Welcoming Eric Houpt as Chief

William A. Petri, Jr., M.D., Ph.D.

Please join me in welcoming Eric R. Houpt as the Chief of the Division of Infectious Diseases and International Health. Eric is the Jack M. Gwaltney Jr. Professor of Infectious Diseases. He received the B.A. from Colgate University, the M.D. from Emory University, and was an Intern and Resident in Internal Medicine at the University of Chicago.  He was a fellow in Infectious Diseases at the University of Virginia from 1999-2002 whereupon he was appointed to the faculty of the Department of Medicine where he has risen through the ranks to Professor of Medicine in the Division of Infectious Diseases and International Health and Vice Chair for Research of the Department of Medicine. Eric’s wife Gwenny Kelly practices OB/GYN in Charlottesville. They have three children Hannah, Lukas, and Logan. Special clinical interests include tropical medicine (for many years he chaired the ASTMH clinical review course) and tuberculosis and non-tuberculous mycobacterial diseases. He is the Tuberculosis Consultant Physician for the Virginia Department of Health and has NIH grants in TB diagnosis and management.

Eric is internationally renowned for the development of molecular diagnostics and application to enteric infections in children in resource-limited settings.  The work has fundamentally changed how infectious diarrhea is recognized, showing that diarrhea is often a multipathogen event and a state of enteropathogen excess above a high carriage baseline.  A recent manuscript in The Lancet showed how molecular diagnostics could assign an infectious cause to diarrhea in over 80% of cases, whereas previously we were in the dark without an etiology, with most of the global childhood diarrhea burden ascribable to just 6 pathogens.  The implications for improved public health are vast.  This work has galvanized global efforts to develop Shigella vaccines and prompted clinical trials by the WHO to evaluate new management strategies for diarrhea.   For this work he was awarded the 2015 Oswald Avery Award for Achievement by the Infectious Diseases Society of America (the highest award for a mid-career investigator).

As I conclude my term as Division Chief there are many people that I wish to recognize and thank. Foremost are Mitch Rosner and Russ Manley whose academic and financial leadership of the Department of Medicine makes everything else possible. Brian Wispelwey has overseen the growth of the clinical enterprise from a single consult service and outpatient clinic. Today there are four inpatient consult services for general and immunocompromised and transplant infections and the long term acute care hospital, outpatient clinics in HIV/AIDS, general infectious diseases, musculoskeletal infections, HIV-HCV coinfection, travelers clinic, and sexually transmitted diseases clinic. Costi Sifri directs Hospital Epidemiology efforts in control of central line and urinary catheter infections Ebola preparedness while recruiting in Carlene Muto a co-Director with a focus on quality and patient safety. Greg Townsend has ably led the Ryan White Clinic which is a model not just for HIV care but how comprehensive health care should be delivered and now in his role in the Dean’s office also promotes diversity. The very capable Ryan White team includes Pam Bickley, Dyan Aretakis, Kathryn Dort, Courtney Grant, and Heather Payne.

Josh Eby continues superb work in leading quality efforts through the new Outpatient Antibiotic Therapy (OPAT) monitoring program and ID&IH QA/QC, and by directing Employee Health. Becca Dillingham leads the HIV-HCV clinic, is key in the Ryan White Program as well as University-wide role as the Director of the Center for Global Health. She has developed the eHealth app “PositiveLinks” to promote adherence to HIV care throughout the Commonwealth. Scott Heysell, in a brilliant collaboration, is applying this app to improve MDR TB care in Siberia, along with his ongoing work to improve therapy through better understanding of TB pharmacokinetics. Heather Hall continues to lead the collaboration of ID with PharmDs, an effort that has contributed immensely to patient care and teaching. Chris Moore directs, Kate McManus co-directs, and Ginny Atwell manages the fellowship program which has expanded from 5 to 10 fellows and is continuously matching the top candidates for fellowship training who are going on to the faculty of medical schools throughout the country. Chris conducts research on sepsis in Uganda while Kate drives studies of the role of the Affordable Care Act on HIV care.

Dick Guerrant continues visionary research on child health in low and middle income countries including discovering the disease called environmental enteropathy responsible for much of child malnutrition and now a major research focus of the Gates Foundation, and is a role model for me and many others. Dick led the founding of the Hunter Chair. Barb Mann oversees the research program of the Division which has grown from $400,000 annually to the current $18,000,000.  She also directs two T32 training programs the Infectious Diseases Training Program in year 41 and the Biothreats Training Program in year 15. Jerry Donowitz is not only a superb clinician but as Medicine Residency Director championed the role of subspecialists as attendings in general medicine which has been a key outreach, service and teaching opportunity for the Division.

Amy Mathers has created and led a program in Antibiotic Stewardship since 2009 as well as an incredibly creative research program on the role of sinks in hospital transmission of antibiotic resistant gram negative bacteria. Chris Arnold has developed a nurse practitioner inpatient consult service (thanks to Rose Lewis and Marie Spilman!) to decompress the general ID consult service, directs the Medicine Acting Internship, has led the development of E-consults and excels as the consummate clinician. Carol Gilchrist has discovered the role of the gut microbiome and parasite genetics in enteric infection. Cirle Warren along with Josh Eby have led the STD clinic while Cirle’s research on C. difficile with our new faculty member Jae Shin has led to the discovery that the susceptibility of the elderly to C. difficile may in part be due to an aged microbiome. Mike Scheld is concluding a distinguished career that included being President of the IDSA and Chair of ICAAC as well as saving the lives and hearing of so many children by discovering the benefit of steroids in bacterial meningitis. He also led the creation of the Mandell Chair in ID.

Molly Hughes continues groundbreaking research on antimicrobial resistance with Matt Crawford while being the only person I know to receive in the same month both an NIH R01 and “Attending of the Year”. Chelsea Marie leads highly sophisticated gene expression analyses of children in Dhaka, Shannon Moonah is breaking new ground on regulation of intestinal inflammation in amebiasis, while Stacey Burgess has discovered gut microbiome to bone marrow communication regulating granulopoiesis. Mayuresh Abhyankar has identified novel TLR agonists as vaccine adjuvants, while Patrick Jackson applies the understanding of HIV mRNA transport to HIV progression. Joann McDermid has brought new expertise in nutrition from Cornell, while Tania Thomas’ focus on TB diagnosis in children brings her to Tanzania and Bangladesh. She also ably leads our Travelers’ Clinic. Wen Yuan leads studies of broadly neutralizing HIV vaccines. Jie Liu, James Platts-Mills and Mami Taniuchi continue a far-reaching collaboration on defining the causes and consequences of enteric infections using a molecular platform called “TAC” which is now the go-to technology for CDC, NIH and the Gates Foundation. It is not an exaggeration to say that their work has changed our understanding of diarrheal diseases.

There is a rich history of leadership in infectious diseases at UVa, dating back to Tommy Hunter who was Dean in the 1960’s and promoted international collaborations in ID, Ed Hook a specialist on salmonella infections who was chair of medicine and recruited Jerry Mandell who founded the ID Division and the NIH T32 training program and led the Division from 1969 – 2001.  Jerry defined ID as a clinical specialty with his book “The Principles and Practice of Infectious Diseases” now going into it 9^th edition. Bob Carey, as Dean, and Mike Thorner, as Medicine Chair, in 2001 provided the new Carter-Harrison labs and conference space to the Division as well as substantial financial support to grow and build.

Jack Gwaltney, Head of the Division of Epidemiology and Virology 1964-2004, demonstrated the importance of hand contact in the transmission of rhinovirus infection and created the Frost, Richardson and Wyeth-Ayerst Chairs in ID!  Fred Hayden, as a member of Jack’s Division did the groundbreaking work demonstrating cure of HSV encephalitis with acyclovir and prevention of family transmission of influenza with oseltamivir.  Barry Farr was Hospital Epidemiologist from 1986-2004 and focused on the prevention of and surveillance for the nosocomial transmission of methicillin-resistant Staphylococcus aureus. Erik Hewlett was Chief of Clinical Pharmacology, discoverer of adenylate cyclase toxin of Bordetella and for two decades led research in the School as Senior Associate Dean, while at the same time, Dick Pearson was Senior Associate Dean for students and pioneer in the cellular immunology of leishmaniasis. Paul Hoffman led the development of a novel anaerobic antibiotic amixicile, and Mike Rein for years was the role model for all of us of a teacher. Finally we have been supported through the years with a great administrative team that includes Jim McGowan, Mutinta Bulanda, Liz Olmsted, Glenn Glover, Pam Schaefer, Serhiy Vitko, Wendi Foster, Lisa Cook, Jenny White, Angie Mawyer, Steve Murphy, Rusty Smith, and Beth McGrath.

 

I think some of our Division’s keys to success have been:

• Building consensus to do the right thing, keeping in mind that what worked a decade or even a year ago may no longer be appropriate.
• Valuing teaching, research, clinical service and faculty development equally. Great research brings great fellows and faculty who provide great clinical care, just as great clinical care is informed by research and brings its own research opportunities.
• Having a faculty that enjoys doing what they are best at. A corollary to this is that we have recruited the very best faculty, fellows and students and gotten out of their way and allowed them to succeed.
• We have cultivated the culture, traditions and history of the Division, acknowledging that we are each part of something far bigger while recognizing and celebrating individual successes.
• Continuity in leadership has benefitted the Division by providing growth and stability. ID&IH has benefitted over the years from consistent and long leadership by Gerald Mandell (ID), Jack Gwaltney (Epidemiology & Virology), Dick Guerrant (Geographic Medicine), and Eric Hewlett (Clinical Pharmacology).
• Diversity has been promoted at all levels. Making careers in science and medicine available to historically underrepresented groups is a big part of what we are all about.

 

Some thoughts on our clinical success:

• When one is caring for a patient, nothing is more important. Uphold the highest standards of professional conduct, with patients treated at the highest standards of competence and compassion, and colleagues treated with respect.
• Hire a small number of faculty whose number one (or even sole) priority is patient care, and have these faculty lead the development of new clinical programs.
• Have the lion’s share of the clinical work conducted by faculty who are also active investigators, as research and clinical service are synergistic and build on one another.
• Have an active QA/QC program that identifies strengths and weaknesses and seeks continual improvement.
• Have faculty conduct the clinical activities that they are best at and enjoy the most.
• Recruit the very best Infectious Diseases fellows as they are the linchpin of the clinical mission.
• Maintain ID faculty on general medicine wards (to reach our own house staff and give them a glimpse of our subspecialty).
• Keep clinical service vs teaching in balance for the fellows, and listen to and act on their concerns and suggested solutions to emerging problems.
• Listen to the concerns of the Medical Center, leadership and colleagues in other Department on how ID can be most helpful in patient care.

 

Important to research success:

• Have tight associations with basic and translational science Departments. This is at both the Division and individual faculty/fellow/student level. A close working relationship for example with the Departments of Microbiology and Public Health Sciences and the Immunology Center have been instrumental in the application of the best of research tools and approaches to the questions of infectious diseases.
• Embedded basic science faculty in the Division are essential for the research mission, including the training of fellows and students in the latest approaches of immunology and microbial pathogenesis. I cannot overemphasize how important this is.
• NIH T32 training programs are essential, as they provide a means to support predoctoral and postdoctoral fellows research, promote interdisciplinary collaboration, and serve as the basis for an interdisciplinary seminar, research in progress programs, classes and journal club.
• Center, Program Project and Network grants from the NIH are key elements for the junior faculty as these provide opportunities for them to lead research projects and develop research themes of their own, prior to their being ready to lead an R21 or R01 on their own.
• Developing young people is key in building a Division. K awards for example have been effective in our Division in providing career opportunities for fellows. In the last 17 years there have been 22 K awards in ID&IH, the “K to R” transition has been made by 8/15 (53%), and ten of our current faculty started with K’s including two URM faculty. Nine graduates of our Program with K’s are distinguished faculty elsewhere.

Teaching and faculty development success feed off of successful clinical and research programs. While one needs to pay attention and nurture teaching and junior faculty, these two missions can only succeed if the clinical and research missions are in turn successful.

 

To sum up, it has been a great professional and personal adventure for me to watch ID&IH grow and prosper, with getting to know my colleagues in ID&IH the greatest reward. I look forward to many more years as a member of our Division.

Fellow with K’s	Current Position	K to R?
Bill Ciesla	Private practice Richmond	K08
Moorman, Jonathan	Quillen College, ETSU	K08 to R01
Parsons, Chris	Pardee UNC Health Care	K08 to R01
Hughes, Molly	Assoc Prof UVa	K08 to R01
Houpt, Eric	Professor UVa	K08 to R01
Huston, Chris	Associate Prof UVM	K08 to R01
Steiner, Ted	Prof, U British Columbia	K08 to R01
Singh, Upinder	Chief ID Stanford	K08 to R01
Moore, Chris	Assoc Prof, UVa	K08
Dillingham, Rebecca	Assoc Prof, UVa	K23 to VDH, NIH
Peterson, Kristine, 2004	Assoc Prof U. Wisconsin,	K08
Eby, Joshua, 2006, MD,	Assoc Prof UVa	K08
Ralston, Katherine,	Asst Prof UC-Davis	K22 (still on K)
Heysell, Scott	Assoc Prof UVa	K23 to, R34, U01
Thomas, Tania	Assoc Prof UVa	K23
Madan, Rajat	Asst Prof U. Cincinnati	K08 (still on K)
Platts-Mills, James, 2012	Assistant Professor UVa	K23 to Gates (still on K)
Archbald-Pannone, Laurie	Assoc Prof Geriatrics UVa	K23
Korpe, Poonam	Asst Prof Johns Hopkins	K23 (still on K)
Moonah, Shannon	Assistant Professor UVa	K08 & Harold Amos (still on K)
Jackson, Patrick	Assistant Professor UVa	K08
McManus, Kate	Assistant Professor UVa	K08 – pending NOA

Summary: Jackson, PatrickAssistant Professor UVaK08McManus, KateAssistant Professor UVaK08 – pending NOA

• 22 K awards,

• K to R transition made by 8/15 (53%)

• 12 of our current faculty started with K’s including two URM faculty.

• 10 graduates with K are distinguished faculty elsewhere, almost entirely were awarded a K the last year of their fellowship and used it to get a high profile academic position.