Happy New Year

With a decade gone, I can't help feeling a bit nostalgic. I completed my training, got married, had a baby girl, adopted two cats and lived in three states. I've lost loved ones, made a lot of new friends and said goodbye to many others.

To all of that, cheers.

But while cleaning the ID desktop for 2010, it would be worthwhile to point out a couple of things and leave some questions in the air:

Universal healthcare — perhaps no other action will have consequences so profound for the way medical care is rendered in this country. Will it pass?
The swine flu pandemic — as we were bracing for the H5N1 avian influenza, a triple reassortant emerged to cause the first pandemic of the millennium. And we saw an abundance of influenza activity during May and June. What will happen next? What if the neuraminidase inhibitors become useless? It took eight months to have a monovalent vaccine developed, tested and on the shelves, but we are still 60,000,000 shy of the 160 million doses recommended to target the at-risk groups. What can we learn from all of this?
There's not a whole lot in the antimicrobial pipeline. We had a blast with new antifungals, but we're still determining the optimal dosing for our preemies. A fifth generation cephalosporin (ceftobiprole) and new lypoglycopeptides (such as telavancin) are being studied to treat MRSA infections, but it seems that it is going to be a while before we can use these in children. We continue to debate how best to use vancomycin, while others alert that "heteroresistant" populations may emerge during therapy and cause clinical failures.
On the vaccine horizon…
- When will we move to version 3.0 of pneumococcal vaccines? Invasive pneumococcal disease remains at historical low rates, but some serotypes like 19A are surfacing as trouble-makers.
- In 2010 will we have a trivalent or a quadrivalent flu vaccine? More importantly, are we ready for tissue-culture based vaccine manufacturing? Any promise with influenza vaccines against conserved epitopes?
- Another year without a respiratory syncytial virus vaccine, and the American Academy of Pediatric’s Committee on Infectious Diseases has recently trimmed both the number of doses and the target population for palivizumab on a cost-benefit basis. Will motabizumab, which is 40 times more potent against RSV than palivizumab in vitro, translate into clinical benefits and reduce the burden of RSV among high-risk patients?
- Looks like we continue to move forward with vaccines for malaria and HIV, but how far we are from immunizing to prevent these voracious killers?
Interferon-gamma assays (cool and trendy) will soon replace the tuberculin skin test (uncool and old-fashioned).
Water in airplanes will be safer for passengers and the crew. After 15% of 327 tested airplanes had water with more coliforms than you should be comfortable fighting, the Environmental Protection Agency has passed new standards. Now, the five-billion dollar cost implies that you either won't get the peanuts, or that you will have to spend a quarter to use the restroom. Shame on all of you who drink airplane tap water!
We have a new 2009 Red Book with a new font size! I hope the 2012 edition will not be printed in Garamond 8. What are we waiting for? Bible paper pages and bibliographic references?
The iDoc is envisioned to facilitate our job as physicians. Wait… 2039 is still far away.
No better place to advertise this great subspecialty than on the TV! I suggest the following topics for Mike Rowe, the host from Dirty Jobs:
- Fecal transplantation for recurrent C. difficile colitis.
- New tampons with glycerol monolaurate that inhibit staphlyococcal toxin synthesis.
- And the award-winner, "Recovery of Campylobacter jejuni in feces and semen of caged broiler breeder roosters following three routes of inoculation.”

Happy New Year and best of luck in 2010!