Reflections on the 47th IDSA Meeting

The 47th Annual Meeting of the Infectious Diseases Society of America concluded on Sunday, November 1, 2009. It was held in the friendly confines of the Pennsylvania Convention Center in Philadelphia, a setting much more "user-friendly" than the enormous and seemingly endless Washington Convention Center in which the joint ICAAC-IDSA meeting was held last year. By all measures, this seemed to be highly successful meeting. Kudos to IDSA President Anne Gershon, MD; the Planning Committee, chaired by Paul Auwaerter, MD; and the IDSA staff for a job well done.

The meeting seemed well attended; there were almost 5,800 registrants, although this figure was not broken down as to the number of members and guests. Again, it was a much more "user-friendly" number of attendees, in contrast to the almost 15,000 people that attended the joint meeting last year. I heard absolutely no one express a desire to have another joint IDSA-ICAAC meeting.

All the foregoing notwithstanding, the whole meeting felt seemingly somewhat muted and subdued, though I know not exactly why. Even the pharmaceutical exhibits seemed a bit subdued, not so much in number but certainly in content. This was especially evident in contrast to the garish pharmaceutical displays at the joint meeting last year.

I’m not aware whether the total pharmaceutical contributions to supporting the meeting were down this year or not. Is this perhaps a reflection of the increasing concern about support of continuing medical education by the pharmaceutical industry? That’s an issue that will be increasingly problematic for the IDSA as well as other subspecialty societies in the future. More of that another time.

Dr. Volberding’s documentary

Easily the high point of the meeting occurred in the morning of October 31, in the context of the Kass Lecturship. The lecturer, Paul Volberding, MD, chose to prepare not a scientific lecture in the usual sense, but rather to create an historical documentary. This, incidentally, was well within the historical interests of Dr. Ed Kass, who himself wrote several historical works, including, among others, a treatise on Thomas Hodgkin and a 25-year history of the IDSA.

In 1981, Dr. Volberding was a beginning assistant professor of oncology at the University of California, San Francisco. Paul, together with Merle Sande, lived the early years of the HIV/AIDS pandemic there, studied the opportunistic infections and the tumors that these patents developed and helped study and defined the medications that sustained them at least for a time — until the development of HAART.

Many of the early voices of that era already have been lost. For us as the IDSA, Merle Sande has been lost as well, though that had nothing to do with the HIV virus. Paul reasoned that it was high time to record those voices that remained to create a documentary that would capture the suffering, the anguish and the small triumphs of those early years from 1981 to 1995. It was entitled "Life Before the Lifeboat."

When the film ended some 40 minutes later, the audience rose to their feet in sustained applause — perhaps not as much for Paul and the film’s creators as for the people and their lives that were so vividly represented in the film. I’m sure there was scarcely a dry eye in the house. It was the most emotional moment I can remember at an IDSA meeting.

N-95 masks

On another topic — more on N-95 respirators and protection of health care workers against transmission of influenza: Updated recommendations were finally released by CDC on October 14, buried in a larger document on infection control measures for 2009 H1N1 influenza in health care settings. The larger document outlines a variety of controls (much like the controls on tuberculosis transmission) including eliminating sources of infection, engineering controls, administrative controls and, finally at the very end, personal protective equipment. The recommendations for respiratory protection for health care personnel have changed but little. N-95 respirators are still recommended as the respiratory protection of first choice. Considerably more latitude, however, was allowed hospitals under circumstances when N-95 respirators were in short supply or simply unavailable. Perhaps this will forestall OSHA citing hospitals who were unable to provide N-95 masks to their personnel (as happened to one hospital in New York during a May 2009 outbreak).

Many (I among them) suspect that CDC was subject to enormous pressures from hospital worker unions, consumer groups, and possible other government agencies in remaining fixed on N-95 respirators as the respiratory protection of choice. Already there are reports of legal action being taken against some hospitals by unionized employee groups for failure to provide the recommended level of respiratory protection to their patient care personnel. Still, it’s sad to realize that CDC can no longer be considered an unfailing source of pure science-based recommendations.

Near the end of the IDSA meeting, in a truly astonishing development, the authors of the Australian study on N-95 masks widely covered at ICAAC, and on which I commented last month, announced that a re-analysis of their data now revealed there was not a significant difference between N-95 and surgical masks. Where lies the truth must remain unknown for now. (See page 21 of this issue of Infectious Disease News for more on this analysis.)

It will be interesting to see how the recommendations for health care personnel change – if at all – for seasonal influenza.

2010 IDSA

Next year’s IDSA meeting will be held in Vancouver, B.C. – one of the world’s most beautiful cities. The challenge will be to keep the attendees in the meetings!