The Top 10 of 2009

Early in the life of Infectious Disease News, we (the editorial board and I) started voting to identify the top ten infectious disease news stories in the year just finishing. These were not necessarily the top scientific advancements, although there were some of those, but rather the most newsworthy infectious disease stories of the year. So once again, we present the top ten infectious disease news stories for the year.

There was universal agreement that the influenza A (H1N1) pandemic was the top news story of the year. The rest of the list follows in no particular order:

2. Health care reform becomes a priority.

3. An investigational HIV vaccine studied in Thailand shows some protective efficacy.

4. Controversy surrounds the recommendation for use of N-95 respirators for respiratory protection against influenza and a study that supported it.

5.Court panel finds no association between vaccines and autism.

6. IDSA panel reviews 2006 Lyme disease treatment guidelines.

7. IDSA updates its guidelines for management of intravascular infections.

8. Global AIDS medication coverage increases 10-fold over 5 years.

9. U.S. lifts ban on HIV-positive persons entering the country.

10. ACIP recommends HPV bivalent HPV vaccine for 10-25 year old females.

Space will permit me to comment on some, but certainly not all of these topics.

Influenza A (H1N1)

So much has been written already about the H1N1 pandemic that there would seem to be little more to say — but yet there is. So much so, in fact, that it will still be a topic in this space next year. Ironically, the supply of H1N1 pandemic vaccine is finally becoming more plentiful, just as the fall wave of the pandemic appears to be subsiding. Curiously, the people who were clamoring for a vaccine last May and June, as the first wave was peaking, are now staying away in droves, fearful that the vaccine was not “adequately tested”. The most interesting question at this time is addressed in the “two views” dialogue between Don Kaye and I that appears on page 13 of this issue. Will there be a winter/spring wave of influenza and if so, which virus will cause it? We’ll know the answer soon enough!

Health care reform

We’ll not know the answer anytime soon to the health care reform debates going on in the U.S. Congress. The chances of passing a bill and having it on the President’s desk before Christmas seem – at this writing in early December – to be vanishingly small. And yet health care, not social security, is by far the largest financial challenge facing the United States; if it is not resolved this year or next, no one is likely to tackle it again for probably several decades. Nor is it clear – at least to me – whether any of the House or Senate bills contain a serious effort to control costs.

HIV/AIDS vaccine

Although it had been published earlier online in the New England Journal of Medicine, the Thai HIV vaccine trial was actually just published in that journal in the December 3, 2009 issue. Presentation of that study at an HIV meeting was accompanied by a great deal of fanfare in the public media. Now that the results have been published in a peer-reviewed journal, the protective effect is seen to be quite modest. It does, however, as pointed out in an accompanying editorial, identify some directions for further research. More will appear in this space next year on this study.

N-95 masks

The controversy about N-95 respirators versus surgical masks for health care worker protection against influenza seems actually to be subsiding somewhat – for at least two reasons. First, the fall pandemic wave seems to be subsiding in this and other countries; and second, and probably more important, many states including my own have moved on and issued their own guidance favoring surgical masks except under circumstances of potential aerosol exposure, thus rendering that part of the CDC recommendations essentially irrelevant. There are rumors that the decision to retain the CDC recommendation for N-95 masks was actually made above the level of the CDC Director. That is rumor, and not fact; but it is not being denied, either.

News of the retraction or reinterpretation of the Australian study showing lack of effectiveness of surgical masks, originally presented at ICAAC in September, has already been covered in these pages. It would seem that there is nothing further to be said until the study appears in a journal.

Vaccine Court

The so-called Vaccine Court, established under the provisions of the Vaccine Injury Compensation Act, finally ruled in a series of cases earlier this year that there was no association between administration of certain vaccines, specifically MMR, and the development of autism. While this may seem to be of little significance for adult infectious disease specialists, it is actually a huge victory of science over irrational fear, anti-science and the whole anti-vaccine community. However, it is no time to rest on our laurels, for I believe there is one more set of alleged autism cases to be brought before the court.

IDSA guidelines

Most readers, I believe, are familiar with the actions of the Connecticut attorney general against the IDSA and the need to establish a second panel to review the findings of the panel that issued the 2006 Lyme Disease guidelines. A report was promised by the end of 2009, but as of this writing it is not yet available. As soon as it is released, we will certainly wish to comment further.

The new IDSA guidelines on the management of intravascular catheter-related infections are a major improvement over the previous guideline published in 2001. In addition to being expanded and more thorough, there are several new sections, and perhaps most important, the guidelines are much more user-friendly. It is not a document everyone will wish to read from beginning to end; rather, it is one to keep handy so one can find the desired recommendations quickly and easily.

HIV travel ban

Finally, lifting the ban on U.S. entry of HIV-positive persons is already having a salutary effect; the 2012 International AIDS Conference will be held in Washington, D.C., the first time this conference has been held in the United States in more than 20 years.

This is another triumph of science over irrational fear.

All in all, 2009 was a very exciting year in infectious disease; but then, that’s why many of us went into this discipline.