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Hobbs is a clinical pharmacy manager and infectious diseases specialist, Cardinal Health.

Athena Hobbs, PharmD, BCIDP, looked at this issue through the lens of treating urinary tract infections (UTI).

Deciphering When to Use New Novel Agents in Clinical Practice

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

Adding oral vancomycin to a systemic antibiotic treatment of a non–

 infection (CDI) to prevent CDI recurrence in at-risk patients was associated with a lower rate of recurrence than in those not receiving vancomycin in a placebo-controlled trial,

 but the difference was not statistically significant and the rates were high in both groups.

"Interventions to prevent recurrent CDI during exposure to systemic antibiotics in a person with prior but not current CDI are needed in clinical practice," Julie Keating, PhD, from the Department of Medicine at the School of Medicine and Public Health at the University of Wisconsin-Madison, and colleagues indicated.

Although the study was underpowered due to challenges in recruiting participants, the investigators found the lack of clear advantage suggested "that other interventions should be investigated for their effectiveness in preventing CDI recurrence after non–CDI-indicated antibiotic therapy."

Keating and colleagues recruited 81 participants with a documented diagnosis of 1 or more CDIs within the past 180 days, completion of a CDI treatment, and receipt of non–CDI-indicated systemic antibiotics for 2 weeks or less and not more than 72 hours at enrollment. The vancomycin group received 125 mg orally daily during and for 5 days after their systemic antibiotic regimen, whereas the control group received placebo in identical capsules. Recruitment challenges, including lack of interest in those with history of CDI to potentially receive placebo, left the size of the cohort 1 less than the minimum calculated to adequately power the study.

With that limitation on drawing conclusions, the investigators reported CDI recurred in 17 of 39 participants (43.6%) in the vancomycin group over the 8-week posttreatment follow-up period compared with 24 of 42 in the placebo group (57.1%). There was a statistically significantly higher rate of carriage of vancomycin-resistant 

(VRE) detected in the gut of those receiving vancomycin (15 of 30; 50%) than those without vancomycin exposure (6 of 25; 24.0%).

 Stuart Cohen, MD, from the Division of Infectious Diseases in the Department of Internal Medicine at the University of California Davis School of Medicine, remarked that although the difference in rate of CDI recurrence between the groups was numerical rather than statistically significant, "the reduction appears to be a clinically meaningful result."

"What is striking, however, is how high the rates of recurrence were in both the treatment (43.6%) and placebo (57.1%) groups," he observed.

Cohen noted that the number of prior recurrences in the participants was not provided, despite risk of recurrence increasing with the number of episodes. He also indicated he would have appreciated the study delving further than VRE colonization to assess overall effect of the vancomycin on fecal microbiota.

Keating and colleagues acknowledged that the study had not evaluated broader effects of the oral vancomycin on the gut microbiome, despite known effects including reduction of baseline commensals, which may facilitate 

"Additional research on patient populations, dosages, and dosing schedules may be needed to determine whether oral vancomycin may provide a greater protective effect within specific parameters while maintaining a low risk profile for patients," they remarked.

1. Keating JA, Xu T, Graham MB, et al. Oral vancomycin for prevention of recurrent 

 infection: a randomized clinical trial. 

. 2025;8(7):e2517834. doi:10.1001/jamanetworkopen.2025.17834

2. Cohen SH. Uncertain benefits of oral vancomycin for prevention of recurrent 

. 2025;8(7):e2521084. doi:10.1001/jamanetworkopen.2025.21084

The role of oral vancomycin in preventing recurrence of C difficile infection (CDI) in at-risk persons receiving systemic antibiotic for non-CDI infection remains unclear after randomized trial.

Effectiveness of Oral Vancomycin in Preventing C difficile Remains Uncertain After Trial

This article was originally published on our sister site, 

New research is shedding light on potential strategies for improving the effectiveness of fecal microbiota transplantation (FMT) for the treatment of 

The study enrolled more than 1000 adult patients with CDI treated with FMT at the Centre for Faecal Microbiota Transplantation (CEFTA) at Aarhus University Hospital and found that the most effective FMT treatment strategy involved administering FMT as multiple-dose capsules or colonoscopy after an extended period of antibiotic pretreatment, regardless of CDI episode, and providing repeated FMT in patients with CDI recurrence. Of note, antibiotic pretreatment choice and prophylactic vancomycin in patients needing antibiotics following FMT did not impact outcomes.

Current treatment guidelines from the American Gastroenterological Association recommend the use of FMT-based therapy in patients with recurrent CDI at high risk of recurrence following standard-of-care antibiotics and in hospitalized patients with severe CDI after standard-of-care antibiotics if there is no improvement.

“Real-world data indicate that one-third of patients do not respond adequately to their first FMT treatment, highlighting the need to optimize FMT treatment strategies,” Sara Ellegaard Paaske, a PhD student in the department of clinical medicine at Aahrus University, and colleagues wrote, calling attention to the current lack of large-scale systematic evidence to guide the decision on when to switch from repeated FMT treatments to antibiotic treatments or to assess the effectiveness of antibiotics in patients recently treated with FMT.

To address this gap in research and inform a rational clinical approach to FMT treatment for CDI, investigators conducted a multisite cohort study in the Central and North Denmark Regions. Eligible patients were aged 18 years or older with CDI treated with FMT applied through capsules, nasojejunal tube, or colonoscopy. CDI was defined as 

associated diarrhea (CDAD), characterised as diarrhea (≥ 3 daily Bristol Stool Form Scale 6-7) coupled with a positive 

The primary outcome was cure of CDAD 8 weeks after treatment, with cure failure defined as CDAD recurrence, suspected CDAD recurrence, death, or colectomy. Patients were followed until achieving CDAD cure 8 weeks after treatment or until they underwent colectomy, were lost to follow-up, or died.

Variables related to the FMT treatment strategy were categorized into pretreatment, FMT, and follow-up, and included variation in choice and length of antibiotic pretreatment, FMT administration, FMT dosing, and use of prophylactic vancomycin in patients needing non-CDI antibiotics during follow-up.

From May 2016 to December 2023, investigators treated 1200 patients with CDI with FMT applied through capsules, nasojejunal tube, or colonoscopy at 10 hospital departments. Of these patients, 30 were lost to follow-up, leaving 1170 patients who received 1643 FMT treatments for inclusion.

Investigators noted vancomycin was the most common antibiotic pretreatment (91%), and capsule FMT was the most frequently used FMT administration (80%).

Among the included patients, 699 (60%; 95% CI, 57%-63%) achieved cure at week 8 following their first FMT treatment, 342 (29%; 95% CI, 27%-32%) had verified recurrence within 8 weeks, 49 (4%; 95% CI, 3%-6%) had suspected recurrence in the 8-week follow-up, 73 (6%; 95% CI, 5%-8%) died during follow-up, and 7 (1%; 95% CI, 0%-1%) received colectomy in the follow-up.

Of the 393 patients with verified or suspected recurrence of CDAD, 326 (83%) were treated with up to 5 FMT treatments. Following repeated FMT treatments, 944 patients (81%; 95% CI, 78%-83%) achieved CDAD cure at the 8-week follow-up, and 113 had CDAD recurrence or suspected CDAD recurrence (10%; 95% CI, 8%-11%).

Upon analysis, prolonged antibiotic pretreatment was associated with greater cure rates (65%; odds ratio [OR], 1.22; 95% CI, 1.10-1.36; 

 <.001). Additionally, investigators noted FMT administration through oral, multi-dose capsules (69%; OR, 1.19; 95% CI, 1.11–1.27; 

 <.001) or colonoscopy (69%; OR, 1.14; 95% CI, 1.04-1.24; 

 = .01) resulted in the greatest cure rates.

Of note, neither antibiotic pretreatment type nor prophylactic vancomycin during non-CDI antibiotics affected cure rates, and in patients for whom FMT was initially unsuccessful, repeated FMT was more effective than antibiotic treatment alone.

“In conclusion, the most effective FMT treatment strategy involved administering FMT as multiple-dose capsules or colonoscopy after an extended period of antibiotic pretreatment, regardless of CDI episode, and providing repeated FMT in patients with CDI recurrence,” investigators wrote.

 “Future guidelines should address FMT dosing, administration methods, and pretreatment duration to assist clinicians in selecting strategies with the highest likelihood of success.”

Paaske SE, Baunwall SMD, Rubak T, et al. Clinical management of 

 infection with faecal microbiota transplantation: a real-world cohort study. EClinicalMedicine. 

2. Brooks A. AGA supports fecal microbiota-based therapies for C diff in new guideline. 

. February 21, 2024. Accessed July 22, 2025. 

https://www.hcplive.com/view/aga-supports-fecal-microbiota-based-therapies-for-c-diff-in-new-guideline

The most successful FMT approach involved administering multiple-dose capsules or colonoscopy following an extended course of antibiotic pretreatment.

Study Explores Therapeutic Approaches to Enhance FMT Success in C difficile Treatment

Sara Embry was newly pregnant and contracted 

 in a most unusual way. She picked up fecal spores at a local restaurant. She had not taken any antibiotics.

Like many people who get the infection, she initially struggled to find answers to her condition. She also lacked information from medical providers. She eventually found support through a 

, and became a peer volunteer, helping others experiencing the condition and seeking answers and comfort.

 to discuss her experience and her involvement with PLF. 

Can you share what it was like to be diagnosed with 

 while pregnant and how you managed both the infection and your pregnancy at the same time?

It was absolutely terrifying, because all the doctors and nurses whom I came in contact with didn't really have much experience with it. They misdiagnosed me. At first, I was extremely sick for a few weeks. 

I thought that I was going to lose my baby. 

For one, there was no information that I could find related to pregnancy and 

 online. I kept asking doctors about it, and no one could give me any information. They just told me that vancomycin was safe for my baby, and that was the extent of it. However, when I was experiencing 

, I was losing weight rapidly. I couldn't get out of bed. I couldn't keep any food down. And for anyone who has been pregnant, they know that nutrients are very important. Morning sickness is already hard, but then adding 

 on top of it—where you're rapidly losing the nutrients that you desperately need for your growing baby—the level of weakness that I experienced was something that I've never had before. My husband and I are modern-day homesteaders, so I'm used to being up and working, doing all the things that I need to do, and I just wasn't able to.

What were some of the most challenging aspects of your recovery  from 

Well, physically, I am already a rather small person, and keeping weight on has always been hard for me but especially in the first part of pregnancy. This was my third pregnancy. At the time, I already struggled with morning sickness and losing weight and trying to maintain that, but I lost 17 lb in a matter of a few weeks. I was extremely weak. I could not get out of bed.  My arms didn't even look like they belonged to me. They look like a child's arms, and I was losing my muscles.

Walking across the house was expending all the energy that I had. That's something that I was absolutely not used to. And I had 2 other young children whom I needed to care for, and I wasn't able to. It was hard on everybody in the family. My husband had to take off work, and not being able to care for myself was something I was not used to experiencing. 

Emotionally, there's an isolation that comes along with 

 that no one really talks about, because you can't invite people over. At first, they'll start offering to bring you meals or help with the kids, but they couldn't be over the house. It was so contagious, and I was terrified of passing it along to anyone. I couldn't let my children sit around me. They couldn't come and talk to me and play with me. It was horrible. It was hard on them. I had an active infection for over a month, and I was completely alone. I couldn't let anyone come around me. And that's something that really messes with your head whenever you are that isolated. 

And when I finally got over the active infection, the fear of recurrence is something that's almost like PTSD [posttraumatic stress disorder], because everything that I eat, I was worried. Am I going to be feeding the infection? Am I giving it? What am I doing to make it worse? What am I doing to make it better? It was every thought that I had. What can I do today that will help me tomorrow and not make it worse? But the fear of recurrence, I mean, I still struggle with that. One of the things that I do, I'm very, very strict about what I eat. Even over a year later, I don't compromise on my diet. I stick to what I know is safe, and that's something that I'm not sure if I'm ever going to be able to look past, because the impact that 

 has on your body is something that you can't even describe to someone unless they've seen it themselves. Even thinking about it just makes my stomach churn, because there's just nothing like it.

It's like PTSD, and it stays with you, even after the experience.



 In talking about this traumatic experience that you had with 

, how did it inspire you to get involved with the Peggy Lillis Foundation?

As I said earlier, finding information on 

was extremely hard. And eventually I did come across the Peggy Lillis Foundation, and they had a handbook for how to deal with the active infection, and it had recipes for foods that were safe. And what to do, like warning signs, all the things that you need to know, and that was the most in-depth. 

Whenever I reached out to them, I couldn't believe that they actually wanted to talk to me. They had people who were checking in on me, and not only did they provide me with the information that I needed to get through the infection but [also] that level of isolation that I talked about. The Peggy Lillis Foundation really helped me with that, because they understood—Christian [Lillis, PLF cofounder,] losing his mom, he really understands—and speaking to them, it just made me feel like I wasn't alone, [when] I had felt alone throughout the whole process up until that point. And so with them, I believe that they're doing good work, and I'm just so incredibly thankful that I want to be able to do that for other people.

In terms of looking at a potential message, what do you hope to convey to the public as well as policy makers through your advocacy work with the foundation?

Yes, well, I stand behind the Peggy Lillis Foundation's vision of where we believe in a world where 

is rare, treatable, and survivable. We believe in spreading awareness and knowing what people are going through, that they're not alone, and that you can get through it [to] the other side. And with me being pregnant, for all those women out there who may have it and can't find any information like I did, my baby is happy and healthy and strong, and they can get through it, too.

 What are the biggest misconceptions about 

, and how can we build better awareness to improve prevention and treatment?

 I think that the biggest misconception is that it won't happen to me. We are people who eat the food that we grow; I'm very health conscious, and it happened to me. It can happen to anybody. The mindset that it won't happen to me. It's for [older] people or people with compromised immune systems or people who take antibiotics. I didn't take any antibiotics. I picked it up by going to a birthday dinner with someone at a restaurant. It can happen to anyone, and it can pull the rug out from underneath you faster than you believe.

I think that another misconception is that it's rare. It's estimated to cause half a million infections each year. It's something that [for] everyone whom I've encountered, they have never heard of it before, and it's happening to so many people.

It's not as rare as we think. I think that everyone just needs to be aware that it is a possibility that could happen to you if you're taking antibiotics, and doctors should warn you. You know this could be an adverse effect of taking an antibiotic, and do you really need the antibiotic? If the answer is yes, then absolutely take it, but if the answer is no, let's explore some other options. Because it's way worse than just trying to describe it to people, but it's definitely something that would outweigh me considering taking the antibiotic again. You take antibiotics once, and you can get 

And also that the spores are everywhere; it's not just spread by taking antibiotics.

It could be on the grocery cart at the store. You don't know, and you need to wash your hands properly. And even then, don't touch your face, and all the things that they've been drilling into our heads the last few years of COVID-19. 

I think that awareness is key. I had never heard of it before. Maybe if I had, I wouldn't have felt so helpless in the beginning. The doctors and nurses whom I encountered were ignorant as well. They just diagnosed me and sent me on my way. They didn't send me any information about it. I had to learn from myself how sick I was, and that was pretty terrifying on its own. Awareness is a big one, because for something that no one's ever heard of, it's affecting a lot of people.

 Can you talk about what you're doing with PLF?

 I attended the summit, and we went to Capitol Hill. We advocated for being able to make your own decisions. As far as prescriptions, having some freedom with your doctor and insurance companies, not dictating what we are allowed to have. There are options when it comes to 

, and being able to advocate for yourself what you need is very important.

And since the summit, I have been working as a peer support volunteer. Anyone who's going through an active infection can contact me. PLF will assign them to me, and I can call them, email them, whatever they are in the need of, what they feel like. Some people don't actually feel like talking on the phone whenever they're in the middle of an infection, but they can email me and I'll email them back, or they can text me, and I just offer that I'm a friend who has been through it. We talked about the isolation of it when you don't know anyone who's going through what you've gone through. I can't give medical advice. Obviously, I'm not a doctor, but if you have questions about what to know or just how I got through some stuff, I'll share my story with them and walk them through it. Just being able to speak to someone who knows really makes a difference. And that's what I want to try to do for other people.

Sara Embry discusses her experience with the infection while pregnant and as a mother to young children as well as finding the Peggy Lillis Foundation to help her cope with the infection and subsequently work as a peer support volunteer for the organization.

A Young Mother With C difficile Deals With Social Isolation, Concerns of Recurrence

The New York City Department of Health and Mental Hygiene (DOHMH) has reported an increase in the ongoing Legionnaires’ disease outbreak in Central Harlem, with 67 confirmed cases and three deaths as of August 5, 2025. The outbreak, first reported in late July, continues to affect residents and workers in ZIP codes 10027, 10030, 10035, 10037, and 10039.

Health officials emphasize that the overall risk to the general public is low, but urge individuals in the affected area who are experiencing flu-like symptoms, especially cough, fever, chills, muscle aches, or shortness of breath, to seek medical care promptly.

NYC Health Department urges immediate medical attention for flu-like symptoms in affected ZIP codes in Central Harlem amid ongoing investigation.



Athena Hobbs

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