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Recent Insights in Understanding the Clinical Impact and Burden of Carbapenem-Resistant Enterobacteriaceae

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

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.

 have identified previously unrecognized pathways through which 

 spreads in health care settings. Although direct patient-to-patient transmission has long been considered the primary mode of infection, researchers found that 

 also persists on hospital surfaces, contributing to delayed and indirect transmission between patients. These findings suggest a need for revised infection prevention strategies to account for environmental reservoirs.

Researchers at the University of Utah conducted a genomic analysis of 

 isolates collected from nearly 200 patients in the intensive care unit (ICU), health care providers' hands, and hospital surfaces. Whole-genome sequencing was used to track transmission events, revealing that 

 frequently survived in the environment and spread to patients who had no direct contact with an infected individual.

More than half of the transmission events identified in the study involved patients admitted at different times, suggesting that 

 can persist in hospital environments for extended periods. The genetic similarity of strains isolated from surfaces and later-infected patients supports the hypothesis that environmental contamination serves as a major, underrecognized reservoir for transmission.

Current infection control strategies emphasize hand hygiene and alcohol-based sanitizers, but these measures may be insufficient given the resilience of 

 spores. Study coauthor Lindsay Keegan, PhD, a research associate professor of epidemiology at the University of Utah, noted that although patient-to-patient transmission rates were consistent with those of prior studies, the extent of environmental transmission was higher than previously reported.

To mitigate the risk of environmental transmission, the researchers recommend

Enhanced environmental cleaning: use of sporicidal disinfectants proven to be effective against 

Increased environmental surveillance: routine monitoring of hospital surfaces to detect contamination reservoirs

Revised hand hygiene protocols: emphasizing soap-and-water handwashing over alcohol-based sanitizers, as 

Expanded use of personal protective equipment: ensuring health care workers take precautions to prevent inadvertent transfer of spores.

Findings from this study, underscoring the environmental transmission of 

 in hospitals, align with existing Centers for Disease Control and Prevention (CDC) guidance on preventing 

infection (CDI) in acute care settings. The CDC emphasizes 5 core strategies: prompt isolation and contact precautions for suspected or confirmed cases, laboratory confirmation of infection, thorough environmental cleaning with sporicidal agents, development of infrastructure to support prevention efforts, and engagement of antimicrobial stewardship programs. These strategies aim to address both direct and indirect transmission pathways, such as contaminated surfaces highlighted by the new genomic research.

 Together, these findings and guidelines reinforce the need for hospitals to go beyond standard protocols and adopt comprehensive, environment-focused infection control practices.

 investigational oral biologic, LMN-201, achieved a 100% initial clinical cure rate for CDI in a preliminary cohort of its RePreve trial. The therapy, taken alongside standard antibiotics, was safe and well tolerated and showed lower recurrence than existing treatments. These early results support LMN-201’s novel dual-target approach, neutralizing 

 bacteria and its toxin, and suggest promise for reducing relapse in patients with high risk.

1. Keegan LT, Tanner W, Orleans B, et al. Environmental and health care personnel sampling and unobserved Clostridium difficile transmission in ICU. 

. 2025;8(4):e252787. doi:10.1001/jamanetworkopen.2025.2787

2. Clinical guidance for C. diff prevention in acute care facilities. Centers for Disease Control and Prevention. Updated March 8, 2024. Accessed April 4, 2025. 

https://www.cdc.gov/c-diff/hcp/clinical-guidance/?CDC_AAref_Val=https://www.cdc.gov/cdiff/clinicians/cdi-prevention-strategies.html

3. Lumen Bioscience’s LMN-201 achieves 100% initial C. difficile clinical cure in preliminary cohort of RePreve trial. Lumen Bioscience. April 3, 2025. Accessed April 3, 2025. https://www.lumen.bio/2025/04/02/lmn-201-preliminary-cohort-repreve-trial/

Environmental contamination plays a larger role than previously recognized, prompting calls for updated infection control strategies.

New Genomic Study Findings Reveal Hidden Pathways of C difficile Transmission in Hospitals

Presented at American Society for Microbiology (ASM) Microbe 2025, a process improvement project led by Navarathna et al at Central Texas Veterans Health Care System evaluated the impact of incorporating enzyme immunoassays (EIAs) into existing polymerase chain reaction (PCR)–based diagnostic protocols for 

The study compared 2 EIA platforms against PCR results and found that EIAs were less than 30% as sensitive as PCR. Of 13 health care–onset CDI (HO-CDI) cases identified during the project, only 3 were confirmed by EIA. Interestingly, 5 inpatients who had positive PCR results but did not meet testing criteria had positive EIA results, indicating potential active infection. Lower PCR cycle threshold values, indicating higher bacterial loads, were significantly associated with EIA positivity, reinforcing the concept that EIAs require a higher level of toxin for detection.

PCR testing has become the dominant method in the US due to its high sensitivity, which has also correlated with increased reporting of HO-CDI cases. However, this sensitivity may lead to overdiagnosis by detecting asymptomatic colonization rather than active infection. To counter this, some centers have adopted a 2-step algorithm adding EIA testing after a positive PCR result or glutamate dehydrogenase screen to improve specificity.

The authors concluded that although multistep testing algorithms might reduce HO-CDI event rates by limiting overdiagnosis, they risk missing toxin-negative CDI cases due to EIA insensitivity. Consequently, the added EIA step may provide limited clinical utility for guiding CDI management decisions.

Navarathna DH, Cornelius L, Wiley L, San Juan M, Bolin S. Are we moving towards diagnostic stewardship or laboratory retrogress on 

testing? Abstract presented at: American Society for Microbiology Microbe 2025; June 19-23, 2025; Los Angeles, CA. Abstract CPHM-P-202.

A study presented at ASM Microbe 2025 questions the clinical value of adding enzyme immunoassays to PCR-based CDI diagnostics amid sensitivity concerns.



Keith S. Kaye, MD, MPH

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