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Lyme Disease Association President, Pat Smith, takes on the major problems surrounding Lyme disease today.

Is the Medical Community Behind the Times When It Comes to Treating Lyme?

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

An overwhelming majority of newly diagnosed HIV patients who accepted Same-Day ART initiation (SDART) also accepted follow-up telehealth appointments.

Of the 69 patients (93.2%) who accepted SDART, 68 of them agreed to a telehealth session.

International AIDS Society (IAS) AIDS 2020 Virtual Sessions.

This study was performed at the Thai Red Cross Anonymous Clinic in Bangkok, Thailand. Telehealth was added to the clinic to continue taking care of patients while keeping social distancing measures in place during coronavirus (COVID-19). In addition, the subsequent lockdown and local travel restrictions greatly affected access to facilities.

For patients who agree to SDART, they were assessed and if deemed eligible received a 4-week ART supply. Their follow-up telehealth was scheduled for 2 weeks afterwards.

Patients who tolerated ART were referred to long-term ART facilities, and another 6-week ART supply was mailed to ensure ART continuation during the transition.

Of the 47 patients who reached the 2-week follow-up, 37 used telehealth. Among the 10 patients who did an in-clinic follow-up visit, 2 had rashes, 3 needed syphilis injectable treatment, and 5 wanted face-to-face consultations. All patients remained on ART.

Rashes were identified in 4 clients, and 2 were managed through telemedicine. Overall, follow-up visits were successfully conducted in 100% of 47 clients, compared to 97.2% of 105 clients from the same period last year

“Telehealth is a safe and promising differentiated ART service delivery method, even for clients who just started on ART,” the investigators wrote. “Equity, economic, and sustainability aspects of SDART telehealth should be explored beyond its application during the COVID-19 pandemic.”

A small study shows a majority of HIV patients open to both starting ART and follow-up telehealth appointments.

Conferences

Telehealth Seen as Viable Option for Same-Day ART Patients

Although many clinicians may still be processing the collective trauma of COVID-19 , it has been nearly five years since the start of the pandemic.

 According to the World Health Organization (WHO), there have been approximately 777 million cumulative cases of COVID-19 with over 7 million deaths attributed to the disease.

The large spikes of COVID-19 cases seen in the winters of 2021 and 2022 decreased in intensity by winter 2023. Indeed, this year's recent cases reported by the WHO demonstrate an overall trending decline. Obtaining exact numbers of severe and critically ill COVID-19 cases in the United States remains difficult but data from the Centers for Disease Control and Prevention (CDC) demonstrates a decreased weekly death rate attributed to COVID-19.

Yet despite improving numbers, for many clinicians the memory of critically ill COVID-19 patients has yet to wane. 

The news of decreasing vaccination rates (CDC reports that 21.0% of adults > 18 have received 2024-2025 updated vaccine) and the constant possibility of a clinically impactful viral mutation linger as veiled threats for the intensivist. The purpose of the following is to provide a brief review of updates in epidemiology, classification of variants, diagnostic considerations, management, and long term effects of those with critical illness due to COVID-19.

Since the initial onset of the 2019 novel coronavirus, numerous variants have been identified. In an attempt to classify clinically significant variants, the WHO developed updated definitions for variant subclasses in 2023. These subclasses include the terms 

Variant Under Monitoring (VUM), Variant of Interest (VOI), and Variant of Concern (VOC).

 VUM and VOI are categorized by scientific nomenclature systems (eg JN118) with VOIs representing variants with genetic changes that affect viral characteristics (eg transmissibility, virulence) and have growth advantages over other variants. 

In addition to meeting the definition of VOI, VOC must be associated with either a detrimental change in clinical disease severity, a change in COVID-19 epidemiology causing substantial impact on health systems, or a significant decrease in the effectiveness of available vaccines. Additionally, VOCs are the only variant identified with Greek letters. To date there have been a total of 5 VOCs: Alpha, Beta, Gamma, Delta, and Omicron. As of December 2, 2024 no VOCs are listed on the WHO website although there is one VOI (JN1) and several VUMs.

Microbiologic work up of COVID-19 should include at a minimum the collection of respiratory specimens for nucleic amplification testing (NAAT). The WHO recommends consideration of fecal specimens and postmortem samples in the deceased. Antibody testing is not recommended in acute illness but testing for other potential etiologies based on local epidemiology such as influenza is encouraged. For severe or critical illness, blood cultures should also be obtained prior to initiation of antimicrobial therapy if able.

The definition of severe COVID-19 differs slightly between guidelines but generally requires hypoxemia at room air (≤90% per WHO,

), tachypnea (respiratory rate > 30), and signs of pneumonia including cough and lung infiltrates on chest imaging. Criteria for critically ill patients is less nuanced and includes those with associated acute organ dysfunction, shock, or need for respiratory support with either non-invasive or invasive ventilation. One of the hallmarks of patients with critical illness from COVID-19 is acute respiratory distress syndrome (ARDS). 

Current guidelines focus on previously established protocols for ARDS with use of high-flow nasal cannula, a trial of non-invasive ventilation, judicious use of intravenous fluids, support for low tidal volume ventilation once mechanical ventilation is required, and prone positioning for intubated patients with a PaO2/FiO2 ratio of < 150.

The WHO currently conditionally recommends awake prone positioning not requiring mechanical ventilation although high quality evidence supporting its use is limited. A trial of higher positive end expiratory pressure (PEEP) is suggested with a focus on patient individualization and monitoring of driving pressures. Routine use of continuous infusions of neuromuscular blocking agents is no longer recommended,

 however can be considered in certain patients such as those with ventilator dyssynchrony. ECMO referral is recommended for capable centers in patients who have refractory hypoxemia (PaO2:FiO2 < 80 mmHg for > 6 hours) despite optimization of a lung protective strategy.

Decreasing rates of COVID-19 and the available pharmaceutical armamentarium against COVID-19 led to the dissolution of the NIH Treatments Guideline Panel in August of 2024. Nevertheless the panel’s work provided a robust foundation for other society guidelines. The Infectious Disease Society of America (IDSA), American College of Physicians (ACP) and WHO provide the basis of high quality clinical recommendations for COVID-19 in 2024.

 The following summarizes currently widely accepted therapeutic options for hospitalized patients with COVID-19. Remdesivir remains recommended as first-line antiviral therapy for hospitalized patients requiring oxygen therapy after demonstrating decreased time to recovery for this population  but is not recommended for patients requiring mechanical ventilation.

 Other recommended antiviral therapies generally focus on management of nonhospitalized individuals and include nirmatrelvir and ritonavir. Immunomodulation therapy consists of steroids which demonstrated decreased mortality in hospitalized patients requiring oxygen who received dexamethasone in the pivotal RECOVERY trial.

 Non steroidal immunomodulatory options include interleukin-6 (IL-6) inhibitors (tocilizumab, sarilumab) and a Janus kinase (JAK) inhibitors (baricitinib, tofacitinib) which have been shown to decrease mortality in critically ill patients requiring oxygen and receiving dexamethasone.

 Although these medications were recommended by the prior NIH guidelines and current WHO guidelines as add-on therapy to dexamethasone for patients on high flow nasal cannula, non invasive ventilation, mechanical ventilation, extracorporeal membrane oxygenation or those with rapidly escalating oxygen requirements and signs of systemic inflammation the IDSA does not advocate for their use in mechanically ventilated patients. 

Additionally, the IDSA gives a conditional recommendation against the use of anakinra, a recombinant IL-1 inhibitor, in the management of severe COVID-19. Antibody therapy via either neutralized antibodies or convalescent plasma is not routinely recommended in severe COVID-19. The former has fallen out of favor due to Omicron sub-variants that developed less 

 susceptibility to multiple neutralizing antibodies. Convalescent plasma on the other hand has no role in hospitalized patients with COVID-19 but is recommended by the IDSA for ambulatory patients with mild to moderate disease with high risk of progression who have no alternative treatment options. There is an additional smattering of other medications (ivermectin, inhaled corticosteroids, famotidine, colchicine) that the IDSA has recommended against in the treatment of COVID-19 infection.

References
1. Makari GJ, Friedman RA. Collective Trauma and Commemoration - A Moment of Silence, Please. 

. 2024;391(6):487-489. doi:10.1056/NEJMp2405167
2.WHO COVID-19 dashboard. WHO. Accessed June 12, 2025.
https://data.who.int/dashboards/covid19/deaths
3. COVID Data Tracker. CDC. Accessed June 12, 2025. 
https://covid.cdc.gov/covid-data-tracker/#datatracker-home
4. Clinical management of COVID-19. WHO. January 13, 2023. Accessed June 12, 2025.
5.Gulick RM, Pau AK, Daar E, et al. National Institutes of Health COVID-19 Treatment Guidelines Panel: Perspectives and Lessons Learned. 

. 2024;177(11):1547-1557. doi:10.7326/ANNALS-24-00464
6.Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. 

. 2013;368(23):2159-2168. doi:10.1056/NEJMoa1214103
7.Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. 

. 2010;363(12):1107-1116. doi:10.1056/NEJMoa1005372
8.Bhimraj A, Morgan RL, Shumaker AH, et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients With COVID-19 (September 2022). 

. 2024;78(7):e250-e349. doi:10.1093/cid/ciac724
9.Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Final Report. 

. 2020;383(19):1813-1826. doi:10.1056/NEJMoa2007764
10. WHO Solidarity Trial Consortium. Remdesivir and three other drugs for hospitalised patients with COVID-19: final results of the WHO Solidarity randomised trial and updated meta-analyses [published correction appears in Lancet. 2022 Oct 29;400(10362):1512. doi: 10.1016/S0140-6736(22)01993-6] [published correction appears in Lancet. 2024 Jan 13;403(10422):146. doi: 10.1016/S0140-6736(24)00005-9]. 

. 2022;399(10339):1941-1953. doi:10.1016/S0140-6736(22)00519-0
11.Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with Covid-19. 

. 2021;384(8):693-704. doi:10.1056/NEJMoa2021436
12.Gordon AC, Mouncey PR, et al. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19. 

. 2021;384(16):1491-1502. doi:10.1056/NEJMoa2100433
13.Marconi VC, Ramanan AV, de Bono S, et al. Efficacy and safety of baricitinib for the treatment of hospitalised adults with COVID-19 (COV-BARRIER): a randomised, double-blind, parallel-group, placebo-controlled phase 3 trial [published correction appears in Lancet Respir Med. 2021 Oct;9(10):e102. doi: 10.1016/S2213-2600(21)00410-0]. 

. 2021;9(12):1407-1418. doi:10.1016/S2213-2600(21)00331-3

Although COVID-19 has receded quite a bit from the minds of many, it still remains a virus that can present serious morbidity and mortality. Here is a review of clinical treatment strategies by an intensivist when seeing patients with severe COVID-19. 

The Lingering Threat: Managing Severe COVID-19 in the Postpandemic Era

U.S. FDA Approves Merck’s ENFLONSIA™ (clesrovimab-cfor) for Prevention of Respiratory Syncytial Virus (RSV) Lower Respiratory Tract Disease in Infants Born During or Entering Their First RSV Season

The US Food and Drug Administration (FDA) has approved Merck’s clesrovimab (MK-1654), a long-acting monoclonal antibody designed to provide passive immunization against respiratory syncytial virus (RSV) for infants during their first RSV season. This single-dose, weight-independent treatment demonstrated strong efficacy in pivotal Phase 2b/3 trials,reducing medically attended RSV lower respiratory infections by 60.5% and RSV-related hospitalizations by 84.3% compared to placebo. Merck plans to make clesrovimab available for the 2025-26 RSV season, expanding preventative options beyond currently approved therapies.

“We’re very proud that the FDA has approved clesrovimab, which is now called enflonsia, for the prevention of RSV for newborns entering their first RSV season,” said Macaya Douoguih, MD, MPH, therapeutic area head for global vaccine clinical development at Merck. “We do plan to make enflonsia available for ordering in July with shipments that will be delivered before the start of the upcoming season later this fall.”

RSV remains a leading cause of hospitalization and death in infants worldwide, highlighting the critical need for effective prevention. Enflonsia’s approval positions Merck alongside Sanofi and AstraZeneca’s Beyfortus, the first FDA-approved long-acting RSV antibody, which has shown 90% effectiveness against RSV hospitalizations.

“Monoclonal antibodies have a very important role to play in terms of addressing the significant burden of RSV, which still remains the leading cause of hospitalization in infants in the US today,” Douoguih added. “It also affirms that demonstrating safety and efficacy through rigorous randomized placebo or active control trials is essential for approval.”

FDA Accepts Merck’s Biologics License Application for Infant RSV Protection

On December 17, 2024, the FDA accepted Merck’s Biologics License Application (BLA) for enflonsia (MK-1654), a long-acting monoclonal antibody designed to protect infants from RSV during their first RSV season.

“What our data show is that we see increasing efficacy with increasing disease severity—and that’s a very important finding,” Douoguih noted. “Our monoclonal combines the convenience of dosing with the strong clinical data showing significant reductions in RSV disease and hospitalizations. It’s really a new, promising preventive option for our large US population.”

The BLA was supported by data from the Phase 2b/3 CLEVER trial, a randomized placebo-controlled study evaluating a single dose of enflonsia in healthy preterm and full-term infants (birth to 1 year). The trial demonstrated a 60.5% reduction in medically attended RSV lower respiratory infections (MALRI) and an 84.3% reduction in RSV-related hospitalizations through Day 150, regardless of infant weight. Interim data from the ongoing Phase 3 SMART trial, comparing enflonsia to palivizumab in infants at increased risk for severe RSV disease, further support the safety and efficacy of enflonsia.

“The approval was based on results from our Phase 2b/3 trial called CLEVER, which evaluated a single dose of enflonsia administered to preterm and full-term infants from birth up to age one, and the trial met its key primary and secondary endpoints,” said Douoguih. “We showed an efficacy of 60.5%, and importantly, we also demonstrated protection against hospitalization—84.3%. Hospitalization is one of the most important outcomes that worry not only clinicians but also the parents.”

“Our approval is also supported by the results from another trial that we did, a Phase 3 trial called SMART, where we evaluated the safety and effectiveness of enflonsia versus palivizumab,” Douoguih explained. “Those two trials were pivotal in supporting the approval.”

Merck’s Long-Acting RSV Antibody Shows High Efficacy in Infant Prevention Studies

, infectious disease physician and product development lead at Merck, presented results from the Phase 2b/3 CLEVER trial, which enrolled 3,614 healthy preterm and full-term infants. The double-blind, placebo-controlled study showed enflonsia reduced medically attended lower respiratory infections by 60.5%, RSV-related hospitalizations by 84.3%, and hospitalizations due to RSV-associated lower respiratory infections by 90.9% over 150 days. Additionally, severe cases of MALRI declined by 91.7%. Safety data indicated a comparable profile to placebo, with no treatment-related deaths.

Interim findings from the ongoing Phase 3 SMART trial, which compares enflonsia with the current standard of care, palivizumab, in high-risk infants, including those with chronic lung or congenital heart disease, showed comparable safety and efficacy, supporting clesrovimab’s use across both healthy and high-risk infant populations.

1. US FDA Approves Merck’s ENFLONSIA™ (clesrovimab-cfor) for Prevention of Respiratory Syncytial Virus (RSV) Lower Respiratory Tract Disease in Infants Born During or Entering Their First RSV Season. Merck. Press release. June 9, 2025. Accessed June 9, 2025. https://www.merck.com/news/u-s-fda-approves-mercks-enflonsia-clesrovimab-cfor-for-prevention-of-respiratory-syncytial-virus-rsv-lower-respiratory-tract-disease-in-infants-born-during-or-entering-their-fir/

2. Merck Announces FDA Acceptance of Biologics License Application for Clesrovimab, an Investigational Long-Acting Monoclonal Antibody Designed to Protect Infants from RSV Disease During their First RSV Season. Merck press release. December 17, 2024. Accessed June 9, 2025. 

https://www.merck.com/news/merck-announces-fda-acceptance-of-biologics-license-application-for-clesrovimab-an-investigational-long-acting-monoclonal-antibody-designed-to-protect-infants-from-rsv-disease-during-their-first-rsv/

3. Merck’s Clesrovimab (MK-1654), an Investigational Respiratory Syncytial Virus (RSV) Preventative Monoclonal Antibody, Significantly Reduced Incidence of RSV Disease and Hospitalization in Healthy Preterm and Full-term Infants. Merck. October 17, 2024. Accessed June 9, 2025. 

https://www.businesswire.com/news/home/20241017875997/en

4. A Phase 2b/3 Study to Evaluate the Efficacy and Safety of an Investigational Respiratory Syncytial Virus (RSV) Antibody, Clesrovimab, in Healthy Preterm and Full-Term Infants. Presentation #166 presented at IDWeek 2024. October 16-19, 2024. Los Angeles, CA.

5. Phase 3, Randomized, Controlled Trial Evaluating Safety, Efficacy, and Pharmacokinetics (PK) of Clesrovimab in Infants and Children at Increased Risk for Severe Respiratory Syncytial Virus (RSV) Disease. Presentation #167 presented at IDWeek 2024. October 16-19, 2024. Los Angeles, CA.

Enflonsia, a single-dose, long-acting antibody, has been FDA approved to significantly reduce RSV infections and hospitalizations in infants, providing new hope for protecting vulnerable babies during RSV season.


Merck’s Clesrovimab (Enflonsia) Receives FDA Approval to Protect Infants From RSV During First Season

Health and Human Services (HHS) Secretary Robert F Kennedy Jr has appointed eight new members to the CDC’s Advisory Committee on Immunization Practices (ACIP), just two days after removing all 17 previous members. The newly named appointees have drawn scrutiny for affiliations with vaccine-skeptical movements and controversial views on public health.¹

Kennedy announced the appointments via a social media post on X.¹

Among the appointees, Malone has promoted unproven COVID-19 treatments such as hydroxychloroquine and ivermectin and has questioned the safety of COVID-19 vaccines. He has also claimed—contrary to expert consensus and peer-reviewed literature—that he played a central role in inventing mRNA vaccine technology.¹

Another appointee, Pebsworth, has served on the board of the National Vaccine Information Center (NVIC), a group widely criticized for spreading vaccine misinformation. A 2021 study by the University of Connecticut found that groups like NVIC often use emotional rhetoric to foster distrust in vaccines.¹

Kulldorff and Meissner were signatories to the 2020 Great Barrington Declaration, which opposed pandemic mitigation strategies such as masking and lockdowns. The declaration advocated for herd immunity through natural infection, a view widely rejected by public health agencies during the COVID-19 pandemic.¹

The American Medical Association (AMA) has adopted an emergency resolution urging a Senate investigation into HHS Secretary (RFK) Jr’s decision to dismiss all 17 members of the CDC’s Advisory Committee on Immunization Practices (ACIP). The action occurred less than 24 hours after Kennedy announced the removals.

The resolution, passed during the AMA’s annual meeting, calls on the Senate Health, Education, Labor, and Pensions (HELP) Committee to probe the firings. It also urges Secretary Kennedy to reverse the decision and reaffirms AMA support for evidence-based, independent vaccine advisory bodies.

Despite debate over the potential political consequences, the resolution passed by voice vote. Delegates from major physician groups, including the American College of Physicians, American Academy of Pediatrics, and others, co-authored the measure. Jason Goldman, MD, the ACP’s liaison to ACIP, introduced the resolution, citing assurances from HELP Chair Sen. Bill Cassidy, MD (R-La), that ACIP would remain intact.

The dismissals followed a June 9 HHS announcement confirming a full reconstitution of ACIP. RFK defended the move as necessary to rebuild public trust and reduce perceived conflicts of interest. He emphasized that the prior committee’s composition, with 13 members appointed in 2024, could have locked in previous policies until 2028.

ACIP, which advises the CDC on vaccine policy, has been a key source of independent, evidence-based recommendations. RFK has criticized its past operation and announced that new members will be installed ahead of the upcoming meeting scheduled for June 25–27, 2025.

Public health leaders, including AMA President Bruce A Scott, MD, and APHA Executive Director Georges Benjamin, MD, voiced concern about the move’s impact on trust and vaccine policy. The CDC has since removed the public listing of the ACIP members from its website.

References
1. Eaton ES. RFK Jr.'s new ACIP appointees include several with ties to vaccine misinformation. June 12, 2025. Accessed June 12, 2025. 

https://firstwordpharma.com/story/5972247

2. U.S. Department of Health and Human Services. HHS Takes Bold Step to Restore Public Trust in Vaccines by Reconstituting ACIP. Press release. June 9, 2025. Accessed June 12, 2025. https://www.hhs.gov/press-room/hhs-restore-public-trust-vaccines-acip.html

3. Ungar L, Seitz A. RFK Jr. ousts entire CDC vaccine advisory committee. Associated Press. Published June 9, 2025. Accessed June 12, 2025. https://apnews.com/article/kennedy-cdc-acip-vaccines-3790c89f45b6314c5c7b686db0e3a8f9

The replacement of all 17 ACIP members sparks concern among medical experts and prompts calls for Senate investigation.

HHS Secretary RFK Jr Replaces CDC Vaccine Advisory Panel With New Appointees

At MADID 2025, William R. Mikesell presented data Showing 20% vs. 16% treatment failure rates in doxycycline and minocycline groups.

A multi-hospital retrospective cohort study conducted across Indiana University Health (IU Health) hospitals has found no significant differences in treatment outcomes between doxycycline and minocycline for managing bone and joint infections. The study, presented at MADID 2025, by William R. Mikesell, PharmD, PGY2 infectious diseases pharmacy resident at Indiana University Health, builds on the foundation laid by the OVIVA trial, which established oral antibiotics as a noninferior alternative to intravenous therapy for these infections.

The study included adult patients treated between January 1, 2016, and August 1, 2024, who received either doxycycline (n=41) or minocycline (n=38) for a minimum of two weeks of a planned six-week antibiotic course. Patients receiving additional antibiotics for unrelated infections, as well as pregnant or incarcerated patients, were excluded.

The primary endpoint was treatment failure, defined as any of the following: emergency department visit or hospital readmission for bone or joint infection, antibiotic change due to resistance, presence of a draining sinus tract or frank purulence near the bone or prosthesis, positive repeat tissue culture, or biopsy evidence of infection. Secondary outcomes included adverse effects, need for extended therapy, and early discontinuation of treatment.

Treatment failure occurred in 20% of doxycycline-treated patients and 16% of those treated with minocycline, a difference that was not statistically significant. The most common infection sites included the foot, followed by the leg, knee, hand, arm, hip, and pelvis. Staphylococcus aureus—both methicillin-resistant (MRSA) and methicillin-susceptible strains—and coagulase-negative Staphylococcus species were the predominant pathogens. Secondary outcomes such as adverse event rates, additional antibiotic duration, and early therapy discontinuation were also similar across both groups.

William R. Mikesell explained the motivation behind the study, stating, “The study originally came up because our providers at University Hospital—which treats more immunocompromised patients—prefer to use minocycline for their bone and joint infections. This is in contrast to Methodist Hospital, where they preferred doxycycline.” He added, “Some of the providers at University wanted us to look into this because they believe minocycline is a better treatment option over doxycycline. There’s research out there suggesting that doxycycline induces its own resistance in MRSA isolates—specifically if they have the TetM ribosomal protection proteins. So, they elected to use minocycline over doxycycline.”

At MAD-ID 2025, William R Mikesell, PharmD, presented data showing 20% vs 16% treatment failure rates in doxycycline and minocycline groups.

Pat Smith

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