The International Conference on Emerging Infectious Diseases (ICEID) was held in Atlanta at the end of August and Jackie Lawler, an epidemiologist at the Orange County Health Department in New York and a member of NACCHO’s Infectious Disease Prevention and Control Workgroup, attended as the NACCHO partner representative on the ICEID 2015 Scientific Program Committee. She has been on the committee since last May, and they were able to suggest topics for presentation at the conference, including antimicrobial resistance, reemergence of vaccine preventable diseases, vaccine hesitancy, the global security agenda, advanced molecular techniques, and the impact of culture-independent diagnostics on public health functions. All of these topics were addressed in one form or another throughout the conference. Ms. Lawler also moderated two sessions. The first was on culture-independent diagnostics and their impact on public health functions and the second session she moderated was titled “Current Issues in STDs.” In the following interview, Ms. Lawler shares important takeaways for local health departments from this conference.
Q: What were the major topics covered in the Culture-Independent Diagnostics session?
A: The speakers addressed some of the challenges in this area for public health, including strain tracking, susceptibility data availability, maintaining isolate-based surveillance, case counting, and case definition modification. They also discussed the value of culture-independent diagnostic tests, such as reducing turn-around time, potentially leading to reduced length of stay in hospitals, and also the ability to reduce transmission if a patient can be diagnosed before leaving the care setting.
While it seemed like the speakers presented more barriers to use than opportunities, it was clear that they all felt that microbiology will undergo radical change in the next 5 years and that those of us in public health will need to adapt by doing more sentinel surveillance, using new technology, and using a sequenced-based approach.
The most interesting take-away for me was that this season the first influenza A & B point of care molecular test will be utilized. It is CLIA approved and more sensitive than the rapid test. This should be an interesting trial for what we might see for clinical diagnostics in the future.
Q: What were the major topics covered in the Current Issues in STDs session?
A: All three speakers discussed the MSM population with respect to resistance of gonococcal infection, the resurgence of syphilis among this particular population, and pre-exposure prophylaxis for HIV. Robert Kirkcaldy from the CDC discussed the Gonococcal Isolate Surveillance Project, which has monitored the susceptibility of Neisseria gonorrhoeae to various antibiotics since 1986. The major revelation from the talk was that they are starting to see some azithromycin resistant strains. Fortunately, the strains that were resistant to azithromycin were still susceptible to cephalosporin and vice versa, which supports the argument for dual therapy.
The second speaker, Khalil Ghanem from the Johns Hopkins University School of Medicine, discussed the reemergence of syphilis and noted that the highest burden is among African American men and MSM. He did emphasize that the most effective methods to control cases are things that all local health departments do: case finding and partner notification. He noted that three month screenings among highly active MSM is extremely cost effective and has a very high yield in terms of identification of partners and other cases. One study even estimated that we could eliminate syphilis by doing this screening with even a subset of this population He emphasized that the place where most of these “high value” individuals were being identified was at STD clinics and not at primary care physician’s offices, emphasizing the importance of local health department clinics.
The final speaker, Mark Thrun, gave a talk that emphasized how effective pre-exposure prophylaxis can be to prevent HIV infection, especially in males when the doses are taken appropriately. He gave an overview of the current studies and concluded that we should probably focus on the MSM population to get the biggest bang for our buck.
Q: What was the most entertaining talk you attended?
A: Dr. Ian Lipkin’s discussion of Infectious Disease in Popular Culture was the most entertaining because most of his talk was clips from movies depicting catastrophic infectious disease disasters. He was the consultant for the movie Contagion and he briefly talked about what it was like to work on a movie to make it as realistic and accurate as possible.
My personal favorite moment was during a plenary session on the reemergence of vaccine preventable diseases. Dr. Walter Orenstein spoke about recent outbreaks of pertussis, measles, and mumps and spoke about a 2009 outbreak of mumps in Orange County, even using data from the third MMR outbreak response to talk about possible control methods. It was a pleasant surprise to see my team’s work on a local level being shown at a conference with such a wide audience and a reminder of the local impact of such events.
Q: How would you describe your overall experience at ICEID?
A: I do feel that overall from each session I attended, there was something I could take home and use on a local level – whether that be just information that the chikungunya season will probably start late this year due to the early drought, working on communicating communicable infectious disease risks to the media, or actual strategies to tackle vaccine hesitancy.
To learn more about ICEID, visit http://www.iceid.org/.