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Highlights from IDWeek 2016
Newsdesk
Highlights from IDWeek 2016 The 5th annual IDWeek meeting was hosted in New Orleans, LA, USA, Oct 26–30. Sean Cleghorn reports. PrEP for HIV and risk compensation
Health-care provider clothing and transmission
Douglas Krakower (Beth Israel Deaconess Medical Center, Boston, MA) presented data on trends in sexually transmitted infections (STIs) at a clinic, against the backdrop of the introduction of pre-exposure prophylaxis (PrEP) for HIV. Clinical trials have shown that PrEP is efficacious in preventing HIV infection and is not associated with decreased condom use or increased sexually transmitted infections. However, there is a concern that risk compensation might occur outside of trial settings—trial participants knew that they might have been taking placebo and thus maintained condom use—and so data from real-world settings are important to inform how best to deliver PrEP to the public. Fenway Health (Boston, MA, USA) is a community health clinic with a long history of providing HIV and STI care for men who have sex with men. Between 2005 and 2015, 19 238 men had at least one clinic visit. Prescriptions of PrEP have increased over the past 5 years, from five in 2011, to 960 in 2015. In age-adjusted multivariable analysis, PrEP use was associated with acquisition of a bacterial STI (hazard ratio 3·43, 95% CI 3·07–3·83). Other factors associated in the model were HIV infection (2·66, 2·43–2·92), being black (1·40, 1·23–1·60), being multiracial (1·45, 1·18–1·77), receiving Medicaid (1·25, 1·06–1·47), being uninsured (1·23, 1·02–1·48), and having unknown insurance status (2·32, 1·94–2·76). These findings suggest that increased screening for bacterial STIs might be needed in these subgroups, and that education about sexual health needs to be improved in men starting PrEP.
Derverick Anderson (Duke University Medical Center, Durham, NC, USA) presented secondary findings from results of the ASCOT trial, designed to assess the transmission of pathogens between health-care workers, patients, and the environment. ASCOT was a single-centre, randomised, controlled trial designed to assess whether nurses’ clothing impregnated with antiseptics is more likely to be contaminated with pathogens than normal scrubs. Samples were taken before and after 40 nurses’ shifts from patients, nurses, clothing, and the environment, and cultured. A transmission event was defined by the presence of pathogens identical according to pulsed-field gel electrophoresis. From 5559 samples, 22 transmission events were confirmed: six from patient to nurse, six from environment to nurse, and ten from patient to environment. Transmitted pathogens included meticillin-resistant and meticillinsensitive Staphylococcus aureus, Stenotrophomonas maltophilia, Acinetobacter baumanii complex, Klebsiella pneumoniae, and Pseudomonas aeruginosa. That pathogens are transmitted within hospitals is nothing new, but findings such as these help to address the less tractable issue of identifying the routes and vectors of such transmission. The results provide a target for improvements in infection control, such as enhanced disinfection and improved hand hygiene.
www.thelancet.com/infection Vol 17 January 2017
Guillain-Barré syndrome and Zika virus infection
Control and Prevention, Atlanta, GA, USA) presented the results of a case-control study assessing the association between Zika virus infection and Guillain-Barré syndrome in Barranquilla, Colombia. Guillain-Barré syndrome is a debilitating autoimmune condition characterised by weakness and sensory abnormalities, and can be fatal. It is known that various infections can trigger Guillain-Barré syndrome, and it has been associated with Zika virus infection in French Polynesia. In this study, the risk of having had symptoms consistent with Zika was compared between patients with Guillain-Barré syndrome between October, 2015, and April, 2016, and controls from the same neighbourhood who were matched for age and sex. Zika virus infection was determined from clinical symptoms by interview and checks of medical records, and serology testing. 53 patients with confirmed Guillain-Barré syndrome (according to Brighton criteria) and 79 controls were enrolled. 30 (75%) cases versus 23 (29%) controls reported at least one antecedent symptom. Cases were more likely than controls to have reported fever (odds ratio 3·35, 95% CI 1·43–7·85), rash (4·0, 1·51–10·45), and myalgia (3·71, 1·29–10·68). Results from serology are pending, although they will be difficult to interpret because of cross-reactivity with dengue virus. These findings reinforce the association between Zika virus infection and Guillain-Barré syndrome.
In a late-breaking session, James Sejvar (US Centers for Disease
Sean Cleghorn
31
Highlights from IDWeek 2016 The 5th annual IDWeek meeting was hosted in New Orleans, LA, USA, Oct 26–30. Sean Cleghorn reports. PrEP for HIV and risk compensation
Health-care provider clothing and transmission
Douglas Krakower (Beth Israel Deaconess Medical Center, Boston, MA) presented data on trends in sexually transmitted infections (STIs) at a clinic, against the backdrop of the introduction of pre-exposure prophylaxis (PrEP) for HIV. Clinical trials have shown that PrEP is efficacious in preventing HIV infection and is not associated with decreased condom use or increased sexually transmitted infections. However, there is a concern that risk compensation might occur outside of trial settings—trial participants knew that they might have been taking placebo and thus maintained condom use—and so data from real-world settings are important to inform how best to deliver PrEP to the public. Fenway Health (Boston, MA, USA) is a community health clinic with a long history of providing HIV and STI care for men who have sex with men. Between 2005 and 2015, 19 238 men had at least one clinic visit. Prescriptions of PrEP have increased over the past 5 years, from five in 2011, to 960 in 2015. In age-adjusted multivariable analysis, PrEP use was associated with acquisition of a bacterial STI (hazard ratio 3·43, 95% CI 3·07–3·83). Other factors associated in the model were HIV infection (2·66, 2·43–2·92), being black (1·40, 1·23–1·60), being multiracial (1·45, 1·18–1·77), receiving Medicaid (1·25, 1·06–1·47), being uninsured (1·23, 1·02–1·48), and having unknown insurance status (2·32, 1·94–2·76). These findings suggest that increased screening for bacterial STIs might be needed in these subgroups, and that education about sexual health needs to be improved in men starting PrEP.
Derverick Anderson (Duke University Medical Center, Durham, NC, USA) presented secondary findings from results of the ASCOT trial, designed to assess the transmission of pathogens between health-care workers, patients, and the environment. ASCOT was a single-centre, randomised, controlled trial designed to assess whether nurses’ clothing impregnated with antiseptics is more likely to be contaminated with pathogens than normal scrubs. Samples were taken before and after 40 nurses’ shifts from patients, nurses, clothing, and the environment, and cultured. A transmission event was defined by the presence of pathogens identical according to pulsed-field gel electrophoresis. From 5559 samples, 22 transmission events were confirmed: six from patient to nurse, six from environment to nurse, and ten from patient to environment. Transmitted pathogens included meticillin-resistant and meticillinsensitive Staphylococcus aureus, Stenotrophomonas maltophilia, Acinetobacter baumanii complex, Klebsiella pneumoniae, and Pseudomonas aeruginosa. That pathogens are transmitted within hospitals is nothing new, but findings such as these help to address the less tractable issue of identifying the routes and vectors of such transmission. The results provide a target for improvements in infection control, such as enhanced disinfection and improved hand hygiene.
www.thelancet.com/infection Vol 17 January 2017
Guillain-Barré syndrome and Zika virus infection
Control and Prevention, Atlanta, GA, USA) presented the results of a case-control study assessing the association between Zika virus infection and Guillain-Barré syndrome in Barranquilla, Colombia. Guillain-Barré syndrome is a debilitating autoimmune condition characterised by weakness and sensory abnormalities, and can be fatal. It is known that various infections can trigger Guillain-Barré syndrome, and it has been associated with Zika virus infection in French Polynesia. In this study, the risk of having had symptoms consistent with Zika was compared between patients with Guillain-Barré syndrome between October, 2015, and April, 2016, and controls from the same neighbourhood who were matched for age and sex. Zika virus infection was determined from clinical symptoms by interview and checks of medical records, and serology testing. 53 patients with confirmed Guillain-Barré syndrome (according to Brighton criteria) and 79 controls were enrolled. 30 (75%) cases versus 23 (29%) controls reported at least one antecedent symptom. Cases were more likely than controls to have reported fever (odds ratio 3·35, 95% CI 1·43–7·85), rash (4·0, 1·51–10·45), and myalgia (3·71, 1·29–10·68). Results from serology are pending, although they will be difficult to interpret because of cross-reactivity with dengue virus. These findings reinforce the association between Zika virus infection and Guillain-Barré syndrome.
In a late-breaking session, James Sejvar (US Centers for Disease
Sean Cleghorn
31