Disclosure Informa0on Western Occupa0onal Health Conference 2012

Transcription

1 Infec&ous Disease: Guidelines, Updates & Implementa&on in the Health Care Se=ng James Watt, MD, MPH Chief, Division of Communicable Disease Control Center for Infectious Diseases California Department of Public Health Disclosure Informa0on Western Occupa0onal Health Conference 2012 James Wa<, MD, MPH I have nothing to disclose. I will not discuss off label use and/or inves0ga0onal use in my presenta0on. Guidelines and Updates Immuniza0ons Treatment of latent tuberculous infec0on

2 Adult Immuniza0ons- - Increasing opportuni0es for preven0on 11 rou0ne vaccines 2 pages of footnotes Schedule varia0ons based on age, occupa0on, other risk h<p:// schedule.pdf Immuniza0on of Health- Care Personnel (HCP) Recommenda0ons of the Advisory Commi<ee on Immuniza0on Prac0ces (ACIP) MMWR 2011;60 (RR7) h<p://

3 Overview 5 rou0ne vaccines Hepa00s B MMR Varicella Influenza Td/Tdap 3 vaccines for special circumstances Meningococcal Typhoid fever Polio Background Vaccine issues Recommenda0ons Preexposure preven0on Criteria for presump0ve immunity Vaccina0on Postexposure management Outbreak control Key Changes from 1997 All HCP, not just those with direct pa0ent care du0es, should receive an annual influenza vaccina0on HCP should receive a single dose of Tdap as soon as feasible (no minimum interval since last tetanus or diphtheria vaccine) Criteria for evidence of immunity for several diseases Improving Influenza Vaccine Coverage among HCP Each health- care facility should develop a comprehensive strategy. Some hospitals and jurisdic0ons have mandated vaccina0on or required masking during influenza season Federal Centers for Medicare and Medicaid Services (CMS) will begin requiring all hospitals to report coverage

4 Treatment of Latent Tuberculous Infec0on (LTBI) Standard regimen: INH for 9 months Barriers to use Concerns about hepatotoxicity Long treatment dura0on Real world comple0on rates 50% Recommenda0ons for Use of an Isoniazid- Rifapen0ne Regimen with Direct Observa0on to Treat Latent Mycobacterium tuberculosis Infec0on MMWR 2011;60(48): Details Rifapen0ne Rifamycin (such as rifampin, rifabu0n) Long half life Used for intermi<ent dosing regimens for TB disease Mul0ple drug interac0ons Dosage by weight 12 weekly doses Directly observed

5 Efficacy HIV infected (South Africa): RPT/INH = INH alone with greater comple0on for RPT/INH Recent contacts/converters aged 2 years and older (mul0center): RPT/INH more efficacious than INH alone (HR=0.38, 95% CI ) with greater comple0on Safety Measure INH/RPT (12 weeks) INH alone (9 months) Permanent drug discon0nua0on 18% 31% Serious adverse events 1.6% 3.0% Discon0nua0on due to hepatotoxicity Discon0nua0on due to adverse event 0.3% 2.0% 4.9% 3.7% Possible hypersensi0vity 2.9% 0.4% P<0.01 for all comparisons Sterling TR et al. NEJM 2011;365: Recommenda0on INH/RPT is an equal alterna0ve to INH for 9 months Must be given by directly observed therapy Recommended for healthy persons 12 years and older May be used for HIV infected, not on an0retrovirals Address drug interac0ons (e.g., hormonal contracep0ves) Monitor for adverse events (hypersensi0vity, hypotension, hepa00s) Should not be used for: Pregnant women HIV infected on an0retrovirals Presumed INH or RIF resistance