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Infectious Diseases Clinical Pharmacist at Erlanger.

Can duration of therapy requirements at the time of antibiotic order entry decrease antibiotic use?

Ordering With Foresight 

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 her interview, Temple’s Stephanie Spivack, MD, talks about how she works with different specialties at the hospital to help this marginalized population gets the care they need and the importance of this in the fellowship program there. 

Connecting the Care Dots for People With Substance Use Disorder 

The Kensington neighborhood of Philadelphia, Pennsylvania, is an area near Temple University Hospital and has been ground zero for the opioid crisis. Along Kensington Avenue, the ravages of the drug crisis can be seen firsthand as people with substance use disorder (SUD) can be seen living in tents along the street. And in recent years, the area has been an open-air drug market. The city and local medical institutions have been working to improve the area and help those in need.

Temple University Hospital and its Lewis Katz School of Medicine are on the front lines caring for people with SUD as well as conducting research about this health issue. For example, Temple’s 

 looks to “carry out research to better elucidate the biological basis of addictive diseases and other effects of drugs of abuse that result in altered states of biological function.” There are a number of areas of research that Temple researchers and clinicians are involved with.

Stephanie Spivack, MD, associate program director of the fellowship program and assistant professor of clinical medicine at Lewis Katz School of Medicine at Temple University, was provided with experience for this type of care during her residency, and it is something she is still passionate about today. A lot of her research on this subject is focused on bacterial infections in people with SUD.

With intravenous drug use comes a host of health issues, including skin wounds, bacterial infections, and cardiovascular disease.

With many of these patients needing continuous care and with limited to no resources, Spivack works with different specialties at Temple to try to find creative ways to provide people with care, especially as there may be barriers for them to stay for their full treatment course.

"We try to make sure we have a backup plan in place. So if patients can't get IV [intravenous] antibiotics or the standard of care, we try to come up with an alternative. We coordinate with our community partners like Prevention Point to make sure there's a follow-up plan in place," she said.

"I think my favorite part of it is that I've gotten to work with people from all different departments. We work closely with addiction medicine, cardiology, surgery, [and] nephrology, and I've gotten to make lots of connections trying to improve care for that population.”



In tomorrow’s episode, Raven Boone, DO, will describe her fellowship experience at Temple.

In the second part of her interview, Temple’s Stephanie Spivack, MD, talks about how she works with different specialties at the hospital to help this marginalized population receive the care they need. 

Stephanie Spivack, MD, talks about the diverse educational experiences afforded fellows during their time at Temple, as well as the devoted clinical care looking to serve the local community

A Fellowship Program Offers Varied Learning Opportunities to Connect the Care Needs of the Local Community 

When speaking to faculty at Temple University Hospital and the Lewis Katz School of Medicine, a similar theme arises: They stay on through residency and their fellowships, and if an opportunity arises, they stay on to become faculty. Rafik Samuel, MD, chief of the Section of Infectious Disease at Temple University Hospital, went down this path, as did Stephanie Spivack, MD, assistant professor of clinical medicine and associate director of the fellowship program at Lewis Katz School of Medicine at Temple University.

It is the fellowship program’s commitment to offering diverse education that allows Temple to deliver the comprehensive clinical care needs of its local citizens.

“Everyone here is united by the same mission of taking care of our North Philadelphia population, and I felt connected to that mission. I liked that we all had that in common as a trainee,” Spivack said. “It's a really great place to learn, because we see everything. I knew that I would get really strong clinical training and feel prepared coming out of residency and then fellowship to take care of patients on my own.”

She stressed the importance of the educational program offerings at Temple, which helped give her a different perspective on care for the local urban area that Temple serves. Spivack noted the 

 within Temple’s Lewis Katz School of Medicine and her experience in the program. The ethics program is designed explicitly with a health equity lens.

“Students who take those courses will get a foundation in bioethics and learn how to apply that to look at ethical issues in our community,” Spivack said. “I did that program when I was a resident here, and I felt like it really gave me a chance to look at things from a different perspective and see the bigger picture of our patient care, and I still carry some of those lessons with me today.” 

In thinking about the diversity of educational experiences, Temple holds a weekly travel clinic for patients who are preparing for trips.

“We do our pretravel immunizations, prophylaxis, and we also do a lot of counseling on how to stay safe and healthy while they're abroad,” Spivack said. “It's a really fun clinic because we get to do preventive care, and we also just get to hear about all these great trips our patients are going on. Fellows are with us in that clinic, and they'll get to experience that and learn how to do it—if that's something that they want to do in their career.”



Look for the next episode on Monday where Spivack talks about Temple’s harm reduction program.

Stephanie Spivack, MD, talks about the diverse educational experiences afforded to fellows during their time at Temple University as well as the devoted clinical care that serves the local community. 

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 and was an adult with 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 


The FDA announced on Monday that Rizo-López Foods (RLF) voluntarily recalled some of its specific dairy products because they have the potential to be contaminated with 

According to the federal agency’s statement, and based on information shared with the Centers for Disease Control and Prevention (CDC) and FDA, Rizo-López Foods may be a potential source of illness in an ongoing nationwide 

The outbreak has resulted in 2 deaths, 26 illnesses, and 23 hospitalizations across 11 states.

The products being recalled include cheese, yogurt, and sour cream and sold under the brand names Tio Francisco, Don Francisco, Rizo Bros, Rio Grande, Food City, El Huache, La Ordena, San Carlos, Campesino, Santa Maria, Dos Ranchitos, Casa Cardenas, and 365 Whole Foods Market.

To get a full listing of the products and brand names, consumers can go 

The recalled products were distributed nationwide by RLF and through distributors. Additionally, the products were sold at retail deli counters including, but not limited to, El Super, Cardenas Market, Northgate Gonzalez, Superior Groceries, El Rancho, Vallarta, Food City, La Michoacana, and Numero Uno Markets.

 in healthy people may have short-term symptoms such as a fever, headache, stiffness, and gastrointestinal discomfort, including diarrhea. However, in children, seniors, and people with weakened immune systems, this foodborne infection can be more severe and could be fatal in some cases. The infection can also cause miscarriages and stillbirths in pregnant women.

For anyone who is suffering these symptoms after eating these products, they are recommended to contact a health care provider right away.

Individuals who purchased these affected products are recommended to dispose them. And for people who have questions, they may contact the company at 1-833-296-2233, which will be monitored 24 hours a day.

According to the CDC, the investigation is ongoing and says it can take up to 3 to 4 weeks to determine if individuals are part of the outbreak, so this could mean there might be more cases reported in the coming days and weeks. 


1. Rizo-López Foods, Inc. Voluntarily Recalls Dairy Products Because of Possible Health Risk. FDA press statement. February 6, 2024. Accessed February 7, 2024.


https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/rizo-lopez-foods-inc-voluntarily-recalls-dairy-products-because-possible-health-risk

2.Listeria Outbreak Linked to Queso Fresco and Cotija Cheese. CDC. February 6, 2024. Accessed February 7, 2024.


https://www.cdc.gov/listeria/outbreaks/cheese-02-24/index.html

The outbreak has seen 2 deaths and 23 hospitalizations across 11 states. 

Mitchell Thelen, PharmD, BCIDP

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