Antimicrobial Stewardship

Ebola

HCV / Hepatitis

Blood-Borne Diseases

Coronavirus / COVID

E. Coli

Food Safety

Listeria

Salmonella

Food Borne Infection / Food Safety

Candida auris

Fungal Infections

C. Difficile

H. Pylori

Norovirus

Gastrointestinal Infections

Healthcare Associated Infections (HAI)

Antibiotics

Immunizations

Vaccines

Prevention

Community-Acquired Pneumonia 

Influenza

Measles

Respiratory Infections

HIV / AIDS

PrEP

Sexually Transmitted Diseases

MRSA

Skin & Soft Tissue Diseases

Lyme Disease

ZIKA

Zoonotic & Vector-Borne Diseases

News

Media

Medical World News

Podcasts

Videos

Insights

Peer Exchange

Media Day

News Network

Roundtables

Conference

Conference Coverage

Conference Listing

Publication

CME/CE

Partners

Resources

Interactive Tools

Special Projects

Contribute

Case Studies

Writers and Mentors

Subscribe

Contagion® is a news resource for infectious disease specialists and practitioners, aiding identification, diagnosis, treatment and prevention.

About Us

Advertise

Editorial

Contact Us

Do Not Sell My Information

Privacy

Terms & Conditions

Contagion Live - Infectious Disease News & Expert Insights

Facebook

LinkedIn

Spotlight

Bench to Bedside With SIDP

C. difficile 

Clinical Corner

Hepatitis

RSV: A New Era in Prevention

Clinical

COVID-19

Climate Change

Covid Vaccine Race

Food-Borne Infections

Healthcare-Associated Infections

Respiratory Diseases

Respiratory Syncytial Virus (RSV)

Video Series

Peers and Perspectives

1rem

Authors

Resident in Internal Medicine at the University of Vermont Medical Center in Burlington.

Environmental modeling shows inpatient IV therapy has the highest carbon, water, and waste footprint, while OPAT offers major reductions.

Comparing The Environmental Impact of Inpatient IV Antimicrobial Administration With OPAT

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

Pranita Tamma, MD, MHS, continues her conversation about a study she was involved in that compared ceftolozane-tazobactam and ceftazidime-avibactam.

Clinical Guidelines, Stewardship Practices for Managing DTR Pseudomonas Infections

In this short series, Pranita Tamma, MD, MHS, associate professor of pediatrics in the Division of Pediatric Infectious Diseases at The Johns Hopkins University School of Medicine, has a discussion about ceftolozane-tazobactam vs ceftazidime-avibactam for gram-negative resistant 

 infections and the latest data supporting these decisions.

In one retrospective observational study, which compared ceftolozane-tazobactam and ceftazidime-avibactam and was funded by the National Institutes of Health, the findings showed similar 30-day mortality rates but higher resistance emergence in the ceftolozane-tazobactam group (38% vs 25%). Tamma was the senior investigator in this trial.

Below is a response from a question about the findings and how they should influence management of this particular infection.

How might the findings of this study influence future clinical guidelines or stewardship practices for managing difficult-to-treat resistant (DTR) 

I think all 3 observational studies were valuable, and I’m glad they were conducted. They addressed an important question involving a serious infection—one where the stakes are high, the number of active drugs is limited, and resistance to the available agents is a real and growing problem. Unfortunately, we are likely to lose these drugs for a substantial portion of DTR 

The good news, in my view, is that none of the 3 studies showed a difference in mortality, which remains the most objective outcome. Based on these results, I don’t think we can say ceftolozane-tazobactam or ceftazidime-avibactam is definitively better or worse for treating DTR 

. My approach would be to test both agents, choose the one that is active against the infection, and monitor the patient very closely.

That said, resistance is a major concern. Across studies, at least 20%—and likely more—of patients treated for DTR 

 with either of these drugs subsequently developed resistance, meaning that when the infection recurs, the same drug is no longer effective. Due to the structural similarities between these agents, there is also considerable cross-resistance. For example, if a patient develops resistance to ceftolozane-tazobactam, resistance to ceftazidime-avibactam is also often expected.

From my perspective, the 3 studies do not change my view that neither drug is inherently superior. However, from an antibiotic stewardship standpoint, I would prioritize ceftolozane-tazobactam when both drugs test active. The reason is that ceftazidime-avibactam offers broader utility beyond DTR 

: It can sometimes be combined with aztreonam to treat metallo-β-lactamase–producing organisms, and it retains activity against certain carbapenem-resistant Enterobacterales such as KPC [

 carbapenemase] and OXA-48–like producers. By using ceftolozane-tazobactam first, we may preserve ceftazidime-avibactam as an option for those other difficult-to-treat pathogens.



The conversation was edited for grammar and clarity.

Pranita Tamma, MD, MHS, discusses recent studies comparing ceftolozane-tazobactam and ceftazidime-avibactam for drug-resistant Pseudomonas infections, emphasizing similar mortality outcomes, high rates of emerging resistance, and the importance of stewardship practices that prioritize preserving ceftazidime-avibactam for broader clinical use.

Ep 2, Part 3 of 4, Robert C. Bransfield, MD, explains how ecological change, zoonotic infections, and neurological impairments may contribute to violent behavior.

Episode 2, part 3, with psychiatrist Robert C. Bransfield, MD, examines how infections can influence neurological function and, in turn, violent behavior. Building on earlier discussions, Bransfield connects ecosystem disruptions, zoonotic disease emergence, animal models, and neurological impairment to the broader question of violence at both the individual and societal level.

Bransfield begins by emphasizing the imbalance between human technological advancement and our ability to address violence and mental health: “A serious concern is that our weapon technology is more advanced than our mental health technology and our technology to understand violence. We need to catch up with that. We lose $20 trillion per year in the world as a result of violence.”

He warns that this imbalance raises questions: “Particularly as we're getting these weapons of mass destruction…are the people who have control of them mentally stable? Is there some way of having safeguards so that there's mental stability in the people who have control of them?”

Ecosystems, Parasites, and Emerging Infections

Bransfield then shifts to ecological disruptions and how they give pathogens a competitive advantage: “In a balanced ecosystem, there's host and there are parasites, and they're in check. But parasites, like 

, reproduce every 20 minutes. Higher life forms reproduce every 20 years. So when the environment rapidly changes, parasites have a great advantage.”

These disruptions, he notes, make populations vulnerable to new diseases: “Globalization makes us exposed to different illnesses that we didn’t have resistance to. COVID-19 was a zoonotic disease.... Who knows how it evolved, but it was catastrophic to millions of people.”

Animal and Human Models of Infection and Behavior

Using rabies as an example, Bransfield describes how animal models illustrate infection-behavior links: “Rabies isn’t really transmitted. It’s not a big issue with people, but it’s a good model. The animal then is more aggressive. It transmits.”

For humans, he highlights a long list of infections with neurological or behavioral implications: “There are about 20 different infections that are identified: 

of different sorts, malaria, cerebral malaria, toxoplasmosis, herpes simplex virus. Damage to the temporal lobe can be related to diminished empathy, and that particularly has significance with violent behavior.”

From Infection to Violence: Neurological Pathways

Not all infections affect the brain in the same way, but some, Bransfield explains, can lead to behavioral change: “Some infections just cause more physical symptoms. Others may affect the brain in different ways, some of which may cause different mental impairments, but sometimes the mental impairment could be violence.”

He points to history for examples: “Encephalitis lethargica was particularly associated with violence. There were 2 pandemics in 1918: the Spanish flu and encephalitis lethargica. Both had some correlation with violence, but especially encephalitis lethargica.”

The neurological mechanism, he says, lies in impaired circuits that normally help us respond to danger appropriately: “In someone who has an illness, you’re fearful when there’s no danger or you’re careless when there is danger and you’re not attentive enough to it.”

Tune into episode 1 of our series, split into 4 parts, for more background context: 

Rethinking Mental Illness: The Overlooked Impact of Infection

In episode 2, part 3 of 4, Robert Bransfield, MD, explains how ecological change, zoonotic infections, and neurological impairments may contribute to violent behavior.

Ecosystem Disruption, Infections, and Violence

US adults experiencing food insecurity had a 78% higher likelihood of current long COVID and a 34% lower likelihood of recovery after prior long COVID, with lower risk observed among those participating in the Supplemental Nutrition Assistance Program (SNAP) and those who were employed. These estimates come from an analysis of 21,631 respondents in the 2022-2023 National Health Interview Survey who reported prior COVID-19 and answered questions on food insecurity and long COVID.

Current long COVID was defined as symptoms lasting at least 3 months after infection and present at the time of interview, whereas recovery meant a history of long COVID without current symptoms. Food insecurity was measured using the validated 10-item National Center for Health Statistics scale. In adjusted models, food insecurity was associated with higher odds of current long COVID (OR, 1.73; 95% CI, 1.39-2.15) and lower odds of recovery (OR, 0.70; 95% CI, 0.54-0.92). Weighted prevalence of current long COVID was 15% among those with food insecurity vs 7% among those without, and interaction tests suggested mitigation with SNAP participation and employment (

These findings position food insecurity as a potentially modifiable risk factor that may influence both development and persistence of long COVID and point to policy levers such as expanding SNAP eligibility, simplifying enrollment, and increasing program awareness. To explore mechanisms, clinical steps, and policy implications, we spoke with study investigators Jaya Aysola, MD, MPH, DTMH, founder and executive director of Penn Medicine Center for Health Equity Advancement, and John C. Lin, MD candidate at the University of Pennsylvania and Truman Scholar.

Aysola said, “The important thing to start out with is that we cannot definitively say, 'So the challenges with association studies [are] that you can't really infer causality or directionality,' right? So you don't know which came first, sort of like the chicken and the egg.”

She set up what we know from practice: “A few things we do know that we do see, just generally, [are] that delayed care due to financial hardship or unemployment can lead to people making tough choices around having to choose food over access to care, for example, which could help with prevention and protection against getting COVID-19 and then subsequently being treated for COVID-19 and perhaps being prevented from getting long COVID,” Aysola said.

Building on possible biological pathways, Aysola added, “We also know that reduced consumption of healthy nutrient-dense food does impact other chronic conditions, and whether it could impact the way one is predisposed to getting long COVID is also an unanswered question but a potential mechanism by [which] this could happen. The way food insecurity manifests in the US is not actually a lack of access to food at large but more a lack of access to nutrient-dense food, and those foods are far more important for chronic diseases. And even in this case, potentially, one would hypothesize, reducing your chances of recovering from COVID-19.”

She also noted the possibility that the relationship runs in the other direction: “The other option is if the direction goes the other way around. So say long COVID may increase your risk of food insecurity by impairing people's ability to work, creating financial hardship, etc. So because we can't really say which direction [it] is going, there are a couple of hypotheses that we can put forward in both directions to explain this link.”

Aysola turned to what clinicians can do now and how policy can reinforce those efforts. Aysola said, “The first thing when I think about what clinicians can do, they could think about, 'What can I do in my practice? And then what can we do from a policy perspective?' But in terms of practice, one of the easiest and first things we need to start to think about is how we can routinely and systematically screen for food insecurity, and not just screen for it or assess it, but actually code it to capture the extent of the issue in our practice.”

She emphasized that documentation is foundational to change. “There are Z codes that people can use to capture when there's food insecurity, that they're assessing, that there's a positive assessment in their practice. They can actually code for that, and that has 2 functions. One is that it captures this extent of the problem. It also sets the groundwork to be able to lobby for what we've done for other things in public health, to lobby for billables around that. For example, smoking cessation, discussion, screen. Screening for smoking started out as merely Z codes, but over time, it became something that you could actually bill for.”

She connected this to building sustainable workflows. “So you could bake into your practice that you've screened for smoking and then you've spent 

 number of minutes discussing smoking prevention and smoking cessation strategies. I think similarly, with social needs and food insecurity specifically, we can march down a similar path where we're starting to make those assessments in a clinical care setting like a practice and beginning to code for it with existing codes and then work our way to beginning to be able to bill for something like that. In order to bill for solutions and fund solutions in a practice-based setting, I think the other thing the clinician does in real time. And when I say bill, I mean bill the insurance companies, not, obviously, the patients.”

She then outlined how practices can pair screening with immediate help. “What I think we can also do as clinicians in the practice-based setting is advocate for resources to assist with positive screens or positive assessments, so either practice-based resources or community-based resources. I think [about] what this shows us from SNAP participation and employment status. So I think from this that SNAP is an absolute benefit. Enrollment is key to all of this, right? And so from a policy standpoint and a practice standpoint, from a practice standpoint, embedding and thinking about how case managers or practice staff are needed to help patients who are eligible for SNAP get enrolled in SNAP are a part of that practice-based resourcing that needs to be done.”

Finally, she called for advocacy through professional societies to widen access. “From a policy standpoint, there needs to be more pressure from clinicians using their national societies to advocate for the importance of enhanced eligibility for SNAP programs. Because what we see, and this is important, is irrespective of employment status. So employed individuals without SNAP benefits who have food insecurity are also more predisposed and have a higher chance of both getting COVID-19 and then not recovering from it. So there's an important [need] to expand benefit enrollment as well, irrespective of employment status and irrespective of the federal poverty line that patients are in, whether they're in higher-income brackets or lower-income brackets.”

Lin underscored the biological and social mechanisms that can tie food insecurity to persistent symptoms. “Food insecurity often leads to poor nutrition, chronic stress, and limited health care access, all of which may impair immune recovery and worsen lingering symptoms. These biological and social stressors can amplify vulnerability to long COVID. It's hard to recover when your body doesn't have the right fuel.”

He outlined concrete steps for frontline teams and public health agencies. “Clinicians can screen for food insecurity just as they do for vital signs and connect patients to SNAP or local food resources. Public health programs can normalize food assistance as part of chronic disease management, not just emergency aid. Nutrition is an important medicine too.”

Aysola also pointed to income-related nuances that strengthen the policy case. Aysola said, “I think one of the findings that our study showed was that if you're at the highest-income brackets, like greater- or middle-income brackets, greater than 200% of federal poverty line, etc, that you're still more likely if you [have] food insecurity to [have] a much greater risk of getting COVID-19 and not recovering from it.”

She contrasted this with lower-income groups and the potential role of benefits. “And I think what that shows you is that sometimes you're at greater risk than those at [a] lower-income bracket, and SNAP, I think, explains that away in the sense that right now, our federal funding, unfortunately, currently, and it's going to get worse before it gets better.”

She then connected these findings to eligibility rules and how they might evolve. “Our federal funding has a very rigid requirement for staff benefits that one could really push to expand eligibility criteria. And maybe not; it doesn't have to be just by income. It could be [to] expand eligibility criteria by certain conditions or [for] folks who are more predisposed, perhaps, to get long COVID. Beyond this, who is more at risk, to have caveats around that. Maybe it's age-based eligibility criteria, etc.”

Finally, Aysola underscored the urgency of policy action amid rising need. “But regardless, right now, we're in a landscape where I'm talking about this, where investments in those programs are actually decreasing or potentially decreasing in another year or so, at a time where food insecurity is increasing in the population at large because of increased costs of groceries, etc. So you have a perfect storm right now by which to wade through with existing eligibility criteria, and so there's a lot of policy work needed to be done to address this issue, which I think is going to be multifactorial, with a lot of people on board, from public health practitioners to folks who are really pushing for how do you invest in food as medicine to individuals like clinicians who are maybe leveraging their societal or national societies, medical societies, to act as that advocate arm and make that connection of food to help.”

Lin added a clear policy prescription. “Policies that expand SNAP eligibility, simplify enrollment, and raise awareness should be top priorities. Fighting long COVID starts with fighting food insecurity.”

Taken together, the investigators’ findings and perspectives point to a practical path forward: integrate routine food insecurity screening into clinical workflows, connect patients to food benefits and local resources, and leverage professional societies to advocate for expanded SNAP eligibility and simpler enrollment so that preventing and treating long COVID includes addressing the social conditions that shape recovery.

Lin JC, McCarthy M, Potluri S, Nguyen D, Yan R, Aysola J. Long COVID and food insecurity in US adults, 2022-2023. 

. 2025;8(9):e2530730. doi:10.1001/jamanetworkopen.2025.30730

Insights from Jaya Aysola, MD, MPH, DTMH; and John C. Lin, MD candidate, on clinical workflows, social needs screening, and policy levers.

Food Insecurity Tied to Higher Long COVID Risk in US Adults 

In Part 1, Kevin A. Ault, MD, Vice President of the National Foundation for Infectious Diseases, discusses ACIP’s recent meeting, including COVID-19 shared decision-making, informed-consent debates, and new policy actions on hepatitis B and MMRV.

“Part 1 of Our Conversation with Kevin A. Ault, MD: ACIP Shared Decision-Making, Informed Consent, and Vaccine Policy

This is part 1 of our conversation with Kevin A. Ault, MD, vice president of the National Foundation for Infectious Diseases and professor of obstetrics and gynecology at Western Michigan University Homer Stryker MD School of Medicine. Ault previously served on the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP), where he helped shape multiple recommendations concerning COVID-19 vaccines in adults, adolescents, and children. He was also an author of the 2023 adult, adolescent, and pediatric US immunization schedules, which include recommendations for maternal immunization and adult hepatitis B vaccination.

In this discussion, Ault reflects on ACIP’s recent meeting, including the shift to shared clinical decision-making for COVID-19 vaccination, the debate over informed consent, and how clinicians in obstetrics, pediatrics, and family medicine can operationalize new policy actions around hepatitis B and measles-mumps-rubella-varicella (MMRV).

“I think shared decision-making has a specific meaning when the ACIP uses that terminology. I think the last time I was on the ACIP, they voted for shared decision-making. And I might not be remembering this correctly, but I’m certainly familiar with the example of human papillomavirus [HPV] vaccination.”

He added, “There are certain populations where there may not be as much benefit to HPV vaccines. And so in that theory, or in that spirit, you would give COVID-19 vaccination to people whom you thought most likely to benefit from vaccination.”

When reflecting on the most recent ACIP meeting, Ault admitted, “I was a little confused about that discussion…because that’s not something that ACIP usually gets into. It was a little unusual to hear that discussion, and we didn’t have an opportunity to look at the questions being voted on or the materials before the meeting.”

He explained that although most clinicians are familiar with the Vaccine Information Statements sheets, “ACIP doesn’t really have any jurisdiction over that. That’s a separate committee that actually makes those up. So…I thought that was a little muddled. You know, informed consent is something that’s done on a very local level, literally in doctors’ offices, and…the ACIP is supposed to be the 35,000-ft viewpoint as far as clinical recommendations.”

Turning to hepatitis B policy, Ault noted, “Prenatal testing for hepatitis B status has been the standard of care since the early 1980s, and so I’m not sure where that was coming from. And again, I’m not sure why ACIP was voting on something that’s already the standard of care.”

He emphasized that the recommendation has been in place for decades, but implementation gaps remain: “Even though we had that recommendation, we still continue to have pediatric and newborn cases of hepatitis B despite a recommendation to universally screen. So we’re never going to get to the point where we have 100% accurate screening 100% of the time. And I don’t think a vote of the ACIP is going to change that.”

He also pointed to disparities in practice: “For women with insurance, there are about 12% that aren’t tested during pregnancy. Could we make that higher? We certainly could. I have not seen equivalent data on Medicaid, but it boils down to about 10,000 infants [who] are exposed to hepatitis B every year.”

On MMRV, Ault reflected on long-standing safety concerns: “There is an increased risk of seizure with the combined vaccine, especially during that vulnerable period, the first year of life. And so that risk has been known for a long time.” He recalled, “If I remember correctly…it’s about one extra seizure for 2300 doses. And so some parents may look at that and say, 'Well, that’s 2299 times out of 2300 it’s not going to be an increased risk.'”

Despite the risks, he stressed the broader safety context: “Febrile seizures are certainly frightening…. I understand that they don’t have longer-term health consequences. Febrile seizures can certainly occur because of measles and chickenpox.”

By comparison with COVID-19 deliberations, Ault suggested the hepatitis B birth dose requires no change: “The birth dose is inexpensive, has been around for 30 years, [and] has worked remarkably well at reducing pediatric hepatitis infections by about 99%. So I’m not sure we’re going to improve on that number.”

COVID-19 vaccination: ACIP kept vaccination for people 6 months or older under shared clinical decision-making, emphasizing individualized counseling on age, prior infection, immunosuppression, and comorbidities. Prescriptions are not required.

MMRV in pediatrics: To reduce febrile seizure risk, ACIP recommended separate MMR and varicella doses before the age of 4 years rather than the combined MMRV product.

Hepatitis B: The committee tabled a proposal to delay the newborn birth dose to 30 days, leaving the current schedule unchanged while reaffirming universal hepatitis B virus (HBV) testing in pregnancy.

ACIP members also urged the CDC to provide clearer, plain-language informed-consent materials and called for more transparent posting of vote language with consistent use of the evidence-to-recommendation framework.

Clinically, the playbook remains stable: continue COVID-19 vaccination via shared decision-making for higher-risk patients, maintain HBV birth-dose practices and universal prenatal testing, and use separate MMR and varicella doses before the age of 4 years. Coverage through Vaccines for Children, Medicare/Medicaid, and commercial plans is expected to continue without new prescription requirements.

In part 1 of our conversation, the VP of the NFID discusses ACIP’s recent meeting, including COVID-19 shared decision-making, informed-consent debates, and new policy actions on hepatitis B and MMRV.

Kevin Ault, MD, on ACIP Shared Decision-Making, Informed Consent, and Vaccine Policy

Dr. Nizet discusses repurposing antibiotics.

What’s Old is New: Rediscovering Antibiotic Utility

, where we spotlight individual medical institutions and infectious disease programs. Today, we spotlight University of California (UC) San Diego’s Skaggs School of Pharmacy and Pharmaceutical Sciences and the university’s extensive research programs and community-based health programs to serve the local population.



Victor Nizet, MD, vice chair for basic research in the Department of Pediatrics and chief of the Division of Host-Microbe Systems & Therapeutics at UC San Diego, says his laboratory has been examining ways in which the immune system and existing medicines interact so they can look to repurpose these therapies for other indications. He is enthusiastic about this work, especially as they are already approved by the US Food and Drug Administration and safe for use in infectious disease.

For example, he and his team published a paper a few years back that studied how ticagrelor (Brilinta), the antiplatelet medication, which is used to prevent blood clots, actually boosted the ability of platelets to kill bacteria in the bloodstream, especially methicillin-resistant 

(MRSA) infections. Since the publication of that paper, Nizet said other groups around the world have been studying how to repurpose therapies. 

“I just learned last month that a large Clinical Trials Network [trial] studying the optimal therapy for 

 infections is going to include an arm in the trial where they're going to repurpose this platelet medicine to help treat 

 infections. And this was all from our observation that patients who had a lower platelet count were having more trouble with 

When it comes to repurposing antibiotics, Nizet and his team have looked at the seesaw effect of drug resistance with regard to infections and how this phenomenon observed, especially with MRSA, where increasing resistance to a drug such as daptomycin or vancomycin leads to increased susceptibility to a different class of antibiotics, such as β-lactams.

In our continuing conversation with Victor Nizet, MD, he discusses how his laboratory is studying how to repurpose antibiotics that susceptibility testing had shown to not be efficacious against certain infections.

Finlay Pilcher, MD

Articles

Latest Updated Articles