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Measles in Ontario, more endoscope-related infections, a study of postnatal Zika infections, research and development on a river blindness vaccine, and using CRISPR to tackle Zika are the articles that make up this week’s Top 5.

Top 5 Contagion&reg News Articles for the Week of June 25, 2017

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

Sputum cultures obtained before rather than after initiating antibiotic treatment were found to detect more respiratory pathogens and fewer opportunistic bacteria of uncertain clinical relevance in findings from a study

of over 15,000 patients that support the intuitive choice of culturing prior to treatment when possible.

"While the recommendation to collect sputum samples before antibiotic treatment is intuitive, supporting research is inadequate and is based on study cohorts limited in size and statistical power or specific patient groups," point out Magnus Paulsson, DMSc, associate professor of infection medicine in the Department of Clinical Sciences at Lund University in Sweden, and colleagues. "Understanding the impact of antibiotics on sputum culture results is important for interpretation of culture results and deciding how to act on the result."

Paulsson elaborated on the need to cautiously interpret sputum culture results obtained after initiating antibiotics in comments on the study with 

"When a microbiology laboratory reports the presence of opportunistic pathogens in a sputum sample collected after the initiation of antibiotic therapy, several interpretations are possible," Paulsson explained. "One possibility is that the reported organism is the true causative agent of the infection and antibiotic therapy should be adjusted accordingly. However, there is also a significant risk that the organism is not the actual pathogen. Misinterpretation in such cases can lead to unnecessary broadening of antibiotic coverage, which may contribute to antimicrobial resistance and other complications."

"It is essential to consider the timing of sample collection, the patient's clinical status, and the likelihood of colonization vs infection before modifying antibiotic therapy based solely on culture results," Paulsson advised.

In adding to evidence of the advantage of prior culturing, however, the investigators acknowledge that such timely collection can be challenging for several reasons, including patients unable to expectorate spontaneously, overcrowded emergency departments with limited feasibility of assisted airway clearance, and the clinical necessity of immediate empirical antibiotic therapy or respiratory support.

In their retrospective cohort study of 21,364 sputum cultures from 15,366 individuals at 9 hospitals over a period of 10 years (2011 to 2021), 46% were obtained with recent or ongoing antibiotic use. For their analysis, they classified antibiotic exposure as none, ongoing (oral antibiotics within 7 days or intravenous within 24 hours), or recent (treatment concluded within 30 days and prior to the criteria for ongoing).

Paulsson and colleagues reported that sputum cultures collected prior to initiating antibiotics revealed respiratory pathogens in 26.4% of samples compared with 12.2% of cultures taken after antibiotic exposure. Opportunistic pathogens were more frequently detected after recent antibiotic exposure.

The most frequently detected respiratory pathogens were 

, but the investigators found that each elapsed hour after antibiotic administration significantly decreased the probability of detecting either. In contrast, they noted, detection of opportunistic organisms except for 

"Collecting samples after antibiotics have been initiated may reduce diagnostic accuracy and potentially increase the yield of opportunistic pathogens, counteracting the goals of stewardship," the investigators concluded.

In addition to advising cautious interpretation of sputum cultures obtained after starting antibiotics, Paulsson suggested that amending practice guidelines might be warranted.

"Personally, I think that guidelines could be updated and that posttreatment samples should only be sent for cultures in select cases; for instance, from patients with chronic pulmonary diseases and pneumonia, very severe disease, or when nonsusceptible organisms are expected," Paulsson said.

1. Bryer M, Johansson E, Ryden H, et al. Sputum culture yields after antibiotic therapy – a retrospective cohort study. 

Study findings underscore value of obtaining sputum culture prior to initiating antibiotics for greater detection of pathogens without opportunistic bacteria of uncertain clinical relevance.

Value of Sputum Cultures Diminished by Prior Antibiotics

A newer FDA-approved antibiotic, sulopenem (Orlynvah), was found to be noninferior to a long-standing treatment, amoxicillin/clavulanate (Augmentin), in adult women with uncomplicated urinary tract infections (uUTIs), according to data from the REASSURE phase 3 trial. The results were published in the 

“Overall success in the microbiologic-modified intent-to-treat population occurred in 318 of 522 (60.9%) participants treated with sulopenem versus 260 of 468 (55.6%) participants treated with amoxicillin/clavulanate (difference, 5.4 percentage points; 95% confidence interval [CI], −0.8 to 11.5), meeting criteria for noninferiority,” the investigators wrote.

Iterum Therapeutics developed sulopenem—its first compound—which is a novel penem anti-infective compound with an oral formulation and intravenous formulation. “We are very pleased that 

 has published the results from the REASSURE trial,” Iterum CEO Corey Fishman said in a statement. “This article highlights the need for new antibiotics, like Orlynvah, for the treatment of uUTI given the increasing rates of multidrug resistance to the currently available antibiotics. We expect Orlynvah to be available to treat women with hard-to-treat infections in the next quarter.”

The REASSURE trial included 2222 adult women with uUTIs, and the median age was 51 years. Participants were randomly assigned to receive either treatment for 5 days. The trial's primary end point was the overall response rate at the test-of-cure visit. 

In terms of adverse events, there were more experienced in the sulopenem group. “Treatment-emergent adverse events occurred more frequently with sulopenem compared with amoxicillin/clavulanate, including diarrhea (8.1% vs. 4.1%), nausea (4.3% vs. 2.9%), and headache (2.2% vs. 1.5%),” the investigators wrote.

UTIs are among the most common infections encountered. There are approximately 15 million emergency department and office visits for symptoms of UTIs and over 40 million total prescriptions for uUTIs in the US annually, with approximately two-thirds or 26 million of those prescriptions written for patients who are at elevated risk for treatment failure, based on market research.

Resistance was also seen in the REASSURE trial. “Ninety-one (9.2%) patients in the primary population (microbiologic-modified intent-to-treat population), the combined population of patients with a positive baseline urine culture and without regard to amoxicillin/clavulanate susceptibility, had a baseline pathogen resistant to three or more classes of antibiotics,” the investigators wrote.

Antibiotic Resistance in the Context of UTI Treatment Developments

Oral sulopenem from Iterum Therapeutics was FDA approved last fall for uUTIs in adult women caused by specific bacteria, including 

, when there are limited or no alternative oral antibiotic options.

“As the first oral penem approved in the US, Orlynvah offers an excellent alternative treatment option for appropriate patients in the underserved uUTI market. With FDA approval and a clear label, we will renew our efforts to achieve a strategic transaction involving Orlynvah with the goal of maximizing value for our stakeholders,” Fishman said in a statement at the time of the approval.

Puttagunta S, Aronin SI, Gupta J, Das AF, Gupta K, Dunne MW. Sulopenem versus amoxicillin/clavulanate for the treatment of uncomplicated urinary tract infection. 

. 2025;4(7):EVIDoa2400414. doi:10.1056/EVIDoa2400414
2. Iterum Therapeutics announces publication of REASSURE trial in NEJM Evidence. News release. Iterum Therapeutics. June 25, 2025. Accessed June 25, 2025. https://ir.iterumtx.com/press-releases/detail/150/iterum-therapeutics-announces-publication-of-reassure-trial
3. Iterum Therapeutics receives U.S. FDA approval of ORLYNVAH (oral sulopenem) for the treatment of uncomplicated urinary tract infections. News release. Iterum Therapeutics. October 25, 2024. Accessed June 25, 2025. 

https://www.iterumtx.com/news/press-releases/detail/136/iterum-therapeutics-receives-u-s-fda-approval-of

Marketed as Orlynvah, oral sulopenem from Iterum Therapeutics was FDA approved last fall for uncomplicated urinary tract infections and has shown efficacy against infections caused by Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis.

Sulopenem Is Noninferior to Amoxicillin/Clavulanate for Uncomplicated UTIs

ACIP Recommends Clesrovimab for Infants Under 8 Months Without Maternal RSV Protection

In a significant move to protect infants from severe respiratory syncytial virus (RSV) disease, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted to recommend clesrovimab (Enflonsia), a newly FDA-approved monoclonal antibody, for all infants under 8 months who lack maternal RSV protection during their first RSV season. The committee also voted to include clesrovimab in the Vaccines for Children (VFC) program, ensuring no-cost access for eligible families. With strong efficacy, over 80% reduction in RSV-related hospitalizations, and a favorable safety profile, clesrovimab offers a simplified, single-dose option that could prevent tens of thousands of RSV-related healthcare visits and deaths annually, reinforcing its role as a vital tool in pediatric RSV prevention.

How Can Scientists and Investigators Find Funding Today?

At the ASM Microbe 2025 conference, Rodney E Rohde, PhD, highlighted growing concerns over federal research funding freezes and their potential impact on public health careers, particularly among students and early-career scientists. As a professor and chair at Texas State University, Rohde emphasized the need for creative alternatives to traditional funding sources, including private foundations, institutional grants, state-level opportunities, and partnerships with local organizations. While federal agencies like the NIH and NSF remain essential pillars of scientific advancement, Rohde stressed the importance of sustained engagement with these institutions to advocate for future investment. Despite current challenges, he remains hopeful that healthy competition for grants will continue to drive innovation and discovery in the life sciences.

Improving Quality of Life For Those With Recurrent C Difficile

 infection (rCDI) significantly diminishes patients' health-related quality of life (HRQoL), often causing anxiety, isolation, and fear of relapse. Paul Feuerstadt, MD, emphasizes the emotional toll of rCDI, likening it to post-traumatic stress, and highlights the transformative impact of fecal microbiota, live-jslm (Rebyota [RBL]), a non-antibiotic treatment approved by the FDA for over two years. A recent quality-of-life survey conducted by RBL’s manufacturer, Ferring Pharmaceuticals, found that patients who responded to RBL reported greater improvements in mental, physical, and social well-being than those on placebo. These gains were linked to beneficial shifts in gut microbiota and bile acid profiles, underscoring the therapy’s dual role in addressing both infection and overall patient wellness.

New Antifungal Drug Olorofim Shows Efficacy in Treating Resistant Fungal Infections

A novel antifungal drug, olorofim, has shown promising efficacy and safety in treating life-threatening invasive fungal infections (IFDs), particularly in patients with limited treatment options due to resistance. In a phase 2b trial involving over 200 patients infected with difficult-to-treat pathogens like azole-resistant 

, olorofim achieved a clinical response in nearly 60% of patients by day 42, with no resistance observed during treatment. John Rex, MD, FACP, chief medical officer at F2G, emphasized the drug’s targeted mechanism and oral formulation, noting its potential as a long-term option for high-risk fungal infections, while cautioning against future misuse in agriculture that could jeopardize its clinical effectiveness.

Antibody Levels Below Traditional Threshold Still Protect Against Hepatitis B in Vaccinated Children

 suggests that children vaccinated against hepatitis B remain protected even when their antibody levels fall below the traditional threshold of 10 mIU/mL, challenging the long-held assumption that such declines necessitate booster doses. Over a 5.4-year period, researchers followed 395 children born to HBV-infected mothers, one of the highest-risk groups, and found no cases of breakthrough infection, even among those with low or declining antibody levels. Notably, some children with reduced antibody levels experienced a natural immune boost without infection, likely due to HBV exposure, underscoring the strength of long-term immunity. While the study did not assess cellular immunity and booster administration wasn’t randomized, its findings may prompt reevaluation of current hepatitis B vaccination policies, potentially reducing unnecessary booster shots in similarly exposed populations.

This week, the ACIP recommends clesrovimab for RSV protection in infants under 8 months without maternal immunity, ASM Microbe talk urges for creative funding solutions amid federal freezes to sustain research and careers, and more.

How Can Scientists and Investigators Find Funding Today? 

As an academic, Rodney Rohde, PhD, SM(ASCP), SVCM, MBCM, FACSc, is teaching students and speaking with young, budding scientists. Rohde is the Regents’ Professor and University Distinguished Professor and Chair for the Medical Laboratory Science Program in the College of Health Professions at Texas State University.

As such, he is keenly aware of what is happening with the federal funding freezes and how this not only influences what research and development is getting done but also how it might influence careers and whether students will decide to go into areas such as public health.

Rohde was in attendance at the American Society for Microbiology Microbe 2025 conference and was an active participant at the meeting, talking about his profession and speaking with his peers. During the meeting, he participated in a career summit where he discussed some of the professional career possibilities, including academia, public health, clinical microbiology, and consulting. He also participated in a session where he discussed his own career journey.

“One of the tough things I think for this field right now is the ongoing changes to some of the career paths; we're struggling a little bit,” Rohde said. “Looking at public health right now, funding has become an issue in our country; it’s a concern among many of my colleagues.”

In terms of research funding, Rohde believes there can be alternative ways to secure it and that it may take some extra or creative ways to find it. 

“What we're doing in the academic world is we're really starting to communicate—we've always done that—but really focus with a fine-tooth comb on what are some options to do funding from the perspective of, say, a private foundation of donors, or internal grants—which can happen with an institution. And then looking at that connected piece of a big topic, infectious diseases is a huge, growing world, but maybe you can find a piece of the pie regionally…. Maybe I start working with other [local] institutions.”

He also mentions there might be opportunities at the state level for grants as well as working with companies and partnering with them.

And lastly, he says it is important for the science industry to continue to engage with the National Institutes of Health (NIH), which is the largest funder of science research, and the National Science Foundation (NSF). 

“We're all really working hard to talk with our government at the federal level and every level about how critically important it is to receive NIH and NSF funding. Because truly, if you look at America and probably the world, most research, drug development, patents, and amazing inventions come out of pure research, and it's expensive,” Rohde said.

Still, he remains optimistic that over the long term, the current funding situation will get better and the competition for grants will help drive innovation and new development.

“It's what our country was founded on with research. Going after those grants is good, friendly competition. It breeds the best types of research and platforms and innovation,” Rohde said. “So hopefully, that will prevail over time.”



Rohde is the host and producer of Contagion’s podcast, 

From Pathogen to Infectious Disease Diagnosis

Rodney Rohde, PhD, SM(ASCP), SVCM, MBCM, FACSc, discusses the ongoing concerns about the federal government’s hold on funding for research and the potential chilling effect that it may have on laboratory professionals and deciding on careers, especially in areas such as public health. He also talks about locating and engaging in potential alternative resources for research funding. 

Conferences

 challenges the prevailing assumption that hepatitis B surface antibody (anti-HBS) levels below 10 mIU/mL signify loss of immunity in children vaccinated against hepatitis B virus (HBV). The research followed 395 children born to HBV-infected mothers over a 5.4-year period and found no cases of breakthrough HBV infection, even in those whose antibody levels fell below the traditional protective threshold.

At the start of the study, approximately 27% of children had anti-HBS levels below the 10-mIU/mL threshold, which increased to 42% at follow-up approximately 5 years later. Despite this decline, none of the 395 children, including those unboosted with low antibody levels, developed hepatitis B infection or had positive test results for HBS antigen (HBSAg). Notably, 15% of unboosted children showed increased antibody levels over time without evidence of infection, suggesting natural immune boosting from HBV exposure in this high-risk group. These results indicate that children vaccinated against HBV remain protected even when their anti-HBS levels fall below the traditionally accepted protective threshold.

The cohort included children with close HBV exposure due to maternal infection who were monitored twice, initially at a mean age of 3.2 years and again at 8.6 years. Participants were categorized based on whether they received a hepatitis B vaccine booster after the first measurement. Researchers assessed serological markers, including anti-HBS, HBSAg, and antibody to hepatitis B core antigen.

The study acknowledged a relatively small subset with low antibody levels, and booster decisions were parent- and physician-driven rather than randomized. Cellular immunity was not assessed, which could also contribute to long-term protection.

Chronic HBV infection remains a global health concern, especially due to mother-to-child transmission. Neonatal immunoprophylaxis, involving a hepatitis B vaccine series and immunoglobulin administration shortly after birth, is the standard preventive measure. Anti-HBS levels greater than or equal to 10 mIU/mL are typically considered protective, but the clinical significance of antibody levels declining below this has been uncertain.

These findings support the notion that declining anti-HBS levels below 10 mIU/mL do not necessarily indicate loss of immunity and that routine booster vaccination may not be required, even in high-risk populations. This could influence future hepatitis B vaccination guidelines and reduce unnecessary booster administration.

1. Shen P, Xu C, Li T, et al. Level of antibody to hepatitis B surface antigen declined below 10 mIU/ml is still protective. 

Global Hepatitis Report 2024: Action for Access in Low- and Middle-Income Countries

. World Health Organization. April 9, 2024. Accessed June 24, 2025. 

https://www.who.int/publications/i/item/9789240091672

New longitudinal study findings suggest booster vaccination may not be necessary despite declining antibody levels.

Contagion®Editorial Staff

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