, there are circumstances where it certainly can be frustrating. You’re going through multiple layers of peer-to-peer [reviews] and multiple appeals and you still ultimately get denied, and it’s the patient who ends up suffering despite your best efforts and despite what guidelines say. There’s often that lag, as Dr Gerding pointed out. Sometimes what you think is the best science and the best thing that’s appropriate for the patient is not covered by their particular policy. That’s ultimately where there can be inconsistencies in terms of what you’re saying to the patient, what you believe is right, and ultimately what their plan covers.","_key":"336368d14b480"}],"_type":"block","style":"normal","_key":"366a80a13197"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1a6e712f11830"}],"_type":"block","style":"normal","_key":"b19dd3dc4be1"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I loop that into my informed consent discussion, too. “I may think that this is the best agent for you, but we may not have that option.” Unfortunately, that’s the state of medicine in health care in the United States. Unfortunately, the science doesn’t always lead some of the decision-making. And because there has to be such a long filter process, it often takes years for the most cutting-edge data to get incorporated into policy. That’s one of the frustrating aspects of practicing medicine today.","_key":"540f3133e6530"}],"_type":"block","style":"normal","_key":"9cc7eaddaa37"},{"style":"normal","_key":"185488b3bc63","markDefs":[],"children":[{"text":"","_key":"81e0297896300","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:","_key":"5aa5464e78940"},{"_type":"span","marks":[],"text":" Let me ask the payers to weigh in on that based on how they define their medical policies and their efforts to be as up-to-date as possible.","_key":"5aa5464e78941"}],"_type":"block","style":"normal","_key":"aab915929157"},{"style":"normal","_key":"153996ed0022","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a04de1eafbff0"}],"_type":"block"},{"_type":"block","style":"normal","_key":"32f6c435e6d6","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Kevin U. Stephens, Sr. MD, JD:","_key":"8b2bce5730080"},{"_type":"span","marks":[],"text":" We look at the FDA guidelines as an approval process that’s important. If it’s investigational and experimental, we typically shy away from those. Albeit, as I mentioned previously, we also have to look at each case. If you have enough information, then those guidelines are only a guidance, and we have the latitude to do what’s in the best interest of the patient. Because as you look at the total cost of care, I can’t overemphasize that you can’t be penny-wise and dollar-foolish. You have to look at the total cost of care and the big picture. That’s where the peer-to-peer process is important, along with talking with the medical director who’s doing the reviewing to see if there’s some common ground.","_key":"8b2bce5730081"}]},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"cd808c9d9db3","_type":"span"}],"_type":"block","style":"normal","_key":"87b461bca641"},{"children":[{"text":"Transcript edited for clarity. ","_key":"92a480a753a9","_type":"span","marks":["strong","em"]}],"_type":"block","style":"normal","_key":"1ca5c806d7b9","markDefs":[]}],"authorMapping":[{"displayName":"Neil Minkoff, MD","_createdAt":"2021-05-25T19:30:11Z","_rev":"FkQz1nQ3RgUoGJsbgpKKL1","_type":"author","_id":"c8184de0-45b4-47e4-b937-08233876e06a","_updatedAt":"2021-05-25T19:30:11Z","url":{"current":"neil-minkoff-md","_type":"slug"}},{"_type":"author","_id":"1ea46ffa-3893-473d-b3f0-08c591f5bbf9","_updatedAt":"2021-11-18T17:05:08Z","url":{"current":"dale-n-gerding-md","_type":"slug"},"displayName":"Dale N. 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use.","_key":"cc46da58a12b"}],"_type":"block","style":"normal"},{"style":"normal","_key":"84ecb034fa8d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"0ab6571457550"}],"_type":"block"},{"children":[{"marks":["strong"],"text":"Kevin U. Stephens, Sr. MD, JD:","_key":"237683ac70610","_type":"span"},{"_type":"span","marks":[],"text":" The first thing is that it isn’t FDA approved yet.","_key":"237683ac70611"}],"_type":"block","style":"normal","_key":"d6325edc9781","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"18c1cd442ec50"}],"_type":"block","style":"normal","_key":"e1b48d6b78f2","markDefs":[]},{"style":"normal","_key":"ac2d386d4fba","markDefs":[],"children":[{"_key":"b346c123046b0","_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:"},{"_type":"span","marks":[],"text":" Yes.","_key":"b346c123046b1"}],"_type":"block"},{"_key":"8d2b56c8ed94","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6b3e4deeee0d0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Kevin U. Stephens, Sr. MD, JD:","_key":"dacc5a2b2f260"},{"marks":[],"text":" That’s one of the barriers we have. The second thing is that we have to do it case by case. It’s a balancing act. You have to look at the prior treatment they used, the risk of recurrence, and the total cost of care. That’s where every case pretty much has to be one-on-one, because you have to weigh the pros and cons vs the patient satisfaction vs the risk of the recurrence and the total cost of care. You also have to look at outcomes. It’s based on all those things. That’s in the platform, particularly in the commercial market, of the payer. Many times the payer, in terms of the employer, will say, “We’re not covering it,” or “We will cover it.” It’s a tight space that we have to navigate in, to say the least.","_key":"dacc5a2b2f261","_type":"span"}],"_type":"block","style":"normal","_key":"7f97d272055e"},{"_type":"block","style":"normal","_key":"3bf1cbfd41fd","markDefs":[],"children":[{"marks":[],"text":"","_key":"ebcb45bb811f0","_type":"span"}]},{"_type":"block","style":"normal","_key":"b2cc06e7d5d3","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:","_key":"c30067057b250"},{"_type":"span","marks":[],"text":" Let me ask you a question. This is a naïve question from my point of view as a former PCP [primary care provider]. We hear a tremendous amount about FMT being so effective here. But it can’t always be effective, right? There must be negative outcomes. Dr Gerding, when do you see negative outcomes in FMT? What are those negative outcomes? Are there ways to predict it?","_key":"c30067057b251"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"04cdb7650f760"}],"_type":"block","style":"normal","_key":"4bb8232de59b"},{"_key":"4105d205e20b","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dale N. Gerding, MD:","_key":"5baf0aa7b3f40"},{"_type":"span","marks":[],"text":" The FDA has issued 3 safety warnings about FMT since 2019 because of transmission of a multidrug-resistant organism [MDRO], an ESBL [extended-spectrum beta-lactamase]–producing ","_key":"5baf0aa7b3f41"},{"_key":"5baf0aa7b3f42","_type":"span","marks":["em"],"text":"Escherichia coli"},{"_type":"span","marks":[],"text":", which resulted in bacteremia and death in a patient. This was traced to the donor stool that was used in the FMT. To answer your question, most of these patients who have run into these severe adverse effects have been very immunocompromised, and that’s one factor.","_key":"5baf0aa7b3f43"}],"_type":"block","style":"normal"},{"style":"normal","_key":"dcff63d293e3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e3c90cb2663d0"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"The second factor is that the donors haven’t been tested for the pathogens that were involved in these [situations]. As the FDA has issued the safety warnings, they have upped the criteria for testing the donor as well and put restrictions on donors. In the early days in FMT, medical personnel used to be common donors for fecal microbiota transplant material. After the multidrug-resistant organism transmission, the FDA has banned those people, as well as people who travel to other countries for medical care and come back. They can’t be donors any longer either. There have been a number of instances.","_key":"058e64b02aae0"}],"_type":"block","style":"normal","_key":"e258f9e960c7","markDefs":[]},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"99efc0848f330","_type":"span"}],"_type":"block","style":"normal","_key":"9b90bfbcdbcd"},{"_type":"block","style":"normal","_key":"281be0cd712d","markDefs":[],"children":[{"text":"The second occurrence was transmission of toxigenic ","_key":"8d625bd6d30d0","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"E coli","_key":"8d625bd6d30d1"},{"text":" and enteropathogenic ","_key":"8d625bd6d30d2","_type":"span","marks":[]},{"marks":["em"],"text":"E coli","_key":"8d625bd6d30d3","_type":"span"},{"_type":"span","marks":[],"text":". There were a couple of deaths, but these weren’t directly attributed to that transmission. They were traced back to the donor again. As a result, the FDA has recommended that the testing for these strains of ","_key":"8d625bd6d30d4"},{"text":"E coli","_key":"8d625bd6d30d5","_type":"span","marks":["em"]},{"_key":"8d625bd6d30d6","_type":"span","marks":[],"text":" be increased as well. And when the COVID-19 outbreak occurred, the FDA noted that COVID-19 was found in the stool and stopped donor efforts during that period until it could be established, but it needed to be done to clear the donors so they could safely donate stool for FMT products. It’s a combination of highly immunocompromised patients plus donors who are carrying organisms that were previously unrecognized as being potentially capable of transmission of infection. The FDA is tightening the controls around that, which is good, and it’s becoming safer."}]},{"_type":"block","style":"normal","_key":"0f7ea446d1a5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a4904d3d65600"}]},{"style":"normal","_key":"fe6d106f4f91","markDefs":[],"children":[{"_type":"span","marks":[],"text":"There’s also a concern about long-term effects. This goes back to data from mice and rats in which you can swap out their microbiota, and as a result, change a lean mouse or rat into an obese mouse or rat simply by changing their microbiota. Those long-term concerns are still ongoing, but there are now registries available that are measuring the long-term outcome of FMT as well. To my knowledge, there haven’t been any long-term effects in humans so far. That’s a long way of saying that if you’re immunocompromised, you need to be careful about FMT, and if you’re a donor, you need to be tested thoroughly before you donate.","_key":"ef79845fa2e00"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"eb9457d543620"}],"_type":"block","style":"normal","_key":"f33ae5c90119","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:","_key":"e0420ac156960"},{"_type":"span","marks":[],"text":" Dr Allegretti, I’m assuming that in your practice, you must have a number of patients on immunomodulators. Does that affect how you approach FMT?","_key":"e0420ac156961"}],"_type":"block","style":"normal","_key":"8b46077902ca","markDefs":[]},{"style":"normal","_key":"f6cf61d9c30a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6952346361a10"}],"_type":"block"},{"children":[{"_type":"span","marks":["strong"],"text":"Jessica Allegretti, MD, MPH:","_key":"725b0b36f7d50"},{"text":" Yes and no. Dr Gerding eloquently outlined some of the more recent concerns that we’ve had, but there are some key points here. Prior to the summer of 2019, there had been no major reports of infection transmission from screened material. We’ve certainly seen case reports from people doing this at home with unscreened material and subsequent infections in that regard.","_key":"725b0b36f7d51","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"1808bfaf1698","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"47df4dc3a7d70"}],"_type":"block","style":"normal","_key":"7241d6ee4e66"},{"children":[{"_type":"span","marks":[],"text":"In the summer of 2019, that FDA safety warning took us all by surprise. The key takeaway point from that is those weren’t being done for ","_key":"70599aa91b440"},{"_type":"span","marks":["em"],"text":"Clostridioides difficile","_key":"70599aa91b441"},{"_key":"70599aa91b442","_type":"span","marks":[],"text":" infection. Those were 2 cases being done in IND [investigational new drug] approved protocol. The FDA was already aware of these protocols. One was for hepatic encephalopathy, and the other for graft-vs-host disease. Those were very immunocompromised patients, and that was being done in a research protocol. They were being done using a hospital-based stool bank where the FDA was aware that they weren’t screening for MDROs in their protocol."}],"_type":"block","style":"normal","_key":"f58dd15da61f","markDefs":[]},{"_type":"block","style":"normal","_key":"9441bb26217b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8e3a6ed0da230"}]},{"_type":"block","style":"normal","_key":"bb3aaab623ff","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Probably the most well-known stool bank in the United States is OpenBiome, which is a nonprofit stool bank. It’s important to note that they’ve been screening for MDROs since their inception. The take-home points for me of that case was that while it was extremely unfortunate, it highlights the need for standardization. We should all be doing the same thing. The fact that it’s not FDA approved has led to different institutions essentially being able to have different protocols. It was helpful that the FDA finally released a list of the minimum mandatory screening requirements to get everybody on the same page.","_key":"5c9bb0422a690"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b726eb8d5c980"}],"_type":"block","style":"normal","_key":"971c879ff70c"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"There are some notable concerns with some immunocompromised patients, mainly for me, in that we don’t routinely test donors for EBV [Epstein-Barr virus] and CMV [cytomegalovirus] because the vast majority of people walking around are colonized with these organisms. If the patient has never been exposed, that may be a risk. In a very immunocompromised patient, I will often screen them to understand their EBV and CMV status, because that’s one situation where you may want to match the donor to the patient if the patient has never been exposed and is seronegative. But otherwise, I do this routinely in patients who are immunocompromised because I routinely use OpenBiome material.","_key":"d3e5a3a8301a0"}],"_type":"block","style":"normal","_key":"c22b65343cf9"},{"_key":"0153f07b50fc","markDefs":[],"children":[{"text":"","_key":"8988ebb345b20","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The screening is very thorough. I include a very thorough informed consent discussion. The biggest concern with immunocompromised patients is that the FMT won’t work. There are higher failure rates, especially in a bone marrow transplant population where they’re on chronic antibiotics for prophylaxis long term. You have to take that into consideration, along with the fact that the patients may need more than 1. But we do this routinely in our patients with IBD [inflammatory bowel disease] who are often triple immunosuppressed, and we haven’t seen any major safety concerns. We actually performed the first prospective study looking at this, and the patients did extremely well.","_key":"a0caa119e2480"}],"_type":"block","style":"normal","_key":"274d69cfcbfa"},{"style":"normal","_key":"e77400245e2c","markDefs":[],"children":[{"_key":"47177217183a0","_type":"span","marks":[],"text":""}],"_type":"block"},{"_key":"4d75c4262796","markDefs":[],"children":[{"_type":"span","marks":[],"text":"You have to put the context into the big picture. Overall, this is a safe procedure. There have been a few highlighted cases of bad outcomes, but show me a drug that doesn’t have that. There’s a lot of more negative press or concern around FMT just because of the nature of how it came to the forefront. 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There’s guidance from the FDA from a couple of years ago. Whom do you recommend for FMT?","_key":"ef933ef44c0e"}],"_type":"block","style":"normal","_key":"2a84c2deecb7"},{"children":[{"_key":"95bdddb63c4c0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"55020e70cfee","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Jessica Allegretti, MD, MPH: ","_key":"bfa86ae28dd90"},{"_type":"span","marks":[],"text":"It’s always important to remind everyone that FMT is not FDA approved for any indication, including recurrent ","_key":"bfa86ae28dd91"},{"marks":["em"],"text":"Clostridioides difficile ","_key":"bfa86ae28dd92","_type":"span"},{"_key":"bfa86ae28dd93","_type":"span","marks":[],"text":"["},{"marks":["em"],"text":"C diff","_key":"bfa86ae28dd94","_type":"span"},{"_type":"span","marks":[],"text":"]. 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You don’t require an investigational new drug license to do this.","_key":"bfa86ae28dd97","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"3c147ccab48a","markDefs":[]},{"_type":"block","style":"normal","_key":"bb9a0217ce81","markDefs":[],"children":[{"marks":[],"text":"","_key":"4849b8c628440","_type":"span"}]},{"_type":"block","style":"normal","_key":"bb48a483cb7c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The guidance in both ID [infectious disease] and GI [gastrointestinal] guidelines is for multiply recurrent ","_key":"31b3fac7a0f80"},{"_type":"span","marks":["em"],"text":"C diff","_key":"31b3fac7a0f81"},{"marks":[],"text":". That’s defined as 3 or more confirmed episodes, and we stress the word ","_key":"31b3fac7a0f82","_type":"span"},{"_key":"31b3fac7a0f83","_type":"span","marks":["em"],"text":"confirmed"},{"_type":"span","marks":[],"text":". You want the test results. 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But if the patient truly has recurrent ","_key":"31b3fac7a0f88"},{"_type":"span","marks":["em"],"text":"C diff","_key":"31b3fac7a0f89"},{"text":", they should be offered an FMT and given that opportunity.","_key":"31b3fac7a0f810","_type":"span","marks":[]}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"eea37935e0300"}],"_type":"block","style":"normal","_key":"45556d2a0fcf","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"We’ve looked at many high-risk patient populations: inflammatory bowel disease, immunosuppressed patients, cirrhotics, and solid organ transplant. It’s safe in all these patient populations and can be utilized. The discussion around how to deliver it, donor screening, and donor material remains interesting. Traditionally, still in 2021 in the adult world, the most common way to offer this is via a colonoscopy. There are capsule preparations, but that’s more difficult to obtain on the routine clinical side. There will eventually be FDA-approved products that are FMT-like that we can use.","_key":"fcab03eb71130"}],"_type":"block","style":"normal","_key":"44db81c3aa60"},{"_key":"a2598f42d610","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7831ab2572030"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"But standardly, it’s mostly via colonoscopy or flexible sigmoidoscopy. I do this routinely. It’s interesting from the payer side because this isn’t FDA approved, so there’s no CPT [current procedural terminology] code for donor stool. You also have to figure out who’s going to pay for this. We bill for the colonoscopy. There’s a code for that, in that you’re doing an FMT via a colonoscopy, but the donor stool question remains interesting. 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Why is treating ","_key":"94b72c0b6924"},{"_key":"e81eecc9995e","_type":"span","marks":["em"],"text":"Clostridioides difficile"},{"marks":[],"text":" [","_key":"a56da167b3f1","_type":"span"},{"_type":"span","marks":["em"],"text":"C diff","_key":"1d47b3adf33e"},{"_type":"span","marks":[],"text":"] so difficult? It seems to be a particularly difficult infection to manage and treat, with a high rate of recurrence. I want to open it up to Drs Gerding and Allegretti to try to enlighten this former staff person why this seems more complicated than a lot of other infections we treat. What are you doing to try to cut that off at the pass for the first infection?","_key":"91a56d668cae"}]},{"_key":"21f1b81e36c1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d63b974a07990"}],"_type":"block","style":"normal"},{"children":[{"text":"Dale N. Gerding, MD:","_key":"90c3019439390","_type":"span","marks":["strong"]},{"_key":"90c3019439391","_type":"span","marks":[],"text":" When "},{"text":"C diff","_key":"90c3019439392","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" was first identified and the treatment was considered to be accomplished, it was identified as a pathogen cause of pseudomembranous colitis. Vancomycin was identified as a treatment agent almost immediately. The issue of recurrence was just considered a nuisance. This persisted through the 1980s and ’90s. At one time, we even banned the use of oral vancomycin in the hospital via CDC [Centers for Disease Control and Prevention] because of the risk of vancomycin-resistant enterococci in the hospital. Metronidazole became the preferred treatment.","_key":"90c3019439393"}],"_type":"block","style":"normal","_key":"c166c9cecec0","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"4bff1f5417030"}],"_type":"block","style":"normal","_key":"78bb80642350","markDefs":[]},{"style":"normal","_key":"7482ff7a6c40","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Around the year 2000, we began to see new strains of ","_key":"96f585310b030"},{"_key":"96f585310b031","_type":"span","marks":["em"],"text":"C diff"},{"marks":[],"text":" causing infections that were much more rapid and severe, with much higher rates of recurrence. That triggered the concern for these patients who were probably neglected in the past. But the evolution of this strain 027, or NAP1 or BI strain, have clearly increased the concern and cause much higher mortality and morbidity in patients. The problem of recurrence is the key issue. We’re getting antibiotic response rates of 90% for the acute treatment, but we’re not getting resolution of this recurrence problem. That’s an issue that doesn’t occur with most infections. We simply haven’t had these kinds of recurrences.","_key":"96f585310b032","_type":"span"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"2b56fcfb8c270"}],"_type":"block","style":"normal","_key":"8cd6b9ac6caf","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"We treat the patient and symptoms resolve, but probably two-thirds are still carrying ","_key":"6b39bf993ac50"},{"marks":["em"],"text":"C diff","_key":"6b39bf993ac51","_type":"span"},{"_type":"span","marks":[],"text":" in the stool after treatment. Those patients can acquire another antibiotic. They can see the ","_key":"6b39bf993ac52"},{"_type":"span","marks":["em"],"text":"C diff","_key":"6b39bf993ac53"},{"text":" proliferate if they had further damage to their microbiota. As a result, these patients remain at risk, sometimes for as long as 6 months. The key issue is that we haven’t been able to eradicate the pathogen in the patient, even though we can eradicate the symptoms with antibody treatment. That’s where we need to be going. We need to figure out how to supplement a normal microbiota to reestablish colonization resistance, or we need to figure out how to get rid of that organism in the stool so we don’t have all these recurrent episodes of ","_key":"6b39bf993ac54","_type":"span","marks":[]},{"marks":["em"],"text":"C diff","_key":"6b39bf993ac55","_type":"span"},{"_type":"span","marks":[],"text":".","_key":"6b39bf993ac56"}],"_type":"block","style":"normal","_key":"8a8868593ca4"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"168f21b152a20"}],"_type":"block","style":"normal","_key":"c6311e0a21c9"},{"_type":"block","style":"normal","_key":"7e74a3180313","markDefs":[],"children":[{"_key":"6e04a8ad13670","_type":"span","marks":["strong"],"text":"Jessica Allegretti, MD, MPH: "},{"text":"I agree. We know that about 80% of patients will do very well with a single course of antibiotics. It’s the 20% or so who go on to recur who we still don’t fully understand. We know that it has something to do with an impaired host response. It’s been shown that low levels of both IgG [immunoglobulin G] and IgM [immunoglobulin M] to toxin result in higher rates of recurrence. That’s why you’ve seen vaccines in development, although we don’t have 1. Because as you know from what’s going on in the country, vaccine development is hard and hard to enroll in.","_key":"6e04a8ad13671","_type":"span","marks":[]}]},{"_type":"block","style":"normal","_key":"4dba769a9a5e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"0f9f92f59e430"}]},{"style":"normal","_key":"9ae665746723","markDefs":[],"children":[{"_key":"d7b80d62e1a70","_type":"span","marks":[],"text":"Those things are being explored because the host response is very important in clearing this infection. But the microbiome—specifically with regard to "},{"_type":"span","marks":["em"],"text":"C diff","_key":"d7b80d62e1a71"},{"_type":"span","marks":[],"text":"—has also come to the forefront as a critical metric in clearing this and reestablishing colonization resistance. Because it’s a spore-forming agent, those spores are very resistant. They’re around. If you don’t decontaminate your home properly, you’re coming home and swallowing huge amounts of spores every day, and you now have this very vulnerable microbiome. That’s why microbiome therapeutics have been so successful in this space.","_key":"d7b80d62e1a72"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c2af5f6fcd480"}],"_type":"block","style":"normal","_key":"90c5ef406524"},{"style":"normal","_key":"2def64e84bb0","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We’ve shown that after FMT [fecal microbiota transplantation], your likelihood of being completely decolonized from ","_key":"932c21f96cda0"},{"_key":"932c21f96cda1","_type":"span","marks":["em"],"text":"C diff"},{"_key":"932c21f96cda2","_type":"span","marks":[],"text":" is very high. To Dr Gerding’s point, after a course of antibiotics, this organism is still around. Vancomycin and metronidazole are bacteriostatic. The bug is around. The difference with a microbiome therapeutic is that you may be able to fully decolonize patients, not only treating them but preventing subsequent recurrences."}],"_type":"block"},{"_type":"block","style":"normal","_key":"7049d7e5e4f5","markDefs":[],"children":[{"_key":"b8ae3e853195","_type":"span","marks":[],"text":""}]},{"children":[{"_type":"span","marks":["strong","em"],"text":"Transcript edited for 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We talked a little about population health. Are you guys doing anything to try to risk stratify the populations proactively or is it just a matter of evaluating patients on a case-by-case basis as the requests come in for different types of medication?","_key":"f9a383756fa9"}],"_type":"block","style":"normal","_key":"8de60f708ce2","markDefs":[]},{"_type":"block","style":"normal","_key":"ff896705fa6f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8f8b10bd3fc50"}]},{"_type":"block","style":"normal","_key":"7bf72f159598","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Kevin U. Stephens, Sr. MD, JD:","_key":"4de903e583e10"},{"_type":"span","marks":[],"text":" I can take a stab at it first. We do both. We do use risk stratification on a population basis. As I mentioned, there are generally 3 different categories: Medicaid, commercial, and Medicare. With each one, there are different stratifications for each population, including age range and so on. And then we also have to tailor each request because they can be fairly different. Many times, the biggest problem is lack of information. We don’t have enough information to make the decision. Many times, if that’s the case, it’s denied. So we use all of the above.","_key":"4de903e583e11"}]},{"children":[{"marks":[],"text":"","_key":"955d56d9adad0","_type":"span"}],"_type":"block","style":"normal","_key":"dbeda2f704a5","markDefs":[]},{"_key":"389536413091","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Karina Abdallah, PharmD:","_key":"41cf937562520"},{"_key":"41cf937562521","_type":"span","marks":[],"text":" Yes, I agree with Dr Stephens. On the Medicare Advantage population, I’ve run some retrospective reviews or studies and benchmarked that against common data points. In the Medicare Advantage population, a third can end up with recurrence. Of those, half of them may end up with 2 or 3 reinfections or recurrences of CDI ["},{"marks":["em"],"text":"Clostridioides difficile","_key":"41cf937562522","_type":"span"},{"_type":"span","marks":[],"text":" infection]. We’re making sure we’re looking at that and bucketing it by not only risk stratification but where the patient is. Where are they? Are they home? Are they in a long-term care facility? Where are they receiving treatments? We have to get down to benchmarking the different facilities to ensure that we’re doing everything that we can from the facility perspective.","_key":"41cf937562523"}],"_type":"block","style":"normal"},{"children":[{"text":"","_key":"f8007a212dab0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"03fe024afa5a","markDefs":[]},{"_key":"c9af35535225","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Lastly, we mentioned employer groups as well. With the employer groups, if these costs are showing up on their radar, we sometimes pull in all-cause data to pair it so that the employer understands. Sometimes with bezlotoxumab [Zinplava], for example, you might be preventing something further down the line. That’s not in every patient, of course. Dr Allegretti went through and said there are certain high-risk patients in whom it’s appropriate to use in, so we use that and try to pair it with the clinical information that they would need to make those coverage decisions.","_key":"141695d98b630"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"25cc03b8dc7d"}],"_type":"block","style":"normal","_key":"c6380589b0ac"},{"_key":"25889c932e39","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Transcript edited for clarity.","_key":"6911859c324f"}],"_type":"block","style":"normal"}],"_rev":"36kaxChiThYqCLNeM4gUMZ","taxonomyMapping":[{"parent":{"_ref":"297fa3d1-5216-46eb-bf51-66c5f77c3c8a","_type":"reference"},"_rev":"J9E0v654gKdSlGLhTDCtmK","name":"Infectious 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Dr Allegretti, you mentioned using bezlotoxumab [Zinplava] for some of your patients. I’m curious how you make the decision on when to use it, who the high-risk patients are who require it, and then to bring it back to the last conversation we’re having, if there are barriers in your use of it.","_key":"b21c3d391993","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"01c3fabba5bf","markDefs":[]},{"markDefs":[],"children":[{"text":"","_key":"9060a99855a00","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"550ede145ded"},{"style":"normal","_key":"57e9c6624f43","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Jessica Allegretti, MD, MPH:","_key":"c162f9959e000"},{"_type":"span","marks":[],"text":" Yes. When we look at the MODIFY I and MODIFY II trials, which Dr Gerding was a big part of, you see that in the general population you only get about a 10% difference in rates of recurrence in those treated with bezlotoxumab as opposed to placebo. However, subsequent analyses have shown that the more risk factors you have for recurrence, the more likely you are to benefit from a therapy like this. Risk factors include older age, immunosuppression, etc.; things that we’ve already talked about today.","_key":"c162f9959e001"}],"_type":"block"},{"style":"normal","_key":"ac95a6ded452","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"127ede514f3c0"}],"_type":"block"},{"_key":"5a3f96993197","markDefs":[],"children":[{"text":"Even when I’m assessing a patient with primary ","_key":"7e0d3500f22e0","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"Clostridioides difficile","_key":"7e0d3500f22e1"},{"_type":"span","marks":[],"text":", I think about how many risk factors this patient has, how likely they are to recur, and what would happen to them if they recur. Would this be a disease-defining event for them? Would they likely be hospitalized? Would this cause substantial morbidity for them? If so, I’m much more likely to use something like bezlotoxumab early in their treatment course and not wait until the patient is multiply recurrent. I’ll even use it in a primary ","_key":"7e0d3500f22e2"},{"_type":"span","marks":["em"],"text":"Clostridioides difficile ","_key":"7e0d3500f22e3"},{"text":"episode if I think it’s necessary.","_key":"7e0d3500f22e4","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"_key":"a8938bbabc9a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a026f7cab24d0"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"8d0c8d92f707","markDefs":[],"children":[{"_type":"span","marks":[],"text":"More commonly, it’s being used in a multiply recurrent patient population, either because you can’t do an FMT [fecal microbiota transplantation], the patient doesn’t want an FMT, or there are contraindications to an FMT. You need something to prevent a subsequent recurrence. I’ve also used this quite a bit in an FMT failure population. If a patient who has already gone through an FMT has recurred despite that, I’ll often use bezlotoxumab there as well and have seen great results. You have to take the patient’s experience into consideration. But if I have a very sick patient with ulcerative colitis and I know if they were to recur it would certainly result in colectomy, I’m very quick to use bezlotoxumab early.","_key":"ce1fd14343d30"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"dcf4fb9328bb0"}],"_type":"block","style":"normal","_key":"f7711442e045"},{"children":[{"_type":"span","marks":[],"text":"Unlike fidaxomicin [Dificid], I’ve had very little difficulty getting bezlotoxumab. Because it’s an IV [intravenous] infusion, the pathway is a bit more clear. Getting that approved is actually quite easy, especially because the indicated label is for any patient at a high risk for recurrence. It’s fairly easy to document that and show why you want to use this agent in patients. On the outpatient side, I’ve had very little trouble getting it done.","_key":"4c3d8400c71e0"}],"_type":"block","style":"normal","_key":"72be10962401","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e949a7a6343b0"}],"_type":"block","style":"normal","_key":"f7b30c67b058"},{"_key":"c179e8c8579f","markDefs":[],"children":[{"text":"As an IBD [inflammatory bowel disease] doctor, I routinely prescribe infusion-based therapies, so this is second nature to me. But I can imagine the reason why you don’t see more use of it is because prescribing an IV infusion is odd for somebody who doesn’t do it often. You have to know where to send the patient. You have to know who’s helping you with the prior authorization. If it’s not something you’re routinely doing in practice, I can imagine you’d say, “I’m going to stay away from that.” That’s why you don’t see use of bezlotoxumab as much as you’d expect, because it’s actually quite easy to use, very safe, and it works in the right patient population.","_key":"2e9c2c877a2e0","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"932d78730f060"}],"_type":"block","style":"normal","_key":"7c3e5288ec7a"},{"_type":"block","style":"normal","_key":"3d8d041a5858","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:","_key":"471993be4c7b0"},{"_type":"span","marks":[],"text":" Dr Gerding, do you want to add on to that in terms of your experience with the drug?","_key":"471993be4c7b1"}]},{"markDefs":[],"children":[{"text":"","_key":"382160a7a86f0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"28d8f7b6c7e4"},{"style":"normal","_key":"7ccdb0c40963","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dale N. Gerding, MD:","_key":"0a0d6b0aaf030"},{"_type":"span","marks":[],"text":" We’re using bezlotoxumab on a limited basis, primarily in patients with multiple recurrences. We were often treating these patients with long tapers and pulse dosing of fidaxomicin or vancomycin [Vancocin] and have been adding bezlotoxumab in addition to the long taper of the antibiotics. We’ve been able to successfully treat the majority of these multiple recurrent patients. But we haven’t used it in first episode ","_key":"0a0d6b0aaf031"},{"text":"Clostridioides difficile","_key":"0a0d6b0aaf032","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" infections, as Dr Allegretti is doing. 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I want to come back to that. But before I do, I want to open it up to the 2 payers on our panel to discuss how they look at drug cost vs cost to the system vs recurrence and so on as you’re looking at the difference between fidaxomicin [Dificid] and vancomycin [Vancocin] and so on and how that affects coverage decisions.","_key":"b5416b2923d0"}],"_type":"block","style":"normal","_key":"039cc41f039a","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7c667a6febcd0"}],"_type":"block","style":"normal","_key":"5a89eb3a7c20"},{"_key":"53af5508a22d","markDefs":[],"children":[{"marks":["strong"],"text":"Kevin U. Stephens, Sr, MD, JD:","_key":"81b5a8110e940","_type":"span"},{"_type":"span","marks":[],"text":" I could start off by saying that it’s very complex. When you get a complicated case, you have to go case by case. Typically, you use the guidelines as a guidance, and that’s when we count on the treating provider to chime in and, as Dr Allegretti said, make their case for the drug they want to use. It’s a competing theme. If you use Flagyl [metronidazole] and you have high readmission and high recurrence, then when you go to the emergency department and you get back and have repeat admissions, that doesn’t help anyone, and the costs are much greater. You have to weigh those types of things, and we have to individualize.","_key":"81b5a8110e941"}],"_type":"block","style":"normal"},{"style":"normal","_key":"82f96a633b7e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"15a9423057590"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"1e86c0717d300","_type":"span","marks":[],"text":"Many times, we have complicated cases and there are a plethora of things that can go on. Many times, the medical records might not completely reflect the dynamics that you’re seeing in the patients. We really like to have those peer-to-peer conversations. I like to pick up the phone and say, “OK, what’s going on? What are you doing? What are you thinking? Have you tried this? Have you thought about this? Let’s see if we can come up with something that makes sense for everyone.” Quite frequently, we do get to that middle ground. And then many times you don’t, as mentioned earlier, and you have the appeal and independent medical review and those things at your disposal, too."}],"_type":"block","style":"normal","_key":"bfbb7b757a75"},{"_key":"19f0389e1ddd","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"669955b5180f0"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:","_key":"f67827fa1ca20"},{"_key":"f67827fa1ca21","_type":"span","marks":[],"text":" Dr Abdallah, based on your title, I’m assuming you’re a quite active member of your organization’s P\u0026T [pharmacy and therapeutics] committee. How do you weigh some of these things? That would be question 1. The follow-up question is, do you think there’s a difference between the way you as an integrated health plan look at this vs the way an independent PBM [pharmacy benefit manager] might look at it?"}],"_type":"block","style":"normal","_key":"a0ffeea3eb88","markDefs":[]},{"_key":"1fef343e8e65","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"36640250e95e0"}],"_type":"block","style":"normal"},{"_key":"69d3d01be994","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Karina Abdallah, PharmD:","_key":"0adc89e4218d0"},{"marks":[],"text":" Thanks, Dr Minkoff. Yes, I’m very active on our formulary and our P\u0026T committees. Broadly and generally speaking, the P\u0026T decisions are made pretty broadly to be able to give each line of business some freedom to do what needs to be done. Dr Stephens mentioned this earlier. We’re a private insurer, Blue Cross Blue Shield of Michigan, and we have a lot of employer groups, so sometimes the decision to cover or not cover comes down to the employer group and cost. That’s what they’re looking at. It’s up to the partner health plans to come in with the data and information to look at total cost of care. That’s something that I strive to do.","_key":"0adc89e4218d1","_type":"span"}],"_type":"block","style":"normal"},{"style":"normal","_key":"bc07e4ff6ba2","markDefs":[],"children":[{"_key":"7db45fede4b40","_type":"span","marks":[],"text":""}],"_type":"block"},{"_key":"814edb94dfb7","markDefs":[],"children":[{"marks":[],"text":"I also oversee the Medicare Advantage population. [","_key":"61ebda980e8b0","_type":"span"},{"_type":"span","marks":["em"],"text":"Clostridioides difficile","_key":"61ebda980e8b1"},{"_key":"61ebda980e8b2","_type":"span","marks":[],"text":"] recurrence is really high in our space, so it’s really important to bring in the studies and show your total cost of care and bring it together for the folks who are making decisions solely based on cost alone. I’ll also mention that Dr Allegretti brought up some good points in terms of what she’s seeing on the other side of it. There’s also the burden of prior authorization, and it’s something that needs to be addressed. We’ve made a lot of great strides over the past few years. I’ve spent a lot of time looking at electronic prior authorization. What can we do to pull out the necessary information from the provider who might not be as familiar as Dr Allegretti is with what information each health plan is looking for in order to make sure they have everything they need to make that decision?"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c6669d89f6dd0"}],"_type":"block","style":"normal","_key":"4457c44fc3ba"},{"_key":"7976a26147b2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The most common reason for a denial is lack of information. Sometimes there are rules and regulations that are put in place that are meant to speed up the health plan’s process so that we can make a decision in a timely fashion, which is obviously better for our patients. But unfortunately, when the initial prior authorization is submitted and it’s missing critical information, such as recurrence or the studies that Dr Allegretti mentioned that can go well, those are sometimes done on appeal. But if that can be brought to the forefront on a case-by-case basis, that will show the most success overall and limit what we sometimes like to call administrative denials where we just don’t have the information that we need.","_key":"e5c9773873510"}],"_type":"block","style":"normal"},{"_key":"b58a402ee065","markDefs":[],"children":[{"text":"","_key":"ffed54c9eafb0","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"6f418ef8e1a3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We have to recognize that the prescribing physician can’t be inundated every day with that paperwork for prior authorization. It comes down to staff training. With a large enough practice, sometimes they have a centralized department that does the prior authorizations. Maybe even the billers can do it. But it’s important to train the staff to recognize what information the health plan needs up front and ensure that comes in up front and then have the health plan make a decision. The problem there is if they don’t meet the health plan’s criteria, which is possible, Dr Stephens already mentioned the appeal and peer-to-peer options that can take place as well, either right after or prior to the decision. Lastly, I want to touch on the point Dr Allegretti mentioned regarding inpatient vs going home and outpatients.","_key":"4598f81f76c90"}]},{"markDefs":[],"children":[{"_key":"2cb57bc81b700","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"6b6af0e7068c"},{"markDefs":[],"children":[{"text":"Neil Minkoff, MD:","_key":"f93457b621710","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":" Right.","_key":"f93457b621711"}],"_type":"block","style":"normal","_key":"f7d5e74ca57e"},{"style":"normal","_key":"618835d8263e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"783ae1fa5d1a0"}],"_type":"block"},{"markDefs":[],"children":[{"marks":["strong"],"text":"Karina Abdallah, PharmD:","_key":"cbbfd1c1831f0","_type":"span"},{"_type":"span","marks":[],"text":" We’ve done a lot of pilots in our...regional health systems where we can embed pharmacists within the hospital system who are employed by the health plan and help with the discharge orders. What can we do to work together to get the prior authorization piece complete? From our end, it’s important that one of our patients has been hospitalized and they’re going to go home, a lot of times with a caregiver, and we don’t want them to go home, send someone to the pharmacy, and get that standard denial from the pharmacy just because they needed prior authorization. It’s important to be proactive in this space in order to ensure that we’re controlling the actual infection and the symptoms that Dr Gerding mentioned earlier on and doing everything that we can to be proactive and prevent recurrences and readmissions to the hospital.","_key":"cbbfd1c1831f1"}],"_type":"block","style":"normal","_key":"dc50b2ce6c31"},{"markDefs":[],"children":[{"text":"","_key":"551cead520650","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"5c748af06a02"},{"children":[{"text":"Dr Minkoff, you mentioned the PBM. A lot of times, the PBMs are delegated completely by some of the payers or health plans to do that prior authorization work. It’s the same here, where they might be just focusing on the prior authorization points. I’d probably encourage the health plan that has those types of items delegated to the PBM to make sure to focus on outcomes looking at those denials. How many were denied that ended up being approved? 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Considerations for Fidaxomicin Use in Recurrent CDI ","contentCategory":{"name":"Videos","_id":"ee14ccb3-3542-4414-9046-927be1198c76","_updatedAt":"2020-04-03T20:03:44Z","_createdAt":"2020-04-03T20:03:44Z","_rev":"Yw6MEKZDMdk6hC2JCPjfiB","_type":"contentCategory"},"internalTag":["clostridium difficile infection","c. diff infection"],"_id":"8d5f5099-040d-45e8-b968-c29640b49763","seoTag":["clostridium difficile infection","c. diff infection","recurrent clostridium difficile infection","recurrent CDI","IDSA/SHEA guidelines","vancomycin","fidaxomicin","fidaxomicin use","barriers to use","cost of fidaxomicin"],"body":[{"videoID":"6281516569001","source":"brightcove","_key":"1c47b55fd98e","_type":"video"},{"_type":"block","style":"normal","_key":"7c912c4d97fc","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5e895060a63b"}]},{"_key":"5ce1d91d078e","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Transcript:","_key":"45de7a4f66c4"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:","_key":"a86be3555b66"},{"_type":"span","marks":[],"text":" Let me ask you a more specific question about some of those protocols. I’ll lead with Dr Gerding on this one. We have new data, or at least a growing literature around fidaxomicin [Dificid] vs vancomycin [Vancocin]. I believe that was addressed in the IDSA [Infectious Diseases Society of America]/SHEA [Society for Healthcare Epidemiology of America] guidelines. Could you comment on that and what you think the data show?","_key":"a067e8764035"}],"_type":"block","style":"normal","_key":"25e97a2c75dd"},{"style":"normal","_key":"66d648411b96","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"32c06b8e82370"}],"_type":"block"},{"_type":"block","style":"normal","_key":"79b0d7d05971","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dale N. Gerding, MD:","_key":"999a4aeb6e370"},{"_type":"span","marks":[],"text":" Sure. It’s very clear from 2 very large trials that were done for registration of fidaxomicin that it reduces recurrence from about 25% in the group treated with vancomycin down to 15% in the group treated with fidaxomicin. That’s largely the basis for the recommendation of fidaxomicin to support sustained cure. In these trials, sustained cure means cure of the infection and no recurrence within 30 days. You could extend that further, but it’s been pretty typical for antibiotic trials to use 30 days for the recurrence period. That’s the basis for the recommendation, or in the case of the IDSA guidelines, the suggestion that fidaxomicin be used rather than vancomycin. This is for first recurrence and first episode of[","_key":"999a4aeb6e371"},{"_type":"span","marks":["em"],"text":"Clostridioides difficile","_key":"999a4aeb6e372"},{"marks":[],"text":"].","_key":"999a4aeb6e373","_type":"span"}]},{"_key":"4147c2e0d911","markDefs":[],"children":[{"text":"","_key":"d74ff5aec43a0","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"94eead79c256","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:","_key":"939d8ededa890"},{"_type":"span","marks":[],"text":" Do you get pushback on that? When you’re trying to prescribe this, are there barriers in your way?","_key":"939d8ededa891"}]},{"_key":"385b3d3e3dc9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"fe8c73a7f6b10"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"127f2ba383f9","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dale N. Gerding, MD:","_key":"d385e87789e80"},{"_type":"span","marks":[],"text":" Sure there are. Fidaxomicin is relatively little used. For example, the previous guidelines from the IDSA in 2017 recommended against the use of metronidazole and recommended both fidaxomicin and vancomycin. At the recent IDWeek meetings, there was an assessment of what effect this has had on the utilization of those antibiotics for treating[","_key":"d385e87789e81"},{"marks":["em"],"text":"Clostridioides difficile","_key":"d385e87789e82","_type":"span"},{"_type":"span","marks":[],"text":"] in the Medicare population. There was a 27% drop in metronidazole use and a 27% increase in vancomycin use. Fidaxomicin use, which was only in 0.8% of patients, also increased to about 1.6%. It doubled, and yet treatment with fidaxomicin was occurring in less than 4% of patients. This is basically all about acquisition cost of the drug because fidaxomicin is more expensive than vancomycin. The language of the recommendation is also tantalizing because of the “We suggest” rather than “We recommend” language that’s used.","_key":"d385e87789e83"}]},{"_key":"2bf84d79377d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"14d1dffff59f0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:","_key":"4c0091ea6ce10"},{"_type":"span","marks":[],"text":" Interesting.","_key":"4c0091ea6ce11"}],"_type":"block","style":"normal","_key":"0c29ba75a880"},{"markDefs":[],"children":[{"_key":"ef80a87508bc0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"ea9b7da6ecfd"},{"_key":"b744debc60ac","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dale N. Gerding, MD:","_key":"ab4af9417f460"},{"text":" The guidelines do have an effect. But interestingly, Medicare patients even in 2018 were still being predominantly treated with metronidazole even though metronidazole was out of the guideline. But it takes time for these guidelines to be adopted. Sometimes they never get adopted very effectively. We’re in a wait and see situation right now. In the VA [Department of Veterans Affairs] system, where I work, they’re still debating how to change the formulary based on the new ACG [American College of Gastroenterology] and IDSA guidelines. Time will tell.","_key":"ab4af9417f461","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"children":[{"_key":"a074e283ffa70","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"992a77c15cd3","markDefs":[]},{"style":"normal","_key":"7f5635b8a118","markDefs":[],"children":[{"_key":"d24cc9b9cb5c0","_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:"},{"_key":"d24cc9b9cb5c1","_type":"span","marks":[],"text":" My follow-up question is, who’s doing most of the prescribing? Is it mostly house staff? Is it mostly primary care doctors? Is it gastroenterologists? Because it seems that would have a lot of impact on who’s following the guidelines and who’s been educated on the most up-to-date guidelines. I’ll open that up to everybody."}],"_type":"block"},{"style":"normal","_key":"41ce34e41bd0","markDefs":[],"children":[{"marks":[],"text":"","_key":"9de8f53a729c0","_type":"span"}],"_type":"block"},{"children":[{"_type":"span","marks":["strong"],"text":"Dale N. Gerding, MD:","_key":"dfa90063bdde0"},{"_key":"dfa90063bdde1","_type":"span","marks":[],"text":" For a first episode, it’s often our house staff or primary care physicians who are making the initial decision about treatment. Infectious disease specialists don’t get involved until there’s been a recurrence or maybe even more than 1 recurrence. I suspect the same is true of gastroenterology, but Dr Allegretti can tell us that."}],"_type":"block","style":"normal","_key":"6c5f0c702234","markDefs":[]},{"_key":"62959b3adb4b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ee8caf36093a0"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Jessica Allegretti, MD, MPH:","_key":"7f08b969fdb70"},{"text":" Yes, I agree. To the initial point about fidaxomicin, cost still remains a huge barrier. I’d certainly be using it much more if patients could get it more easily. But what ends up happening is maybe you start it on the inpatient side and then they leave with a prescription and it’s a copay of $1600, for example, and then they just can’t complete it. We’re more mindful of starting a course of it in the hospital knowing that patients aren’t going to be able to finish that course leaving the hospital. As a[","_key":"7f08b969fdb71","_type":"span","marks":[]},{"text":"Clostridioides difficile]","_key":"7f08b969fdb72","_type":"span","marks":["em"]},{"marks":[],"text":" hospital working group, we just met as well to update our internal policies in line with the guidance. But that remained a large concern.","_key":"7f08b969fdb73","_type":"span"}],"_type":"block","style":"normal","_key":"7721b2a8e380","markDefs":[]},{"_type":"block","style":"normal","_key":"4a8a448682df","markDefs":[],"children":[{"marks":[],"text":"","_key":"c9d1e5713aa00","_type":"span"}]},{"_type":"block","style":"normal","_key":"73a8259bb466","markDefs":[],"children":[{"_type":"span","marks":[],"text":"On the outpatient side, I’m probably one of the people using fidaxomicin the most, just because I’m willing to do the prior authorizations and the necessary paperwork. Whereas somebody in a busy primary care practice might not have the resources or time to be able to do that, so prescribing something like vancomycin or, unfortunately, even metronidazole may just be easier. We see that quite a bit. I still see metronidazole being used despite the updated guidelines, probably for sake of ease.","_key":"e74a71182a4f0"}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"7c1a703a9e010"}],"_type":"block","style":"normal","_key":"f59de2ed915c","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:","_key":"0e5dfafe8a050"},{"_key":"0e5dfafe8a051","_type":"span","marks":[],"text":" Do you have infrastructure help available in your institution? I was a medical director there at one point, so I know a little about it. Do you have infrastructure help from either your clinic, the physician organization, or even from the Mass General Brigham Specialty Pharmacy in terms of trying to help navigate through those decisions and choke points?"}],"_type":"block","style":"normal","_key":"d21f6c8ddf02"},{"style":"normal","_key":"33ac6e2eaa17","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"dcf64c95f43b0"}],"_type":"block"},{"markDefs":[],"children":[{"text":"Jessica Allegretti, MD, MPH:","_key":"fa3ad52598b90","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":" Fortunately, the answer is yes. We have several layers of pharmacy support depending. I’m also an IBD [inflammatory bowel disease] doctor, so I work with the specialty pharmacy quite closely. But for something like fidaxomicin and even bezlotoxumab [Zinplava], which I also prescribe quite a bit, oftentimes we can check ahead of time. I can work with my pharmacy colleagues and ask, “Is this going to be covered? What’s their copay going to be looking like?” So that I don’t go down the rabbit hole while the patient is suffering.","_key":"fa3ad52598b91"}],"_type":"block","style":"normal","_key":"187abc8fc377"},{"_key":"43dfaa5ac5d4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"846e26986ae20"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"But oftentimes, if I feel very strongly about it, I do have a team of excellent pharmacists who can help me with the prior authorization process and, if there’s denials, help with appeals, because that’s often what ends up happening. We have templated letters ready to go so that we can submit them with the data and literature. Those things are needed in practice to get some of these things done. Because as you can imagine, if you get a denial and then you have to sit on the phone, schedule that peer-to-peer yourself, and write the appeal letter yourself, that’s hours out of your day that you could be seeing patients.","_key":"55d6af0283720"}],"_type":"block","style":"normal","_key":"ad7e63175dcb"},{"children":[{"_type":"span","marks":[],"text":"","_key":"f96d5adb90bd0"}],"_type":"block","style":"normal","_key":"16f77f109e0b","markDefs":[]},{"_key":"05fec6aa0454","markDefs":[],"children":[{"_key":"01f3168a176e0","_type":"span","marks":["strong"],"text":"Neil Minkoff, MD:"},{"marks":[],"text":" Yes.","_key":"01f3168a176e1","_type":"span"}],"_type":"block","style":"normal"},{"_key":"4d74156f92aa","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6c2a67489a070"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"67edc3a9794a0","_type":"span","marks":["strong"],"text":"Jessica Allegretti, MD, MPH:"},{"_type":"span","marks":[],"text":" The ability to do what I do is helped substantially by the fact that I have a support team around me to help me do it.","_key":"67edc3a9794a1"}],"_type":"block","style":"normal","_key":"8b277f2b8845"},{"_type":"block","style":"normal","_key":"63210a38b1a1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e886ed4a39ab"}]},{"style":"normal","_key":"b73ef094c2a0","markDefs":[],"children":[{"_key":"f71b4bf34282","_type":"span","marks":["strong","em"],"text":"Transcript edited for clarity."}],"_type":"block"}],"url":{"_type":"slug","current":"practical-considerations-for-fidaxomicin-use-in-recurrent-cdi"},"link":"/view/practical-considerations-for-fidaxomicin-use-in-recurrent-cdi","updatedOn":null,"authorMapping":[{"url":{"current":"neil-minkoff-md","_type":"slug"},"displayName":"Neil Minkoff, MD","_createdAt":"2021-05-25T19:30:11Z","_rev":"FkQz1nQ3RgUoGJsbgpKKL1","_type":"author","_id":"c8184de0-45b4-47e4-b937-08233876e06a","_updatedAt":"2021-05-25T19:30:11Z"},{"_createdAt":"2021-11-18T17:05:08Z","_rev":"6wrYVWz3RAqbgtl3HOrIrR","_type":"author","_id":"1ea46ffa-3893-473d-b3f0-08c591f5bbf9","_updatedAt":"2021-11-18T17:05:08Z","url":{"current":"dale-n-gerding-md","_type":"slug"},"displayName":"Dale N. 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","_key":"a233131be9cf0","_type":"span"}],"_type":"block","style":"normal","_key":"b81c768e778c","markDefs":[]},{"_key":"2f45288c2984","markDefs":[],"children":[{"_key":"07a78bf3d251","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"49c8ca94ae03","markDefs":[],"children":[{"_type":"span","marks":["underline","strong"],"text":"Transcript","_key":"1a78b47f227b"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ae0785720b35"}],"_type":"block","style":"normal","_key":"7f81e57f281c"},{"_key":"f736ec126c9d","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Could you describe the New Vaccine Surveillance Network's primary goals and the role you play in predicting the impact of potential new vaccines?","_key":"35165dc6ad4b0"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"","_key":"0c8380566c73"}],"_type":"block","style":"normal","_key":"7ca279365a8a","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"The New Vaccine Surveillance Network has been going on for over 2 decades, and 1 of the main goals is to understand the impact that new vaccines, or current vaccines, have on the burden of illness, both for acute respiratory illness and acute diarrheal illness. ","_key":"94a7068b7c9d0"}],"_type":"block","style":"normal","_key":"c953b498b2e5","markDefs":[]},{"_type":"block","style":"normal","_key":"134912467362","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"58e4dc70ccba"}]},{"_type":"block","style":"normal","_key":"1345ad2f69c4","markDefs":[],"children":[{"_key":"5e721ede60ea","_type":"span","marks":[],"text":"This network was very important in describing the burden of influenza disease in children, which then led to the recommendations for a universal influenza vaccine. The cool thing about this is active prospective population-based surveillance. What that means is that any child that comes in with respiratory symptoms, so fever, cough, runny nose, or shortness of breath, they're approached and asked if they will enroll into the study. "}]},{"_key":"2cf75e0c465e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ba9ea3acabf9"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"74b4f4685eb3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Then, we collect specimens, so we'll get a nose swab and/or a throat swab and test it for the most common viruses. That's regardless of if the pediatrician is testing for illnesses like RSV, flu, or other things. What we do is we're able to show what the true burden of illness and diseases that are out there. Once we have a baseline to show, before a vaccine is introduced, what the baseline is. Then, after a vaccine is introduced, we can show over time how that is impacted. 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The first one that got approved became available in January, so it's been 10 or 11 months; the other one became available in June. We are seeing some really optimistic signs. I think the most important thing for","_key":"b53da8e319830"},{"_key":"030b05acdf5c","_type":"span","marks":["em"],"text":" C diff"},{"text":" patients, our community, and our movement is that it had been 12 years since any new treatment for ","_key":"fed8a33237da","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"C diff","_key":"ff0642b768fe"},{"marks":[],"text":" had been approved by the FDA. And so, the approval of not just 1, but 2 new treatments, which were a completely new paradigm for treating this disease and preventing recurrence, I think has really restored hope for a lot of us and made us think fighting for the past 20 years has been worth it, and feeling like we're going to get to a place where people don't suffer. ","_key":"c6fc15502af3","_type":"span"}],"_type":"block","style":"normal","_key":"f542a8699b70"},{"_type":"block","style":"normal","_key":"02678fe746f1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c79e9f1c7210"}]},{"children":[{"_type":"span","marks":[],"text":"What we really want to change with these new therapies, or preventatives, is when patients are battling recurrent ","_key":"c0586a2da3be"},{"_key":"203c2e1fb84f","_type":"span","marks":["em"],"text":"C diff"},{"_type":"span","marks":[],"text":", often they're given endless rounds of antibiotics. You might get vancomycin, and then you fail vancomycin, or vancomycin fails you, I should say. Then you're put on a vancomycin taper, and that doesn't work. So then you're given fidaxomicin. So, at this point, we're talking you've been sick for 2 months already. If you're somebody who works and has a family, that's incredibly disruptive. Then, for a time, people were getting a fecal microbiota transplant [FMT], or a stool transplant. But the FDA always considered that experimental, so it really limited the number of people that were able to access that; there's probably about 180,000 people who get recurrent ","_key":"8813262a5a0e"},{"_type":"span","marks":["em"],"text":"C diff","_key":"e973c3acc95e"},{"_type":"span","marks":[],"text":" every year, and maybe 10% or 20% of them were able to access an FMT. So, now that we have FDA-approved products, what we hope is that everyone will get that preventative to stop them from getting a recurrence. ","_key":"1f85fb84f197"}],"_type":"block","style":"normal","_key":"f611a6629b91","markDefs":[]},{"_key":"0f6a260b1a44","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ecfb838552bd"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I think they're also beginning to not just help people who are getting them right now, but also beginning to change practice guidelines. Prior to this, the standard was the antibiotics had to fail 3 times before you'd even be considered for an FMT. Again, depending on the exact prescription, it could be weeks or months of you suffering before you were offered this sort of treatment of last resort with a fecal transplant. What we hope is that with these new therapeutics, you will get this microbiome intervention way sooner, and so you'll have less physical and socioemotional damage than patients that didn't have access to these therapies. ","_key":"1eb46bf19dd2"}],"_type":"block","style":"normal","_key":"0ebf45f00150"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"13187b4a7470"}],"_type":"block","style":"normal","_key":"586a0b744065"},{"style":"normal","_key":"9e6a5d8542c4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"There's definitely been a little bit of sticker shock. These therapies, they are expensive compared to what has been the previous regime, but by interrupting the cycle of recurrence, they will ultimately save us money. The average cost of somebody who's dealing with multiply recurrent ","_key":"0932324c1139"},{"_type":"span","marks":["em"],"text":"C diff,","_key":"0299d1918fb7"},{"text":" for their treatment is around $40,000. What we ideally would like to see is that when a patient tests positive for ","_key":"909242c3c4ec","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"C diff","_key":"eff44c90e119"},{"_type":"span","marks":[],"text":" that they're given a narrow spectrum of antibiotic to sort of limit the further disruption of their microbiome. Then, if they get a recurrence—and, even with the best antibiotic we have now, about 10% to 15% will—they will then get a microbiome restoration preventative after that first recurrence to hopefully prevent further occurrences. ","_key":"1151a0dd10cb"}],"_type":"block"},{"_type":"block","style":"normal","_key":"899e9ef52b31","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"98ca61157735"}]},{"_key":"49752773cde8","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Another reason why that's really important is because what we know, and there was a recent article about this that came out a few months ago, is that for every time somebody recurs, their chances of recurrence increases. So, you get ","_key":"76ff9db16870"},{"_type":"span","marks":["em"],"text":"C diff","_key":"655dc40bdba0"},{"_key":"5da18b74ffbc","_type":"span","marks":[],"text":", you get treated, you have a 20% chance of recurring. You get that recurrence, now you have a 40% chance of recurring. You get a second recurrence, it's a 60% chance of recurring. 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That's something that we invest a lot of time and energy into; people need to know about ","_key":"1b09ae023e66"},{"_type":"span","marks":["em"],"text":"C difficile","_key":"4206890280fd"},{"_key":"d21b5e3d9a9f","_type":"span","marks":[],"text":" so that they can prevent it. We have an enormous issue with the overuse of antibiotics. 50% of antibiotics prescribed in this country are medically either unnecessary or inappropriate, meaning the person doesn't have a bacterial infection, or they're not given the right dose, or they're given too broad an antibiotic when they could have a more narrow one. "}],"_type":"block","style":"normal","_key":"77954e44a65c"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"9ac26ed5ceaf"}],"_type":"block","style":"normal","_key":"8f2069428424"},{"children":[{"marks":[],"text":"I think people have considered antibiotics to just be like, I take it, it fixes a thing in me. 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Maybe if you start to have symptoms of ","_key":"9a125846b0eb"},{"_type":"span","marks":["em"],"text":"C diff","_key":"acd81fa3c7d1"},{"_type":"span","marks":[],"text":", like prolific diarrhea, you won't just think, \"Oh, I ate something bad.\" Especially if it continues for more than a day or so, you'll go and seek treatment, seek testing. ","_key":"7927fd11de1f"}],"_type":"block","style":"normal","_key":"b265f715f13c","markDefs":[]},{"_type":"block","style":"normal","_key":"91e7f367eb7e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d68e2561047c"}]},{"_key":"40cd7e79a3a4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Since 2018, we've had this month-long campaign to commemorate C diff Awareness Month in November. We started really small on social media back in 2018; we reached about 80,000 people who probably didn't know about ","_key":"e3a4fc0744f4"},{"_type":"span","marks":["em"],"text":"C diff","_key":"3ec8f18a6ea3"},{"_type":"span","marks":[],"text":". ","_key":"534e9a0a63d8"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5066a42c0ec0"}],"_type":"block","style":"normal","_key":"052cfaa7733b"},{"children":[{"_type":"span","marks":[],"text":"In the past 4 years, we've really continued to invest in the campaign itself, bringing on a publicist, and growing our partnerships with professional associations and other disease organizations. By the end of last year, we had gone from reaching 80,000 people that first year to over 16 million people.","_key":"c9a74437a213"}],"_type":"block","style":"normal","_key":"c15feba9fbb0","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d958c92658d4"}],"_type":"block","style":"normal","_key":"45191556c71d"},{"style":"normal","_key":"170d583774a7","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"What are the key messages you hope the public will take away from this campaign?","_key":"e88fd0ddbd62"}],"_type":"block"},{"style":"normal","_key":"4b7bc08c0bdd","markDefs":[],"children":[{"marks":[],"text":"","_key":"eed80faba30e","_type":"span"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"So, when it comes to C diff Awareness Month and the \"See C. diff\" campaign, we always have our sort of general messaging that we're looking at every year, which is to help people understand that ","_key":"d24f3c6eac7b"},{"marks":["em"],"text":"C diff","_key":"8e93d525ac92","_type":"span"},{"text":" is a dangerous and potentially deadly infection that's hiding in plain sight. People might know that some person's grandmother had it in the nursing home, but they don't really deeply understand it. We also want them to understand that it's the most common health care–associated infection, that it is considered an urgent threat, that it is preventable, it is treatable; having that knowledge and being aware is always going to make you better equipped to pursue treatment. ","_key":"d6707504fd86","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"d12d0454c675","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"411fa3c1ac5e"}],"_type":"block","style":"normal","_key":"5ce786ea9a1e"},{"_key":"b1313ddf0a0d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Each year, we also look at having a specific theme for that year. This year, our main tagline is \"See C. diff Prevented.\" What we've come up with are these 7 opportunities that there are to prevent ","_key":"a5dbbeff6aac"},{"_type":"span","marks":["em"],"text":"C diff","_key":"b8c3f14f39af"},{"_type":"span","marks":[],"text":" infections, both the primary infection and the secondary infection. ","_key":"eebb3564397c"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7ac973ec5d9d"}],"_type":"block","style":"normal","_key":"6101983ce4fc"},{"children":[{"marks":[],"text":"We're promoting this a lot on social media, but just to give you a quick rundown: The first one is avoid unnecessary antibiotics. The second one is to eat a diet that's high in fiber and supportive to the gut microbiome. Three is to ensure an accurate diagnosis; unfortunately, where we are with diagnostics is that some of them are a little too sensitive and some of them aren't quite sensitive enough, so a better educated patient can have a better conversation with their doctor. ","_key":"7452522dfe37","_type":"span"}],"_type":"block","style":"normal","_key":"dd79c2e79ca0","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c58ecb660ce4"}],"_type":"block","style":"normal","_key":"28015f6a6d45"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"If your loved one is diagnosed, learn about ","_key":"1eadc2e437a6"},{"_type":"span","marks":["em"],"text":"C diff","_key":"9031d11da5c4"},{"text":". How does it work? How does it spread? What are the risk factors? How do you protect your family from spreading it to them? Number 5 is taking proper precautions, again, coming back to this prevention message. A lot of people have C diff in their home, they're not in the hospital, so how do you take the steps to make sure you're cleaning the spaces that the person with C diff is staying in with a bleach solution, that you're giving it enough time to do that. ","_key":"bc99fd8a3f18","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"c4b49a89543b"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"83a0e6f9f4e9"}],"_type":"block","style":"normal","_key":"b4e78b7d98d3"},{"children":[{"text":"Number 6 is get the best antibiotic. Even though they're no longer approved by the guidelines, people still get metronidazole; it's doesn't work that well, it's also a very toxic antibiotic, so we want people to be able to ask for vancomycin, fidaxomicin, whatever is the best treatment. Also, we want them to know how to prevent additional recurrences. Obviously, they get their first recurrence, it could be an FMT [fecal microbiota transplant]; more likely now it'd be one of these new microbiome therapies. So, seek that out and advocate to get that. ","_key":"a664f5e544280","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"ebfda75dcc76","markDefs":[]},{"markDefs":[],"children":[{"text":"","_key":"e80ee92eec5e","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"2669e541da8f"},{"style":"normal","_key":"b75e132327a0","markDefs":[],"children":[{"text":"Those are the 7 opportunities that we're looking for, and we're trying to make them as understandable for people as possible and create a roadmap. So, that's what we're looking at this year. 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"}],"_type":"block","style":"normal","_key":"a9d34cd1600a","markDefs":[{"nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/compendium/infectious-disease","_key":"899d07f4f594"}]},{"_type":"block","style":"normal","_key":"9f794d6048a0","markDefs":[],"children":[{"_key":"af16088f6933","_type":"span","marks":[],"text":""}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Halasa is a professor of pediatrics at VUMC, Division of Pediatric Infectious Diseases. Her research focuses on determining the burden of diarrheal and respiratory illnesses in pediatric and specialized populations and how to reduce them. Currently, Halasa is the principal investigator (","_key":"5e049df38264"},{"_type":"span","marks":["strong"],"text":"PI","_key":"5bd6b2b31f79"},{"_type":"span","marks":[],"text":") of the Vanderbilt site of the New Vaccine Surveillance Network, which was established in 1999 by the CDC to predict the impact of potential new vaccines.","_key":"9bfcbde0c564"}],"_type":"block","style":"normal","_key":"890e7a234b8a"},{"children":[{"text":"","_key":"f78cea899284","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"2348d5a800e2","markDefs":[]},{"_key":"cfcb07c24439","markDefs":[],"children":[{"text":"Transcript","_key":"ee7bc40aea88","_type":"span","marks":["strong","underline"]}],"_type":"block","style":"normal"},{"style":"normal","_key":"a9f02fd7a8eb","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3a8eb970eec4"}],"_type":"block"},{"_type":"block","style":"normal","_key":"61567f5b1e84","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"What do you see as the most pressing challenges in diarrheal illnesses today, particularly concerning pediatric and specialized populations?","_key":"15e8a287b9bc"}]},{"_key":"96bb33266435","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"188a385a7a2e0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"As a part of the New Vaccine Surveillance Network, we do acute gastroenteritis surveillance, and this is at 7 sites across the United States. For kids that come in with vomiting within a 24-hour period, or 3 loose stools in a 24-hour period, we approach them and we collect their stool. We actually test them for pathogens that cause acute gastroenteritis. And what we've seen after the rotavirus vaccine is that norovirus is the most common cause of why kids are being hospitalized, seen in the ED [emergency department] and the outpatient setting. ","_key":"dbdf5d794fe4","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"19dbab3f757b"},{"style":"normal","_key":"cc181e1cd400","markDefs":[],"children":[{"_key":"b05e7974f844","_type":"span","marks":[],"text":""}],"_type":"block"},{"style":"normal","_key":"09e5aabf5001","markDefs":[],"children":[{"text":"There are still some cases of rotavirus, and if they get it, they're actually a little more severe compared to the other viruses and pathogens, but the burden compared to before the rotavirus vaccine existed is much lower.","_key":"846ff32a1fbc","_type":"span","marks":[]}],"_type":"block"},{"style":"normal","_key":"72eb202b3466","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e828c5416c88"}],"_type":"block"},{"style":"normal","_key":"198d95344a14","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Could you share some successful strategies or interventions you found to help reduce the burden of diarrheal illnesses?","_key":"19b880055419"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"08a4226226f6"}],"_type":"block","style":"normal","_key":"d39469328385"},{"_key":"aae4ea8f784a","markDefs":[],"children":[{"marks":[],"text":"The rotavirus vaccine has definitely been the most effective way of reducing the burden, specifically to rotavirus. Something that has actually been very simple to reduce the severity of acute gastroenteritis—not necessarily getting it, but once you get it, to reduce the severity—is oral rehydration therapy and, here in the United States, IV [intravenous] therapy.","_key":"cbbd27be5f110","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"4c2983fc9038"}],"_type":"block","style":"normal","_key":"f9f38d76dd0a"},{"_key":"d560f1db3b5d","markDefs":[],"children":[{"_key":"cb84fb379215","_type":"span","marks":[],"text":"Bringing individuals in for hydration has reduced at least the severity of illness, and it's been effective. 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We're hoping by October. So I know that's sort of just right around the corner, we get a lot of these in the offices or out in the communities where we can do vaccinations. And the CDC is pushing to get this covered under a program we use a lot, the VFC, which stands for Vaccines for Children, which covers the kids without insurance or medical assistance. So those kids were able to get vaccinated and protected as much as everyone else. And when you look at how much it benefits, when they've done studies, people that got these monoclonal antibodies for RSV, the infants, hospitalizations dropped dramatically. And we know a lot of things, some things come down to cost and money. We know that preventing a hospital visit can save a whole lot of money. So using these vaccines should help overall make children healthier [and] a whole area healthy, but also help reduce costs.","_key":"898441cb75de0","_type":"span"}],"_type":"block","style":"normal","_key":"c20c3a0e2876"},{"children":[{"text":"What can parents do to slow the spread of RSV this season?","_key":"f84ecca12450","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"6a4ecf9aa281","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"So a lot of things that we've talked about we've known before, a lot of people learned a lot during the initial pandemic of COVID-19, is that a lot of people would send kids to school sick or send kids to daycare sick, parents would go to work sick, and we know that if you're actively ill, and you're around other people, you have a higher chance of spreading it. We found out masks work in reducing the risk of certain transmission of a lot of infections. Early on when masking was pretty regulated and tight, we saw a whole lot less of flu, RSV, COVID-19, a lot of other things going on, so we know that can help.","_key":"20b08eed03a60"}],"_type":"block","style":"normal","_key":"831247aa7da6"},{"_key":"ae43969a3a56","markDefs":[],"children":[{"_key":"16ab017b65d4","_type":"span","marks":[],"text":"It's not as effective in an infant because we know they're [unlikely to] wear masks but if they're around someone that's sick, wearing a mask can definitely help. Good hygiene, handwashing helps minimize the spread. But overall, good [protection of the] immune system is good, a well-balanced diet. For infants, I mean, most of their calories are coming from breast milk or formula, but also getting [a healthy diet], those things can help. And then the the big thing is the vaccine stuff. I mean, we know that's an easy 1-stop [option]. 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That's why we're big on the vaccine schedules. That's why we have to see children every so often make sure they're growing and developing well, to just sort of help prevent serious issues or if we can catch things earlier, we know outcomes are definitely better. It'll definitely be more preventative. What's nice is we're able to get more kids vaccinated, get kids more immune to RSV, at least for the short amount of time, and with pretty much less of a hassle. If you only have to come in once to get the job done, as opposed to 5 times, it's definitely helpful. So it's going to get kids covered for longer periods of time and get more kids covered.","_key":"a46f89eb229b0","_type":"span"}],"_type":"block","style":"normal","_key":"6bb810358583"},{"children":[{"text":"Will these monoclonal antibodies become as commonplace as the flu vaccine?","_key":"cfba9feca344","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"73492dde5a86","markDefs":[]},{"_key":"e572f4e610a7","markDefs":[],"children":[{"_type":"span","marks":[],"text":"I think at this point, if this is what we have, then yes, it'll definitely help because we know this is really the only thing we have to cover to protect infants against RSV. Going back to your earlier question, where you mentioned other injections, immunizations come along. So there are actually vaccines for RSV, but it's for the older population, those 60 and older. And that's more that active immunization. I think, until we can get a good active vaccination program for infants, monoclonal antibodies will help. We know last year was pretty rough with RSV; it came a whole lot earlier than expected [and] lasted longer. So we know the more we can prevent [1 child] from getting it, that's 1 less child that can then pass it on to someone else. So we know, until we get something better, these monoclonal antibodies are going to be the best that we have to help prevent RSV in infants.","_key":"da138f1f68bb0"}],"_type":"block","style":"normal"}],"_updatedAt":"2023-09-07T16:48:16Z","authorMapping":[{"_rev":"sgy4yN0CjmArmRDnE2Khrz","_id":"15b1de57-6a71-4655-ba17-eeaa1c733634","biography":[{"children":[{"_type":"span","marks":[],"text":"Julia is an associate editor for The American Journal of Managed Care® (AJMC®) and joined AJMC® in 2022. 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There's what we call active and passive immunization. The active is what we've known for the longest. I mean, that's a lot of the typical vaccine schedule. For some vaccines, there's oral vaccines [which] are the ones you have to give an injection, where you either inject parts of a virus or bacteria or a weakened virus or bacteria. And then your body sort of responds to that. So your own immune system identifies those materials as foreign, they create antibodies against those, and they also create what we call memory cells so that later on in life, if the same material gets introduced, your body's already aware of it, and it can start producing your own antibodies. So that's what we call more the active immunization, and that's a lot of the other vaccines we've had go through before. ","_key":"fcb863b7e3b10","_type":"span"}]},{"children":[{"marks":[],"text":"The monoclonal antibodies, that's more of what we call passive immunization, so that's where the antibodies are already made. In the case with RSV, those are antibodies made in a lab and you get those injected into your own body, so the antibodies are already there. So they know how to attach to, in this case, the RSV. Over time your body degrades them because they're not your own, so that's where they don't last as long. So the active immunization usually works better, gives you more lifelong protection, whereas the passive immunization it gives you good protection for that certain amount of time until your body sort of starts degrading what they consider foreign.","_key":"62d0a9a61534","_type":"span"}],"_type":"block","style":"normal","_key":"60fd71bed362","markDefs":[]},{"_key":"6a6f9b9ee786","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"66d2d0e4e4d0"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"469b71cd53f1","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"How helpful are monoclonal antibodies in treatment of RSV?","_key":"5ab86dccc5d1"}]},{"_key":"bc993a682ec6","markDefs":[],"children":[{"_type":"span","marks":[],"text":"It's definitely helpful. The big thing about this new one that's coming out for RSV in infants is just how long it lasts. So for years, we've actually had monoclonal antibodies against RSV as a different product. It didn't last as long, so kids actually had to come in for the injections like once a month for 5 to 6 months, every RSV season. When they looked at how much it cost and how effective it was, only a small percentage of kids were actually eligible for those, for the older ones. Those are kids born really premature or had specific heart, lung, or even immunodeficiency issues. 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