Ebola Outbreak and Enterovirus in the Limelight at IDWeek

Daniel M. Keller, PhD

October 06, 2014

PHILADELPHIA — With the first case of Ebola diagnosed in the United States and an outbreak of enterovirus D68 making headlines, IDWeek 2014 could not be more timely. The program planning committees for the infectious disease conference — which runs from October 8 to 12 here at the Pennsylvania Convention Center — have reacted swiftly to address concerns in the infectious disease world.

Sessions on Ebola, Middle East respiratory syndrome (MERS), and the Chikungunya virus have been added to the program, said Larry Pickering, MD, from the Infectious Diseases Society of America, who is IDWeek program chair.

"There's going to be a 30-minute session on Ebola immediately after the opening festivities," Dr. Pickering told Medscape Medical News.

Bruce Ribner, MD, the infectious disease physician at Emory Healthcare in Atlanta, will talk about his experience caring for and successfully treating the 2 patients brought from Africa.

Additional sessions on Ebola and other emerging outbreaks will take place the same afternoon. Robert Fowler, MD, has been working in Africa and will hopefully be back to talk about his international experience and his on-the-ground activities, said Dr. Pickering. Then Inger Damon, MD, from the Centers for Disease Control and Prevention (CDC), will talk about what is being done to curtail the Ebola outbreak in both Africa and the United States.

Dr. Damon will be followed by Harold Margolis, MD, head of the CDC Dengue Branch in San Juan, Puerto Rico, who will talk about the "immense Dengue outbreak." And Lyle Peterson, MD, from the CDC in Fort Collins, Colorado, will discuss the current status and future prospects of the Chikungunya outbreak in the Americas.

"Chikungunya is a pretty significant disease if you get it, and very common internationally, but now we're starting to see it in this country," Dr. Pickering said.

We're only a plane ride away from some pretty severe diseases.

A MERS–coronavirus session will focus on the second year of the virus. Although not as big a problem as it was, "it's still out there," he said. Four talks will give the worldwide perspective, review the response to the first cases in the United States, discuss risk factors for transmission in healthcare settings, and address animal models of the disease, therapeutics, and vaccines.

"We're only a plane ride away from some pretty severe diseases," said Dr. Pickering.

Another addition to the program is a short plenary session on the recent pediatric enterovirus D68 outbreak in the United States. A second enterovirus add-on session (not yet listed in the meeting program) will feature clinicians from Children's Hospital Colorado in Aurora.

Pediatric Enterovirus

Ravi Jhaveri, MD, from the Pediatric Infectious Diseases Society, who is vice-chair of the IDWeek program committee, told Medscape Medical News that he expects to hear about neurologic manifestations, including paralysis, from D68.

"Colorado is where the first reports came from, and I've heard there are some reports from Boston as well," he said. "We're definitely seeing it around the country."

In addition, enteroviruses besides D68 are major causes of viral meningitis and other severe illnesses in newborns. Researchers will present results from a multicenter trial of pleconaril in neonates with enterovirus sepsis. The drug was developed for the common cold but was abandoned more than a dozen years ago because of adverse effects. Now there's an attempt to resuscitate it, Dr. Jhaveri reported. "It may be useful and tolerable in cases of severe disease."

Flu is a behemoth and far surpasses any other infection we talk about.

Several oral sessions will be devoted to influenza. "That's always a major draw for people," said Dr. Jhaveri. "When you think about the number of deaths and complications, flu is a behemoth and far surpasses any other infection we talk about."

Three of the presentations will look at previously uncommon strains of influenza that have the potential to cause epidemics because the population has not been exposed to them. The presentations will cover vaccine development, choices of vaccines, and antivirals on the horizon.

Several sessions on HIV will focus on newly approved therapies and new drugs in the pipeline. In addition, a symposium will be dedicated to updates to recent guidelines.

HIV News

Rochelle Walensky, MD, from the HIV Medicine Association, who is program chair for IDWeek and associate professor of medicine at Harvard Medical School in Boston, pointed to an important talk on factors associated with the selection of initial antiretroviral therapy.

She noted that the most recent US Department of Health and Human Services guidelines have seven alternatives for recommended first-line therapy in treatment-naive patients, and even more for those with viral loads below 100,000 copies. "This abstract is particularly timely as we consider how decisions regarding first-line treatment are made," she said.

Another symposium will explore progress toward a cure for HIV. With President Obama's $100 million pledge to fund research into a cure, numerous approaches under investigation, and the frustrating outcomes for the handful of patients who were thought to be cured but who have relapsed, this is a "not-to-miss session," Dr. Walensky said.

She also recommended a symposium on hepatitis C management in patients with HIV, which will provide information on new approaches to noninvasive liver staging, today's new therapies, and treatments in the pipeline. With effective and short-course new treatments, and more to come, "this session offers great opportunities to get up to speed on the latest in and future of hepatitis C," she said.

New Techniques in Epidemiology

Before a problem can be addressed, it must be defined and identified, said Mary Hayden, MD, from the Society for Healthcare Epidemiology of America (SHEA), who is IDWeek program committee chair.

For example, epidemiologists are now gathering regional results on antibiotic resistance. "This is very important because we know that control of antibiotic resistance is much more effective if done regionally than if done in individual hospitals within a region," Dr. Hayden told Medscape Medical News. A presentation by Scott Fridkin, MD, from the CDC, will address this issue, as will one by Alice Guh, MD, also from the CDC, on carbapenem-resistant Gram-negative bacilli.

Another topic of interest is the prevention of healthcare-acquired infections. Rigorous intervention trials are providing more secure evidence on which to base prevention recommendations. Michael Klompas, MD, will present the SHEA Featured Abstract and IDWeek Program Committee Choice Award Winner on the "Wake Up and Breathe Collaborative," a multicenter evaluation trying to prevent ventilator-associated events.

There will also be a state-of-the-art session on Clostridium difficile, a major problem in hospitalized adults. The session will address current diagnosis, treatment, new capsule fecal microbiota transplants, and challenging cases.

As well, the meeting features 2 prominent lectures in epidemiology: the Joseph F. Smadel Lecture by Robert A. Weinstein, MD, from the Cook County Health and Hospital System in Chicago; and the SHEA Lectureship, delivered by Lisa Saiman, MD, on infection prevention and control in pediatrics.

The closing plenary session of IDWeek will focus on molecular diagnostics and the way these techniques are revolutionizing what we understand about infectious diseases. Four high-profile speakers will cover the state of the science, the role of whole-genome sequencing, and next-generation diagnostics to improve public health.

IDWeek Not All Business

With the Pennsylvania Convention Center near the historic district of Philadelphia, convention attendees can visit nearby attractions. The Liberty Bell, Independence National Historical Park, and the National Constitution Center are no more than a 15-minute walk away. Other attractions are the Philadelphia Museum of Art, the Eastern State Penitentiary, the Franklin Institute, the Please Touch Museum, and the Betsy Ross House.

The University of Pennsylvania, its Museum of Archaeology and Anthropology, and Drexel University are also nearby, as is the Monell Chemical Senses Center. A special attraction for anyone interested in healthcare and its history is the Mütter Museum of the College of Physicians of Philadelphia. Its collection includes medical oddities, anatomical and pathological specimens (like an 8-foot megacolon and a skeleton showing ossified soft tissue from fibrodysplasia ossificans progressiva), wax models, and antique medical equipment.

Elfreth's Alley, America's oldest continually inhabited residential street, dating to 1702, is a beautiful small street of brick row houses.

In addition to an abundance of restaurants within easy reach of the convention center, Reading Terminal Market, a thriving public market just across the street, is not to be missed. Lunchtime is an adventure there, with offerings of Pennsylvania Dutch, Indian, Mexican, Asian, Middle Eastern, Greek, Mediterranean, German, deli, and soul foods, as well as hearty breakfasts. And, of course, being in Philadelphia, one can always try a cheese steak sandwich.

Dr. Pickering, Dr. Jhaveri, Dr. Walensky, and Dr. Hayden have disclosed no financial relationships.


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