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Updating Pneumococcal Vaccine Recommendations

Updating Pneumococcal Vaccine Recommendations

Pneumococcal disease is an infection caused by Streptococcus pneumoniae bacteria (also referred to as pneumococcus). These bacteria can cause many types of illnesses, including pneumonia, meningitis, and ear, sinus, and bloodstream infections. Pneumococcus is spread when people cough, sneeze, and/or are in close contact with others who are infected. Symptoms depend on the part of the body that is infected. They can include fever, cough, shortness of breath, chest pain, stiff neck, and confusion and disorientation. Symptoms may also include sensitivity to light, joint pain, chills, ear pain, sleeplessness, and irritability. In severe cases, pneumococcal disease can cause hearing loss, brain damage, and death. Pneumococcal disease is a leading infectious cause of serious illness among older adults in the United States. Studies have identified certain patient groups that are more likely to become ill with pneumococcal disease. These high-risk groups include adults aged 65 and older and children younger than 2 years of age. People with weakened immune systems (eg, those with HIV/AIDS), those with chronic illnesses (eg, diabetes, heart disease, and asthma), and individuals who smoke cigarettes are at increased risk for getting pneumococcal disease. Vaccines Have Helped The incidence of pneumococcal infections among children and adults in the U.S. has dropped since a 7-valent pneumococcal conjugate vaccine (PCV7) was initiated for routine use among infants in 2000 and was later replaced by the 13-valent pneumococcal conjugate vaccine (PCV13) in 2010. “For decades, the 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been recommended for use in adults aged 65 and older for the prevention of pneumococcal infections,” explains Tamara Pilishvili, MPH. More recently, the FDA approved PCV13 for use...
Complications

Complications

Yesterday I readmitted two patients to the hospital with surgical complications. One was a man who had a colon resection 6 weeks ago. He has had the ‘dwindles’ since discharge. He’s lost weight, has no energy and no appetite. A CBC done yesterday showed his white blood cell count was elevated, and a metabolic panel shows impending renal failure. I suspect he has an intrabdominal abscess despite the fact that he has no fever. The second patient is 3 weeks out from a complex incisional hernia repair that involved reconstruction of her entire abdominal wall with placement of a large sheet of surgical mesh under the muscle layers. She is a morbidly obese diabetic and has developed a wound infection. If the infection reaches the mesh, I’ll have to remove it, undoing her entire repair. Complications are a fact of life in surgery. No matter how good a surgeon you are, no matter how carefully you manage patients, something will go wrong once in a while. As my Chief was fond of saying, “If you do big surgery, you get big complications.” Intellectually I know this. But days like yesterday try my soul. The first thing I ask myself when a patient has a complication after surgery is, “What did I do wrong?” Did I make a technical error? Did I miss some critical sign or lab value? I’m not comfortable until I’ve looked for those things, and even then feel that I must have missed something. This is the default mode for most surgeons I know. That type of thinking is built into our training. The ritual of...
Progress Seen in Managing Blacks With HIV

Progress Seen in Managing Blacks With HIV

Research has shown that the percentages of blacks who are linked to and retained in HIV care, taking antiretroviral therapy (ART), and achieving viral suppression are lower than those of other racial and ethnic groups. According to recent estimates, blacks account for 44% of the total number of people in the United States living with HIV but represent just 12% of the U.S. population. The National HIV/AIDS Strategy was developed in an effort to reduce the number of new HIV infections, increase access to care, improve health outcomes for those with HIV, and reduce HIV-related health disparities. “To achieve these goals, blacks with HIV need high levels of care and viral suppression,” says Y. Omar Whiteside, PhD. Achieving these goals calls for 85% of blacks with diagnosed HIV to be linked to care, 80% to be retained in care, and the proportion with undetectable viral loads to increase by 20% by 2015. A Large Analysis In an issue of the Morbidity & Mortality Weekly Report, Dr. Whiteside and colleagues conducted a study to provide clinicians with proxy measures to determine where the U.S. stands in achieving the goals outlined in the National HIV/AIDS Strategy. The analysis included 19 jurisdictions with complete reporting of all levels of CD4 and viral load test results. These jurisdictions represented 44% of all blacks with HIV living in the U.S. in 2010. The study found that about 75% of blacks diagnosed with HIV were linked to care, but less than half received regular care or were prescribed ART, and only about one-third had achieved viral suppression. “One of the most important findings was that...
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