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Antimicrobial Resistance Interagency Task Force
2007 Annual Report (Released June 2008)

Action Items 27—48

Action Item #27: Explore Ways To Integrate Appropriate Use Information into Antimicrobial Package Inserts and Promotional Materials, To Provide Such Information to Patients with Each Prescription, and To Provide Clear Guidance to Industry To Ensure That Promotion of Antimicrobials Directed Towards Consumers Encourages Appropriate Use and Discourages Inappropriate Use.

Project Title: Get Smart: Know When Antibiotics Work - pharmacy initiative: patient monograph project

• Agency: CDC
• Description: In 2005, Get Smart developed a partnership with Catalina Health Resource, the largest distributer of prescription packaging advertising in the U.S. The antibiotic adherence message developed as part of the Pharmacy Initiative was placed as ads with antibiotic prescriptions nationwide.
• Results: During fall 2005, the Get Smart adherence PSA ran for 6 weeks nationally, due to donations of space from Catalina Health Resource. 13,000 pharmacies were reached along with over 1.25 million people, valuing $1.4 million in advertising cost. A larger scale paid campaign took place in fall 2006, from partner donations received through CDC Foundation. Catalina Health Resource completed a second campaign in Michigan to compliment the Roundup pilot program, lasting 3 months (January 2006-April 2006) in Michigan pharmacies, with nearly 350,000 impressions statewide. There is currently no support for this activity.

Action Item #28: Articulate Factors That Support the Current Approach of Requiring Prescription-Only Dispensing for All Systemic (e.g., Nontopical) Antimicrobial Drugs Used In Clinical Medicine.

Action Item #30: Convene an Advisory Panel or Other Expert Group in Involving Stakeholders and Partners To Consider Issues Related to Resistant Pathogens That Cause Serious Infections for Which Available Treatments Options Are Very Limited or Nonexistent.

Project Title: Antimicrobial Drug Development Public Workshop (sponsored by FDA, IDSA and ISAP)

• Agency: FDA, CDC, NIH
• Description: Workshop provided information for and gained perspective from advocacy groups, industry and others on various aspects of antimicrobial drug development, including clinical trial design issues.
• Results: Workshop held April 15-16, 2004. Discussed the use of pharmacodynamic information in appropriate dose selection in clinical trials of anti-infective agents, and summarized the issues with developing antimicrobial drugs by allowing data from one serious disease to be supportive of data in another less serious disease such that sponsors would only have to perform one trial instead of two in the less serious disease. CDER resistance web site to access workshop transcripts (http://www.fda.gov/cder/drug/antimicrobial/default.htm)

Project Title: Experts Meeting: community-onset methicillin-resistant Staphylococcus aureus: implications for antimicrobial therapy and potential prevention strategies

• Agency: CDC
• Description: CDC convened a two-day meeting of approximately 20-25 experts to discuss issues surrounding the diagnosis, treatment, and prevention of community-associated MRSA infections (CA-MRSA). Participants included clinical experts and epidemiologists from academic institutions and public health agencies with expertise in CA-MRSA and other Staphylococcal infections, as well as representatives from relevant professional societies.
• Results: Strategies for the clinical management of MRSA in the community, based on discussions held at this meeting, in conjunction with additional data was posted on the CDC website in March 2006: www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_04meeting.html. In 2007, based on these strategies, CDC, the American Medical Association, and the Infectious Diseases Society of America, developed a treatment algorithm for the outpatient management of MRSA skin and soft tissue infections: www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_skin.html.

Project Title: Appropriate use of antimicrobials

• Agency: VA
• Description: The VHA has a national formulary, develops and implements care guidelines, and provides extraordinary educational opportunities for staff to deal with questions concerning appropriate use of antibiotics. This is an ongoing activity, but the effort will continue to be enhanced by further collaboration with federal agencies and other partners (including the private sector) since appropriate antibiotic usage involves many components such as physician education, education of the public, appropriate drug advertising, control of over-the-counter antibiotic use, and many other items that require intervention both inside and outside of the federal systems.
• Results: Ongoing. Infectious Diseases Field Advisory Committee has representation on the national Antimicrobial Medical Advisory Panel (MAP) for pharmacy.

Project Title: National MRSA Summit and MRSA Implementation Task Force

• Agency: VA
• Description: National MRSA Summit with VA and non-VA experts to come to consensus on implementation. This Summit was used to compliment much work done by the National MRSA Prevention Initiative Implementation Task Force; it also helped to determine future issues for the Task Force and National Program Office.
• Results: MRSA Summit held May 2-3, 2007; work of Implementation Task Force will be ongoing. Subworkgroups for special patient populations of nursing home/long-term care/community living centers, spinal cord injury and polytrauma units have been formed, along with subworkgroups to address issues of patient education, employee education, decolonization and duration of contact precautions.

Action Item #31: Convene A Working Group To Examine the Impact of Federal Reimbursement Policies for Home Parental Antimicrobial Treatment, Appropriate Antimicrobial Use, and Appropriate Use of Antimicrobial Susceptibility Testing. Where Needed, the Working Group Will Make Recommendations for Modifying These Policies.

Action Item #32: Develop and Submit Measures for Appropriate Antimicrobial Use to the National Committee for Quality Assurance for Inclusion in Health Plan Employer Data and Information Set (HEDIS), Which Provides Comparative Data on Managed Care Organizations

 

Project Title: a Surgical Site Infection Antibiotic Prophylaxis plan

• Agency: VA
• Description: VHA has introduced surgical site antibiotic prophylaxis as a performance measure for VHA systems nationwide. These performance measures constitute 50% of the annual evaluation for Executive Career Field (ECF) performance plans for VHA regional directors and individual medical center directors. The particular performance measures relative to surgical site infection antibiotic prophylaxis include percent of the cases the drug began timely, percent of the cases the appropriate drug was given, and percent of the cases the drug was discontinued timely.
• Results: For Federal Fiscal Year 2005, VHA has introduced surgical site antibiotic prophylaxis as a performance measure for VHA systems nationwide. Refinement with additional measure of appropriate antibiotic choices chosen for FY 2008,

Project Title: Community-acquired pneumonia treatment

• Agency: VA
• Description: VHA Office of Quality and Performance has also added community-acquired pneumonia treatment timing measures and in pursing appropriate antibiotic choice measures.
• Results: During FY 2006 these measures have been introduced and are being refined. Ongoing FY 2008

Action Item #33: Evaluate The Potential Impact Of Improved Diagnostic Tests, Including Rapid Point-of-Care Tests on Antimicrobial Drug Use and Patient Care, and Assess Their Financial Implications. Take into Account Tests That Distinguish Between Bacterial and Viral Infections, Tests That Identify Resistant Pathogens, and Tests That Distinguish Common Clinical Entities such as Bacterial Sinusitis and Acute Bacterial Otitis Media from Illnesses with Similar Manifestations for Which Antimicrobials Are Not Beneficial.

Project Title: Research career award (K08): Randomized trial of sinus CT for acute sinusitis.

• Agency: AHRQ
• Description: Sinusitis is a common medical disease with a tremendous economic impact on health care. The investigator sought to determine the most cost-effective strategy for the management of acute sinusitis from the societal and payers' perspectives. A Markov disease simulation model compared four treatment strategies: (1) no antibiotic, (2) empiric antibiotic, (3) CT-based antibiotic, and (4) clinical guideline-based antibiotic.
• Results: Empiric antibiotic treatment was the most cost-effective from the societal perspective. Clinical guideline-based treatment was the most cost-effective strategy from the payers' perspective ($38,515/quality-adjusted life year). Cost and effectiveness of antibiotics, time lost from work, and prevalence of acute bacterial sinusitis were influential variables. Empiric antibiotic treatment is a cost-effective strategy from the short-term societal perspective. However, antibiotic resistance will lead to increased costs and reduced efficacy of this strategy in the long term. Clinical guidelines provide a low-cost method of targeting therapy (Anzai Y et al. Am J Rhinol. 2007; 21:444-51.).

Action Item #38: Identify Factors That Promote Transmission of Drug-Resistant Pathogens in Healthcare Facilities, in Extended Care Facilities, and in Community Settings, Including Daycare Centers in the Community at Large. These May Include Characteristics of the Facilities and of the Populations They Serve.

Project Title: Long term care infection surveillance

• Agency: VA
• Description: A national VA taskforce developed a prototype web-based point prevalence survey which was subsequently beta-tested and used for the actual survey. CDC-based definitions of infections were used. Long term plans are to develop and improve standardized infection surveillance of VHA nursing homes. Develop a nursing home care educational session for use with VHA nursing home care units.
• Results: National nursing home survey was completed in Fall 2005. Data analysis and review are ongoing, with report released by the Office of the Inspector General. Publication of article in Am J Infect Control. 2006 Mar;34(2):80-3. Ongoing evaluation of surveillance methodologies and standards are actively being pursued, along with development of education session(s) for use by personnel within VHA nursing home care units (e.g., conference which may be multi-purposed with development of web-based sessions/components from this). Results of first national point-prevalence survey of all VA long-term care facilities released by the Office of the Inspector General for VA. A second national point-prevalence survey was completed January 2008 and analysis is ongoing at this time. Also, first national VA conference on Infection Prevention and Control in Long Term Care completed January 2008.

** TOP PRIORITY **

Action Item #39: Evaluate the Effectiveness (Including Cost-Effectiveness) of Current and Novel Infection-Control Practices for Health Care and Extended Care Settings and in the Community. Promote Adherence to Practices Proven To Be Effective.

Project Title: Task Order: Testing techniques to radically reduce antibiotic-resistant bacteria (methicillin-resistant) Staphylococcus aureus, or MRSA.

• Agency: AHRQ
• Description: The overall purpose of this task order is to measurably reduce hospital-acquired MRSA infections in acute-care facilities or hospitals and document how this was done, in order to help others achieve success in similar settings.
• Results: The informatics group has continued to focus on data entry and improving data reporting ability. In addition, the project directors are currently focusing on fashioning a weekly metrics report from each hospital that includes admission and discharge cultures, hand hygiene observations, and barrier isolation observations. One participating hospital can provide all of the above data. The other five hospitals as yet only have internal data that they use to report within their group. Intervention, training, and assessment activities are under way at the collaborating sites.

Project Title: Centers of Excellence in Healthcare Epidemiology (Prevention Epicenters)

• Agency: CDC
• Description: Academic medical centers conduct research to improve infection control practices. Current projects address improving antimicrobial use in acute care facilities, the epidemiology of transmission of resistant organisms in the ICU setting, and exploring novel approaches to preventing transmission.
• Results: Recent and ongoing activities include: 1) completed a pilot multi-center evaluation of the use of novel approaches to routine skin antisepsis (daily chlorhexidine baths) to reduce transmission of antimicrobial resistant organisms among ICU patients. This has been expanded to a multi-center cluster-randomized trial. 2) Ongoing study of assessment of colonization pressure in ICUs as a predictor of transmission of MRSA and VRE. 3) Evaluation of the risk of invasive sequelae following acquisition of MRSA and VRE colonization during hospitalization. 4) Examining inter-facility and inter-community transmission of MRSA in hopes that increased communication between facilities, electronic alerts, and infection control measures at point of transport can disrupt transmission and prevent the clonal establishment of MRSA within the targeted communities. 5) Using electronic health information to generate electronic alerts for patients at high risk for MRSA carriage. 6) Using electronic databases to measuring antimicrobial utilization in ICUs.

Project Title: Six SigmaTM process to promote hand hygiene in VA medical facilities.

• Agency: VA
• Description: National VA effort to use the Six SigmaTM process in the hand hygiene promotion effort. Pilot project at 3 VA medical facilities, with products from the testing to be distributed nationwide to all VA medical facilities.
• Results: Six Sigma process regarding hand hygiene being tested at 3 VA medical facilities. Publishied as "Using the six sigma process to implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 intensive care units." J Gen Intern Med. 2006 Feb;21 Suppl 2:S35-42. with authors Eldridge NE, Woods SS, Bonello RS, Clutter K, Ellingson L, Harris MA, Livingston BK, Bagian JP, Danko LH, Dunn EJ, Parlier RL, Pederson C, Reichling KJ, Roselle GA, Wright SM.

Project Title: Methicillin-resistant Staphylococcus aureus patterns in VA.

• Agency: VA
• Description: MRSA laboratory data collected nationwide from VA medical facilities to identify antibiotic resistance patterns.
• Results: Abstracts presented at the Society for Healthcare Epidemiology of America Annual Scientific Conference April 2007, Baltimore MD authors: G Roselle, R Jain, S Kralovic, L Simbartl about MRSA, at the Society for Healthcare Epidemiology of America Annual Scientific Conference April 2006, Chicago, IL authors: S Kralovic, L Danko, L Simbartl, G Roselle about MRSA, at the Society for Healthcare Epidemiology of America Annual Scientific Conference April 2005, Los Angeles, CA authors: S Kralovic, L Danko, L Simbartl, G Roselle about Clostridium difficile. Invited presentation of the MRSA Prevention Initiative at the annual meeting of the Association of Professionals in Infection Control and Epidemiology scheduled for June 2008.

Project Title: AHRQ 1 UC1 HS014237 Toward a Safety Culture: Reducing Nosocomial Infections

• Agency: VA
• Description: VA personnel led a regional research study sponsored by AHRQ designed to look at rapid-cycle implementation strategies of evidence-based practices that are known to reduce health care associated infections
• Results: Primary study accrual has completed and review and reporting of results is ongoing. This regional cooperative project received the 2005 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Ernest Amory Codman award and demonstrated findings of: i) reduced central line infections by 50 percent. ii) increased adherence to evidence-based practices to 95 percent from 30 percent. iii) created a new model for facilitating improvement as a community, with an increased chance of success, sharing of successful strategies, reducing rework across the sites, and speeding the implementation process.

Project Title: Toyota Production System (TPS) process to reduce infection

• Agency: VA
• Description: Through a demonstration project sponsored by CDC, VA facilities in Pittsburgh along with other health care institutions in the region participated in evaluation of a methodology (Toyota Production System process) for implementing change in infection control practices.
• Results: Has demonstrated decrease with sustained success in resistant Staphylococcus aureus within facility Abstract presented at the Society for Healthcare Epidemiology of America Annual Scientific Conference April 2006, Chicago, IL authors R Muder, E McCray, C Cunningham, P Perreiah, C Squier, R Sinkowith-Cochran, J Jernigan. Ongoing

Action Item #43: Conduct a Public Health Campaign To Promote Hand Hygiene and Other Hygienic Practices, as well as Other Behaviors That Prevent the Transmission of Infectious Organisms, in Collaboration with Professional Societies and Stakeholders. This Campaign May Be Coordinated with the Public Health Education Strategy To Promote Appropriate Antimicrobial Use Described in Action Item #25: Prevention and Control.

Project Title: Infection -Don't Pass It on Campaign

• Agency: VA
• Description: The Veterans Administration campaign, “Infection: Don't Pass It On” is a national campaign launched in the fall of 2004. The major focus of this ongoing campaign is hand hygiene, respiratory etiquette, and preparedness for infectious disease emergencies.   
• Results: Initiated Fall 2004 and ongoing. 2005 winner of Excellence in Public Health Award from the National Public Affairs Association. During Association of Professionals in Infection Control and Epidemiology National Conference June 2006 in Tampa, FL, presented as a general concurrent session.

Project Title: National MRSA Prevention Initiative

• Agency: VA
• Description: Nationally directed MRSA Prevention Initiative incorporating a bundle approach consisting of hand hygiene, contact isolation, active surveillance culturing and cultural change/transformation.
• Results: Directive signed Jan 12, 2007 by Under Secretary for Health and all sites with acute care facilities have initiated at least one care unit (preferably an ICU) as of March 1, 2007

Action Item #44: Facilitate and Support the Activities of Infection Control Programs in Health Care Settings as a Component of Medical Care. Promote Infection Control Education at all Stages of Training and Practice for all Health Care Workers Who Have Contact with Patients.

Project Title: Infomercials taped and aired on VA Knowledge Network. Viewed by VHA employees.

• Agency: VA
• Description: 2-3 minute “infomercials” covering issues relating to influenza, PPD's and bloodborne pathogens
• Results: Completed. Airing of infomercials ongoing.

Project Title: National Center for Health Promotion Monthly Topics

• Agency: VA
• Description: Some of the monthly topics address specific diseases and some address specific infectious diseases preventive measures
• Results: Information on the following, rotation of monthly disease prevention and health promotion which regularly include infectious diseases topics. Dissemination point for annual influenza-pneumococcal vaccination toolkit information.

Project Title: Planned Long Term Care Conference in September 2006

• Agency: VA
• Description: Issues of antibiotic resistance discussed.
• Results: Completed January 2008.

Project Title: National MRSA Prevention Initiative

• Agency: VA
• Description: Nationally directed MRSA Prevention Initiative incorporating a bundle approach consisting of hand hygiene, contact isolation, active surveillance culturing and cultural change/transformation.
• Results: Directive signed Jan 12, 2007 by Under Secretary for Health and all inpatient acute care units have established the MRSA Prevention Initiative nationwide in VHA. Ongoing

Action Item #45: Support Ongoing Public Health Education Campaigns on Food Safety, such as FDA and USDA's Fight BAC Program, Whose Aims Are To Educate Food Producers, Retailers, and Consumers About Food Safety Practices That Reduce Foodborne Infections (Including AR Infections).

Project Title: Innovative FS program for low literacy food handlers

• Agency: USDA
• Description: Using enhanced and distance education programs
• Results: Ongoing. Funded by CSREES, NIFSI program. (univ of connecticut) See csrees website.

Project Title: Science-technology based fs education programs on safe food handling

• Agency: USDA
• Description: Focused on consumers with use of collected data, databases
• Results: Ongoing. Funded by CSREES, NIFSI program. (univ of mo) See CSREES website.

Project Title: Good Agricultural Practices on line course for produce safety

• Agency: USDA
• Description: Will also assess impact of training
• Results: Ongoing. Funded by CSREES, NIFSI program (Cornell) See CSREES website.

Project Title: Risk analysis based food defense certification program

• Agency: USDA
• Description: For professional and academic programs
• Results: Ongoing. Funded by CSREES, NIFSI program (univ of md) See CSREES website.

Project Title: Food Safety training programs for ethnic vendors

• Agency: USDA
• Description: Evaluate programs and implement changes, particularly for Asian and Mexican foods
• Results: Ongoing. Funded by CSREES, NIFSI program. (univ of fl) See csrees website.

Project Title: Fight BAC!® Campaign

• Agency: CDC, FDA, USDA
• Description: This national program emphasizes the four basic safe handling behaviors: Clean, Separate, Cook, and Chill.
• Results: Ongoing: For over 10 years, USDA, FDA, and CDC, have served as the Federal liaisons to The Partnership for Food Safety Education, the public/private partnership that created the Fight BAC!® Campaign  

Project Title: USDA/FSIS Safe Handling Outreach Initiatives

• Agency: USDA
• Description: Examples of FSIS' efforts include media events, consumer brochures, public service announcements for keeping food safe during power outages, food safety camps for children, development of 5 brochures on food safety for at-risk audiences: people with cancer, HIV/AIDS, diabetes, transplant recipients, and older adults. FSIS provides a toll-free telephone service, the USDA Meat and Poultry Hotline, to help prevent foodborne illness by answering consumer questions about the safe preparation and handling of food handling.
• Results: Ongoing.

Action Item #47: Support Community-Based Programs That Promote and Facilitate Availability of Recommended Vaccinations for Adults and Children.

Project Title: Annual Influenza/Pneumococcal Vaccine Toolkit

• Agency: VA
• Description: Influenza/Pneumococcal Vaccine Toolkits were developed to enhance local influenza/pneumococcal immunization programs throughout VA, and contain promotional items along with directive containing most recent influenza vaccine recommendations
• Results: Updated toolkits are sent to VA facilities nationwide in the fall of each year for 2003-2004 season, 2004-2005 season, 2005-2006 season, 2006-2007 season, and 2007-2008 season. Planning for the toolkit for the 2008-2009 season toolkit is underway.

Project Title: Annual Influenza Vaccination Directive

• Agency: VA
• Description: Provide to the field facilities central direction for the consistent use of influenza vaccination and treatment strategies nationwide within VHA.
• Results: Each year a Directive is signed and delivered to the local VA medical centers giving guidance and direction on each new years influenza vaccine and antiviral medications for the treatment of influenza disease including potential influenza viral resistance. This has been ongoing since 1992 and continues--most recent directive was released for 2007-2008 influenza season.

Project Title: Pneumococcal and Influenza Vaccination as Performance Measures

• Agency: VA
• Description: For many years VHA has included the delivery of both influenza vaccination and pneumococcal vaccination to at-risk populations (based on CDC recommendations) as a key performance measure for patient care. Performance measures constitute 50% of the annual evaluation for Executive Career Field (ECF) performance plans for VHA regional directors and individual medical center directors. Directive measures each year are signed by VHA Under Secretary for Health regarding annual influenza immunizations for patients, and also encouraging healthcare worker participation.
• Results: Ongoing. Additional measures for missed opportunities with inpatient admissions currently admitted for high-risk illnesses, including pneumonia have been added to the performance measures for FY 2008.

Action Item #48: Identify Vaccines Useful in Preventing Drug-Resistant Infections and Reducing Antimicrobial Drug Use and Evaluate Novel Methods For Improving Coverage with These Vaccines.

Project Title: ABCs special projects on pneumococcal resistance: prevention using vaccine and risk factors for fluoroquinolone resistance

• Agency: CDC
• Description: This proposal sought funding to complete two ongoing case-control studies being conducted in ABCs areas. The purpose of the first project is to evaluate the effectiveness of pneumococcal conjugate vaccine in children 3-59 months of age. The study began enrolling in FY 2001 and by the end of FY 2003 had enrolled 3031 children in eight ABCs areas; in FY 2004, study personnel will be enrolling children 24-59 months of age for one additional year to meet an objective of assessing effectiveness specifically for that age group. The purpose of the second project is to identify risk factors for invasive disease in adults caused by fluoroquinolone-resistant pneumococci. Cases are adults with invasive pneumococcal disease caused by a fluoroquinolone-resistant strain; 2 controls are selected for each case from subsequent cases caused by susceptible strains in adults. This study is ongoing in 9 ABCs areas and, based on our sample size estimates, will continue until Spring 2005.
• Results: The vaccine effectiveness studies have been completed. For the vaccine effectiveness study, PCV7 was shown to be highly effective at reducing invasive pneumococcal disease caused by vaccine serotypes and antimicrobial resistant strains (Whitney et al, Lancet 2007). For the second study, nursing home residence and exposure to fluoroquinolones in the 3 months prior to disease were risk factors for infection with fluoroquinolone-resistant invasive pneumococcal disease.

Project Title: H. influenzae type B (HIB) vaccine

• Agency: FDA
• Description: Monitoring of polysaccharide conjugated vaccines, including regular inspections of the production facilities, review and conduct of Lot Release studies, and review of amendments to the current Biologic License Application.
• Results: Ongoing. Several licensed vaccines. Continued vaccine supply essential to maintaining the near elimination of resistant H. influenzae disease in the U.S.

Project Title: Pneumococcal vaccine

• Agency: FDA
• Description: Monitoring and guidance provided to current manufacturer of a seven-valent conjugate vaccine. Ongoing. One licensed conjugate vaccine for the prevention of invasive disease and acute otitis media in infants and small children. Studies suggest decrease in AR among S. pneumonia isolates coincident with wide spread use of conjugate vaccine in infants. One licensed multivalent polysaccharide vaccine for the elderly.Facilitating clinical development of a more immunogenic vaccine for the elderly.
• Results: Ongoing. One licensed polysaccharide and one licensed conjugate vaccine for the prevention of invasive disease and acute otitis media. Studies suggest decrease in antimicrobial resistance among S. pneumonia isolates coincident with wide spread use of conjugate vaccine in infants. One licensed multivalent polysaccharide vaccine for the elderly.

Project Title: Influenza vaccine

• Agency: FDA
• Description: Regulatory and research support of annual trivalent inactivated and live intranasal influenza vaccine development, production and licensure, including additional manufacturers and novel technologies. Facilitating expanding indication to additional age groups and select immunocompromised populations.
• Results: Influenza immunization is currently recommended for children 6 to 59 months old. At the February 2008 ACIP meeting, there was discussion and vote to included children through 18 years old. Five seasonal influenza vaccines are licensed and distributed in the U.S. These vaccines include Medimmune (FluMist®), Sanofi (Fluzone®), Chiron (Fluvrin®), ID Biomedical (FlulavalO), and GSK (Fluarix®).

Project Title: Pandemic Influenza vaccine

• Agency: FDA
• Description: Regulatory and research activities to support development, licensure and rapid widespread availability of vaccines for pandemic influenza.
• Results: 10 INDs were submitted for vaccines against potential pandemic influenza virus strains H5N1, H7N3, and H9N2, or against seasonal influenza. * Nov 2007: CBER co-chaired and participated in an FDA-EMEA meeting to discuss evaluation of pandemic/prepandemic influenza vaccines for licensure/marketing authorization. * Dec 2007: CBER participated in an FDA-NIH-WHO workshop on Immune Correlates of Protection Against Influenza A Viruses in Support of Pandemic Vaccine Development to (1) identify gaps in current abilities to develop and evaluate pandemic influenza vaccines; (2) facilitate implementation of a global research agenda to improve efficacy assessment of pandemic influenza vaccines.

Project Title: Improve use of vaccines related to prudent use of antibiotics

• Agency: VA
• Description: Dept. of Veterans Administration, VHA Directive 2001-053. Influenza Vaccine – Recommendations for 2001-2002. Published and placed on VA Intranet website 8/28/01. Infomercials were aired on VA Knowledge Network regarding influenza vaccine. Performance Measurement Program, 2001 and 2002 VHA Performance Measurement System Technical Manuals list Influenza Immunization and Pneumococcal Immunization as Preventive Care Quality Performance Measures, with specific recommendations for these immunizations for Nursing Home Care Units within VHA system.
• Results: The VHA is already in the forefront of immunization practices as is evidenced by the pneumococcal and influenza vaccine usage rates compared to the national averages. In addition, influenza vaccine use increases each year in the VHA as emphasis on this program continues. Therefore, this action item is already under way and will continue to be an area of emphasis area for the VA.

<— Previous Section: Action Items 21–26        Next Section: Action Items 49—66 —>

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