Office of Research & Development

VA research on

Infectious Diseases

Infectious diseases are disorders caused by microorganisms such as bacteria, viruses, fungi, or parasites. Microorganisms that cause disease are collectively caused pathogens.

While many organisms live in and on humans, and are normally harmless or even helpful, some can cause disease under certain conditions. They do so either by disrupting the body's normal processes or by stimulating the immune system to produce a defensive response, resulting in high fever, inflammation, and other symptoms.

Some infectious diseases can be passed from person to person through contact with bodily fluids, coughing, sneezing, and other methods. Others are transmitted from insect or animal bites, or by ingesting contaminated food or water or other environmental exposures.

Many infectious diseases can become difficult to control, if the infectious agents develop a resistance to commonly used drugs. Bacteria, for example, can accumulate mutations in their DNA, or acquire new genes that allow them to survive contact with antibiotics that would normally kill them.

VA has determined that nine infectious diseases are related to military service in the first Gulf War, Iraq, and Afghanistan. They include malaria, brucellosis, campylobacter jejuni, coxiella burnetli (Q fever), mycobacterium tuberculosis, nontyphoid salmonella, shigella, visceral leishmaniasis, and west Nile virus. A fuller description of these diseases can be found here.

Selected Major Accomplishments

  • 1946: Developed and tested effective therapies for tuberculosis through multicenter clinical trials that led to the development of the VA Cooperative Studies Program
  • 2005: Demonstrated the effectiveness of a new vaccine for shingles, a painful skin and nerve infection affecting older adults
  • 2011: Published findings showing a 60 percent or greater decrease in MRSA infections from a VA-wide infection control initiative
  • 2014: Learned that treatment for pneumonia that included the antibiotic azithromycin (Zithromax) was associated with a significantly lower risk of death and a slightly increased risk of heart attack
  • 2015: Found that patients who received antiretroviral therapy within a year of their infection were half as likely to develop AIDS, compared with those who waited longer
  • 2016: Determined that a hospital infection-control program aimed mainly at methicillin-resistant Staphylococcus aureus (MRSA) can also significantly reduce transmission of bacteria that cause infections such as pneumonia, blood infections, surgical infections, and meningitis.

Overview

VA researchers are advancing the understanding, prevention, and treatment of numerous infectious diseases, ranging from the common cold to major public health threats such as tuberculosis, AIDS, hepatitis C, and influenza. They have developed a number of effective new preventive strategies, vaccines, and drugs for infectious diseases.

Some researchers are focusing on infectious diseases that may endanger American troops serving abroad, such as malaria and leishmaniasis. Others are searching for new approaches to treat infectious diseases, focusing on how pathogens change and drug resistance evolves.

Historical studies

One of the earliest contributions made by VA researchers to medical science was establishing effective treatments for tuberculosis (TB), a bacterial disease that is spread through the air from one person to another. TB can be fatal if not treated properly.

Evidence of tubercular decay has been found in the spines of Egyptian mummies thousands of years old, and TB was common in ancient Greece and Imperial Rome. As late as the 19th century, the disease occurred at epidemic proportions in Europe and North America, and TB remained a major health problem well into the 20th century.

The first head of VA research was a TB specialist, and in the 1920s and 1930s, VA researchers published a number of scientific papers on the subject. After World War II, VA and the Department of Defense conducted a major study to test the effectiveness of the antibiotic streptomycin to treat TB. While initial results were very favorable, researchers soon learned that the antibiotic could cause inner ear damage, and that many patients developed resistance to the drug.

In 1947, however, VA researchers determined in a follow-up study that a lower dose of streptomycin could achieve similar good results with fewer side effects and less risk of drug resistance. These studies, conducted at a number of VA facilities, were among VA's first-ever large-scale clinical trials. They eventually led (in 1972) to the development of VA's Cooperative Studies Program, which plans and conducts large multicenter clinical trials and epidemiological studies for VA.

Tuberculosis

Although TB rates in the United States have fallen to all-time lows, largely thanks to antibiotics such as streptomycin and its successors, 11 million Americans are infected with the TB germ, up to 10 percent of whom will develop the disease if they are not treated.

Stopping latent tuberculosis from developing—Accordingly, VA researchers have continued to study the disease. In 2011, an international study that included six VA sites found that patients with latent tuberculosis (those who are infected but have no symptoms and are not contagious) could keep the disease from developing by taking a combination of drugs (rifapentine and isoniazid) once a week for three months.

The combination appears to work just as well as the previous standard of care, which called for taking one of the drugs (isoniazid) every day for nine months. Nearly 8,000 people at high risk of developing TB from Brazil, Canada, Spain, and the United States took part in the study.

Improving an existing antibacterial drug—In 2016, researchers with the VA Tennessee Valley Health Care System and Vanderbilt University found that a small chemical change to floroquinolone, an existing antibacterial drug used to treat TB, results in a compound that is more effective against tuberculosis enzymes.

The new compound, a modified version of the drug moxifloaxin, also maintains its activity against drug-resistance forms of the enzyme, and could lead to a more effective treatment for tuberculosis.

Shingles

Shingles, or herpes zoster, results from the reactivation, multiplication, and spread of chickenpox virus that remains dormant in sensory nerves. It is marked by a painful, blistering rash, and can affect anyone who had chickenpox as a youth. Doctors in the United States treat more than a million cases each year.

Most cases of shingles clear up within two to three weeks, but some patients suffer anguishing nerve pain for months or even years. This stage, called postherpetic neuralgia, can involve burning, throbbing, stabbing, or shooting pain and can lead to insomnia, weight loss, depression, and other medical problems.

Shingles vaccine—In 2005, VA researchers and their colleagues published the results of the Shingles Prevention Study, one of the largest adult vaccine trials anywhere. The results showed that a vaccine called Zostervax was well tolerated and protected older adults over 60 from shingles and postherpetic neuralgia.

Since then, the study team has continued to study the vaccine's benefits and ways it can be used most efficiently.

Researchers from throughout VA in a 2013 study found the vaccine is safe for older adults with a prior history of shingles. They have also determined it is safe and effective for people in their 50s (the original trial included only people 60 and older); and that the efficacy of the vaccine gradually declines in the years following vaccination, so that a second dose may be needed.

HIV/AIDS

Human immunodeficiency virus (HIV) is the chronic, progressive disease that leads to Acquired Immune Deficiency Syndrome (AIDS). The virus was first identified 30 years ago. According to amFAR, the foundation for AIDS research, nearly 39 million people have died of AIDS worldwide, and nearly 37 million are now living with HIV infection. In the United States, VA is the single largest provider of medical care for HIV/AIDS.

VA researchers are focused on improving HIV screening rates and the identification of the HIV virus in primary care settings throughout the department; managing HIV, including the many complex clinical and social problems of Veterans with the virus; and improving access to care and care equity for Veterans who are vulnerable due to their geographic, racial, and ethnic status.

Screening for the HIV virus is crucial, because up to a quarter of people with HIV don't know they have it. Not only don't they get the care they need, but they also risk infecting others.

Early antiretroviral therapy—In 2015, researchers from the South Texas VA Healthcare System and the University of Texas at San Antonio found that patients who received antiretroviral therapy within a year of their infection were half as likely to develop AIDS compared to those who waited longer. They were also more likely to achieve and maintain a normal level of infection-fighting T-cells.

The study contradicted traditional HIV treatment methodology, which encourages physicians to wait until patients reached certain infection thresholds before recommending antiretroviral therapy.

Preventing bone loss—A 2016 study by researchers with the Atlanta VA Medical Center and Emory University found that a single dose of the drug zoledronic acid inhibits the bone loss that is common in HIV-infected patients. This bone loss is increased during the first two years of treatment with antiretroviral therapy.

The research team studied 63 HIV positive individuals, ages 30 to 50 years, who did not have osteoporosis, had no history of immunological disease other than HIV, and had serum vitamin D and calcium levels within the normal rage. Half were given zoledronic acid, and the other half were given a placebo.

They found that treatment with zoledronic acid was associated with a 73 percent reduction in bone loss, relative to the placebo, after 12 weeks, and a 65 percent reduction at 25 weeks. The effect lasted throughout the entire 48 weeks of the clinical trial.

Bone loss was higher in men, compared with women, in the placebo arm of the study, and the protection against bone loss was greater in men than in women in the treatment arm.

Influenza (flu)

The flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccine each year.

Flu vaccine dosage—In 2015, researchers at the Philadelphia VA Medical Center and the University of Pennsylvania attempted to determine whether standard-dose or a higher dose version of flu vaccine were better for Americans over 65.

The study, which looked at more than 165,000 VA patients, found that for those between the ages of 65 and 84, the standard dose worked just as well. However, for Veterans 85 or older, the higher dose was better in terms of avoiding hospitalization for the flu or pneumonia.

Determining flu season—Another 2015 study, by researchers with VA and other health care institutions throughout the nation, described a new algorithm to help hospitals and public health officials determine the earliest stages of flu season. Having this information could help them preserve resources while combatting the virus.

The algorithm, which researchers call the Above Local Elevated Respiratory Illness Threshold (ALERT) uses routine information, such as the number of influenza cases confirmed per week in a region, to determine where and when the flu needs to be combatted.

The tool takes a region's flu history into account and allows users to identify the number of cases per week they believe would signal the start of the season in their area. It also identifies the length of time influenza outbreaks are likely to last.

Pneumonia

Pneumonia is common among older Americans, and sends hundreds of thousands of seniors to the hospital each year.

Treating pneumonia in the ICU—A 2015 study by researchers with VA and the University of Michigan Medical School found that many seniors with this lung infection had a better chance of surviving if they went to an intensive care unit instead of a general hospital bed—and that despite ICUs' reputation as a high-cost place to care for patients, the costs to Medicare and hospitals were the same for both groups.

Researchers looked at data from 1.1 million hospital stays at nearly 3,000 hospitals between 2010 and 2012. They focused on patients "on the bubble"—those whom doctors could send to either an ICU bed or a general bed, depending on their judgment.

The team is now evaluating if the ICU is beneficial for other conditions, including chronic obstructive pulmonary disease, congestive heart failure, and heart attack.

Pneumonia and heart problems—Older men hospitalized with pneumonia may also be at risk of heart problems. In 2011, researchers at the South Texas Veterans Health Care System completed a national study of the records of more than 50,000 patients admitted to VA hospitals with pneumonia who were aged 65 or older.

They found that about 10 percent of these Veterans experienced congestive heart failure within 90 days of their admission to the hospital. Virtually the same percentage experienced an arrhythmia (a problem with the rate or rhythm of the heartbeat.) Another 1.5 percent had a heart attack. Most of these events occurred while patients were in the hospital.

The study's authors suggested that cardiovascular events may be a principal reason for death following the onset of pneumonia in older people, and recommend further studies to determine whether interventions can reduce the frequency of these events.

Zithromax antibiotic—In a separate study published in 2014, researchers looking at the records of 65,000 older patients hospitalized with pneumonia found that treatment that included the antibiotic azithromycin (Zithromax) compared with other antibiotics was associated with a significantly lower risk of death and a slightly increased risk of heart attack. The researchers concluded there is a net benefit associated with azithromycin use in patients hospitalized for pneumonia.

Lung cancer and infectious lung disease

Positron emission tomography (PET) is a medical imaging technique that produces 3-D images showing differences between healthy and diseased tissue. PET commonly uses a radioactive tracer called FDG (fluorodeoxyglucose), so the test is sometimes called an FDG-PET scan.

FDG-PET scans are often used in combination with computed tomography (CT) scans to diagnose lung cancer. In 2014, a team from VA's Tennessee Valley Health Care System and Vanderbilt University Medical Center in Nashville found that FDG-PET scans combined with CT are not as good at detecting lung cancer in regions where there is endemic infectious lung disease, compared with regions where such disease is not widespread.

The researchers reviewed 70 previous studies on FDG-PET. In patients who had pulmonary nodules but not lung cancer, FDG-PET was 16 percent more likely to give a false-positive result when the patients lived in regions where infectious lung disease is prevalent. This suggests that the lung diseases common in those regions may sometimes be mistaken for cancer on imaging tests.

Examples of regional lung diseases include histoplasmosis and blastomycosis, which are caused by inhaling airborne fungal spores. TB is also much more common in some regions of the United States than in others.

Preventing hospital-acquired infections

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics called beta-lactams. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin, and amoxicillin.

MRSA is a dangerous infection, difficult to eradicate, that can cause pneumonia or infect wounds and the bloodstream. It is primarily spread through direct physical contact with a person or object carrying the bacteria, and typically resides on the skin or in the nose. Health care procedures can leave patients especially vulnerable to MRSA.

To combat MRSA, VA obtains nasal specimens from all patients when they are admitted, transferred, or discharged; isolates all patients who test positive for MRSA; emphasizes the importance of thorough hand-washing for all staff; and is working to continuously improve infection control at all VA facilities.

Improving microbiology database searches—A team of VA researchers, based in Salt Lake City, reported in 2012 that natural language processing—the technology used by Internet search engines to make sense of people's search terms—could be used effectively to identify MRSA-related terms in microbiology databases and thereby aid in surveillance efforts.

Antimicrobial properties of copper—Another group of researchers, from the Charleston VA Medical Center, Medical University of South Carolina, and Sloan Kettering Cancer Center in New York, tested the antimicrobial properties of copper by replacing surfaces in eight intensive care rooms with antimicrobial copper versions. These surfaces included bed rails, tray tables, nurse call buttons, and IV poles—the surfaces in patient rooms most likely to carry harmful germs.

They found, in 2013, that the use of antimicrobial copper surfaces in these rooms cut the amount of bacteria in the rooms by 97 percent, and also resulted in a 41 percent drop in the rate of hospital-acquired infections.

Preventing MRSA through antiseptic bathing—In a 2013 study published in the New England Journal of Medicine, VA researchers and their colleagues found that infections acquired in hospitals are less likely to occur when acute-care patients are bathed daily with a simple, inexpensive antiseptic called chlorhexidine.

In addition to reducing bloodstream infections by 28 percent, daily antiseptic baths reduced the rate of acquiring multi-drug resistant organisms such as MRSA by 23 percent—and the benefits of daily antiseptic baths increased the longer patients remained on intensive care units.

Disinfecting using UV light—A 2015 study by researchers with the Central Texas Veterans Health Care System in Temple found that, in 12 minutes, a pulsed xenon ultraviolet (UV) light system could disinfect a hospital room as well as a human can.

Before and after UV disinfection, the team took samples of five "high-touch" surfaces in 38 patient rooms, including the patient call button, bedrail, and tray table, as well as the handrail and toilet in the restroom.

They found that the UV method cut the number of bacterial colonies per room by about 70 percent, roughly the same level of effectiveness as manual disinfection.

The team does not recommend that UV cleaning replace manual cleaning, but complement it instead. A previous 2014 study by the research team indicted that the two methods together can effectively kill between 90 and 99 percent of all aerobic bacteria in an average hospital room.

Removing protective gear improperly leads to contamination—Researchers at the Louis Stokes VA Medical Center in Cleveland and their colleagues used fluorescent lotion and black light in a 2015 study to demonstrate that health care workers often contaminate their skin and clothing while removing their protective gear. This contamination can spread germs and place the workers at risk of infection. Contaminated personnel can also spread pathogens to other susceptible patients.

Doctors, nurses, and other health care personnel at four VA and non-VA Cleveland-area hospitals were asked to participate in simulations in which they put on and removed protective gowns and gloves. A small amount of fluorescent lotion was then placed in the palm of their hands, which they rubbed between their hands and smeared on their gowns.

The investigators checked the skin and clothing of the study participants for the lotion after the participants removed those gowns and gloves, and found that either their skin or their clothing was contaminated 46 percent of the time—70 percent of the time when the protective equipment was removed improperly.

C. difficile infections

C. difficile is an intestinal bacterial infection that is difficult to treat using standard antibiotic treatment, because it has a very high recurrence rate. As many as 30 percent of patients experience recurrent episodes of the illness.

Treatment with nontoxic spores—Such infections can result in repeated hospitalizations, malnourishment, and dehydration and, occasionally, death. In 2015, an international team of researchers led by investigators with the Edward Hines, Jr. VA Hospital in Illinois found that giving spores of nontoxic C. difficile by mouth could stop repeated bouts of C. difficile infection.

The team randomly assigned 168 adult patients with C. difficile infections who had been treated for their infection to receive doses of either 10,000 or 10 million spores per day of nontoxic C. difficile in liquid form for 7 or 14 days, or to receive an identical placebo. Statistically significant reductions of relapses in infection were shown in those who received any dose of nontoxic C. difficile; the best results were shown in those who received 10 million spores a day for seven days.

Fecal transplantation—Also in 2015, VA researchers and researchers with the University of Minnesota looked at a procedure that dates back thousands of years and found it can be an effective method for battling C. difficile infections. The procedure, called fecal transplantation, involves removing stool containing healthy bacteria from a donor and inserting it into a sick patient.

The investigators' review looked at the results of studies involving data for more than 500 patients with C. difficile infections, and learned that fecal transplantation proved successful in treating 85 percent of patients with recurring infections. The researchers concluded that such transplantation is a safe and effective way to treat recurrent infections.

Risk factors for C. difficile—In December 2015, VA researchers published an analysis of information from the Veterans Affairs Surgical Quality Improvement Program's Database in JAMA Surgery. The database documents all non-cardiac operations at 134 VA medical centers each year.

They found that VA hospitals' rates of postoperative C. difficile infection are related to the number of preoperative antibiotics patients have taken, the complexity of their procedures, and the complexity of the hospital's surgical program—in addition to the already-known risk factors for the infection.

The researchers focused on 468,386 procedures performed during a four-year period, and documented that 1,833 cases of C. difficile infection were diagnosed within 30 days of surgery, an overall incidence of 0.4 percent. They found that patients who had taken three or more antibiotics before surgery were nearly six times more likely to develop C. difficile than patients who had taken only one or no antibiotics.

In addition, patients who underwent more complex surgical procedures were at increased risk of this complication, as were patients at hospitals that frequently handled complex procedures. Those who developed the infection had significantly higher rates of illness and death than those who did not, as well as longer postoperative hospital stays.

Environmental hazards

For many of the more than 2.6 million service members who have served in Iraq and Afghanistan, respiratory health after deployment has become a major concern. One reason for problems such as persistent cough or shortness of breath may be burn pits—large open-air ditches in which the military disposed of trash ranging from human waste to compact discs and plastics.

Additional reasons for respiratory problems among Iraq and Afghanistan Veterans may include other airborne hazards including sand and dust storms and general air quality.

A 2015 review of 19 studies on this issue appeared to confirm higher rates of respiratory problems for service members during deployment and immediately afterward, but was inconclusive on whether those problems would affect the long- term health of these Veterans. The research team, from VA's War-Related Illness and Injury Study Center in New Jersey, suggested that additional studies were needed.

This study follows a 2011 report from the Institutes of Medicine (IOM), which was also inconclusive about the long-term health effects of burn pits, and recommended further study. The IOM report also drew attention to other deployment risks that may harm respiratory health.

Iraq and Afghanistan Veterans are encouraged to visit the website of VA's Airborne Hazards and Open Burn Pit Registry, where they can enroll in the registry to learn about and help researchers learn more about potential health effects. Veterans concerned about their exposure to burn pits are encouraged to talk to their health care provider or local VA environmental health coordinator. A directory of these coordinators is found here.

More on Our Website

Selected Scientific Articles by Our Researchers

A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Oxman MN, the Shingles Prevention Study Group, et al. The zoster vaccine markedly reduced morbidity from herpes zoster and postherpetic neuralgia among older adults. N Engl J Med. 2005 Jun 2;352(22):2271-84.

Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. Jain R, Kralovic SM, Evans ME, Ambrose M, Simbarti LA, Obrosky DS, Render ML, Freyberg RW, Jernigan JA, Muder RR, Miller LJ, Roselle GA. A program of universal surveillance, contact precautions, hand hygiene, and institutional culture change was associated with a decrease in health care-associated transmissions of and infections with MRSA in VA. N Engl J Med. 2011 Apr 14;364(15):1419-30.

Effect of daily chlorhexidine bathing on hospital-acquired infection. Climo MW, Yokoe DS, Warren DK, Perl TM, Bolon M, Herwaldt LA, Weinstein RA, Sepkowitz KA, Jemigan JA, Sanogo K, Wong ES. Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of multidrug-resistant organisms and development of hospital-acquired bloodstream infections. N Engl J Med. 2013 Feb 7;368(6):533-42.

Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit. Salgado CB, Sepkowitz KA, John JF, Cantey JR, Attaway HH, Freeman KD, Sharpe PA, Michels HT, Schmidt MG. Patients cared for in ICU rooms with copper alloy surfaces had a significantly lower rate of incident hospital acquired infections or colonization with MRSA than did patients treated in standard rooms. Infect Control Hosp Epidemiol. 2013 May;34(5):479-86.

Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia. Mortensen EM, Halm EA, Pugh MJ, Copeland LA, Metersky M, Fine MJ, Johnson CS, Alvarez CA, Frei CR, Good C, Restrepo MI, Downs JR, Anzueto A. Among older patients hospitalized with pneumonia, treatment that included azithromycin compared with other antibiotics was associated with a lower risk of 90-day mortality and a smaller increased risk of myocardial infarction. These findings are consistent with a net benefit associated with azithromycin use. JAMA. 2014 Jun 4; 311(21):2199-208.

Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis. Deppen SA, Blume JD, Kensinger CD, Morgan AM, Aldrich MC, Masssion PP, Walker RC, McPheeters ML, Putnam JB Jr, Grogan EL. FDG-PET scans combined with CT are not as good at detecting lung cancer in regions where there is endemic infectious lung disease, compared with regions where such disease is not widespread. JAMA. 2014 Sep 24:312(12):1227-36.

Triggering interventions for influenza: the ALERT algorithm. Reich NG, Cummings DA, Laurer SA, Zorn M, Robinson C, Nyquist AC, Price CS, Simberkoff M, Radonovich LJ, Perl TM. The ALERT algorithm provides a simple, robust, and accurate metric for determining the onset of elevated influenza activity at the community level. Clin Infect Dis. 2015 Feb 15;60(4):499-504.

Influence of the timing of antiretroviral therapy on the potential for normalization of immune status in human immunodeficiency virus 1-infected individuals. Okulicz JF, Le TD, Agan, BK, Camargo JF, Landrum ML, Wright E, Dolan MJ, Ganesan A, Ferguson TM, Smith DM, Richman DD, Little SJ, Clark RA, He W, Ahuja SK. Deferral of antiretroviral therapy beyond 12 months of the estimated date of seroconversion diminishes the likelihood of restoring immune health in individuals with human immunodeficiency virus 1. JAMA Intern Med. 2015 Jan;175(1):88-99.

Can pulsed xenon ultraviolet light systems disinfect aerobic bacteria in the absence of manual disinfection? Jinadatha C, Villamaria FC, Ganachari-Mallappa N, Brown DS, Liao IC, Stock EM, Copeland LA, Zeber JE. Pulsed xenon-based ultraviolet light systems effectively reduce aerobic bacteria in the absence of manual disinfection. Am J Infect Control. 2015 Apr 1;43(4):415-7.

Administration of spores of nontoxigenic Clostridium difficile strain M3 for prevention of recurrent C. difficile infection: a randomized clinical trial. Gerding DN, Meyer T, Lee C, Cohen SH, Murthy UK, Poirier A, Van Schooneveld TC, Pardi DS, Ramos A, Barron MA, Chen H, Villano S. Nontoxigenic C. difficile strain M3 is safe and well-tolerated in patients with C. difficile infections, and can reduce recurrences of the infection. JAMA. 2015 May 5;313(17):1719-27.

Fecal microbiota transplantation for clostridium difficile infection: a systematic review. Drekonja D, Reich J, Gezahegn S, Greer N, Shaukat A, MacDonald R, Rutks I, Wilt TJ. Fecal microbiota transplantation may have a substantial effect with few short-term adverse events for recurrent Clostridium difficile infection. Ann Intern Med. 2015 May 5;162(9):630-8.

Relationship between Toxoplasma gondii and mood disturbance in women Veterans. Duffy AR, Beckie TM, Brenner LA, Beckstead JW, Seyfang A, Postolache TT, Grower MW. A study describing biobehavioral relationships between chronic Toxoplasma gondii infection, depression, and dysphoric moods in women Veterans. Mil Med. 2015 Jun;180(6):621-5.

Comparative effectiveness of high-dose versus standard-dose influenza vaccination in community-dwelling Veterans. Richardson DM, Medvedeva EL, Roberts CB, Linkin DR; Centers for Disease Control and Prevention Epicenter Program. High-dose flu vaccine was not found to be effective than small dose vaccine in protecting against hospitalization for influenza and pneumonia among older patients, except for having a protective effect in the oldest group of patients. Clin Infect Dis. 2015 Jul 15;61(2):171-6.

Factors influencing antibiotic-prescribing decisions among inpatient physicians: a qualitative investigation. Livorsi D, Comer A, Matthias MS, Perencevich EN, Bair MJ. A physician-based culture of prescribing antibiotics involves overusing antibiotics and not challenging the decisions of colleagues. Infect Control Hosp Epidemiol. 2015 Sep;36(9):1065-72.

Association of intensive care unit admission with mortality among older patients with pneumonia. Valley TS, Sjoding MW, Ryan AM, Iwashyna TJ, Cooke CR. Among Medicare beneficiaries hospitalized with pneumonia, Intensive Care Unit admission of patients for whom the decision appeared to be discretionary was associated with improved survival and no significant difference in costs. JAMA. 2015 Sep 22-29;314(12):1272-9.

Analysis of morbidity and mortality outcomes in postoperative Clostridium difficile infection in the Veterans Health Administration. Li X, Wilson M, Nylander W, Smith T, Lynn M, Gunnar W. The number and class of antibiotics administered after surgery, preoperative length of stay, procedural characteristics, surgical program complexity, and patient comorbidities are associated with postoperative C. difficile infections in the VHA. JAMA Surg. 2015 Nov 25:1-9.

Contamination of health care personnel during removal of personal protective equipment. Tomas ME, Kundrapu S, Thota P, Sunkesula VA, Cadnum JL, Mana TS, Jencson A, O'Donnell M, Zabarsky TF, Hecker MT, Ray AJ, Wilson BM, Donskey CJ. Contamination of the skin and clothing of health care personnel occurs frequently during removal of contaminated gloves or gowns. JAMA Intern Med. 2015 Dec 1; 175(12):1904-10.

Fluoroquinolone interactions with mycobacterium tuberculosis gyrase: enhancing drug activity against wild-type and resistant gyrase. Aldred KJ, Blower TR, Kerns RJ, Berger JM, Osheroff N. A new approach to defining drug-enzyme interactions with the potential to identify novel drugs with improved activity against tuberculosis. Proc Natl Acad Sci USA, 2016 Feb 16:113(7):E839-46.

Infectious Diseases Fact Sheet


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VA Research in the News

New drug combination treats hepatitis C patients also infected with HIV, UC San Diego Health news release, July 21, 2015

Coordinated effort critical for stopping spread of hospital-acquired infections, University of Utah news release, Aug. 4, 2015

Hospital workers often transfer germs when removing gloves, gowns, Fox News Health, Oct. 12, 2015

Hospital workers less likely to have had flu shot than you might think, Health.com, Dec. 15, 2015

Alcohol also damages the liver by allowing bacteria to infiltrate, UC San Diego news release, Feb. 10, 2016

Slight chemical change may improve TB treatments: study, Vanderbilt University news release, Feb. 11, 2016

Redefining sepsis: an international effort to improve patient outcomes, University of Pittsburgh Medical Center news release, Feb. 22, 2016

Zoledronic acid can prevent early bone loss in HIV patients on antiretroviral therapy, Emory University news release, Feb. 23, 2016

VA and other U.S. Government Online Resources

Infectious Diseases, Office of Public Health, U.S. Department of Veterans Affairs

Office of Infectious Diseases, Centers for Disease Control and Prevention

National Institute of Allergy and Infectious Diseases, National Institutes of Health

Immunization and Infectious Diseases, HealthyPeople.gov

Infectious Diseases, MedlinePlus

Protecting communities from infectious disease, U.S. Global Health Initiative


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