California Medical Association

Tuesday, June 30, 2015

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Providing news to the San Francisco Medical Community.


CDC Panel Urges Expanding Pool of Young People Who Receive Meningitis B Shot

An advisory committee for the Centers for Disease Control and Prevention is recommending that all 16- to 23-year-olds to consider the vaccine. Previous guidance was limited to those at high risk of exposure to the disease, like lab workers and students at colleges with outbreaks.

The Advisory Committee on Immunization Practices (ACIP) has expanded its recommendation for immunization against meningitis B, a rare but potentially deadly strain of meningitis.

The committee’s revised guidance broadens the group of young people that the CDC thinks should consider getting the shot, and increases the likelihood that health insurance policies will pay for the injection.

The previous recommendation was limited to people at high risk of getting the disease — such as lab workers and students at colleges with outbreaks of three or more cases. Now the advisory committee on immunization urges all young people between the ages of 16 and 23 to talk to their doctor about whether the shot is a good idea for them, too.

Last fall, the Food and Drug Administration approved two new vaccines against the fifth strain of bacterial meningitis, and recommended its rather narrow use by people at high risk of contracting the illness. The new guidelines say that if doctors and any patients agree the vaccine is appropriate, it should be given.

The CDC committee stopped short of firmly recommending that all people aged 16 to 23 get the shot; rather it urges these patients to consult their doctor about whether the shot makes sense for them — a subtle but important difference. And, so far, the committee has been silent about younger adolescents; some unanswered questions remain about the vaccine's complete effectiveness and how long it lasts. Once those questions are answered, committee members say, they'll likely revisit the recommendation, and perhaps suggest expanding it further.

Source: NPR, June 29, 2015


SB 277 Clears State Assembly

Senate Bill 277 jumped its final hurdle in the state Assembly today, clearing the house with a 46-30 vote. The bill now heads back to the Senate, where legislators will consider amendments made in the Assembly.
 

Today’s decision aligns with the opinions of two-thirds of Californians, who believe children should not be allowed to attend public school unless they are vaccinated, according to a recent Public Policy Institute of California poll.

The San Francisco Medical Society would like to thank the legislators, especially Assemblymember David Chiu who is a co-author of SB 277, for their support and leadership on this important piece of legislation that will improve public health and keep our communities safe.

SB 277 would remove the personal belief exemption (PBE) from school vaccination requirements, allowing exemptions only for medical reasons. The SB 277 immunization requirements would apply to students first admitted to school or who enter seventh grade after July 1, 2016. It would also help protect the most vulnerable, including babies too young to be immunized and people who are immunocompromised, by making it more difficult for preventable diseases to spread.

The bill has received widespread support from health and education organizations across the state, including the SFMS and CMA; the American Academy of Pediatrics, California; California State PTA; California Immunization Coalition; and the California Children’s Hospital Association. Additionally, several other community groups, local governments, and newspapers have also endorsed the bill.


CURES 2.0 FAQ; DOJ to Work with SFMS/CMA to Provide Short-Term Solution to CURES Upgrade Problem

The California Medical Association (CMA) has been tracking Department of Justice (DOJ) efforts to update Controlled Substance Utilization Review and Evaluation System (CURES), California’s prescription drug monitoring database.

According to DOJ, accessing the new version of CURES will require Internet Explorer version 11, Firefox or Chrome Internet browsers. DOJ has indicated that, effective July 1, users of Internet Explorer 10 or earlier will not be able to access CURES. There will be no backward compatibility to earlier versions of this browser. This change, only recently revealed, will cut off controlled substance prescribers with health information technologies that require use of older versions of Internet Explorer. Thousands of physicians will lose access to CURES if DOJ does not change their implementation plan.

In response to concerns raised by the SFMS and CMA, the DOJ has agreed to a short-term solution to prevent loss of access for CURES users with the new version launch. DOJ has committed to keeping the current version of CURES accessible for users who cannot access the new version because of browser compatibility issues.

Based on communications with DOJ, CMA has produced a summary of what CURES users should know about the launch of the new system, including updates on access and registration changes.


Access Patient Information in the Current Version of CURES (1.0) and the New Version of CURES (2.0)

What do currently registered prescribers need to know about any changes that take place on June 30 that might impact their ability to access CURES?

Current CURES users will be able to access the new system, CURES 2.0, with their current user ID and password. Upon initial login to CURES 2.0, users will be required to update their security questions and answers and re-establish a new password. Users must also review their CURES account profile to verify their information is accurate, make necessary updates, and acknowledge CURES Terms and Conditions. Once this has been completed, the user may begin searching patient information in CURES. The user must also access CURES on a compatible browser.

Are there limitations to what Internet browsers can be used to access CURES 2.0? Are particular browsers recommended over others?

CURES 2.0 users must use Microsoft Internet Explorer version 11.0 or higher, or current versions of Mozilla Firefox, Google Chrome or Safari. Earlier versions of Internet Explorer will not be supported.

What about those who cannot access CURES 2.0 on a compatible browser?

CURES 1.0 will remain accessible to users with unsupported versions of Microsoft Internet Explorer.

How long will CURES 1.0 access remain an option?

Unknown. At time of writing, DOJ has not indicated that it will develop backward compatibility to include previous versions of Internet Explorer and is instead asking users to upgrade their systems. DOJ has not indicated a specific time frame and has requested stakeholder input as to what timeframe is needed for users to upgrade to CURES 2.0 browser requirements. CMA will continue to work with DOJ and other stakeholders on a long-term solution. If you have input on this issue, please contact CMA’s Legal Information Line at (800) 786-4262 or fkader@cmanet.org.

Are there any other hardware or software requirements or recommendations for accessing CURES 2.0?

No.

Will there be a new webpage for logging into CURES 2.0?

Users should go to the current CURES login webpage, where they will be redirected to the new CURES 2.0 login screen or may choose to use version 1.0.

If a current CURES user is locked out of the system for some reason, how can he/she regain access?

There will be online assistance for users in case they need their login information. Additionally, users may contact the CURES Help Desk at (916) 227-3843 or cures@doj.ca.gov (email address will become effective on June 30).

What other changes are expected with CURES 2.0?

CURES 2.0 is intended to provide faster, more reliable service to accommodate use by all controlled substance prescribers and dispensers in the state. The new system will include a delegation function, online resolution when locked out of CURES or if a password is forgotten, and various ways to customize how you see and use patient information.

Note that the system is still not considered “real time,” as California law permits up to a week for dispensers to report to the system after dispensing a controlled substance to a patient. Also note that the data in CURES remains only as accurate as what dispensers report.

CURES Registration

What changes to the CURES registration process will occur on June 30?

On or after June 30, a new applicant must initiate an online registration process in order to gain access to CURES. Once complete, the process will provide access to both CURES 1.0 and 2.0.

In order to complete the application form, prescribers and dispensers must produce copies of their state medical or pharmacist license, Drug Enforcement Administration (DEA) registration certificate (prescribers only), and California driver license or other official government photo identification and have these copies notarized. The notary must affirm that the person appearing is the person identified in these supporting documents. These notarized documents must then be uploaded in PDF format with the CURES online application. The current registration process of mailing in notarized documents will no longer be supported.

DOJ states that a subsequent CURES 2.0 release will further streamline the registration process for California licensed prescribers and pharmacists. There is currently no information on when a more automated registration process will be available.

What happens to prescribers who have submitted application documents under the old registration requirements but have not yet been granted access?

Prescribers and pharmacists who submitted application documents using the old registration method prior to June 30 will continue to have their registrations processed. If approved, these applicants will be granted access to both CURES 1.0 and 2.0.

Who is required by law to register to use CURES by January 1, 2016?

All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate (DEA Certificate) must register to use CURES by January 1, 2016. There is no state mandate to use CURES before prescribing.


SF AIDS Walk

San Francisco Medical Society was among the first in San Francisco (and in California) to push for legalized syringe exchange programs, appropriate tracking and reporting processes, optimal funding, and more. The SFMS was, naturally, at the center of medical advocacy for solid responses to the AIDS epidemic. Due to our advocacy, we were able to get the California Medical Association to adopt state policy on HIV prevention and treatment.

The progress that has been made is extraordinary but there is still more work to be done. On July 19, the 29th Annual Aids Walk San Francisco will take place. Quest Diagnostics, is once again a Premier Sponsor of the event, which will continue to benefit Project Inform as well as dozens of other AIDS service organizations in the Bay Area.

Ricky Kim, Director and Project Management of Infectious Disease at Quest Diagnostics said, “As the leading provider of HIV testing services in the US, we are proud of our partnership with AIDS Walk San Francisco and its lead beneficiary, Project Inform – an organization whose goals are so strongly in line with ours. Both through our sponsorship and by organizing a large team of our employees, AIDS Walk San Francisco provides us with an ideal opportunity for Quest Diagnostics to better educate and serve the Bay Area community.

Quest Diagnostics has planned many unique activations at the Quest Diagnostics booth throughout the day. Activities include body/face painting stations, a dedication station where one can publicly recognize those they are walking in honor/memory of and a scavenger hunt along the walk route with prizes benefiting well-deserving organizations.

For more information and to register for the AIDS WALK SF 2015 please visit https://sf.aidswalk.net/apiwellness.


This is a sponsored post from Quest Diagnostics. Quest Diagnostics is the world’s leading provider of diagnostic testing, information and services that patients and doctors need to make better health care decisions. Quest Diagnostics will soon provide HIV test results 20 days earlier than traditional HIV tests.

SFDPH Health Advisory: Chicago Reports Invasive Meningococcal Disease among Men Who Have Sex with Men; Recommendations for San Francisco

The Chicago Department of Health reported a cluster of invasive Serogroup C meningococcal disease (IMD) among men who have sex with men (MSM) since mid-May 2015. Characteristics of cases include HIV-positive status and the use of digital apps to meet sexual partners. Chicago DPH has recommended meningococcal vaccination for local HIV-positive MSM, as well as for local MSM regardless of HIV status who have close or intimate contact with multiple partners, or who seek partners through the use of digital applications.

The San Francisco Department of Public Health (SFDPH) has been closely monitoring IMD locally. There have been no cases of IMD reported among San Francisco MSM since 2011.

IMD is transmitted by close or intimate personal contact. Individuals who wish to reduce their risk of contracting meningococcal disease should consult with their provider regarding vaccination and modification of risk behaviors. Serogroup C is contained in the currently available meningococcal conjugate vaccines; however, vaccination is not 100% effective in preventing IMD.

Actions requested of SF clinicians

  1. Meningococcal vaccination should be offered to San Francisco MSM and male-to-female transgender persons, regardless of HIV status, who expect close or intimate contact with MSM currently residing in, or traveling from Chicago. To achieve protection, vaccination should be completed at least 7-10 days prior to potential exposure. Increased travel and events such as festivals during the summer and fall may increase exposure risk.
  2. Immediately report all San Francisco residents with suspected or confirmed meningococcal disease to the 24/7 Communicable Disease Control Unit (CDCU) of SFDPH at (415) 554-2830. Page the on-call physician if after hours. Do not wait to report until the diagnosis is culture-confirmed; any delay in reporting compromises the ability to identify close contacts and ensure they receive timely antibiotic prophylaxis. SFDPH can assist with coordinating Polymerase Chain Reaction (PCR) testing if needed.

Invasive Meningococcal Disease Background and Transmission

IMD results from Neisseria meningitidis bacteria which can cause meningitis (infection of the tissues surrounding the brain and spinal cord) or septicemia (infection of the blood). Even if diagnosed early and treated with appropriate antibiotics, IMD still sometimes results in death, permanent brain damage, hearing loss, or kidney failure. Symptoms usually occur 1-10 days after exposure, and often within 4 days.

IMD is transmitted by contact with spit, phlegm, mucus, or other fluids from the nose or mouth of someone who already has, or is in the process of developing, meningococcal disease. Typically this occurs from kissing, intimate or sexual contact, sneezing or coughing, living in a crowded space together, or sharing drinks, cigarettes or eating utensils with someone who is infected (who may not show signs of disease).

Clinical Description – Prompt Recognition of Cases is Key

Prompt recognition and antibiotic treatment of meningococcal disease is critical. Symptoms of meningitis may include sudden onset of fever, headache, and stiff neck, accompanied by nausea, vomiting, photophobia, and altered mental status. Symptoms of septicemia may include fatigue, nausea, vomiting, cold hands and feet, chills, severe muscle aches or abdominal pain, rapid breathing, diarrhea, and a petechial or purpuric rash.

The following may be helpful in making the diagnosis:

  • A thorough examination of the skin, conjunctiva and pharynx for petechiae, with particular attention to pressure zones beneath clothes, the palms and the soles
  • Severe muscle or abdominal pain, particularly when there is no apparent alternative etiology
  • Blood pressure values that are in the normal range but are actually low considering the heart rate, temperature, and severity of illness (e.g., BP 100/60 with a heart rate of 140)
  • Platelet counts between 100,000-150,000/mm3

While any one finding does not necessarily indicate IMD, the constellation of findings warrants closer scrutiny and consideration of antibiotic therapy. Antibiotics should not be delayed to obtain diagnostic specimens.

Vaccination and Other Prevention Measures

One dose of meningococcal conjugate vaccine (Menactra® or Menveo®) is recommended for most adults at increased risk of IMD. Persons with HIV should receive a 2-dose primary series, administered 8-12 weeks apart, as evidence suggests that persons with HIV may not respond optimally to a single dose.

While highly effective, vaccination is not 100% effective. Those wishing to further reduce their risk of contracting IMD should consider avoiding contact with spit, phlegm, mucus, or other fluids from the nose or mouth of other persons, especially persons not well known to the individual. In addition, vaccine efficacy wanes over time; adults with ongoing increased risk of IMD are recommended to receive a booster dose every 5 years.

Click here to view the updated SFDPH Meningococcal Disease health advisory.


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