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As antimicrobial therapies become less effective, more people are at risk for infections that can progress to sepsis.

Sepsis and Antimicrobial Resistance Awareness Gain Ground, But Action Must Continue

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

In the second part of an interview with Andrea Prinzi, PhD, MPH, SM(ASCP), she talks about the significance of how that foundation played such a significant role against the disease as well as the remain hurdles to its eradication and how polio’s vaccine are a lesson applied to medical science. 

What We Can Learn From Polio

In 1938, President Franklin D. Roosevelt founded the National Foundation for Infantile Paralysis, the name of which he later changed to the March of Dimes Foundation. Roosevelt, himself experiencing paralysis from polio as an adult, became deeply involved in this cause.

 He experienced paralysis in 1921 at the age of 39 years as a result of polio.

With the creation of the foundation, Andrea Prinzi, PhD, MPH, SM(ASCP), field medical director of US medical affairs in clinical and translational science at bioMérieux, says Roosevelt came up with a unique plea that was designed to apply to all Americans. 

“He said every single person in the country, no matter what your status or your wealth, can donate one dime to this cause, and everybody felt like they could relate to that,” Prinzi says. “It reached people who maybe had been excluded from conversations before or people who didn't come from wealth and didn't feel like they could make a donation toward the cause." 

This was a novel way to increase philanthropy that is still being used today, with people giving what they can to causes.

Prinzi says this mobilized the fundraising, and people were sending dimes to the White House. With these monies raised, it helped fund the work of Jonas Salk, MD, who developed his polio vaccine.

“There were a lot of other things that came from this. The power of unifying behind a single cause and getting the public to have a shared responsibility for the wellness of the whole of people. It was also that polio was very, very frightening for people and impacting children heavily. So there's a lot of emotion tied [to] children—a lot more mobilization there. You also had a lot of public figures and celebrities getting behind this cause as well, which was really helpful."

Today, there are only 2 countries in the world where polio is endemic: Pakistan and Afghanistan.

 Although these countries are still dealing with polio, Prinzi says the progress made throughout the rest of the world has come to the point where most countries do not have to think about it and that what has happened in recent years is cases of vaccine-derived polio.

“In some cases, very rarely, but in cases, it can mutate to end up causing paralysis or severe disease in people who come in contact with that, and this is specifically true for the type 2 vaccine–derived polio virus,” Prinzi says. “It's responsible for greater than 90% of cases when this occurs.... Work has been done to develop vaccines that address that type of polio virus…. A vaccine was authorized by [the] World Health Organization that essentially makes the type 2 vaccine–derived polio virus less likely to mutate into something that can cause serious disease.”

She says this is a good example of the evolution of science and making changes to adapt to differing circumstances. This is the reality compared with what some in the public believe, which is that science is supposed to be perfect from the beginning. This can certainly be seen as a good example as it relates to COVID-19 public health policy and the vaccines.

“There's likely, very rarely, one single answer to a problem, and the public has to remember that things change and adapt, and we change and adapt and learn with those things, and then hopefully we evolve our science to match that,” Prinzi said. “That's something that I think has gotten a little lost on the public in recent years. We expect science to be perfect all the time and fix the problem right away, and that's just not really how these things work."



In the next installment of this series, we will discuss Roosevelt’s battle with polio and how he did not let the disease prevent him from living his life, including becoming president. 

References
1. Franklin Roosevelt founds March of Dimes. History. Updated May 27, 2025. Accessed July 28, 2025. https://www.history.com/this-day-in-history/january-3/franklin-roosevelt-founds-march-of-dimes
2. Poliomyelitis. World Health Organization. Accessed July 28, 2025.
https://www.who.int/health-topics/poliomyelitis

In the second part of an interview with Andrea Prinzi, PhD, MPH, SM(ASCP), she talks about how the March of Dimes played such a significant role against the disease, how the polio oral vaccine is a singular lesson that can be applied to medical science as a whole, and the understanding of the need to adapt to changing circumstances. 

What We Can Learn From Polio and Its Vaccines

Andrea Prinzi, PhD, MPH, SM(ASCP), provides insights on these areas and in part 1 of a 2 part interview, she discusses how polio cases rose and the severity of it, as well as Jonas Salk’s approach to his vaccine’s development of the debilitating and deadly disease.

Polio: Reviewing its History and the Development of its Vaccine 

Polio is an ancient disease with limited evidence of its existence throughout antiquity. It was not until the late 19th century that the disease became well-documented.

An increase in polio cases coincided with the emergence of the Industrial Age and the transition of people moving from mostly rural, farming environments to cities. This led to more people living closer together and the potential for greater transmission. And paradoxically, the increase of sanitation strategies that came about during this period led to more polio cases, explains Andrea Prinzi, PhD, MPH, SM(ASCP).

“There was this level of protection that was occurring in areas where there weren't the best hygiene or sanitary conditions,” says Prinzi of the agrarian society. “There were areas where there was this level of protection, particularly among parents of young children. They were passing some level of protection to their children by having been exposed to the virus, either through breast milk or carriage of the infant or fetus. There was protection that was happening, and then when everything got really clean, some of that protection was actually lost. Cases started to spike. It's this really strange example of where we saw sanitary improvements contributing to new cases of infection.”

Prinzi is the field medical director of US medical affairs in clinical and translational science at bioMérieux, and she examined this subject in an article she wrote for the American Society for Microbiology in the past year titled “

Polio's Last Stand: The Global Fight for Eradication

.” The article details polio's history as well as the more recent initiatives to rid the world of the disease.

Jonas Salk, MD, is well-known as the creator of one of the polio vaccines. What may not be as well-known is how he was very different in the way he worked and his approach to vaccine development.

In terms of how he worked, Prinzi says he worked with a small team without the backing of the pharmaceutical industry. However, she says he did have some government funding, which ruffled the feathers of a contemporary, Albert Sabin, MD, who was the creator of the oral polio vaccine.

Prinzi says Salk took a divergent path from the existing line of scientific work being done at that time because he looked to develop an inactivated polio vaccine instead of trying to develop a vaccine with a live virus, the attenuated immunization, like Sabin was working on.

“He [Salk] had a lot of reservations around using something that was a live attenuated virus, even though that was what a lot of the research was being focused on at the time,” Prinzi says. "According to the academic and research community, he was going outside the box. He was doing things his own way, being nontraditional, which they didn't really love. And he even said at one point that he just marches to the beat of his own drummer.”

Vaccine Testing, Losing Public Trust, and Vaccine Hesitancy

Both Salk and Sabin’s testing methods for their polio vaccination were questionable. Salk and Sabin tested the vaccines on themselves, their families, and marginalized populations such as children with disabilities and incarcerated individuals. 

“A lot of ethics review material came from the polio saga,” she says.

Despite these issues, both vaccines were eventually used by the public and had great success. Salk's vaccine was developed first and used widely in the US. In fact, it has been reported that 2 years before the vaccine was widely available, the average number of polio cases in the US was more than 45,000. By 1962, several years after vaccination began, that number had dropped to 910.

Prinzi points out there were issues of public mistrust about the polio vaccine back then. Although Salk’s vaccine was a great success as a public health initiative, one major issue did arise that led to the transition to Sabin’s vaccine.

“There was one manufacturer in particular that did not follow the very specific instructions for how to produce this killed virus vaccine, and some batches actually went out with live virus in the vaccine, and this led to disastrous consequences and huge fallout,” Prinzi says. “And even though this is really related more to a manufacturing error than the vaccine—as it had been truly designed and was intended to be developed. This led to a ton of mistrust in the killed vaccine. And so with the Salk vaccine, folks didn't want to use it anymore, and they wanted a solution that was not that vaccine—even though that vaccine had been demonstrated to be safe and effective in tons of people.”

Because of this, the US transitioned to Sabin’s oral vaccine, which was being used globally, especially in places where there was limited infrastructure. Prinzi points our Sabin’s vaccine was inexpensive and easy to use. It could be simply dropped onto a sugar cube and given to people or in a recipient’s mouth.

However, over time, the US switched back to the inactivated polio vaccine because of some cases of vaccine-derived polio cases in Sabin's immunization.

Although there were issues associated with both vaccines, ultimately, their development and deployment have led to the near global eradication of polio. There are only 2 countries in the world today where polio is endemic: Pakistan and Afghanistan.

 This stands as a monumental achievement and a shining example of the development of these vaccines as well as the public health immunization efforts that worked greatly toward eradication.



This is the first in a series on polio looking at its history, the extraordinary work to create a vaccine, fundraising for the vaccine, and the current public health climate as it relates to vaccines. In the next installment of our series, Prinzi discusses the March of Dimes fundraising efforts and the modern-day public health strategies to reduce polio. 

References
1. Prinzi A. Polio's last stand: the global fight for eradication. American Society for Microbiology. September 19, 2024. Accessed July 27, 2025.


https://asm.org/articles/2024/september/polio-s-last-stand-the-global-fight-for-eradicatio


2. History of Salk. Salk Institute for Biological Studies. Accessed July 27, 2025. 

https://www.salk.edu/about/history-of-salk/jonas-salk


3. Poliomyelitis. World Health Organization.

Accessed July 27, 2025.
https://www.who.int/health-topics/poliomyelitis





Andrea Prinzi, PhD, MPH, SM(ASCP), provides insights on how polio cases rose despite sanitation and hygiene improving as well as Jonas Salk’s and Albert Sabin's approaches to their vaccines' development.

Polio: Reviewing Its History and the Development of Vaccines 

David Margolis, MD discusses his team’s work at the UNC HIV Cure Center including vaccines, treatments, 

Pinpointing HIV Cure Therapies

, where we spotlight individual medical institutions and infectious disease programs. Today, we spotlight the University of North Carolina (UNC)’s Institute for Global Health and Infectious Diseases.

The UNC HIV Cure Center was created to support novel and impactful research needed to advance therapies to induce an HIV remission.

 The director of the center is David Margolis, MD, distinguished professor of Medicine, UNC. Margolis and his team have been conducting HIV translational research including investigating basic molecular, virological, and immunological phenomenon, and leveraging insights to develop new interventions in HIV disease.

In addition, Margolis is the principal investigator for CARE (Collaboratory of AIDS Researchers for Eradication), an NIH-funded research organization that seeks to develop the tools to bring an HIV cure from the bench to the clinic. He is the principal investigator of NIH-funded studies combining immunotherapies (antibody-like molecules or antiviral T cell infusions) and small-molecule anti-latency agent (HDAC inhibitor) in FDA-approved investigations to attempt to precisely document the depletion of persistent HIV infection.

“Our group is really more focused on curing infection, which is probably a more difficult goal, but I think probably the right, ultimate goal that we should have,” Margolis said.

“We work in the tiniest recesses of science and biology, trying to understand how the virus works once it hides in a cell, how to get it out of hiding, and how to eradicate all the infected cells." He explains this is for people with HIV that are virally suppressed and taking their medicine every day. The goal is to eradicate those hidden, infected cells and help these individuals stop taking daily treatment. 

One area of his work has been around combination therapy. For example, he and his team looked at the cancer drug, vorinostat, and immunotherapy and how it can coax HIV-infected cells out of latency and attack them.

"The idea is that when HIV infects a person, it enters the cell and becomes like a parasite—a passenger of a few infected cells in the body. Medicines can stop the spread of infection within a person and restore normal immune system function...but that leftover, hidden virus becomes a passenger gene in the infected cell. So we have to treat the cell, sort of like cancer. You're trying to find the cells that are a little abnormal in the sea of all of the other normal cells,” Margolis said.

"We use vorinostat, which is actually a drug developed in cancer for the same reason, it affects cancer cells differently than it does normal cells in a person with cancer. Vorinostat affects HIV infected cells differently than HIV uninfected cells in a person who is HIV positive who's on therapy. Vorinostat induces expression of the virus inside the cell, so the cell now becomes a target for the immune system," Margolis said.

This area of study is in the very early phases of research, and Margolis is looking to either continue his work with vorinostat or utilize other drugs to unveil the HIV virus so it can be seen and cleared. 



In the next episode, leaders from UNC's Special Pathogen Center discuss what it is like to be in the field during an outbreak caring for patients with high-consequence infectious diseases, and offer insights on how well prepared the US is for these situations.


Reference
1.David Margolis, MD. UNC School of Medicine. Accessed September 4, 2025. 
https://www.med.unc.edu/medicine/infdis/people/david-margolis-md/




David Margolis, MD discusses his team’s work at UNC looking at combination treatment that includes the cancer drug, vorinostat, and immunotherapy as a potential HIV cure.

Committed to HIV Cure Therapies Through Novel Research

In the second segment with leaders of UNC Special Pathogen Centers Team, they discuss what it is like to be in the field caring for patients with high-consequence infectious disease outbreaks. And how the US is set up infrastructure-wise to deal with such a potential outbreak.  

Caring for Patients in a High-Consequence Infectious Disease Hot Zones

, spotlighting individual medical institutions and infectious disease (ID) programs. Today, we spotlight the University of North Carolina (UNC)’s Institute for Global Health and Infectious Diseases (IGHID).

Right now, there is an ongoing Ebola outbreak in the Democratic Republic of Congo (DRC). As of September 4, there has been 15 deaths, and 28 suspected cases identified across 2 health zones (Bulape and Mweka) in the Kasai province of the DRC. Four of the cases were among healthcare workers. Laboratory tests have confirmed it is the Zaire strain of Ebola.

 This is considered a hot zone, which is an area that has contagious pathogens creating an outbreak of high-consequence infectious disease (HCID).

“Africa CDC stands firmly with the people of the Democratic Republic of Congo. I have met with the Minister of Health to coordinate an urgent response, and we are taking strong measures to bring this outbreak under control — protecting communities and supporting the health workers on the frontlines,” Jean Kaseya, Africa CDC Director General, said in a statement.

This current outbreak is a reminder that these scenarios can flair up anytime. These types of high-consequence infectious disease outbreaks such as Ebola, Lassa Fever, and Marburg Virus, have occurred outside the US. However, they can potentially happen anywhere.

With that in mind, the US has developed a plan to address such scenarios. Specifically, the US federal government in partnership with state and local areas are building regional biopreparedness strategies. Part of this is to create specialized medical centers across the country to transport and treat patients with HCID.

For example, UNC’s Special Pathogens Response Center (SPARC) is one of 13 facilities that can handle these types of situations. These centers interact and coordinate training with other health care facilities, such as local and regional hospitals, to aid them in dealing with individuals with HCID.

Part of the training is to ensure any necessary quarantining of individuals is done in a way that minimizes the risk to the greater public. To prepare for big public events such as next year's FIFA World Cup being held in the US, national readiness exercises have been conducted this summer for HCID threats.

 and are led by the US Department of Health and Human Services’ Administration for Strategic Preparedness and Response.

UNC conducted its Tranquil Passport exercise earlier this summer. Leading these exercises were William A. Fischer II, MD, director of emerging pathogens at UNC’s Institute for Global Health and Infectious Diseases, and David Wohl, MD, professor of medicine in the Division of Infectious Diseases at UNC. To learn more about this particular exercise, check out our first segment of the interview with Fischer and Wohl listed below.



Biopreparedness Exercises Look to Contain High-Consequence Infectious Disease Outbreaks



Fischer and Wohl have both spent time in hot zones in Africa treating patients with Ebola and Lassa fever. They have set up field treatment units during outbreaks to isolate and care for patients. Their work in Liberia has directly informed emerging pathogen response and preparedness in North Carolina.

When in the field dealing with outbreaks, Fischer says they are not difficult, but there are complicated and require an incredible amount of coordination.

“What's really complicated about these events is the unknowns,” Fischer said. “And a lot of times what's happening is that patients are presenting—many of these diseases, in fact—present with nonspecific symptoms. So, the first big problem is identifying an outbreak occurring and then trying to identify who has that specific infection. Then it's setting up a multidimensional response that is able to ensure the safe delivery of care to people who are infected with that special pathogen, while at the same time maintaining essential health care services. And that's a pretty complicated feat in the field.”

“And it involves a number of different—what we refer to as pillars of response—basically trying to identify who's been infected and who's at risk of becoming infected,” Fischer said.

These pillars of response include:

Diagnostic testing to identify those who become infected

Case Management of patients with these special pathogens

Wohl says there are distinct differences in dealing with an outbreak in a hot zone in Africa compared to western countries. “These are not places that have a lot of health care,” Wohl said. “Diagnostics are not readily available; Just basic treatment could be really stretched, and the expertise isn't often there.”

Although western countries such as the US have better infrastructure in place that doesn’t mean there are not inherent challenges here. Wohl says the West Africa Ebola outbreak of 2014 to 2016 that infected over 28,000 people with the deadly disease informed the US of its shortcomings.

"We could be better prepared,” Wohl said of that outbreak. “Even though we have the diagnostics, the IV fluids, dialysis machines, ventilators and lots of really smart people, that doesn't mean everything's there. So even with that head start, there's a lot of coordination.” 

And another aspect of this that is significant—both here in the US as well as in Africa—is public trust.

“Part of our efforts are trying to build bridges with communities so that there is a trusted source of information about how to stay safe during an outbreak, whether it's in this country or around the world, and how to get information as that outbreak or as that public health threat evolves,” Fischer said.

In the next episode, Michael Herce, MD, MPH, MSCR

 discusses his work around implementation science and building partnerships to create better access to healthcare for marginalized populations.

References
1. New Ebola Outbreak Confirmed in the Democratic Republic of Congo. Africa CDC. September 4, 2025. Accessed September 5, 2025.
https://africacdc.org/news-item/new-ebola-outbreak-confirmed-in-the-democratic-republic-of-congo/
2. Tranquil Passport: testing the nation’s special pathogen readiness ahead of the FIFA World Cup. National Emerging Special Pathogens Training & Education Center. July 2, 2025. Accessed August 26, 2025. https://netec.org/2025/07/02/tranquil-passport-testing-the-nations-special-pathogen-readiness-ahead-of-the-fifa-world-cup/

In the second interview segment with leaders from UNC's Special Pathogen Center, they discuss what it is like to be in the field during an outbreak caring for patients with high-consequence infectious diseases, and offer insights on how well prepared the US is for these situations.  

Konrad Reinhart, MD

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