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O c t o b e r 1 5 , 2 0 0 6 • w w w. i n t e r n a l m e d i c i n e n e w s .

c o m News 9

CDC Recommends Routine HIV Hand Washing

Screening Regardless of Patient Risk Dispensers Can
BY ROBERT FINN clinics, community clinics, correctional 1991 to fewer than 240 per year today.
Spread Bacteria
San Francisco Bureau health care facilities, and primary care In an effort to decrease that number BY BRUCE JANCIN
settings. further, the CDC is recommending that Denver Bureau

he Centers for Disease Control The new recommendations do not ap- repeat HIV testing be provided in the
and Prevention has recommend- ply to nonclinical settings, such as com- third trimester for all women in areas L I S B O N — The dispensers of alcohol-
ed that voluntary HIV screening munity centers or outreach programs. with high HIV prevalence, not just for based disinfectant for hand washing that are
be a routine part of medical care for all Earlier recommendations, published in women at high risk for HIV. Further- ubiquitous in hospitals and physicians’ of-
patients between the ages of 13 and 64 1993 and 2001, called for HIV testing in more, a rapid HIV test should be used fices are often contaminated with bacteria,
years. patients with known risk factors or in during labor for all women whose HIV including potential pathogens, Dr. Kiran
The recommendations are intended communities with HIV prevalence rates status remains unknown at the time of Mangalpally cautioned at the 12th Inter-
to simplify the HIV testing process in above 1%. But many facilities do not delivery. national Congress on Infectious Diseases.
health care settings and to increase HIV have information on local HIV preva- The CDC expects health care facilities He cultured the push bars of 44 such
diagnosis among an estimated 250,000 lence, and many providers report that to begin phasing in routine testing im- dispensers at Mount Vernon (N.Y.) Hos-
Americans who are HIV positive but re- they do not have time to conduct risk as- mediately, but the agency plans to issue pital, where he is a resident in internal
main unaware of their infection. sessments. additional guidance for health care medicine. Of the 44 dispensers, 35 (80%),
“There are some things that never Requirements for separate written con- providers in early 2007 that will provide proved culture positive. The push bars are
should happen,” Dr. Julie L. Gerberding, examples of model approaches and prac- activated by pressure applied by the palm
the CDC’s director, said during a press tical tools for implementation in various or fingers, which releases a squirt of hand
briefing. “No child in the United States ‘No person in the types of health care settings. rinse or foam. But the disinfectant does
should be HIV infected from birth. No United States It’s expected that most patients would not reach the push bar itself.
person in the United States should [lack] should [lack] be screened a single time but that patients The testing showed that 29 of the push
access to treatment or diagnosis. And ul- access to with known risk factors would be bars grew coagulase-negative staphylo-
timately no person in the United States treatment or screened annually. cocci and 4 grew Staphylococcus aureus, in-
should acquire HIV infection.” diagnosis.’ The CDC has made no recommenda- cluding 2 that yielded methicillin-resistant
Studies show that almost 40% of indi- tion as to the type of test that should be S. aureus. Another two push bars grew
viduals diagnosed with HIV receive that DR. GERBERDING performed. Both the enzyme-linked im- nonstaphylococcal bacteria.
diagnosis within a year of the infection munosorbent assay and the rapid HIV For comparison, Dr. Mangalpally also
progressing to AIDS, and presumably sent for HIV testing and for pretest coun- test would be acceptable, for example. cultured 11 doorknobs from hospital bath-
about 10 years after they were initially in- seling also placed barriers in the path of “Depending on the nature of the test, rooms, and found that 9 were culture pos-
fected. Often, this is too late for them to testing. we anticipate that in general, an HIV-neg- itive; all of those grew only coagulase-neg-
fully benefit from treatment. The new recommendations mandate a ative test would cost in the range $8,” Dr. ative staphylococci.
Furthermore, it is estimated that peo- voluntary “opt-out” approach, in which Bernard Branson said at the briefing. “This is one of those simple things we
ple who are unaware of their infection ac- patients would be specifically informed “Because you have to do confirmation don’t think about much,” the physician
count for 50%-70% of new sexually trans- that HIV testing is part of routine care. and longer counseling for the [much noted in an interview at the congress
mitted HIV infections. People who are All patients would be screened regardless smaller] number of people who will test sponsored by the International Society for
aware of their HIV infections typically of risk, pretest counseling would not be positive, the cost can be as high as $80.” Infectious Diseases.
take steps to protect their partners. required, and posttest counseling would Dr. Branson, who is associate director Alternatives to push bar–operated dis-
The recommendations, slated for pub- generally be required only for patients for Laboratory Diagnostics at the CDC’s pensers that would reduce the potential
lication in the Sept. 22, 2006 issue of the with a positive test result. Division of HIV/AIDS Prevention, said for infection are touch-free dispensers op-
CDC’s Morbidity and Mortality Weekly Also included are recommendations that many published cost-effectiveness erated by foot pump, electronic sensor, or
Report, are intended for any health care aimed at enhanced screening of preg- studies suggest that the cost of HIV voice activation technology. These devices
facility in the public or private sector that nant women. Existing recommenda- screening is comparable with other com- are commercially available, he noted.
currently conducts diagnostic testing or tions for screening in this population mon health screenings, such as those for Dr. Mangalpally said he has shared his
screening. These facilities include hospi- have been remarkably successful in pre- breast cancer and hypertension. study findings with hospital administrators
tal emergency departments, urgent care venting mother-to-child HIV transmis- These studies suggest that routine but is unsure if they will switch to the
clinics, inpatient services, substance sion: The number of infants born with screening would cost about $15,000 per hands-free technology, which is more cost-
abuse treatment clinics, public health HIV has declined from about 1,650 in quality-adjusted life year. ■ ly than what is currently being used. ■

Flu Vaccine to Be Shipped Earlier Adacel Shortage Called Temporary;

And in Greater Amounts This Year Boostrix Supply Still Adequate
M akers of influenza vaccine will pro-
duce and distribute 100 million dos-
es of the agent by early January—more
month or so, but people will have plenty
of opportunities to be vaccinated during
October and November, as well as De- A temporary shortage in the supply
of Adacel—the tetanus-diphtheria-
The supply shortage of Adacel is ex-
pected to be resolved by the end of
than ever before and nearly 25% more cember or later,” he noted. pertussis vaccine marketed by Sanofi- 2006, said Susan Watkins, a spokesper-
than were shipped last year—with most Vaccine manufacturers shipped just over Pasteur—is expected to last until the son for Sanofi-Pasteur. A new vaccine
doses to arrive in October and November, 81 million doses of vaccine last year, only end of the year. production facility in Toronto that will
according to the Centers for Disease Con- 15 million of which had arrived by the end Boostrix, the Tdap booster vaccine provide a sevenfold increase of the sup-
trol and Prevention. of last October, according to vaccine man- that is manufactured by GlaxoSmith- ply of vaccines with pertussis compo-
Shipments already have begun, and all ufacturers. This year, however, around 75 Kline, is in good supply, according to nents was approved by the Food and
providers who have ordered vaccine will million are expected to have arrived by the Centers for Disease Control and Drug Administration in late August. It
receive at least some doses by the end of that time. Prevention. has already started to manufacture the
October, the CDC said in a statement. The CDC and the Food and Drug Ad- Adacel (Tetanus Toxoid, Reduced DTaP vaccine Daptacel, and will begin
“When and how much vaccine each ministration have been working with vac- Diphtheria Toxoid and Acellular Per- producing Adacel next, she said.
health care provider or clinic receives de- cine makers to prevent a shortage of vac- tussis Vaccine Adsorbed) is indicated as —Elizabeth Mechcatie
pends on [whom] they ordered from and cine. According to the CDC, influenza a booster for adolescents and adults
when they ordered,” cautioned Dr. Lance incidence was low from October through aged 11-64 years, while Boostrix is indi- Updates on the Adacel shortage will be
Rodewald, director of the agency’s im- early January last year but increased sig- cated for adolescents aged 10-18 years. provided on the CDC Web site at
munization services division. “We expect nificantly in February and peaked in ear- For information about Adacel availabil-
that some ... may get or have more in- ly March. ity, call Sanofi-Pasteur at 800-VACCINE. default.htm.
fluenza vaccine than others in the first —John R. Bell