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Epclusa: What Have We Learned?

Along with a 1 reported case in Massachusetts, the

New Hampshire Department of Health and Human Services (DHHS) has confirmed a person infected with eastern equine encephalitis (EEE) has died. The public health agency said the person was hospitalized due to severe central nervous system disease. The last reported human EEEV infection in New Hampshire was in 2014, when DHHS identified 3 human infections, including 2 fatalities. In the same statement, DHHS mentions there has been 1 confirmed case in Vermont this summer.

On August 16, the Massachusetts Department of Public Health (MDPH) released a statement discussing the confirmation of the first human case of EEE in the state this year. The confirmed case was discovered in an 80 year old man who was exposed to the vector borne disease in Worcester County. As a result, the risk level in the local communities of Douglas, Oxford, Sutton, and Webster has been raised to critical, and in Dudley, Northbridge, and Uxbridge the risk is increased to high.

Additionally, the neighboring communities of Auburn, Charlton, Grafton, Leicester, Mendon, Millbury, Millville, Southbridge, and Upton are now considered at moderate risk according to MDPH.

“This is the first time we have seen a person infected with EEE in Massachusetts since 2020,” Public Health Commissioner Robbie Goldstein, MD, PhD, said in a statement. “EEE is a rare but serious disease and a public health concern. We want to remind residents of the need to protect themselves from mosquito bites, especially in areas of the state where we are seeing EEE activity.

Though very rare, EEE is serious and a potentially fatal disease that can affect people of all ages. EEE is generally spread to humans through the bite of an infected mosquito. There were 12 human cases of EEE in Massachusetts in 2019 with 6 deaths, and 5 human cases with 1 death in 2020. There were no human cases of EEE in Massachusetts in 2021, 2022, or 2023.

EEE has a fatality rate of 33% to 70%, with most deaths occurring 2–10 days after the onset of symptoms.

In addition to a high mortality rate, long-term physical and mental complications, including permanent neurological deficits have been identified in many people who survive EEE.

Plymouth is approximately 40 miles south of Boston along the coast, and Worcester County is in the middle of the state, so the 2 areas are not in close proximity, but due to the elevated risk locally, the town of Plymouth decided to take action in response to outdoor parks. As of last Friday, all town public parks and fields are close daily from dusk until dawn.

“As Mass DPH has now elevated Plymouth’s EEE risk status to high, it is important to take extra precautions when outdoors and follow state and local health guidelines to avoid unnecessary risk to exposure to EEE. The health and safety of our community, residents, and visitors remain our priority,” Plymouth’s Commissioner of Health and Human Services, Michelle Bratti, said in a statement.

According to the Centers for Disease Control and Prevention (CDC) most people who are infected with the virus do not develop symptoms; however, for those that do, the date from the bite to the onset of the illness is 4 to 10 days. EEE can also result in fever or neurologic disease. The type of illness will depend on the age of the person and other factors. Those who are infected can develop meningitis.

There are no FDA-approved treatments for EEE and for patients who develop severe cases, they can be hospitalized to receive supportive treatment.

Over the weekend, MDPH detailed plans of spraying for mosquitos including aerially in areas of Plymouth County, and truck-mounted spraying in parts of Worcester County. As of Saturday, 10 communities in Massachusetts were raised to high or critical risk for EEE virus.

“The risk from EEE is high in parts of Plymouth County and critical in parts of Worcester County,” State Epidemiologist Catherine M. Brown, DVM, said in a statement. “In addition to recommending that people use mosquito repellent with an EPA-registered active ingredient and clothing to reduce exposed skin, we also recommend that evening outdoor events be rescheduled to avoid the hours between dusk and dawn. The mosquitoes most likely to spread EEE are most active during the dusk to dawn hours.”

There are preventative strategies to avoid EEE, and the MDPH has listed such measures 

For those who live in Massachusetts and want more information on EEE, it can be found 

 or by calling the DPH Division of Epidemiology at 617-983-6800.

1.NH DHHS Identifies Person Infected with Eastern Equine Encephalitis Virus in New Hampshire.The New Hampshire Department of Health and Human Services. August 27, 2024. Accessed August 28, 2024.
https://www.dhhs.nh.gov/news-and-media/nh-dhhs-identifies-person-infected-eastern-equine-encephalitis-virus-new-hampshire
2. State health officials announce season’s first human case of Eastern Equine Encephalitis in Massachusetts. MDPH. August 16, 2024. Accessed August 27, 2024.
https://www.mass.gov/news/state-health-officials-announce-seasons-first-human-case-of-eastern-equine-encephalitis-in-massachusetts
3.Plymouth to Close all Public Parks and Fields from Dusk to Dawn. Town of Plymouth. August 23, 2024. Accessed August 27, 2024. PDF.
4. Eastern Equine Encephalitis: Symptoms, Diagnosis, and Treatment. CDC. May 15, 2024. Accessed August 27, 2024.
https://www.cdc.gov/eastern-equine-encephalitis/symptoms-diagnosis-treatment/index.html
5. State officials announce plans to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE. MDPH. August 24, 2024. Accessed August 27, 2024. 
https://www.mass.gov/news/state-officials-announce-plans-to-spray-for-mosquitoes-in-sections-of-worcester-and-plymouth-counties-due-to-eee



The town of Plymouth decided to prohibit people from using the parks from dusk to dawn due to concerns over eastern equine encephalitis after a man contracted the rare disease in the state.

Concerns Over Mosquito-Borne Illness Causes Massachusetts Town to Create Curfew for Parks, Spraying in Counties

Lyme disease is typically treated with antibiotics, and most people experience a resolution of symptoms. However, the disease can become chronic and debilitating for some individuals. This condition has been named Lyme infection-associated chronic illness (IACI). Approximately 5% to 10% of patients go on to experience prolonged symptoms—often including fatigue, pain, and cognitive impairment—that can last for years and significantly limit function and quality of life.¹

Charting a Path Toward New Treatments for Lyme Infection-Associated Chronic Illnesses

, from the National Academies of Sciences, Engineering, and Medicine

 aims to prioritize research into treatments that improve function and quality of life for people living with IACI.¹

“There is an urgent need to identify and develop safe and effective treatments for Lyme IACI that can restore functionality and quality of life, and it is possible for that work to start now,” Kent Kester, chair of the committee that wrote the report and executive director of research and development at the Coalition for Epidemic Preparedness Innovations, said in a statement. “People living with this condition deserve to have information that allows them to both make informed decisions about their own health and to have safe and effective treatments available to them.”

The report highlights an unrealized opportunity for researchers, clinicians, and people living with other infection-associated chronic illnesses—such as myalgic encephalomyelitis/chronic fatigue syndrome or Long COVID—to share knowledge to better understand common mechanistic pathways or treatments that may be applicable across these diseases. Pooling research efforts to examine the pathogenesis and treatment of persistent symptoms could streamline discovery and maximize the impact of funding.

The report recommends that the department of Health and Human Services develop an integrated strategic plan for research on infection-associated chronic illnesses to facilitate collaboration across different disease research efforts. This plan should improve understanding of commonalities across diseases and help advance effective interventions.

According to the National Academies, they convened a committee of experts to assess the evidence for disease mechanisms, diagnoses, and treatments of Lyme IACI, and to chart a pathway for the development of new treatments. Contributors to the report include the National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Global Health; Board on Health Sciences Policy; and the Committee on the Evidence Base for Lyme Infection-Associated Chronic Illnesses Treatment.

The report again emphasizes the potential for cross-condition collaboration among researchers and patients facing chronic illnesses like ME/CFS or long COVID, aiming to identify shared biological mechanisms and therapeutic approaches. By coordinating research and funding, the impact of scientific discovery could be enhanced.

Named after the town of Lyme, Connecticut, where a small cluster of cases in both adults and children occurred in 1975, the disease had existed for years before being officially identified. Today, several factors are contributing to Lyme disease becoming the most common vector-borne disease in the US.

In 2023, more than 89,000 cases of Lyme disease were reported to the Centers for Disease Control and Prevention (CDC) by state health departments and the District of Columbia. However, these numbers come from routine national surveillance and may underrepresent the actual burden. The CDC estimates that approximately 476,000 people in the US are diagnosed with Lyme disease each year using other data collection methods.This number likely includes patients who are treated based on clinical suspicion but do not actually have Lyme disease, according to the federal agency.

To view the report, interested parties can go 



References
1. Research Funders Should Prioritize Finding Treatments to Ease Symptoms of Chronic Illnesses Associated with Lyme Disease, Not Wait for Certainty on Cause, Says New Report. National Academies of Sciences, Engineering, and Medicine. May 8, 2025. Accessed May 14, 2025.
https://www.nationalacademies.org/news/2025/05/research-funders-should-prioritize-finding-treatments-to-ease-symptoms-of-chronic-illnesses-associated-with-lyme-disease-not-wait-for-certainty-on-cause-says-new-report
 2. Lyme Disease Surveillance and Data. CDC March 13, 2025 Accessed May 14, 2025.
https://www.cdc.gov/lyme/data-research/facts-stats/index.html

A small percentage of people who contract the tick-borne illness have lingering symptoms and health issues after the acute infection has been treated, but there are no FDA-approved therapies to deal with prolonged symptoms. A new report looks to address this issue.  

New Report Calls For Funding Treatments, Greater Emphasis on Chronic Lyme Disease

More than 80% of adults support COVID-19 vaccination, but hesitancy linked to side effects, geopolitics, and misinformation remains a challenge, says lead researcher Mahmud Sheku, MPH, MSc.

More than 80% of adults in Sierra Leone said they would accept COVID-19 vaccines for themselves or their families, according to a study presented at the 2025 Annual Conference on Vaccinology Research. The study surveyed 2,146 adults to assess vaccine awareness, acceptance, and hesitancy.

Researchers from the University of Siena, the Sierra Leone Ministry of Health, and other institutions found that 75.2% of respondents were aware of COVID-19 vaccines, and acceptance rose to 85% when vaccination was required. Main reasons for acceptance included beliefs in safety, immunity, and trust in vaccines.

Although, hesitancy was also reported. It was linked to concerns about side effects, doubts about effectiveness, and skepticism about the pandemic itself, often influenced by social media and misinformation.

Mahmud Sheku, MPH, MSc, a PhD student at Emory University and lead investigator on the study, explained the origins of the work, “I conducted this study around December or January, during the COVID-19 pandemic, just as the vaccines were about to hit the market. I had just graduated from my master’s program in vaccinology. I was listening to people from different backgrounds and wanted to get a deeper understanding of what was happening.” What Sheku found was a deep undercurrent of distrust in vaccines depending on their country of origin,even when those vaccines were locally approved.

“There was a buildup of social media narratives and misinformation within communities. These narratives framed vaccines from certain countries as experimental and unsafe compared to others,” he said. “That developed into geopolitical perceptions. People came to believe that the vaccine manufacturing processes were uncertain or risky, and that taking such vaccines might harm them.”

According to the survey, while 32.4% of respondents were willing to accept vaccines from any country as long as they were approved locally, 15.1% said they would reject vaccines from China, 12.6% from India, and 11.4% from the United States. Smaller but notable percentages expressed distrust in vaccines originating in Germany, Russia, the United Kingdom, and Belgium.

To overcome such biases, Sheku emphasized the role of trusted local messengers, “We have to look at community leaders and professionals as trusted messengers. They can re-emphasize the importance of vaccines, how safe they are, and the rigorous approval processes they go through before being released to the public,” he said. “Each country has a national regulatory authority that independently reviews vaccine data before granting a local license. And vaccines approved by the WHO’s Emergency Use Listing have met all international safety and development standards.”

The study also revealed a widespread preference for vaccines with fewer side effects, reported by 55.7% of participants, even when this meant lower efficacy, “This reflects limited understanding in some communities about how vaccines work,” Sheku noted. “People need to understand the difference between protective efficacy and the reactogenic profile of vaccines.”

According to Sheku, vaccine education efforts must go beyond slogans and address the root of people’s concerns, “We should tailor messaging to specific populations using locally relevant content. Translate vaccine development concepts into local languages. Use targeted campaigns for communities with high hesitancy. Explain the stages of development and the role of all the agencies involved in ensuring vaccines are safe.”

The study’s findings, he believes, can support vaccine developers as well, “Safety is paramount. Developers should aim to minimize side effects where possible. But public trust also depends on education. People need to know that a side effect doesn’t mean the vaccine is unsafe—it’s just the immune system responding.”

Sheku M, Clemens R, Clemens SAC, Kargbo I, Swaray IB. COVID-19 vaccine acceptability: a cross-sectional mixed-methods study in Sierra Leone. Poster #25 presented at the 2025 Annual Conference on Vaccinology Research. May 5–7, 2025; Washington, DC.

Conferences

High Vaccine Acceptance in Sierra Leone Highlights Role of Trust, Messaging, and Misinformation

Outpatients with cancer were found to be at a greater risk of bacterial infections compared to those without it, according to a new study published in 

“The rates and corresponding (IRRs) [Incidence Rate Ratios] of AMR pathogens per 1000 isolates was also higher in patients with cancer compared with patients without cancer, particularly for carbapenem non-susceptible 

Addressing a few pathogens, the investigators found the following:

Extended-spectrum β-lactamase (ESBL) producers:

“AMR proportions and IRRs for most key pathogens were up to three-times higher in isolates from outpatients with cancer than those without cancer, highlighting the need for enhanced surveillance, infection prevention, and timely diagnostic stewardship to improve antibiotic prescribing in this population,” the investigators wrote.

This large study was conducted from April 1, 2018 through Dec 31, 2022. The investigators reviewed 1,655,594 total pathogen isolates. Of the 2 cohorts involved in the study, 53,006 isolates were from 27,421 patients with cancer and 1,602,588 isolates were from 928,128 patients without cancer. The data was collected from the Becton, Dickinson and Company (BD) Insights Research Database. The study included adults seeking care in 198 outpatient health-care settings in the US.

For patients with cancer undergoing chemotherapy, they can develop neutropenia which lowers white blood cells and greatly increases the risk for infections.

 Approximately 60% of deaths for cancer patients come from infections, especially those with hematological malignancies.

According to 1 study, the most common infections are pneumonia and influenza, followed by parasitic diseases and other infections, and septicemia, respectively. Prostate cancer was found to be the most common cancer associated with infectious diseases, followed by breast cancer and Kaposi sarcoma.

The investigators point out the value of recognizing resistance in these patients. "Improving our understanding of the frequency and consequences of AMR in patients with cancer is a crucial step towards optimizing antimicrobial stewardship and mitigating the possible negative effects of AMR on cancer management and outcomes."

1. Gupta V, Satlin MJ, Yu KC, et al. Incidence and prevalence of antimicrobial resistance in outpatients with cancer: a multicentre, retrospective, cohort study. 

. 2025;26(5):620-628. doi:10.1016/S1470-2045(25)00128-7
2. Preventing Infections in Cancer Patients. CDC. November 14, 2024. Accessed May 13, 2025. 


https://www.cdc.gov/cancer/features/preventing-infections.html


3. Muhammed Khaled Elfaituri et al. Incidence of Infection-related mortality in cancer patients: Trend and survival analysis.. 

A large retrospective cohort study demonstrates greater resistance across different pathogens in this patient population compared with those who do not have  cancer. 

Greater Incidence of Antimicrobial-Resistant Infections in Outpatients With Cancer

Robert Hopkins Jr, MD, the medical director of the National Foundation for Infectious Diseases (NFID) discusses the importance of this and that more people forget to do so after key times or believe it is not needed. 

Handwashing: An Infection Prevention Method That We Forget? 

Handwashing often takes place after encounters with people, using the bathroom, or touching doors or other areas where the public has been utilizing. However, it can be quite a personal decision and one associated with people’s beliefs about germs.

A new survey commissioned by the National Foundation for Infectious Diseases (NFID) and released as part of its 2025 State of Handwashing Report, asked about people’s behaviors around handwashing. The results showed there is quite a bit of variability for when people wash their hands.

One of the takeaways from the report confirmed that many adults know how important it is to wash their hands, and yet it is easy to forget in everyday life.

For example, the report showed that 48% of US adults admit to forgetting or choosing not to wash their hands at key times, like after visiting grocery stores, restaurants, or coffee shops, or a healthcare setting (doctor’s office, pharmacy, clinic, or hospital). In addition, 1 out of 5 (20%) admit to not washing their hands, even though handwashing can help prevent approximately 80% of infectious diseases.

When it comes to the amount of time needed, a majority knew the correct cleaning method and time needed to kill germs.

“Sixty-two percent of the survey respondents correctly stated that washing your hands for 20 seconds with soap and water effectively reduces the spread of germs,” said Robert Hopkins Jr, MD, the medical director of NFID. “Only 13% believe that less than 20 seconds is enough, while 24% thought that you needed more time.”

Hopkins did point out some areas that can be problematic in terms of contracting or spreading germs. 

“Only 30% reported they're most likely to wash their hands after a cough or sneezing, which is a concern, especially given what we know about how easily we spread respiratory disease by droplets,” he said.

He did note men and women do differ a bit in terms of handwashing strategies.
Hopkins said that 34% of men surveyed were more likely to forget to wash their hands; whereas, 27% of women forget. Additionally, 34% of women were more likely to use alternatives, like hand sanitizers, than men ( 23%).

Along with the report, NFID has launched its Hands In For Handwashing campaign to raise awareness about the importance of handwashing to help stop the spread of infectious diseases.

“The campaign is to raise awareness about the importance of hand washing— really to help stop the spread of infectious diseases. We want to encourage everyone to wash their hands as 1 component of an effort to stay healthy and avoid infections. About 80% of infectious diseases are spread by dirty hands,” Hopkins said.

Hopkins says hand washing is one component of an infection prevention strategy that should also include vaccination as well as other elements.

As part of the campaign, NFID is also going out on the road with a Clean Hands Caravan, that includes a mobile handwashing station to make it easier for people to wash their hands in places where germs can spread.

For its next stops, Hopkins says the caravan will be at the World Barbecue Cooking Contest in Memphis from May 14 to 17, and at the Atlanta Jazz Festival from May 24 to 26.

To learn more about the campaign or read the handwashing report, go 

Reference
1.New National Survey Finds Nearly Half of US Adults Admit to Not Washing Their Hands at Key Moments. NFID press release. May 5, 2025. Accessed May 5, 2025.
https://www.nfid.org/new-national-survey-finds-nearly-half-of-us-adults-admit-to-not-washing-their-hands-at-key-moments/

Robert Hopkins Jr, MD, the medical director of the National Foundation for Infectious Diseases discusses the results of the organization's new survey and the surprising findings that many people forget to wash their hands after key times or believe it is not needed. 

Multinational real-world analysis underscores the effectiveness of SOF/VEL across diverse populations and highlights the need for timely treatment initiation to improve patient outcomes.  You said: set up ama citation: 276 The SVR10K Hepatitis C study: final results show 98.9% SVR in 7,000 patients treated with SOF/VEL in Asia, Latin America, Middle East, Nordic and Southern Europe Soo Aleman, Ming-Lung Yu2, Fatima Higuera-de-la-Tijera3,Francisco Javier Garcia-Samaniego4, Marta Casado-Martin5, Grace Lai-Hung Wong6, Mario Álvares-da-Silva7, Joaquin Cabezas8,Miguel Castruita9, Oscar Beltran10, Mohammed Alzaabi11, Aastha Chandak12, Marta Martinez12, Artak Khachatryan12,Linda Chen13, Candido Hernández14, Kim Vanstraelen15, Yu Jun Wong16.  ChatGPT said:

Global Study Reports 98.9% SVR with SOF/VEL in Over 7,000 Hepatitis C Patients

A multinational real-world study of 7,027 patients treated with sofosbuvir/velpatasvir (SOF/VEL) for hepatitis C virus (HCV) infection reported a sustained virologic response (SVR) rate of 98.9%. "We're really excited to share this data at EASL this year," said Anu Osinusi, MD, MPH, vice president of clinical research for hepatitis, respiratory, and emerging viruses at Gilead Sciences. "The study demonstrates that the high effectiveness of SOF/VEL in real-world populations aligns with previous findings, reinforcing the global applicability of current HCV treatment guidelines."

The study, conducted across Australia, Canada, Europe, and the US, found that SVR rates remained above 97% across all geographic regions, genotypes, and patient demographics, including those with coexisting conditions such as HIV or mental health disorders. "We’ve seen that these pan-genotypic direct-acting antiviral agents for hepatitis C have consistently shown high SVR rates across diverse populations," Osinusi said. "These results emphasize the broader applicability of these treatments worldwide."

Patients in the study had a median age of 55 years (IQR 46–64), with 66% of patients aged 50 years or older. Males represented 65% of the cohort, and the study found that HIV/HCV coinfection was more common in males (5.8% vs 2.1%, p < .001), as was genotype 3 infection (35% vs 20%, p < .001), particularly in males aged ≥50 years. "The gender-related disparities in the prevalence of coinfection and genotype 3 infection are important considerations for developing more targeted treatment strategies," Oshinusi said.

While SVR rates remained high across both sexes and age groups, the study also examined the time to treatment initiation (TTI). "One important context to share is that the SVR 10k study wasn’t actually set up to analyze healthcare models. But it did look at time to hepatitis C treatment initiation, which showed clear improvements compared to past real-world data," Osinusi explained. "However, there is still room for improvement, as only 24% of the evaluated population initiated treatment with direct-acting antivirals within the first 30 days after their last positive RNA test. Some regions performed better than others in this regard."

The study revealed that females had a shorter median TTI compared to males. Among patients treated within the first month, 40% of females were treated compared to 25% of males (p < .001). "While it seems like the gender gap is reversing, more than half of patients in the study are still being treated more than six months after their diagnosis," Osinusi noted. "This demonstrates that there is still significant room for improvement in treatment initiation, particularly across all populations, regardless of gender."

SVR rates were consistently high across both males and females, including those with genotype 3 and cirrhosis. "Our data show that even in the presence of more challenging factors like genotype 3 and cirrhosis, SVR rates remained above 97%, which is a strong indicator of the effectiveness of these therapies," Osinusi added. "The key message here is that minimizing the time to treatment initiation will result in better outcomes for all patients, reducing the risk of severe liver complications and increasing treatment rates across the board."

In conclusion, the study highlights the importance of timely treatment for HCV, regardless of a patient's demographic or clinical profile. "The urgency to treat and minimize delays is crucial. Over time, it will result in fewer people having poor liver outcomes and will improve treatment rates for everyone infected with hepatitis C," Osinusi emphasized. These findings, coupled with the high SVR rates achieved globally, reaffirm the role of SOF/VEL as an effective treatment option and the importance of continuing efforts to optimize treatment initiation for all patients.

Aleman S, Yu ML, Higuera-de-la-Tijera F, et al. The SVR10K Hepatitis C study: final results show 98.9% SVR in 7,000 patients treated with SOF/VEL in Asia, Latin America, Middle East, Nordic and Southern Europe. Poster 276 presented at EASL 2025. May 7-10, 2025, New Amsterdam.

Multinational real-world analysis underscores the effectiveness of sofosbuvir/velpatasvir (SOF/VEL) across diverse populations and highlights the need for timely treatment initiation to improve patient outcomes.

Ashley Sheridan, PharmD

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