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Zandraetta Tims-Cook, MD, MPH, highlights the need for inclusive HIV prevention strategies and discusses the potential of long-acting injectable PrEP in improving care and reducing disparities.

Expanding HIV Prevention: Overcoming Barriers and Embracing Long-Acting PrEP

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 expert discusses how COVID-19 has disrupted traditional respiratory virus patterns with summer surges now preceding the typical winter flu season, while declining vaccine uptake among younger populations threatens to leave vulnerable groups increasingly exposed to seasonal illness complications.

Contributing Factors to Respiratory Illness

As the US moves into the fall, concerns about seasonal respiratory viruses and COVID-19 are resurfacing. Traditionally, respiratory virus season intensifies during the winter, but COVID-19 has disrupted these predictable patterns. Recent years have shown recurring COVID-19 surges, often peaking in August and again in January. This year followed a similar trend, with a late-summer peak in August that is now declining. Experts suggest increased summer travel and school breaks may contribute to these seasonal blips. Current COVID-19 indicators—including emergency department visits, test positivity rates, and deaths—are trending downward. Meanwhile, influenza has not yet emerged significantly, though early signals have appeared in parts of the Midwest and Southeast. Historically, influenza activity accelerates around the holiday season, especially after Thanksgiving, when travel and gatherings increase.

The conversation also highlighted concerns about vaccine uptake. Although vaccination remains strongly recommended for older adults and vulnerable populations, enthusiasm appears to be waning among younger, healthier groups. This trend could indirectly endanger high-risk individuals, since community-level immunity plays a key role in protecting them. Studies have shown, for example, that vaccinating nursing home staff often provides more protection to residents than vaccinating residents themselves.

Looking ahead, experts warn that reduced vaccine coverage—particularly for COVID-19 and influenza—may increase pneumonia incidence and other complications among the vulnerable. While it is difficult to predict the exact trajectory of this respiratory season, the combination of evolving COVID-19 strains, shifting vaccine policies, and anticipated winter gatherings could heighten risks in the months ahead.

AAn expert discusses how COVID-19 has disrupted traditional respiratory virus patterns with summer surges now preceding the typical winter influenza season, while declining vaccine uptake among younger populations threatens to leave vulnerable groups increasingly exposed to seasonal illness complications.

Jennifer Le, PharmD, MAS, FIDSA, FCCP, FCSHP, continues the conversation on vancomycin dosing in this population as well as her work with meropenem in severely ill children. 

Utilizing Pharmacokinetic Modeling for Meropenem in Children With Sepsis

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

Jennifer Le, PharmD, MAS, FIDSA, FCCP, FCSHP, worked with a team of investigators, including 

, who studied population-based pharmacokinetic modeling for meropenem in children with sepsis with varying renal function.

Their work was published earlier this year in the journal 

“We prospectively evaluated meropenem clearance (CLMERO) and volume of distribution (V1-MERO), innovatively assessing renal biomarkers (serum creatinine [SCr], serum cystatin C [SCys], and neutrophil gelatinase-associated lipocalin [SNgal]), in infants aged ≥ 4 weeks and children on intravenous (IV) meropenem 20 mg/kg every 8 h from 2019 to 2023. Cases with sepsis were matched to controls without sepsis,” Le et al wrote.

Their analysis included 27 participants with 19 cases and 8 controls. Although this was a small trial, Le explained this was an inherently difficult group to study.

“It was one of the hardest models, because the patients we selected were on the extreme spectrum of renal function,” Le said to 

. “I had so much instability with the model that we created, and so we had to add more patient data to make something knowledgeable that we could export to and let others know.”

In terms of results, clearance and volume of distribution were significantly lower in children with sepsis compared with nonseptic controls. “Meropenem clearance, V1-MERO, and eGFR-MS [estimated glomerular filtration rate mass spectrometry] were significantly decreased in cases versus controls, with higher variability of eGFR-MS in cases…. Wide variation in meropenem concentrations in children with sepsis as compared to those without sepsis prompts close monitoring of GFR and drug concentrations in this population,” the authors wrote.

“If kidney function changes each day, the dose should be changing too, right? To accommodate that, it needs the kidney to clear the drug. So we conducted a prospective study getting samples, getting kids who were already on meropenem for a clinical indication, and we were able to see huge variation in meropenem clearance between kids who are septic vs not. And it's not only different between children; it's different within that same child,” Le said.

In terms of their study’s approach, she found pharmacokinetic modeling advantageous to create some clinical takeaways, including the following:



 Standard dosing (20 mg/kg every 8 hours) may not reliably achieve therapeutic exposure in this population.

 Close monitoring of kidney function and possibly drug levels (therapeutic drug monitoring) is needed, especially during the dynamic early phase of septic shock.

 Biomarkers beyond creatinine (such as cystatin C, NGAL) could improve dosing precision.

“That's the beauty of population-based pharmacokinetic modeling: You can actually get an estimation of that variation within that patient, whereas a lot of other types of pharmacokinetic analysis don't do that, so we're able to see the trends.”



In the next episode, UC San Diego's Nimish Patel, PharmD, offers his insights on his approach to prescribing HIV preexposure prophylaxis and clinical management of this form of prophylaxis.



Reference
1. Le J, Huynh J, Vo B, et al. Variability in meropenem distribution and clearance in children with sepsis: population-based pharmacokinetics with assessment of renal biomarkers. 

. 2025;64(5):769-777. doi:10.1007/s40262-025-01495-3




Jennifer Le, PharmD, MAS, FIDSA, FCCP, FCSHP, discusses her collaboration on this innovative work with this therapy in severely ill children. 

Jennifer Le, PharmD, MAS, FIDSA, FCCP, FCSHP, talks about her work on the 2020 Vancomycin Guidelines for children as well as her efforts to implement Bayesian therapeutic drug monitoring for children in Vietnam.

Bayesian Precision in Children: Getting Vancomycin Dosing Correct in This Population

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

Jennifer Le, PharmD, MAS, FIDSA, FCCP, FCSHP, professor of clinical pharmacy at Skaggs School of Pharmacy and Pharmaceutical Sciences at UC San Diego, points out that when the first vancomycin guideline was published in 2009, it left out the pediatric population. All the data they had was in adults with trough concentrations. This guideline led many pediatric hospitals throughout the US to start adopting this because it was the only guideline that was published and there were no data available in the pediatric population. Consequently, some hospitalized children taking vancomycin saw an increase in acute kidney injury. 

Le notes that most cases were transient, but she wanted to shift from trough monitoring to area under the curve (AUC) Bayesian monitoring to reduce these serious adverse effects. When she joined UC San Diego, she received a National Institutes of Health grant to support her hypothesis, and she went to work studying the ongoing issue.

“One of the first studies that I published, it was the largest study of its kind—over 700 children, over 1000 drug concentrations—that we had on vancomycin. This was published in 2013 and showed that we need to move away from trough monitoring to AUC Bayesian monitoring, and this will be more precise in kids,” Le said. “And in fact, if we use this, we don't need to increase the dose in most of our patients and [can] actually prevent acute kidney injury in approximately 1 out of every 4 children.”

Her work with pediatric patients has taken her overseas to different countries, including Vietnam. She talks about the challenges of limited resources associated with low- and middle-income countries.

“In countries where they're resource limited…the eagerness is there, the passion is there, the knowledge is there…but as a resource-limited country, the biggest challenge is affordability,” Le said.

As an example, she points to using Bayesian estimation, which requires a tool.

“It's integrating AI [artificial intelligence] machine learning in a sense. It goes through this algorithm to figure out what the best dose is for kids. And without that tool, you can't really conduct Bayesian estimation or drug monitoring,” Le said. “So the biggest challenge is that most of these products are usually $10,000 per year, per institution, which is not affordable in these countries.”

She collaborated with professor Hai Le Ba at Hanoi University of Pharmacy in Vietnam to create a Bayesian tool for vancomycin that is now available for free and accessible in Vietnam. Her hope is to repeat this in other countries.

In the next episode, Le discusses her approach to dosing for meropenem in children with sepsis.

Jennifer Le, PharmD, MAS, FIDSA, FCCP, FCSHP, talks about her work on the 2020 vancomycin guidelines for children as well as her efforts to implement Bayesian therapeutic drug monitoring for children in Vietnam.

Jacinda Abdul-Mutakabbir, PharmD, MPH, describes the curriculum with students, their involvement in community-based care and the support students receive at UC San Diego.  

Student Support, Academic Rigor, and  Extensive Real-World Clinical Experience 



Jacinda Abdul-Mutakabbir, PharmD, MPH, assistant professor of clinical pharmacy and antimicrobial resistance researcher at UC San Diego, has been studying the intersection of racism, antimicrobial resistance, and vaccine equity. She teaches a course on this emerging topic at the university, and her focus has been on creating community-based clinics within vulnerable areas of San Diego. In the past year, they have created 4 clinics, which build upon the clinics she developed in San Bernardino County, where she previously taught. In recent years, she has published papers on this subject, and her students at UC San Diego participate in care at these clinics.

“They provide screenings for preventable illnesses, because, like I talked about, prevention is the primary point and we know that there's a gap when it comes to screenings, especially for areas that are more deprived,” Abdul-Muttakabbir said. “So we are working to bridge the noncommunicable diseases gap and to help individuals identify those elements, but more importantly, providing them education.”

Although she is now in the middle-level part of her career, Abdul-Mutakabbir talks about being a young academic who was recruited for UC San Diego and the support of her chair. 

“I joined there as a junior professional. I remember even when it came time for my recruitment, when I was brought over to UCSD [UC San Diego] or encouraged to apply, my current chair, Dr Linda Awdishu, she connected with me, and we really built a friendship. And it was from that friendship that she said, 'You know, I want to be able to support you.' UCSD can really provide you the support that you need to succeed.”

This positive effect on the staff translates to its students.

“We welcome the students as colleagues very early on in their careers, and we support them…. It's just such a great place to learn, such a great place to grow, and beautiful location,” she said.



This is the last in the UC San Diego series. To view other interviews from the series, go

Jacinda Abdul-Mutakabbir, PharmD, MPH, describes the university's atmosphere, students' involvement in community-based care, and the support they receive.  

UC San Diego: Student Support, Academic Rigor, and Extensive Real-World Clinical Experience 

Michael E. Herce, MD, MPH, MSCR, discusses this concept and how it works to improve access to healthcare for populations who have been disproportionately burdened by various infectious diseases such as HIV, tuberculosis, and COVID-19.

Implementation Science and Gaining Access to Healthcare for Infectious Disease 

, 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.



Implementation science is “the scientific study of methods to promote the systematic uptake of research findings and other [evidence-based practices] (EBPs) into routine practice, and, hence, to improve the quality and effectiveness of health services.”

“Implementation scientists are really concerned with the what, why and how interventions work, in the real world, and then testing strategies to make them better,” said Michael Herce, MD, MPH, MSCR, associate director of International Operations for the Institute for Global Health and Infectious Diseases, UNC.

For Herce, much of his work has been focused on serving underserved and historically marginalized populations, including incarcerated and justice-involved people in Malawi, Zambia, and North Carolina.

“I really learned two lessons,” Herce said of his work. “The first is to always have humility, and the second is to build partnerships. So by having humility and building partnerships, I'm able to work with local communities and organizations that are able to share their lived experiences of a health problem with me and then also teach me how best to work within local health systems and within local community structures to have the most positive impact.”

Herce says the biggest barriers to bringing proven interventions for diseases like HIV, TB, or COVID-19 to the populations that need them most is political will and the failure of collective action.

“Too often in healthcare systems, healthcare teams and providers are fragmented. Organizations that work within a medical space may be disconnected from organizations working in the community, Herce said. “And so there's a barrier in bringing together people to come up with solutions. So under the best-case scenario, implementation science has strategies that bring diverse people and perspectives together to solve a common problem and generate a solution.”

He uses the example of COVID-19, and how during the height of the pandemic, UNC worked to bring together academic healthcare and community partners to devise shared goals.

“ It was sharing reliable health information with each other and within our networks, and then when we inevitably came across a hurdle, sitting down together and troubleshooting as one team,” Herce said.



This is the last in the UNC series, to view other interviews from the series, go


Reference
1. Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015 Sep 16;3(1):32. doi: 10.1186/s40359-015-0089-9. PMID: 26376626; PMCID: PMC4573926.



Michael Herce, MD, MPH, MSCR, discusses this concept and how it works to improve access to healthcare for populations who have been disproportionately burdened by various infectious diseases such as HIV, tuberculosis, and COVID-19.

Zandraetta Tims-Cook, MD, MPH

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