NEW HYDE PARK, NY – A new guideline released Thursday by the Infectious Diseases Society of America (IDSA) notes that most people with compromised immune systems are especially vulnerable to illness and should receive the flu shot and other vaccinations. The guideline, entitled "Clinical Practice Guideline for the Vaccination of the Immunocompromised Host," was authored by Lorry G. Rubin, MD, director of the pediatric infectious diseases at Cohen Children's Medical Center of New York in New Hyde Park, NY, and professor of pediatrics at the Hofstra North Shore-LIJ School of Medicine, and will be published online Thursday in Clinical Infectious Diseases.

The new guideline aims to aid primary care physicians and specialists who treat immunocompromised patients (people with compromised immune systems, such as those with cancer, HIV infection and Crohn's disease), and those who live with immunocompromised patients.

"The guideline provides 'one-stop shopping' for clinicians caring for children and adults with compromised immune systems and includes recommendations and evidence for all vaccinations, from influenza to chicken pox," said Dr. Rubin. "Previously, the recommendations were difficult to retrieve because in most cases information had to be accessed individually by vaccine rather than by the category of patient disease."

The new guideline includes recommendations for most available vaccinations, ranging from hepatitis A, measles, mumps and rubella and other childhood vaccinations to those for influenza, pneumococcus and herpes zoster. It applies to patients with congenital immune deficiencies, HIV/AIDS, cancer, solid organ transplant (such as kidney and liver), stem cell transplant, chronic inflammatory conditions (such as rheumatoid arthritis and Crohn's disease), sickle cell disease and asplenia, cochlear implants, and cerebrospinal fluid (CSF) leaks. The guideline notes that most immunocompromised patients six months or older should receive the annual influenza shot, but should not receive the live attenuated influenza vaccine that comes in the form of a nasal spray. Patients receiving intensive chemotherapy or who have received anti-B-cell antibodies in the previous six months are unlikley to benefit from a flu shot.

The panel that developed the guideline includes adult and pediatric specialists in gastroenterology, immunology, infectious diseases, hematology, oncology, rheumatology and stem-cell and solid-organ transplantation. In addition to Dr. Rubin, the panel includes: Myron J. Levin, MD, Per Ljungman, MD, PhD, E. Graham Davies, MD, Robin Avery, MD, Marcie Tomblyn, MD, Athos Bousvaros, MD, Shireesha Dhanireddy, MD, Lillian Sung, MD, PhD, Harry Keyserling, MD, and Insoo Kang, MD.

The vaccination of immunocompromised patient guideline will be available in mobile device, pocket-sized quick-reference editions, and on the IDSA website https://www.idsociety.org. 

ANNAPOLIS, MD—Recent breaches, including the first documented patient-to-patient transmission of hepatitis C in a U.S. dental practice, underscore the importance of understanding and complying with safe infection control practices. Dental professionals will obtain a solid foundation in just three days by attending the CORE Infection Control Boot Camp presented by the Organization for Safety, Asepsis and Prevention (OSAP). Mark your calendars now to attend the course in Tampa, FL, January 6-8, 2014, at the Wyndham Tampa Westshore.

“The CORE infection control curriculum is considered essential training for dental professionals,” said Therese Long, OSAP executive director. “It’s rigorous and delivers 24 hours of continuing education credits, a comprehensive resource binder, checklists, tools and more in three days…that’s why it’s a ‘boot camp.’ Attendees will receive the right information delivered by national experts in a convenient and cost-effective package. Plus, we are offering an optional exam so attendees can demonstrate their competency in this critical function to ensure the safe and infection-free delivery of oral healthcare.”

As part of OSAP’s 30^th anniversary, members and federal employees are eligible for a special discounted rate of $300. The non-member rate is $450. Registration is open, and the deadline to register is December 20, 2013. Space is limited. OSAP has negotiated a special rate at the Wyndham Tampa Westshore.

The course is designed for infection control coordinators, educators responsible for infection prevention and safety instruction, state compliance officers, risk managers, federal service employees responsible for infection control duties, and consultants and sales representatives who want to demonstrate a CORE level of infection control competency.

For more information and to register, visit https://www.osap.org/?page=CoreICMain.

For the latest infection control information, guidelines and resources, visit www.OSAP.org.

About OSAP

The Organization for Safety, Asepsis and Prevention is the world’s leading membership association exclusively dedicated to preventing disease transmission and ensuring the safe and infection-free delivery of oral healthcare for all. As a nonprofit organization, OSAP helps dental practitioners close the gap between policy and practice. Its members include dental and other healthcare professionals, consultants, researchers and nongovernmental organizations, manufacturing and distribution companies, policy makers and academia. For more information, visit www.OSAP.org.

National Influenza Vaccination Week is a national observance that was established to highlight the importance of continuing influenza vaccination. 

Click here to learn more. 

Read an overview article for dental healthcare providers on hepatitis C in the current issue of The Journal of the American Dental Association. The article helps raise awareness about healthcare-associated transmission of hepatitis C and provides an update on changes in testing and treatment.

Click here to access the full text article.

Click for the OSAP's Hepatitis C Issue Toolkit 

The association between poor oral health and increased risk of cardiovascular disease should make the reduction of sugars such as those contained in junk food, particularly fizzy drinks, an important health policy target, say experts writing in the Journal of the Royal Society of Medicine.

Poor oral hygiene and excess sugar consumption can lead to periodontal disease where the supporting bone around the teeth is destroyed. It is thought that chronic infection from gum disease can trigger an inflammatory response that leads to heart disease through a process called atherosclerosis, or hardening of the arteries. Despite convincing evidence linking poor oral health to premature heart disease, the most recent UK national guidance on the prevention of CVD at population level mentions the reduction of sugar only indirectly.

Dr Ahmed Rashid, Department of Public Health and Primary Care, University of Cambridge, who co-wrote the paper, said: "As well as having high levels of fats and salt, junk foods often contain a great deal of sugar and the effect this has on oral health may be an important additional mechanism by which junk food elevates risk of CVD." He added: "Among different types of junk food, soft drinks have raised particular concerns and are the main source of free sugar for many individuals."

The authors refer to the well-publicised New York 'soda ban' controversy which has brought the issue to the attention of many. Yet, they point out, in the UK fizzy drinks remain commonly available in public areas ranging from hospitals to schools. Dr Rashid said: "The UK population should be encouraged to reduce fizzy drink intake and improve oral hygiene. Reducing sugar consumption and managing dental problems early could help prevent heart problems later in life." 

ANN ARBOR—Mixing energy drinks with alcohol is riskier than just drinking alcohol alone, according to a new study that examines the impact of a growing trend among young adults.

Published in the current issue of the Journal of Adolescent Health, the study was conducted by Megan Patrick of the University of Michigan Institute for Social Research and Jennifer Maggs of Penn State University.

"We found that college students tended to drink more heavily and become more intoxicated on days they used both energy drinks and alcohol, compared to days they only used alcohol," said Patrick, lead author of the study.

While the U.S. no longer permits manufacturers to premix high-caffeine products with alcohol, mixed drinks such as vodka Red Bulls and Jäger bombs, made by dropping a shot of Jägermeister liquor into a glass of Red Bull, are becoming increasingly popular.

According to the researchers, the public health implications include not only physical risks to individuals from blacking out and alcohol poisoning, for example, but also exposing the community to dangerous situations in which young adults may be "wide awake drunk" after a night of partying.

Patrick and Maggs analyzed data on 652 college students over a period of four semesters. During four two-week periods, the students answered questions every day about their consumption of energy drinks and alcohol, and about any negative consequences they experienced as a result—from having a hangover to getting into trouble.

"Our findings suggest that the use of energy drinks and alcohol together may lead to heavier drinking and more serious alcohol-related problems," Patrick said. "As energy drinks become more and more popular, we should think about prevention strategies for reducing the negative consequences of using energy drinks and of combining energy drinks with alcohol."

The study was funded by the National Institute on Alcohol Abuse and Alcoholism and conducted under NIAAA grant numbers R21AA021426 and R01AA016016.

Established in 1949, the University of Michigan Institute for Social Research is the world's largest academic social science survey and research organization, and a world leader in developing and applying social science methodology and in educating researchers and students from around the world. ISR website: https://home.isr.umich.edu

Tooth decay is the number one chronic infectious disease among children in the United States, affecting 42 percent of children aged 2 to 11 years. Furthermore, according to the Centers for Disease Control and Prevention, more than one-fourth of U.S. children age 2 to 5 have tooth decay. If left untreated, tooth decay causes pain and infections that may lead to problems such as eating, speaking, playing and learning.

Under the Patient Protection and Affordable Care Act (ACA), an estimated 3 million children are expected to immediately gain dental insurance coverage under state health insurance exchanges and an additional 3 million under Medicaid. The AAPD worked closely with health care legislators to secure the inclusion of the pediatric oral health benefit requirement as part of the ACA’s essential health benefits package.

"America’s pediatric dentists are uniquely trained to address the important oral health issues that children face," said Dr. Warren A. Brill, pediatric dentist and AAPD president. "Between the epidemic of dental disease among children and the significant changes to dental coverage under healthcare reform, parents and caregivers need an authoritative resource to help them navigate these critical issues related to the health and well-being of children."

The new branding includes the unchanged AAPD logo mark paired with a new tagline that reflects the approachability, care and expertise of pediatric dentists.

"‘The Big Authority on Little Teeth’ branding is designed to clearly communicate the AAPD’s role as a primary source of children’s oral health information to the public," said Dr. John S. Rutkauskas, AAPD CEO. "We believe this new branding maintains our existing identity while moving the organization in a new direction to better connect with consumers."

AAPD Members:Interested in using the new logo and branding in your practice? Visit our new "Using the AAPD Logo" page to download the logo and policies governing its use in your promotional materials.

(SACRAMENTO, Calif.) -- People with health insurance are more likely to use preventive services such as flu shots and health screenings to reduce their risk of serious illness, but they are no more likely than people without health insurance to engage in risky health behaviors such as smoking or gaining weight, researchers at UC Davis and University of Rochester have found.

The findings, published in the November-December issue of the Journal of the American Board of Family Medicine, contradict the common concern that expanding health-care coverage may encourage behaviors that increase utilization and costs.

"The notion that people with insurance will exhibit riskier behavior is referred to by economists as 'ex ante moral hazard' and has its roots in the early days of the property insurance industry," said Anthony Jerant, professor of family and community medicine at UC Davis and lead author of the study. "After buying fire insurance, some people wouldn't manage fire hazards on their property. But health care is different. Someone might not care if their insured warehouse burns down, but most people want desperately to avoid illness."

Jerant and his colleagues evaluated respondents in the Medical Expenditure Panel Survey, a source of national data on the costs and uses of health care. They included adults who entered the survey between 2000 and 2008, participated for two years and had insurance at least once during those two years of participation. The team then compared data on 96,021 respondents while they were insured to data on them while they were uninsured.

Specifically, the team compared health behaviors that are often detrimental to health such as smoking, seat belt use and weight gain. They also focused on use of preventive care services that are intended to protect health, including flu vaccinations, colorectal cancer screenings, mammography, pap smears and PSA (prostate-specific antigen) tests. In addition, the researchers examined numbers of office visits, prescriptions and other expenditure metrics.

The results showed that changes in health insurance status were closely linked to preventive care, which increased with coverage and decreased without it. The gain or loss of coverage, however, had no significant relationship to changes in health behaviors. This contradicts a belief long-held by some health economists that mandating the purchase of health insurance coverage may increase risky behavior. While this belief is at odds with the experiences of many physicians, this is the first time the relationship has been vigorously investigated in a national sample of adults of all ages.

"There has been a concern that people would say, 'Hey, I have insurance now, I don't have to worry about my diet. If I get heavy and develop a problem, I can just go to a doctor and have it treated,'" said Jerant. "Empirically, we find that's not the case. Health insurance coverage did not worsen the health habits we studied."

"These results do show that having health insurance affects the likelihood of receiving important preventive services that can potentially reduce the chance of an influenza-related hospitalization or death and prevent or detect colorectal or cervical cancer," said co-author Kevin Fiscella, professor of family medicine at the University of Rochester School of Medicine. "This is a critical message, as many states continue to debate whether to expand Medicaid."

While the results of this study generally support the broad intent behind the Affordable Care Act (ACA) to expand insurance coverage as one means to encourage preventive care, Jerant urges caution.

"The people in our study voluntarily acquired health insurance, while the ACA is mandatory," he said. "We will need to verify whether our findings apply to mandatory coverage. People may behave differently when coverage is mandated."

In addition, the study does not address why gaining insurance improves receipt of preventive care but not health behaviors that can have profound health effects. The authors suggest that this may result from clinicians having a greater vested interest in preventive interventions, which are more directly under the clinicians' control and easier to bring about than sustained lifestyle changes. The authors also point out that studies have found that clinical efforts to encourage weight control, seat belt use and smoking cessation have limited efficacy.

While preventive care increased for those with insurance, that increase was not uniform across different types of care. For example, insurance increased cancer screenings, such as colonoscopies, much more than flu shots. The authors hypothesize this may be due to differences in cost and access, as vaccines are relatively inexpensive for uninsured people to buy and are widely available in many workplaces, drugstores and other places -- not just in health-care facilities

Ultimately, the study findings counter a theoretical barrier to health insurance expansion.

"Now we have empirical evidence that patients don't change the health behaviors we studied as a consequence of changes in their health insurance alone, and we've confirmed that insurance encourages people to get vaccinations and cancer screenings," Jerant said. "In other words, insurance works."

In addition to Jerant and Fiscella, study authors were Daniel Tancredi and senior author Peter Franks of UC Davis. The research had no external funding. A copy of the study is available at https://jabfm.org/content/26/6/759.full.

UC Davis Health System improves lives by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education and creating dynamic, productive community partnerships. It encompasses one of the country's best medical schools, a 619-bed acute-care teaching hospital, a 1,000-member physician practice group and the Betty Irene Moore School of Nursing. Together, they make UC Davis a hub of innovation that is transforming health for all. For information, visit https://www.healthsystem.ucdavis.edu. 

E-cigarettes have been widely promoted as a way for people to quit smoking conventional cigarettes. Now, in the first study of its kind, UC San Francisco researchers are reporting that, at the point in time they studied, youth using e-cigarettes were more likely to be trying to quit, but also were less likely to have stopped smoking and were smoking more, not less.

"We are witnessing the beginning of a new phase of the nicotine epidemic and a new route to nicotine addiction for kids," according to senior author Stanton A. Glantz, PhD, UCSF professor of medicine and director of the Center for Tobacco Control Research and Education at UCSF.

E-cigarettes are battery-powered devices that look like cigarettes and deliver an aerosol of nicotine and other chemicals. Promoted as safer alternatives to cigarettes and smoking cessation aids, e-cigarettes are rapidly gaining popularity among adults and youth in the United States and around the world. The devices are largely unregulated, with no effective controls on marketing them to minors.

In the UCSF study, the researchers assessed e-cigarette use among youth in Korea, where the devices are marketed much the way they are in the U.S. The study analyzed smoking among some 75,000 Korean youth.

The study appears online in the current issue of the Journal of Adolescent Health.

"Our paper raises serious concern about the effects of the Wild West marketing of e-cigarettes on youth," said Glantz.

Despite industry claims that it markets only to adults, e-cigarettes have achieved substantial penetration into the youth market. In the U.S., the federal Centers for Disease Control and Prevention recently reported that the majority of adolescent e-cigarette users also smoke regular cigarettes, and that the percentage of middle and high school students who use e-cigarettes more than doubled from 2011 to 2012. An estimated 1.78 million U.S. students had used the devices as of 2012, said the CDC.

In the UCSF study, the researchers report that four out of five Korean adolescent e-cigarette users are "dual" smokers who use both tobacco and e-cigarettes.

The authors conclude that young e-cigarette smokers "are more likely to have tried quitting smoking, which suggests that, consistent with cigarette marketing messages, some youth may be using e-cigarettes as a smoking cessation aid…Use of e-cigarettes is associated with heavier use of conventional cigarettes, which raises the likelihood that actual use of e-cigarettes may increase harm by creating a new pathway for youth to become addicted to nicotine and by reducing the odds that an adolescent will stop smoking conventional cigarettes."

The data for the study came from the Korea Youth Risk Behavior Web-based Survey, an annual, nationally-representative survey conducted by the Korea Centers for Disease Control in 2011. The sample included 75,643 youth in grades 7 through 12.

Sungkyu Lee, PhD, lead author of the paper and a UCSF postdoctoral fellow at the time that he conducted the study, noted that e-cigarette use has skyrocketed in Korea: less than one percent of youths had tried the product in 2008 when the device was first introduced, compared to more than nine percent in 2011. Lee is now on the staff of the National Evidence-Based Healthcare Collaborating Agency in Seoul, Korea.

Among students who used e-cigarettes, eight percent were concurrently smoking conventional cigarettes. After adjusting for demographics, current cigarette smokers in the study were found to be much more likely to use e-cigarettes than non-smokers.

The researchers also found that the odds of using e-cigarettes were considerably higher among students who had made an attempt to quit smoking than those who had not. Students no longer using cigarettes were rare among current e-cigarette users, the researchers said.

Rachel Grana, PhD, a UCSF postdoctoral fellow, was a co-author of the study.

The research was funded in part by the National Cancer Institute; the University of California Tobacco Related Diseases Research Program; and the Hellmann Family Fund.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children's Hospital.