Division of Infectious Diseases

Learn more about our open Community ID physician position!

Content provided by Dr. Starlin

Our community infectious diseases team aims to provide service to patients outside of main University of Nebraska Medial Center (UNMC) campus. It is one of the few fully dedicated Academic Community Infectious Disease services in the country and we are proud to embrace Nebraska Medicine’s (NMC) and UNMC’s vision and mission to offer services to all Nebraskans- because in Nebraska, we take care of each other.

We provide unparalleled experience in clinical care which plays a vital role in our Infectious Disease program. Our community infectious disease team members are also fully involved in division’s multiple academic, clinical and research activities. The core physicians are Dr. Richard Starlin, Dr. Richard Hankins and Dr. Daniel Brailita.

Dr. Rick Starlin, service line director (Center); Dr. Richard Hankins (left), Dr. Dan Brailita (right)

The service started in 2018 with Dr. Starlin as service line director. Dr. Starlin has many years of experience practicing infectious disease at UNMC as well as community based infectious diseases in several hospitals throughout Nebraska. He brings significant expertise in the field of employee health, occupational health, atypical mycobacterial infections, and orthopedic infection.

The service expanded adding Dr. Hankins, who joined from inside the ranks of our own UNMC infectious disease fellowship program, bringing further expertise and interest in infection prevention, antimicrobial stewardship, community-based infections, medical education and public health.

In early 2021, Dr. Brailita joined the division further adding significant community infectious disease, DHHS medical consultative services for tuberculosis, and infection prevention expertise. Dr. Brailita has helped build a large hospital and clinic based infectious diseases practice in areas of Nebraska previously void of ID.  In addition to our core physicians, several other academic ranked physicians with interest in community ID participate in our community service. Likewise, the core physicians participate in ID rotations on the UNMC Main campus. We have excellent support from outstanding advanced practice providers who are valued team members and have established a relationship of trust and respect with many community physicians.

While providing on-site services to facilities in Omaha area, our community infectious disease service recently expanded to strategically support several major facilities in Nebraska, using the newest technology and telemedicine services. Currently we provide on-site ID coverage and consultative services at Bellevue Medical Center (BMC) and Madonna Rehabilitation Hospital (MRH) in Omaha. Coverage at BMC allows ID to work collaboratively with primary care and other specialists in a community hospital setting. Many of the complex patients discharged from NMC continue their medical care at MRH. The Community ID service is thus able to follow and provide continuity of care for these patients.

We are providing Telemedicine ID Consultative Services at Madonna Rehabilitation Hospital in Lincoln, as well as inpatient and outpatient ID Telehealth services to Mary Lanning Healthcare, a community hub in Central Nebraska. There are plans for expansion of Telehealth services to several other facilities. We have the capability to interconnect with our partners from Antimicrobial Stewardship Program (ASAP), Nebraska Infection Prevention and Control Program (ICAP) and others. Our physicians serve as associate medical directors for these important projects that address ID/IP needs in the state.

Our UNMC ID Fellows have participated and appreciate the opportunity to spend time on Community ID and Telehealth with our core team/ faculty. Community ID is now included in the formal training of our fellows.

We are open to further expansion of our services. For a Community ID attending there are endless opportunities to shape one’s career. While our service has clinical focus, the career pathways of our team are very diverse and open, with every individual taking a different approach to clinical and non-clinical research, public health training and directorship, academic career and teaching, advocacy, and involvement in community projects. The position is perfect for a physician who is looking for a clinically-oriented career path. The community ID faculty position can also be adapted for those who are interested in research or teaching.  Opportunities to immediately engage in FTE-funded academic work in infection control and prevention are available through Nebraska ICAP/ASAP.

Learn more and apply: https://unmc.peopleadmin.com/postings/59954

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Antibiotic Awareness Week Publication Alert: Confronting antimicrobial resistance beyond the COVID-19 pandemic

Antibiotic Awareness Week 2021,”an annual observance that raises awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic use” runs this year from November 18-24 2021. This is a global campaign with messaging from the CDC and the WHO calling on all of us to not only Be Antibiotics Aware, but to actively engage in activities to reduce the spread of antimicrobial resistance.

To kick off #USAAW21 and #WAAW21, we share this #ThrowbackThursday publication from September 2020: Confronting antimicrobial resistance beyond the COVID-19 pandemic and the 2020 US election. I coauthored this perspective in the Lancet with Drs. Steffanie Strathdee and Sally Davies.

In this article, we highlighted ongoing challenges due to antimicrobial resistance worldwide: 700K deaths per year, costing US100 trillion globally, and more than 2.8 million infections/35K deaths/$20billion in healthcare expenditures in the US.

We also described how the current COVID-19 pandemic is likely exacerbating antimicrobial resistance, with excessive antibiotic use when not clinically indicated, and redirection of resources globally away from antimicrobial stewardship to COVID-19 activities.

We end with a call to action that “the path forward is not only one that builds back from the COVID-19 pandemic, but also addresses AMR in the context of pandemic preparedness” and “collaboration is the most effective way to tackle global health threats“.

Click on the figure to enlarge. COVID-19 Related Antimicrobial Resistance Challenges and Potential Solutions

Read more of the perspective piece here: https://www.thelancet.com/article/S0140-6736(20)32063-8/fulltext/#bib2

UNMC ID Antimicrobial Stewardship Pharmacists celebrated with Acute Care Pharmacist of the Year and Rising Star Pharmacist Awards

Content provided courtesy Colleen Malashock, PharmD, BCPS

Thirty-three acute care pharmacists received heartfelt nominations from sixty-five peers and colleagues for Pharmacist of the Year 2021. The criteria for this honor included embodiment of our ITEACH values, demonstrating professionalism and leadership, serving as a role model for other colleagues with regard to advancing the profession of pharmacy and having a positive impact based on service to the community. This year, two awards were given – the Acute Care Pharmacist of the Year Award, and the Rising Star Pharmacist Award: both awardees came from the UNMC ID division.

Bryan Alexander, PharmD, BCIDP, AAHIVP  was selected as the winner of the Acute Care Pharmacist of the Year award. Dr. Alexander has been with Nebraska Medicine for three years. In addition to his role leading the Outpatient Antimicrobial Therapy (OPAT) team, he has been instrumental in the distribution of COVID-19 monoclonal antibody therapeutic agents throughout the state of Nebraska. He was asked to work with the State Health Department to develop a system to equitably distribute these agents and ensure areas with COVID-19 hot spots had the products and knowledge to administer them.

Dr. Alexander was nominated by six colleagues. Jasmine Marcelin, MD, stated in her nomination, “He consistently embodies ITEACH values. His attention to detail is impeccable, and I trust him completely to advise me on antimicrobial decisions in difficult patient scenarios.”

He was also nominated by James Lawler, MD, who highlighted, “Bryan has been front and center in Nebraska Medicine’s fight to limit the impact of COVID-19 in the Omaha community and across the state. Through his leadership, the state was able to administer thousands of courses to the most vulnerable, preventing hundreds of hospitalizations and deaths.”

Bryan Alexander, PharmD, was recognized with this year’s Acute Care Pharmacist of the Year award

In addition to the Acute Care Pharmacist of the Year, a Rising Star Pharmacist was also honored.

This year’s recipient of the Rising Star award is  Andrew Watkins, PharmD. Dr. Watkins joined the staff of Nebraska Medicine last July after completing our PGY2 Infectious Diseases Residency program in June 2020. He serves as the pharmacy coordinator for the Nebraska Antimicrobial Stewardship Assessment Program (ASAP) program.

One of his three nominations came from Muhammed Salman Ashraf, MD, who states, “He has been a great team player and worked with ICAP and Global Center for Health Security colleagues, long-term care pharmacies, hospitals, long-term care facilities and many other partners across the state to set up a long-term care monoclonal antibody program which is a unique model across the country.”

Andrew Watkins, PharmD, was named the Rising Star Pharmacist

We are thrilled to acknowledge the accomplishments and express our gratitude for the work done by these two pharmacists for Nebraska Medicine and the state of Nebraska this past year. What a great way to launch into the upcoming Antibiotic Awareness Week, than to start off celebrating two of our Antimicrobial Stewardship pharmacists!

Round 2: IDWeek 2021 “Ryder’s Review”

Content provided by Dr. Jonathan Ryder, second year UNMC ID fellow

Now as a second-year fellow (and second year attendee), IDWeek 2021 had a different feel. The virtual conference was no longer a new experience, having done this at IDWeek 2020 and SHEA 2021. While we hope for in-person meetings in the near future, I settled in for this conference a bit easier than last year. Once again this year, I felt quite fortunate to attend this conference as part of my fellowship training, as the emphasis on fellow education at UNMC is clear.

The first day of IDWeek 2021 as a second-year fellow is the Vincent T. Andriole Board Review Course. We covered high-yield material across several sessions, including UNMC’s Dr. Andrea Zimmer presenting on infections in transplant recipients. Next, we had the Fellows’ Day Workshop immediately preceding the meeting. This workshop kicked off with several challenging ID cases. We then had sessions to prepare for job interviews and contracts that provided perspective on our futures. Additionally, we had breakout sessions in areas of career interest, so I attended the session on antimicrobial stewardship.

Officially IDWeek started with 24 hours of COVID-19, the second consecutive Chasing the Sun day. This year focused more on COVID-19 vaccine development. I particularly enjoyed the perspectives on the development of mRNA technology born out of research on RSV vaccines. I also enjoyed learning about research on post-acute sequelae of COVID-19.

The next four days of IDWeek were my favorite: various sessions on innumerable infectious disease topics. With great anticipation prior to IDWeek, I always map out which sessions to attend. However, it is tough sledding given the abundance of high-quality sessions. I try to focus on my areas of interest (antimicrobial stewardship, endocarditis, antibiotic resistance) while balancing this with sessions that I need to learn more about (HIV, outpatient ID). I was fortunate to share my favorite IDWeek sessions with Dr. Sara Dong on the Febrile podcast this year, so check it out to hear a bunch of clinical pearls.

In conclusion, I had a highly educational experience at IDWeek 2021 once again with a wide swathe of expert speakers covering high yield infectious disease topics. However, I truly hope we can have an in-person conference this upcoming year. With two straight years of virtual conference, I have not been able to meet the infectious diseases community in-person, including several fellows that I have interacted with virtually. Here is to hoping to seeing everyone in Washington D.C. in 2022!

COVID-19 vaccines at the Specialty Care Center

(Pictured: Adele Haas, CMA, prepares and administers COVID-19 vaccines to patients at the SCC)

Since mid-August 2021, the Nebraska Medicine Specialty Care Center (SCC) has been busy administering Pfizer BioNTech COVID-19 vaccine to patients at the clinic. Many of these patients were previously hesitant about receiving COVID-19 vaccines elsewhere in the community, but had expressed willingness to complete it at the SCC.

At that time (8/13/21), Just over 70% of the approximately 1200 patients at the SCC had already completed the initial COVID-19 vaccine series. Nichole Regan, APRN at the clinic, stated, “We were really excited about these numbers, but wanted to continue to educate the 30% of our patients that weren’t yet vaccinated, and connect them to vaccination resources. Knowing we could offer the vaccine right here in clinic, we had a hunch that would help patients feel more willing and comfortable to get vaccinated.”

Two months later, the clinic COVID-19 vaccine completion rate has steadily risen to 75%, and the SCC is also now offering Pfizer third doses and booster doses to those eligible.

A small group of patients have received their THIRD dose of a COVID-19 mRNA vaccine, based on guidance released by the CDC in August 2021, directed at immunocompromised patients. In terms of persons with HIV, immunocompromised patients are considered to be those not on antiretroviral therapy (ART), and/or with CD4 counts less than 200 cells/mcL.  These guidelines actually impact a very small percentage of patients at the SCC, as over 91% of the patients are on ART with undetectable HIV RNA viral loads.

The SCC has also now ramped up vaccine clinic operations to offer Pfizer COVID-19 vaccine BOOSTERS daily, as all patients with HIV are eligible for a mRNA booster 6 months after receiving the 2nd dose of either Pfizer or Moderna vaccines (based on HIV as a qualifying medical condition, regardless of viremic control and immune function). They are also providing Pfizer boosters to patients who initially received a Janssen COVID-19 vaccine at least 2 months ago.

Content provided by Nikki Regan, MSN, APRN, NP-C

Introducing a new Nebraska DHHS funded UNMC ID ECHO Educational Series

Introducing a newly launched educational initiative, the UNMC ID Health equity and Quality Improvement ECHO Project. The goal of the program is to achieve health equity, address COVID-19 disparities, and improve the health of all Nebraskans using a quality improvement approach. The course is being offered at no cost to the learners through the University of Nebraska Medical Center (UNMC) Infectious Diseases (ID) ECHO program and is funded by the Nebraska DHHS via a CDC grant awarded to principle investigators/course directors Drs. Nada Fadul and Salman Ashraf, from UNMC ID.

This one-and-a-half-year course is highly recommended for all healthcare workers who are involved in COVID-19 prevention and management efforts at patient, community, or an organizational level. Sessions will begin Nov. 3 and meet twice a month via Zoom. The course will be especially helpful for anyone looking to learn health equity, cultural sensitivity and quality improvement principles and apply those in their practice.  Learners will be able to obtain AMA PRA Category 1 CME CreditsTM, ANCC contact hours, ASWB ACE credits, or PACE credits free of cost for each session they will attend (approval is currently pending for PACE credits). In addition, learners who will attend >70% of the sessions and implement a quality improvement project will receive a certificate of completion (“Health Equity and Quality Improvement Champion”) from the UNMC ID ECHO program at the end of the course.

Healthcare entities whose representatives are enrolled in the educational training will also have the option to apply for up to $2000 in expense reimbursement related to approved project implementation within their scope of practice target on reducing health disparities. The funding is available to support up to 100 approved projects. Twice monthly sessions will be held via Zoom platform on the first and third Wednesdays of each month between 12:00 to 1:30 pm CST starting November 3rd, 2021. The first hour of each session will be mandatory for receiving the educational credits followed by an optional 30-minute discussion.

For more information and registration, please visit the project website at https://www.unmc.edu/intmed/divisions/id/ECHO/health-equity/index.html. You can also reach out to the UNMC-ID ECHO program manager, Nuha Mirghani, MD, MBA. Read a recent UNMC Today article about the project here.

From left, principal investigators/course directors: Nada Fadul, MD, FIDSA, and Muhammad Salman Ashraf, MBBS, FIDSA

We appreciate our ID Pharmacists

We LOVE our UNMC ID Pharmacists! Today marks the end of National Pharmacy Week and we want to share our appreciation and thanks for the hard work and invaluable contributions of our pharmacists at UNMC ID. Our pharmacists are exceptional clinicians giving us the clinical advice we need on antimicrobials and drug interactions. They are also published national experts in Antimicrobial Stewardship and HIV, experienced educators in both the College of Pharmacy and College of Medicine, and phenomenal colleagues all-around. Our division would not function as well as it does without these individuals, and we cannot thank them enough. Join us in giving some love to our pharmacists!

Meet our UNMC ID Pharmacists:

(TOP ROW L-R):

Josh Havens, PharmD, BCPS: Pharmacy Coordinator of the UNMC Specialty Care (HIV) clinic, PI on several clinical studies, coordinator of our Pre-exposure Prophylaxis (PrEP) clinic, and HIV clinic pharmacy rotation preceptor.

Bryan Alexander, PharmD, BCIDP, AAHIVP: Clinical and Antimicrobial Stewardship Pharmacist and coordinator of Outpatient Parental Antimicrobial Therapy (OPAT) program.

Scott Bergman, Pharm.D., FCCP, FIDSA, BCPS, BCIDP: Antimicrobial Stewardship Pharmacy Coordinator, ID Pharmacy Residency Program Director, Pharmacy residency ID rotation education coordinator and preceptor, education award recipient. He is also the current President of the Society of Infectious Diseases Pharmacists.

Andrew Watkins, PharmD: Remote ASP Pharmacist & Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) Outreach Coordinator. He was the inaugural graduate of our ID pharmacy residency program.

(BOTTOM ROW L-R):

Molly Miller, PharmD: ASP/OPAT Pharmacist and recent graduate of our ID pharmacy residency program.

Anthony Podany, PharmD: Clinical Pharmacist at UNMC Specialty Care clinic, HIV clinic pharmacy rotation preceptor, and HIV researcher with many collaboration on AIDS Clinical Trials Group (ACTG) studies.

Danny Schroeder, PharmD: ASP Pharmacist, Nebraska Medicine Bellevue

Kimberly Scarsi, PharmD, MS, FCCP, BCPS-ID: Clinical Pharmacist at UNMC Specialty Care clinic, HIV clinic pharmacy rotation preceptor, HIV principal investigator with many collaboration on AIDS Clinical Trials Group (ACTG) studies and recipient of several research awards. She is also a College of Pharmacy representative on the UNMC Faculty Senate and member of the HIV Medicine Association (HIVMA) board of directors.

Jeremy Tigh, PharmD: PGY2 Infectious Diseases Pharmacy Resident

Sean Avedissian, PharmD: Assistant Professor, College of Pharmacy, lectures in Infectious Disease and Pharmacokinetics. His primary research interests are related to the pharmacokinetic modeling of antibiotics/antivirals in special populations (HIV, critically-ill)

Publication Alert: Structural Vulnerability among Patients with HIV and SARS-CoV-2 Co-Infection

The content below was provided by Natasha Hongsermeier-Graves, MD/MPH student at UNMC College of Medicine/Harvard School of Public Health. She led a recently published study, collaborating with another UNMC medical student Rohan Khazanchi, and UNMC ID faculty Drs. Jasmine Marcelin and Nada Fadul. (cover image courtesy CDC)

In the early months of the pandemic, it became apparent that the most marginalized and minoritized communities within the UNMC HIV clinic were being disproportionately impacted by COVID-19. In our study recently published in AIDS Care, we set out to explore the sociodemographic and clinical characteristics of 37 individuals at our HIV clinic who had developed COVID-19 as of August 27, 2020.

We performed a retrospective chart review of these patients to collect information on demographics, comorbidities, HIV outcomes, and COVID-19 outcomes.

Ninety-two percent of PWHC had at least one comorbidity, with increased BMI and hypertension being the most common. All 37 had suppressed viral loads prior to diagnosis with COVID-19, and all 37 survived.

Relative to our overall HIV clinic population, groups of patients who were overrepresented among those who became co-infected with SARS-CoV-2 included over twice as many Hispanic patients, three times as many undocumented patients, and four times as many refugee patients. The majority of co-infected patients worked “essential” labor jobs, such as health care, food processing/service, or janitorial work.

 Patients with HIV/SARS-CoV-2 Co-Infection (N=37)  HIV Registry (N=1128)
Ethnicity  
Not Hispanic or Latinx24 (64.9)946 (83.9)
Hispanic or Latinx13 (35.1)180 (16.0)
Missing0 (0)2 (0.2)
Legal status  
Refugee6 (16.2)45 (4.0)
Undocumented5 (13.5)47 (4.2)

These findings highlight how structural vulnerabilities—which are sociopolitically imposed risk factors like discrimination, legal status, poverty and beyond which impact a patient’s opportunity to achieve optimal health—play a key role in facilitating the inequitable harms of both the HIV epidemic and the COVID-19 pandemic. Although the risk factors for contracting HIV and SARS-CoV-2 may differ, the same marginalized groups are disparately harmed by both viruses.

Structural vulnerabilities including racism, stigmatization, and inequitably distributed health, economic, and educational resources place minoritized and immigrant communities at increased risk of both HIV and COVID-19. For example, the vast majority of Black and Hispanic PWHC in our study worked “essential” jobs, which did not offer paid sick leave, work-from-home flexibility, or adequate personal protective equipment during the pandemic.

As COVID-19 continues to reify longstanding health inequities in the U.S., the need remains for structural interventions to ameliorate the inequitable trajectory of the pandemic. This should include strategic measures like paid leave for essential workers to seek vaccination, mobile vaccination units for patients with housing instability, place-based resource targeting to socially vulnerable neighborhoods, and partnerships with trusted community organizations and leaders.

Natasha Hongsermeier-Graves, pictured left, led this project. She is an MD/MPH student at UNMC College of Medicine/Harvard School of Public Health. She is passionate about advocating for health equity in any way that she can.

Read the full article here.

Citation: Hongsermeier-Graves N, Khazanchi R, Marcelin JR, Fadul N. Structural vulnerability among patients with HIV and SARS-CoV-2 Co-infection: descriptive case series from the U.S. Midwest. AIDS Care. 2021 Sep 28:1-6. doi: 10.1080/09540121.2021.1981224. Epub ahead of print. PMID: 34579598.

Publication Alert : “Moment vs Movement: Mission-Based Tweeting for Physician Advocacy”

 

Drs. Kelly Cawcutt & Jasmine Marcelin have served as Co-Directors for Digital Innovation & Social Media Strategy for UNMC ID for several years, and continue to strive to advance communication, amplification, advocacy and education from the Infectious Diseases Division at UNMC, and in the field of Infectious Diseases, as a whole. With that, they also continue to collaborate and publish scholarly articles on the use of social medicine in medicine.

Their recent publication, written with several other social media experts in medicine, provides guidance and insight into how mission-based tweeting can be used effectively, and how to do it. The 5 A’s of Mission Based Tweeting are found below, but please read the entire article for more excellent content!

Marcelin  JR et al. Moment vs Movement: Mission-Based Tweeting for Physician Advocacy. J. Hosp. Med 2021;8;507-509. 

Link to the full article – https://www.journalofhospitalmedicine.com/jhospmed/article/243007/hospital-medicine/moment-vs-movement-mission-based-tweeting-physician

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Looking forward to meeting you at the #IDWeek2021 Virtual Career Fair!

It’s job hunting season! Usually we love to meet with all of you job seekers in person at IDWeek, and this year our excitement is no different, and we will be waiting to meet you online! This event is FREE for you to attend and you will have the opportunity to meet with our Division Chief Dr. Mark Rupp, as well as several amazing faculty: Drs. Nada Fadul, Rick Starlin, Nico Cortes-Penfield, and Salman Ashraf. Register for the virtual career fair and attend on October 14 at 5pm-8pm EDT/4pm-7pm CDT/2pm-5pm PDT.

Looking for your first position out of fellowship, or your next fulfilling position in your journey? The UNMC ID Division is a robust group comprised of 27 ID physicians, advanced practice providers, pharmacists, and clinical and research support staff. We provide full spectrum infectious disease care at our clinical partner, Nebraska Medicine.   Members of the division pursue specialty interests in all areas of infectious diseases including Biopreparedness, Critical Care, Orthopedic ID, HIV, Infection Control, Antimicrobial Stewardship, Occupational Health, Clinical Microbiology, Oncology ID, Solid Organ Transplantation ID, etc. We enjoy productive collaborative relationships with clinicians and scientists in numerous departments. We have a full portfolio of funded research and a robust educational mission including a thriving ID fellowship training program.    

Read more about why we are awesome and check out our three open positions: General ID, Community ID, and Immunocompromised ID – https://blog.unmc.edu/infectious-disease/

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