HPN Daily Update s1

June 30, 2016 Next flu pandemic could double past cost estimates A pandemic influenza outbreak in the United States could have widespread economic costs nearly double the total amounts experts have previously calculated, depending on how the public, government, and businesses responded to an epidemic, according to policy and risk experts in a new study. Using an advanced methodology also applicable to the Zika virus and other biothreats to calculate the total cost of an influenza outbreak, the experts conclude that if the public used influenza vaccines during a pandemic outbreak the U.S. GDP loss would be $34.4 billion. It would be a lot higher, however, if the public didn’t use vaccines: $45.3 billion. That’s a much larger price tag than other studies have found. But it’s not just the use or non-use of vaccines that drives costs. Most economic studies of pandemic influenza focus on direct impacts such as vaccination, hospitalization, injury, death, and business revenue or profit losses from reduced workforce. Behavioral reactions include, for example, voluntary and mandatory avoidance of public places and interactions, such as sporting events, subway stations, quarantines, and travel bans, with significant economic ripple effects. The study was conducted as part of an effort by the U.S. Department of Homeland Security’s National Biosurveillance Integration Center (NBIC) to strengthen its decision-support capabilities. In their study, the authors estimate “the relative prominence of the various economic consequence types,” as well as complicating factors, many of them not addressed in any prior study. These complicating factors include different types of avoidance behavior, such as the already noted avoidance of public events and facilities. The study analyzed the economic impacts of a seasonal and a pandemic outbreak scenario. For both scenarios, vaccinations reduce the overall spread of the virus and, hence, are expected to reduce the magnitude of overall economic impacts. Results indicate that, in the absence of avoidance and resilience effects, the pandemic scenario could result in a U.S. GDP loss of $25.4 billion, but vaccination could reduce the losses to $19.9 billion. But when avoidance and resilience are taken into account, a pandemic influenza outbreak could result in GDP losses of $45.3 billion without vaccination and $34.4 billion with vaccination. Visit Newswise for the study. New study sheds light on how some survive Ebola A first-of-its-kind Ebola study yields clues to how some people are able to survive the deadly virus and suggests possible avenues for treatments that could save more lives. Researchers at Centers for Disease Control and Prevention, Emory University School of Medicine, and University of Nebraska Medical Center analyzed the immune responses of Ebola patients treated in the United States. Their study was recently published online in the Clinical Infectious Disease Journal in the article entitled, “Kinetic Analysis of Biomarkers in a Cohort of U.S. Patients with Ebola Virus Disease.” This is the first time researchers have been able to study Ebola virus disease (EVD) using samples taken from patients during both their illness and recovery. In the seven U.S. patients, researchers tracked 54 different markers of immune- system activity from hospital admission until the day of discharge. Among the seven patients, five had moderate EVD and two had severe EVD requiring mechanical ventilation and dialysis. The results show patients with severe EVD had high levels of virus in their blood and out-of-control immune responses leading to destruction of healthy tissues, multisystem organ failure, shock, and, in most cases, death. In contrast, patients with moderate EVD had strong, healthy immune responses that were able to control the virus. All of the patients with moderate illness and one patient with severe illness survived. Visit CDC for the report. More Zika cases in New York, all from travel abroad Zika cases continue to tick up in New York City and the health commissioner urges everyone to be vigilant when traveling to countries where the virus is rampant. The city has confirmed 233 cases of Zika, all of which were a result of people traveling, New York City Commissioner of Health Dr. Mary T. Bassett said Wednesday. The most frequently visited areas among the patients were the Dominican Republic, with 140 cases, Puerto Rico, with 20 cases and Guyana with 14. The remaining 59 cases were from people who traveled to other countries. Of the 162 New York City women with Zika, 24 are pregnant. The health department is not releasing details on the progress of the fetuses. Some infants born with the virus have microcephaly, a severe birth defect where babies have very small heads and are developmentally delayed. The virus can also cause hearing loss, eye problems and stunted growth. Between Jan. 19 and June 24, 3,906 New Yorkers were tested for Zika. Of the 233 cases, the most were from the Bronx, where 95 people tested positive. Manhattan has 52 cases, Queens had 42 and Brooklyn had 39. None have been reported in Staten Island. Visit the New York Daily News for the story. Biden threatens funding cut if cancer trials conceal results Vice President Joe Biden threatened Wednesday to pull federal funding for cancer studies that fail to publicly disclose their results, putting pressure on researchers, clinicians and drug companies to speed up progress toward cancer cures. Hosting a cancer summit in Washington, Biden said the culture in the cancer research world is stifling progress, and he said was "committed to doing everything in my power" to change that culture. He cited concerns that prominent medical institutions that receive millions in taxpayer dollars are flouting a federal rule that says they must submit their results to a publicly accessible database within a year. For months, Biden has been imploring cancer researchers to share their data and trial results more freely, so that scientists can build on each other's progress and more readily identify treatments that might work for individual patients. His ultimatum at the summit was the first time Biden has suggested failure to heed that call could lead to National Institutes of Health grants being terminated. At the summit, the showpiece of Biden's yearlong "moonshot," the vice president said the world was "on the cusp of breakthroughs." Yet he suggested the cancer community was essentially standing in its own way. He called out drug companies for unnecessary price increases and major research hospitals for insufficient collaboration. To illustrate what's on the cutting edge, the Energy Department and the National Cancer Institute announced new programs to analyze cancer data with supercomputers, plus another computing program teaming up with drug maker GlaxoSmithKline to speed up drug development. IBM unveiled plans to donate its Watson supercomputing technology to help Veterans Affairs ramp up its precision medicine program by sequencing the genomics of tumors for 10,000 patients over two years. (Associated Press) Visit ABC News for the story. Doctors are burned out by busywork: Study Of all professionals in the U.S., doctors experience some of the highest rates of burnout: the feeling of being so emotionally exhausted from work that you start to feel indifferent about those you’re serving. More than half of doctors feel this way, recent research shows. Studies have linked burnout to a rise in unprofessional behavior, a drop in patient satisfaction and a greater chance that a doctor will make a major medical error. There’s no one cause for doctor burnout, but a new study published in Mayo Clinic Proceedings has found a major one: the increasingly electronic nature of medicine. The digital parts of doctoring, like maintaining electronic health records, were linked to physician burnout. Like many of us, doctors are spending more and more time in front of their screens. Health records are now maintained electronically and doctors submit medication orders to pharmacies by computer—both strategies meant to streamline doctors’ visits, reduce errors and improve patient care. But digitization affects doctors too—and not, it seems, for the better. Researchers at the Mayo Clinic looked at several months of 2014 survey data from 6,560 U.S. physicians measuring features of work life, including burnout and electronic use. Even after controlling for factors like age, sex, specialty and the number of hours doctors work per week, the researchers found a strong link between burnout and time spent doing digital work. Of the many physicians who used electronic health records, 44% were dissatisfied with them and nearly 63% of doctors believed that EHRs made their jobs less efficient. Nearly half of doctors said that they spent an unreasonable amount of time on clerical tasks related to patient care. Older doctors hated the electronic aspects of their jobs more than young physicians, possibly because they had to adjust to new technology that comes more easily to younger professionals. But the dissatisfaction with electronic busy work cut across generations. When specialty was considered, urologists, family medicine doctors, ear, nose and throat doctors and neurologists were the least satisfied with clerical work. Just as disturbing, doctors were split on whether or not electronic health records actually improved patient care; 41% believed that they did not. Visit TIME for the story. US senators warned on Zika after failing to pass funding One day after Zika funding failed in the Senate, U.S. lawmakers heard a sobering assessment of the virus' potential to do harm and America's lack of preparedness to fight the mosquito that carries it. The deputy director of the Centers for Disease Control and Prevention, Anne Schuchat, noted that more than 500 pregnant women in the United States have contracted Zika, and the number is certain to rise. Senators also heard unsettling new medical data concerning the virus, which few researchers had focused on prior to last year. Christopher Zahn of the American College of Obstetricians and Gynecologists noted that the risk of a congenital heart defect in a newborn is about 1 percent, but the risk of a Zika infection causing a birth defect like microcephaly is 13 percent or higher. With no vaccine on the immediate horizon and America's mosquito season well underway, Zahn said, "The only guaranteed way to prevent [Zika birth defects] is contraception. So access to contraception both domestically and abroad is crucial to address this issue." Access to contraception became a central point of contention in the Senate debate leading up to Tuesday's vote blocking the $1.1 billion to fight Zika. Democrats objected when a majority of Republicans inserted cost offsets that included a cut in funds to Planned Parenthood, a major provider of birth control to women. University of Wisconsin pathologist David O'Connor said he is confident a Zika vaccine will work, but that developing one and demonstrating its safety and efficacy will take time. Schuchat said CDC funding currently exists for small-scale studies, but not large ones. With no vaccine and only a patchwork of mosquito-control programs across the United States, many Americans may choose mosquito repellent as a primary defense. Visit Voice of America for the report. FDA clears first test to detect specific genetic markers for certain antibiotic-resistant bacteria from clinical specimens The U.S. Food and Drug Administration cleared for marketing the Xpert Carba-R Assay, an infection control aid that tests patient specimens to detect specific genetic markers associated with bacteria that are resistant to Carbapenem antibiotics. Carbapenem antibiotics are widely used in hospitals to treat severe infections. These resistant organisms are commonly referred to as Carbapenem-resistant Enterobacteriaceae, or CRE, and have been reported in almost all states within the U.S. “By using a specimen taken directly from a patient to test for the presence of genetic markers, hospitals can more quickly identify these dangerous bacteria resistant to certain antibiotics,” said Alberto Gutierrez, M.D., director of the FDA’s Office of In Vitro Diagnostics and Radiological Health within the Center for Devices and Radiological Health. Current methods to identify colonization with CRE or other resistant organisms rely on growing bacteria from fecal material in cultures, which are then subjected to antimicrobial susceptibility testing to determine in vitro susceptibility to antimicrobial agents. Bacterial culture methods and susceptibility testing may take up to four days, and additional testing is often also required to confirm that carbapenemase, an enzyme that inactivates carbapenem antibiotics, is present. The Xpert Carba-R Assay tests specimens directly taken from patients, which are usually obtained by rectal swabs, for the presence of five different genetic markers that are associated with carbapenemase, the enzyme produced by CRE. The Xpert Carba-R Assay is intended as an aid in infection control and can be used in conjunction with other clinical and laboratory findings. According to the Centers for Disease Control and Prevention, CRE infections most commonly occur in people with exposure to healthcare settings, like hospitals and long-term care facilities. Because of this, these types of infections often occur among patients who are receiving treatment for other serious conditions. Visit FDA for the announcement. To get doctors to do the right thing, try comparing them to their peers Healthcare providers are exploring how electronic record keeping and digital communication can be used to influence doctors on a wide range of actions, including following up on worrisome test results, making a correct diagnosis and choosing the right treatment. The challenge: getting doctors to accept prodding that might interfere with their own judgment or intentions when they already feel overloaded with electronic alerts, reminders and other messages. “Doctors are ingenious in circumventing anything in a computer, and if it makes their job harder they are just going to work around it,” says Jeffrey Linder, an internist, director of the Primary Care Practice Based Research at Brigham and Women’s Hospital in Boston, and an associate professor at Harvard Medical School. Dr. Linder’s research on curbing the dangerous overprescribing of antibiotics suggests doctors do respond to certain electronic nudges and feedback about what they are doing—especially when it involves comparing how they stack up against their peers. “The model has been if we get people the right information they will do the right thing; but, sad to say, it doesn’t work,” says Dr. Linder. “Doctors know they should not prescribe antibiotics for colds and viral illnesses, but if they are confronted by a sick patient who is a little bit anxious and wants something for treatment,” they often prescribe the drugs. In a study published February in JAMA, Dr. Linder and colleagues tested three “behavioral interventions” to prevent inappropriate prescription of antibiotics for acute respiratory-tract infections. After receiving a primer in appropriate prescribing, 248 physicians in 77 primary-care practices in Boston and Los Angeles, including Brigham and Women’s Hospital practices, received one or more interventions. Prescribing rates for the different groups were compared for 18 months before and after the interventions were turned on. A control group had no interventions. One intervention, “suggested alternatives,” presented doctors with a range of choices suggesting nonantibiotic treatment; a second, “accountable justification,” prompted clinicians to write an explanation justifying a prescription for antibiotics if they chose such a treatment. A third, “peer comparison,” sent emails to clinicians that compared their antibiotic prescribing rates with those of “top performers” who had the lowest inappropriate prescribing rates. While the first intervention had no statistically significant effect, both accountable justification and peer comparison led to statistically significant reductions in inappropriate antibiotic prescribing. Peer comparison helped reduce prescriptions that weren’t warranted from 20% to 4% as doctors got monthly individual feedback about their own prescribing habits for 18 months. Researchers say such electronic interventions have to be carefully designed. “It takes a lot of work to convert data into useful information that influences physician decisions in real time,” says Hardeep Singh, a patient-safety researcher at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston. Dr. Singh wasn't involved in the antibiotic study. “Information must be accurate, presented to physicians at the right moment, perceived by them to be of high value and must make it easier for them to do the next step,” Dr. Singh says. Visit the Wall Street Journal for the report. Class I Recall: HeartWare Ventricular Assist Device (HVAD) batteries HeartWare Inc. is recalling the batteries used on HeartWare Ventricular Assist Device because they may lose power prematurely due to faulty cells. If the HVAD system is not connected to an additional power source shortly after the system sounds an alarm indicating a low battery level, the pump will stop working and the patient may experience serious adverse health consequences, including death. This recall includes batteries used on HVAD, Serial numbers: BAT000001 to BAT199999, Model number 1650, manufacturing dates: May 19, 2013 to July 1, 2015 and distribution dates: May 21, 2013 to July 31, 2015. A total of 18,631 units were recalled nationwide, including Washington D.C. The HVAD helps deliver blood from the heart to the rest of the body. It is used in patients who are at risk of death from end-stage left ventricular heart failure and who are waiting for a heart transplant. The system includes a pump implanted in the space around the heart (pericardium) and a controller that controls the speed and function of the pump. Visit FDA for the notice.