IDWeek Perspective: What's Happening in Public Health: Public Health Watch

IDWeek 2019 is upon us and, not surprisingly, an oral abstract session entitled “What's New and Happening in Public Health” caught our eye.

The name could (hopefully) be used to describe the subject matter of this column, after all.

The session will be held on Friday, October 4^th, and feature 5 abstracts, many of which are being presented by researchers affiliated with the US Centers for Disease Control and Prevention (CDC). Topics range from an assessment of water-borne diseases in the United States to descriptions of an outbreak of invasive pneumococcal disease (IPD) in Israel and case clusters of invasive group A streptococcus infections in Denver nursing homes. In addition, an abstract will provide an overview of the clinical features of enterovirus A71- vs enterovirus D68-associated acute flaccid myelitis, while another will address “missed clinical opportunities” for infection prevention and substance use disorder treatment among people who inject drugs.

“[Our] project is timely considering the ongoing opioid epidemic,” noted Ghinwa Dumyati, MD, professor, New York Rochester Emerging Infections Program, University of Rochester Medical Center, a co-author of the last abstract. “Most of the focus in the media is on overdose-related deaths, [but] infections such as endocarditis related to opioid injections are responsible for significant morbidity, mortality, and cost.”

Indeed, Contagion® has covered the infectious disease-related collateral damage caused by the opioid crisis here in the United States and chronicled research describing the potential benefits of needle-exchange programs in the prevention of hepatitis C among injection drug users and the HIV and hepatitis case clusters within these populations. According to Dumyati, the goal of the project to be presented in Washington DC on Friday was to “identify modifiable risk behaviors in persons who inject drugs and opportunities to intervene prior to the development of infection.”

She added, “Our present abstract focuses on prior health care contact as an opportunity to prevent infections. We identified several gaps in prevention, such as lack of education on safe injection practices to prevent bacterial infection, during prior emergency room visits or hospitalizations, and [patients not] receiving medication-assisted treatments… for opioid use disorder, especially for those evaluated in emergency rooms.”

Dumyati and her colleagues, including researchers from academic institutions across the country as well as the CDC, published other findings from their project in the July 5^th issue of Morbidity and Mortality Weekly Report.

CDC researchers are also behind the report on water-borne disease prevalence in the US scheduled for the session. At present, estimates of the numbers of Americans sickened by exposure to contaminated water vary widely, ranging from as low as 4 million to as high as 32 million annually, according to the CDC. The agency is striving to get a better handle on disease burden to “provide a better understanding of the top waterborne pathogens driving illness and healthcare costs in the US and… help public health and water representatives focus resources toward developing effective and cost-efficient disease prevention strategies.”

The issue is particularly timely, given ongoing water crises in Flint, Michigan and Newark, New Jersey.

Renewed attention is also being paid to invasive pneumococcal disease, particularly as the efficacy of the PCV13 vaccine continues to be assessed. Researchers from Israel will be describing an outbreak in the country caused by a novel Streptococcus pneumoniae serotype 2 clone.

And, although acute flaccid myelitis remains relatively rare, at least in the United States, the rise in cases caused by enterovirus D68 is cause for concern, given potential differences in clinical presentation.

Finally, with nursing homes being a common site for infectious disease outbreaks, researchers from the CDC and the Colorado Department of Public Health and Environment will be discussing invasive Group A streptococcus infections among resident populations.

Abstracts 1887, “Estimating the Burden of Waterborne Disease in the United States;” 1888, “A Nationwide Outbreak of Invasive Pneumococcal Disease (IPD) Caused by a Novel Streptococcus Pneumoniae Serotype 2 (SP2) Clone in the PCV13 Era, in Israel;” 1889, “Clinical Features Distinguishing Enterovirus A71 and Enterovirus D68-Associated Acute Flaccid Myelitis in Colorado, 2013-2018;” 1890, “Missed Clinical Opportunities to Prevent Infections and Treat Substance Use Disorder (SUD) in People Who Inject Drugs (PWID);” and 1891 “Invasive Group A Streptococcus Infections Among Residents of Multiple Nursing Homes—Denver, Colorado, 2017—2018” will be presented as part of an oral abstract session (#199) entitled “What’s New and Happening in Public Health,” scheduled for Friday, October 4, 2019, at IDWeek 2019 in Washington DC.