NEWS IN INFECTIOUS DISEASES
The opioid epidemic and rates of infective endocarditis
In the United States, rates of infective endocarditis (IE) associated with injection drug use (IDU) are rising in the context of the opioid epidemic. Between 2007 and 2017 in North Carolina, hospitalizations for IDU-associated IE increased approximately 12-fold, from 0.92 to 10.95 per 100,000. There were more than 2600 hospitalizations, with a steady increase in surgery for IDU-associated IE over time. In the final year of the study, 42 percent of IE valve surgeries were performed in patients with IDU-associated IE, who were younger, more commonly female, and more commonly white compared with other surgical patients with IE. The opioid epidemic is reshaping the epidemiology of IDU-associated IE and the health care resources required for effective management.
Schranz AJ, Fleischauer A, Chu VH, Wu LT, Rosen DL. Trends in Drug
Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data. Ann Intern Med. 2018 Dec 4.
Durability of protection following fractional dosing of yellow fever vaccine
In the setting of a yellow fever outbreak, fractional dosing is a strategy for extending vaccine supply; however, the durability of vaccine protection with this approach is unknown. In a follow-up analysis of a randomized trial that included 75 adults who had received primary vaccination with 17D yellow fever vaccine, the number of participants with protective levels of yellow fever-neutralizing antibodies after ten years was comparable to a 0.1 mL fractional dose and a standard 0.5 mL dose (98 versus 97 percent). A limitation of these findings is that less than half of participants from the original trial participated in the study. Nonetheless, these data could inform use of fractional dosing in preventive vaccination campaigns, beyond outbreak settings.
Roukens AHE, van Halem K, de Visser AW, Visser LG. Long-Term Protection After Fractional-Dose Yellow Fever Vaccination: Follow-up Study of a Randomized,Controlled, Noninferiority Trial. Ann Intern Med. 2018 Dec 4;169(11):761-765.
UpToDate, December, 2018.
