VDH Clinician Letter: Meningococcal Disease Outbreak Update, Invasive Group A Strep Infections

Via vdh.gov

Dear Colleague:

I am writing to provide you with important updates on several emerging conditions of public health significance.

Meningococcal Disease Outbreak in Eastern Virginia

The Virginia Department of Health continues to respond to a community outbreak of meningococcal disease in the eastern region of Virginia.  Twelve cases of invasive meningococcal disease (IMD) serogroup Y have been reported since June 2022 in eastern Virginia,  a doubling of cases since VDH notified eastern region providers in September 2022.  Most case-patients have presented with symptoms of IMD meningococcemia, including fever, chills, nausea, and vomiting.  All isolates available for sequencing (9 out of 12) were genetically related and susceptible to ciprofloxacin and penicillin.  VDH has not identified a common risk factor; we suspect the cases are connected by asymptomatic community transmission.  Case-patients are all residents of Hampton Roads and most are Black or African American adults between 30-60 years of age.  Eleven case-patients are unvaccinated for serogroup Y, and one is partially vaccinated.  Three case-patients have died from complications associated with the disease, indicating this outbreak strain may have a higher case fatality rate (25% CFR) than is commonly observed in serogroup Y cases.  This strain is believed to be circulating more widely, both in Virginia and other states.

VDH responds to reports of suspect meningococcal disease by rapidly identifying close contacts for whom short-term antibiotics are recommended for prophylaxis and recommending one dose of the meningococcal conjugate vaccine (MenACWY) to all outbreak-associated close contacts who are identified as high-risk for meningococcal disease.

Healthcare Providers should maintain a high index of suspicion for IMD.  Immediately notify your local health department (LHD) of clinical findings or laboratory results of gram-negative diplococci or Neisseria meningitidis from a normally sterile site. Your LHD can coordinate sending specimens/isolates from newly identified cases to the Division of Consolidated Laboratory Services (DCLS) for serotyping.  Ensure that all individuals who are high-risk for meningococcal disease are up-to-date on the MenACWY vaccine.  Continue to encourage routine administration of the MenACWY vaccine in younger children and adolescents, as required for students enrolled in the 7th and 12th grades.

Increase in Invasive Group A Strep Infections

The Centers for Disease Control and Prevention (CDC) have noted an increase in invasive group A Streptococcus (iGAS) infections in children in the United States.  Although the number of iGAS cases reported in children in Virginia is not above average for this time of year, we are observing increased activity in general.  Group A Streptococcus bacteria can cause a range of illnesses; severe iGAS infections include necrotizing fasciitis and streptococcal toxic shock syndrome and require immediate treatment, including appropriate antibiotic therapy.

VDH responds to reports of suspect iGAS infections by rapidly identifying close contacts for whom short-term antibiotics are recommended for prophylaxis, and urgently investigating clusters of GAS infections, especially in high-risk settings such as among residents of long-term care facilities and school aged children.

Please consider the following actions:

  • Consider iGAS as a possible cause of severe illness, including in children and adults with concomitant viral respiratory infections. Be mindful of potential alternative agents for treating confirmed GAS pharyngitis in children due to the shortage of amoxicillin suspension.
  • Offer prompt vaccination against influenza and varicella to eligible persons. Educate patients, especially those at increased risk, on signs and symptoms of iGAS requiring urgent medical attention, especially necrotizing fasciitis, cellulitis and toxic shock syndrome.
  • Notify your local health department (LHD) as soon as possible about severe iGAS cases affecting minors or clusters of any iGAS infections. All cases of Streptococcal disease, Group A, invasive or toxic shock should be reported within 3 days to VDH.  Laboratories in Virginia are required to submit GAS isolates to DCLS when cultured from a normally sterile site.

Thank you for your attention and partnership.

Sincerely,

Laurie Forlano, DO, MPH
Acting State Epidemiologist and Director
Office of Epidemiology

Colorectal Cancer Screening: 4 Steps for Success in Your Practice

By Arthur J. Vayer, Jr., MD, FACS
Woodbridge, Va

Are you talking to your patients about colorectal cancer screening? Colorectal Cancer Awareness Month is an important time for conversations with your patients about the disease, including screening and prevention — because your patients are more likely to have seen, heard, or read information about it right now. It’s also the perfect time to assess how your own practice is doing with patient screenings, because you know screening is the secret weapon in the fight against cancer.

Setting up your practice for colorectal cancer screening success is as easy as following 4 steps recommended in a guide by the National Colorectal Cancer Roundtable (NCCRT), which was co-funded by the American Cancer Society and the Centers for Disease Control and Prevention. We’ve summarized the guide for you below.

#1 Make the Recommendation for a Colorectal Cancer Screening

Are you consistently recommending screenings? According to the guide, the primary reason patients don’t get screened is their doctor didn’t make the recommendation. You can see how this makes communication with your patients critical. Create the messages you and your staff will use to discuss colorectal cancer screening with your patients, which take into consideration their risk status, individual preferences, and insurance coverage. Determine how you will overcome objections relative to their receptivity to screening. Consider how you will present screening options. The guide offers several helpful tools for your practice about screening options and patient readiness, although be advised it does not reflect the new 2018 American Cancer Society guideline for colorectal cancer.

#2 Develop a Colorectal Cancer Screening Policy

Create an action plan for colorectal cancer screening, engaging your staff in its development as well as its execution. Inputs for the plan should include national screening guidelines (which you can find on the colorectal cancer screening guidelines for healthcare professionals page of the American Cancer Society website), the realities of your practice, patient history and risk level, patient preferences and insurance coverage, and local medical resources. Patient education and communication tools are essential to this action plan. Both the NCCRT site and the American Cancer Society page have links to tools for your practice as well as patient education materials you can download.

#3 Be Persistent with Reminders

You procrastinate, get busy, get distracted, and push things to the back burner. And so do your patients. Delays go up especially if the task is something someone doesn’t really want to do — and getting screened for colorectal cancer certainly fits that bill. Develop a system for taking action that includes how and when your office will follow up with patients, like with secure phone calls, letters, and electronic communications they have access to. Beyond tracking whether a screening was done, create a follow-up for all positives as well.

#4 Measure Practice Progress

If you’re not measuring it, you’re not effectively monitoring it; so says common business wisdom. Measure your practice’s progress so you can adjust your plans and policies to increase screening rates among your patients. Ask staff for their feedback to discover opportunities for improvement.

Despite colorectal cancer being the fourth most common cancer and the fourth leading cause of cancer-related deaths in the U.S., only about 70 percent of adults ages 50 to 75 are up to date with their screenings. Physicians are mission-critical to impacting improvement in screening rates, which hopefully will impact treatment success rates as well. Diagnosing your practice for colorectal cancer screening success is imperative if you want to be part of the solution.

Dr. Vayer specializes in surgery with a focus on Colon & Rectal Surgery and has over 20 years of general surgery experience.

The information contained in this blog is for educational purposes only and does not constitute health care advice.

New Resources from the AMA: Webinars, Events, Reports, and More

The following are resources from the American Medical Association’s (AMA) Professional Satisfaction and Practice Sustainability unit.

Podcasts

No One Left Behind: Expanded Peer Support and Second Victim Syndrome

Dr. Alicia Pilarski, Associate Professor of Emergency Medicine, Associate Chief Medical Officer, and Medical Director of the Supporting Our Staff (SOS) Peer Support Program for Froedtert Hospital & Medical College of Wisconsin, shares her experience building an expanded peer support program for the entire health care team. Listen on Apple Podcasts or Spotify.

Reframing Compassion Fatigue: Compassion as a Tool for Combating Burnout

Dr. Rola Hallam, British-Syrian consultant anesthetist, humanitarian and founder of CanDo, a social enterprise that enables local, frontline health care workers to provide health care to their own war-affected communities, shares the story of her “valley of darkness” and how compassion can be a tool to combat burnout. Listen on Apple Podcasts or Spotify

Private Practice Simple Solutions Learning Sessions

Support Staff Recruitment

This eight-week session focuses on recruiting and retaining support staff for your private practice. Session one available on demand, Session 2 launches March 28. Register now.

Team-Based Care

Using the AMA STEPS Forward® Team-Based Care Toolkit as a guide, this eight week session covers topics such as pre-visit planning, expanded rooming and discharge, team documentation, prescription management, and EHR in-basket management. Launches April 4, 2023. Register Now.

Webinars

Supporting Private Practices: AMA & Medline University | Tuesday, March 7 | 10:15 a.m. CT

Learn how to use the AMA STEPS Forward® Private Practice Playbook to your advantage in this open access webinar designed to help physicians streamline employee training in their private practices. Register Now

Exploring Physician-led Innovation through Entrepreneurship and Intrapreneurship | Thursday, March 16 | 11 a.m. CT

Hear a live panel of physician entrepreneurs and intrapreneurs discuss their journey towards building the future of health. Presented by the Future of Health Immersion Program and AMA STEPS Forward® Innovation Academy. Register Now

Actionable Insights: Key Steps to Engaging Patients in Psychosocial Interventions | Thursday, March 23 | 10 a.m. CT

Experts will discuss the spectrum of brief psychosocial interventions along with how best to use them to help address behavioral health needs for both adult and pediatric patient populations. Presented by the BHI Collaborative and AMA STEPS Forward® Innovation Academy. Register now

Publications

High cost of broken relationships

This BMJ Quality & Safety editorial co-authored by Dr. Christine A. Sinsky, AMA Vice President of Professional Satisfaction, offers recommendations on how to decrease the high costs of physician turnover by prioritizing relationships and reducing burnout.

Funding Research on Health Workforce Well-being to Optimize the Work Environment

This JAMA Viewpoint article co-authored by Dr. Christine A. Sinsky, AMA Vice President of Professional Satisfaction, outlines the importance of federal funding to support research on system interventions that promote clinician well-being.

Reports

2022 Telehealth Impact Report (pdf)

This newly updated report offers a thorough overview of AMA’s efforts to aggressively expand digital medicine advocacy, research, and resources to better understand the specific needs around telehealth and digitally enabled care.

Events

The American Conference on Physician Health: Call for Abstracts

Last chance to submit an abstract for ACPH 2023! Especially interested in showcasing research focused on the connection between health information technology and physician well-being. Deadline is March 15.

The American Conference on Physician Health: Sponsors & Exhibitors

Show your dedication to prioritizing physician health by becoming an ACPH 2023 Exhibitor and/or Sponsor! Learn more at the ACPH 2023 Sponsors & Exhibitors website.

Virginia State Loan Repayment Program Accepting Applications through March 31

In an effort to attract health care professionals to underserved areas to improve and increase access to quality health care practitioners, the Virginia Department of Health is now accepting applications for the Virginia State Loan Repayment Program.

Applicants are sought for Primary Care Practitioners, Mental Health Practitioners, and Dental Health Practitioners in a HPSA in Virginia to serve at least two years. Additional funds are available for those who live and work in the Tobacco Region.

The application deadline is March 31st, 2022.

More details and application submission available here. Questions can be directed to [email protected] or call 804-864-7431.

Medicaid Unwinding Summit: Reserve Your Space

Wednesday, March 8, 2023
9:30 am – 12:00 pm
Greater Richmond Convention Center

Recent federal guidance has ended the protections put into place in March of 2020, preventing Medicaid members from losing coverage in the program due to changes.

With those requirements coming to an end, the Department of Medical Assistance Services (DMAS) and the Department of Social Services (DSS) are preparing to resume normal Medicaid operations in March of 2023. Over the course of 12 months, redeterminations for ongoing Medicaid eligibility will be initiated for all 2.2 million Virginians enrolled in Medicaid.

To learn more, attend the Medicaid Unwinding Summit at the Greater Richmond Convention Center on March 8th. Click here to RSVP.

Freedom Virginia: Honoring our Black Healthcare Heroes

To honor the tremendous contributions of the Black healthcare heroes in the Commonwealth, join Freedom Virginia’s celebration on February 25 at 4 PM at the Hope Center in Roanoke, Virginia.

The event will honor Burrell Memorial Hospital, Henrietta Lacks, Dr. Finn Victor, Miriam Smith, RN, Dr. Walter Claytor, and many more. Speakers include Shmura Glenn and a representative from the Harrison Museum.

Sign up here.

CMS Seeking Comment: HHS Releases Initial Guidance for Medicare Prescription Drug Inflation Rebate Program

Under President Biden’s prescription drug law, drug companies will pay rebates to the federal government for raising prescription drug prices faster than the rate of inflation. The Centers for Medicare & Medicaid Services (CMS) released the initial guidance detailing the requirements and procedures for the new program.

Read full details and fact sheets here.

As part of the initial guidance, CMS is seeking comment from the public on key topics, including:

  • the process to determine the number of drug units for rebatable drugs
  • reduction of rebate amounts for certain Part B and Part D rebatable drugs in shortage and in cases of severe supply chain disruptions
  • the process to impose civil monetary penalties on manufacturers of Part D rebatable drugs that fail to pay rebates
  • assuring accuracy of the inflation rebate payments

Comments must be received by March 11, 2023. More information here.

 

Do Your Patients Know the 8 Essentials of Heart Health?

By Gary Miller, MD, FACC

You know the American Heart Association (AHA) added a new factor to its cardiovascular health checklist in 2022, expanding its Life’s Simple 7TM to Life’s Essential 8TM guidelines.

But do your patients know about the new factor?

With so much competition for your patients’ time and attention from news and social media — in addition to the demands of work and life — it’s more than likely they aren’t aware. Right now during February’s American Heart Month it’s a perfect time to make sure your patients know about the new factor as well as remind them about what they can focus on to help keep their heart healthy all year round.

Here’s a highlight-reel breakdown of the AHA’s Life’s Essential 8TM you can use as a guide to talk to your patients — starting with that 8th new factor: sleep.

  1. Sleep Duration

Healthy sleep is critical for optimal cardiovascular health! Adults need 7 to 9 hours of sleep every night. Depending on their age, children may need more. Sleep helps patients better manage weight, blood pressure, and risk for Type 2 diabetes. Encourage your patients to monitor their sleep with an app or wearable device to discover any concerns they can then bring to your attention.

  1. Diet

Most people understand the diet-health connection these days, but it’s never a bad idea to remind your patients that how and what they choose to eat affects more than just their waistline. In fact, for patients with hypertension, diet may have the biggest impact on reducing their heart attack risk. The AHA recommends assessing diet based on the Dietary Approaches to Stop Hypertension eating pattern, also known as DASH, which includes: high intake of fruits, vegetables, nuts and legumes, whole grains, and low-fat dairy, and low intake of sodium, red and processed meats, and sweetened drinks. The National Heart, Lung and Blood Institute has a helpful DASH diet chart you can refer your patients to for an overview.

  1. Blood Pressure

The AHA’s blood pressure guidelines have not changed since 2017. Remind patients that their levels should be less than 120/80 mm Hg for optimal heart health, and that adherence to the other 7 factors of these Life’s Essential 8TM guidelines can help reduce blood pressure, including the DASH diet, sleep, and physical activity, plus strategies like stress management and weight loss.

  1. Physical Activity

If they aren’t already, your patients need to get moving! For adults, that means at least 150 minutes of moderate-intensity aerobic activity like a brisk walk per week ­— or at least 75 minutes of vigorous-intensity aerobic activity like running per week. Children likely need more, based on their age. The ultimate goal during activity is to raise their heart rate and break a sweat! Remind your patients they don’t have to go to the gym, because everyday activities like dancing and pushing a lawn mower count!

  1. Body Mass Index

Though experts acknowledge body mass index (BMI) is an imperfect metric for a variety of reasons, the fact that it’s easily calculated and widely available still makes it a reasonable gauge to assess weight concerns that may lead to health problems. Generally speaking, your adult patients should strive for a BMI between 18.5 and 24.9 for the best cardiovascular health. You will know best how to inform them the impact of their race, ethnicity, or ancestry on BMI ranges. You can also recommend the Centers for Disease Control and Prevention’s BMI calculators for your patients — there’s one for adults and one for children.

  1. Nicotine Exposure

The Life’s Essential 8TM guidelines have been updated to include restricting inhaled nicotine-delivery systems, including e-cigarettes and vaping devices, as well as traditional cigarettes. However your patients are getting it, nicotine remains a no-no for heart health.

  1. Blood Lipids

The metric for blood lipids has been updated in the Life’s Essential 8TM guidelines to use non-HDL cholesterol as the preferred number to monitor instead of total cholesterol. The reason for the change is the fact that non-HDL cholesterol can be measured without required fasting, which increases its availability to be reliably calculated. This is good news for you and for your patients.

  1. Blood Glucose

This metric was also updated in the Life’s Essential 8TM guidelines and expanded to include the option of hemoglobin A1c readings or blood glucose levels for people with or without Type 1 or Type 2 diabetes or prediabetes, because hemoglobin A1c can better reflect long-term glycemic control.

One of every three patients (32%) hospitalized with COVID-19 show heart muscle damage from release of the heart muscle protein troponin .  And 25% develop the heart rhythm disorder atrial fibrillation. Covid-19 can cause an inflammatory response and trigger a system wide clotting reaction triggering lung and heart clots. Influenza can also trigger a system wide inflammatory response that can trigger heart attacks   Protect your heart health by keeping your COVID-19 and influenza vaccinations up to date!

In addition to collaborating with you to understand and improve their heart health and reduce risks, your patients can do a self-assessment using the Life’s Essential 8TM guidelines online with the AHA’s My Life Check® Tool, although they will need their metrics for blood pressure, blood lipids, and blood glucose to complete the assessment.

The information contained in this blog is for educational purposes only and does not constitute health care advice.

New Resources from the AMA

Excess Mortality Among Physicians During The COVID-19 Pandemic

This newly published JAMA Internal Medicine research letter, co-authored by AMA Research and Policy Manager Lindsey Carlasare with a team from Stanford University School of Medicine, seeks to better understand the effects of the pandemic on physician mortality rates.

Listening Campaign: Engage Physicians to Uncover Sources of Burnout

A new AMA STEPS Forward® toolkit outlines the 7 STEPS needed to successfully carry out a Listening Campaign, including 9 practical tools to help uncover and address sources of physician burnout.

Private Practice Simple Solutions: Support Staff Recruitment

Release Date: Feb. 14, 2023

This new eight-week session featuring Dr. Justin Holtzman, Medical Director of Holtzman Medical Group, focuses on recruiting and retaining support staff for your private practice. Register Here.

To access the complete collection of previously released Simple Solutions sessions, click here.

Supporting Private Practices: AMA & Medline University

Tuesday, March 7 | 10:15 am CT

Learn how to use the AMA STEPS Forward® Private Practice Playbook to your advantage in this open access webinar designed to help physicians streamline employee training in their private practices. Following the webinar, AMA members will have access to a curated Medline University course list that can be assigned to their care teams. Register Now.

AMA STEPS Forward® Podcast Episode 43

How a Telephone Consultation Model Eased Call Burden for Frontline Specialists
Dr. Alfred Atanda, Director of Clinician Well-Being at Nemours Children’s Health, shares his experience piloting a telephone consultation model aimed at reducing call burden for infectious disease specialists.

LISTEN NOW: Apple Podcasts | Spotify

AMA STEPS Forward® Podcast Episode 44

The Importance of Screening for Social Determinants of Health

Margaret Bavis, DNP and Assistant Professor, Rush University College of Nursing, discusses how CommunityHealth, one of the largest volunteer-based health centers in the nation, assesses and optimizes social determinants of health to improve patient care.

LISTEN NOW: Apple Podcasts | Spotify

Debunking Regulatory Myths: Protected Health Information (PHI) Disclosures

Does HIPAA require that health care providers obtain patient authorization to disclose PHI for treatment purposes?

The American Conference on Physician Health (ACPH): Call for Abstracts

Oct. 11-13, 2023 | Palm Desert, CA

The ACPH theme this year is “Building the workplace of the future.” Contribute to the conversation by showcasing your work! Hurry – abstracts are only accepted until March 15.

AAP President Sandy Chung, MD Attends FMLA White House Event

AAP President Sandy Chung, MD, FAAP, attended an event at the White House to mark the upcoming anniversary of the Family and Medical Leave Act (FMLA). For the last 30 years, the law has helped many Americans take up to 12 weeks of unpaid leave, without the risk of losing their job, to care for a new child or sick family member or when they are seriously ill. The AAP continues to advocate for comprehensive paid family and medical leave policy.