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1rem

Regulators cite four new serious adverse event reports, halting US distribution while global access efforts continue.

FDA Suspends US License for Valneva’s Chikungunya Vaccine IXCHIQ

ECDC warns climate shifts are driving longer mosquito seasons and expanding disease transmission, calling for stronger surveillance, vector control, and clinician preparedness.

World Mosquito Day: Record Chikungunya and West Nile Cases in Europe

Morris County resident was infected despite no recent travel; risk to public remains low, officials say.

NJDOH Investigating First Possible Locally Acquired Malaria Case in New Jersey Since 1991

After a three-month review, the FDA and EMA have cleared continued use of IXCHIQ in adults 60+, adding new safety warnings for elderly individuals with chronic conditions.


FDA Lifts Pause on Chikungunya Vaccine IXCHIQ Use in Adults 60+ Following Safety Review

China's largest recorded chikungunya outbreak prompts strict mosquito control and mandatory hospitalization in Foshan.

China Reports Over 7,000 Chikungunya Cases in Guangdong Province Amid Aggressive Containment Efforts 

Pediatric infectious disease expert Sharon Nachman, MD, explains how to identify symptoms, assess travel risk, and prevent mosquito-borne illness in kids.

As global cases of chikungunya rise, especially in regions such as the 

, clinicians in the US are keeping watch, particularly when it comes to pediatric patients. While domestic transmission remains unlikely, travel-related cases are expected to continue.

Sharon Nachman, MD, division chief for pediatric infectious disease at Stony Brook Children’s Hospital, explained that chikungunya is spread exclusively through mosquitoes, not from person to person. “The virus, or chikungunya, is carried by mosquitoes. It does not transmit person to person,” Nachman said. “A lot of the concerns we've had with other viruses—being in a crowd and passing it from one to the other—are not there for chikungunya because it's passed by mosquitoes. You have to be in an area that these mosquitoes live.”

Currently, the mosquito species responsible for chikungunya transmission is not found in the northern United States. “We're not seeing it in the northern United States because that mosquito that carries that virus, and that virus, are not here,” she said. “The cases that we see in New York are not native to New York, but rather people who traveled.”

 are available but not universally recommended. “There are two preventative vaccines,” Nachman explained. “One is a live attenuated vaccine, which means that you can't take it if you have any underlying immune issues, if you're older, etc. The second one is not a live vaccine, and anyone can take it over age 12. But we don't want to give it out if we don't need to give it out.”

The recommendation to vaccinate depends largely on travel plans. “If you're going to live in a country that has lots of chikungunya for at least a month, we'd recommend the vaccine. But if you're going, for example, to the Dominican Republic for just a quick vacation, that's not someone who we recommend a vaccine for.”

For children, symptoms tend to be nonspecific, including fever, fatigue, and body aches. “Kids, just like adults, can easily get infected. And of course, you can imagine—kids to mosquitoes—they taste delicious, and mosquitoes always find our children,” she said. “The kids present with fever, feeling poorly, muscle aches and joint aches. They won’t have a rash. And the most important thing we'll hear from them is that they recently traveled.”

If there's no recent travel, testing for chikungunya is not typically pursued. Although, Nachman stated, “if you said to me, ‘My family just got back from the southern hemisphere a few days ago, and now my kid is having fever and they feel terrible,’ but really not having respiratory symptoms, more like body aches and fatigue and fever, I would say you're probably going to be having a mosquito-infected disease called chikungunya.” Treatment is supportive only: “Rest, Tylenol, Motrin, chicken soup—those things really work—and you have to wait it out.”

Preventing mosquito exposure remains the key strategy. “The advice we give to families, not just for chikungunya, but for all the mosquito vector pathogens, is: don't let the mosquitoes breed in your backyard,” Nachman said. This includes eliminating standing water, staying indoors at dusk, and using DEET-based repellents. “If you see standing water, dump it out. Don’t leave water in flower pots or in the, you know, containers, because that is a wonderful place for the mosquitoes to breed.”

For families planning international travel, she recommends discussing destination-specific risks with a healthcare provider. “Knowing who you are and where you're traveling and for how long you're going to be there will help you and your physician decide what medications or other things you need to do before you go.”

Chikungunya and Children: What Rising Global Cases Mean for US Families

At ASM Microbe 2025, Pelumi Oladipo discusses E marmotae’s reduced motility, misidentification as E coli, and the diagnostic tools closing the gap

In part 2 of our interview, Pelumi (Magret) Oladipo, a fourth-year PhD candidate at Wayne State University School of Medicine, spoke with 

 that may help explain its underrecognition as a human pathogen. The discussion, which builds on her diagnostic study presented at ASM Microbe 2025, included new insight into the organism’s temperature-sensitive motility, its frequent misidentification as 

, and the next steps in validating two species-level diagnostic tools.

 exhibit a temperature-sensitive motility and biofilm-forming ability, with both the phenotypes more pronounced at lower temperature—to be precise, at 28 degrees Celsius—than that of the body temperature, which is 37 degrees Celsius,” Oladipo said.

Motility is a known virulence factor in many bacterial pathogens. Oladipo explained that their study found 

 at both temperatures, which may help explain its lower clinical frequency and potentially different disease presentation.

“This reduced motility may contribute to the reason why 

, and might also produce a different disease profile when infections occur,” she said.

“Motile bacterials are better able to, you know, migrate to vulnerable sites of infections, more effectively evade tissues, as well as potentially evade various host different responses. Some bacterial pathogens deliberately stop producing flagella at host temperature in order to, you know, avoid detection by the host immune responses, and then motility may not be essential for its pathogenicity.”

This complexity, Oladipo emphasized, underscores the need for more focused research on 

. “Overall, this study is, you know, the study of 

 is still not well studied, and our findings have already emphasized the complexity of 

 and its potential to thrive in diverse environments,” she said. To help address the identification challenges, Oladipo’s lab applied their newly developed diagnostic tools to a set of clinical isolates initially labeled as 

“To begin validating tools that we created, you know, we collaborated with a clinical hospital to screen a collection of 

 isolates that was obtained from patient samples,” she said. “Our goal was to, you know, determine whether any had been misidentified and were actually 

, because, you know, it has often been misdiagnosed as 

Using a species-specific qPCR assay and a MALDI-TOF MS biomarker, the team re-screened 100 

 isolates from clinical samples. “We got one out of 100 that was identified as 

. And this result has been, you know, further confirmed through whole-genome sequencing, supporting the accuracy and the clinical utility of our assay.”

Oladipo believes these tools could soon be applied more broadly in the clinical setting. “Yes, the species-specific qPCR assay and the MALDI-TOF MS biomarker that I have mentioned previously… have a very strong potential for use in clinical microbiology labs or in any clinical laboratory,” she said. “So our assays work very well, and that has been able to, you know, help us to distinguish the species from 

The findings support the growing recognition of 

 as a clinically relevant, yet underdiagnosed, pathogen. With distinct virulence traits and emerging diagnostic solutions, Oladipo’s work adds critical insight into a species long overshadowed by its better-known counterpart, 

Oladipo PM, Tibbetts RJ, Sivertsen A, et al. New diagnostic methods for 

 and the first report of its identification in clinical isolates in North America. 

. Preprint posted online July 10, 2025. doi:10.1101/2025.07.10.25331261

At ASM Microbe 2025, Pelumi Oladipo discusses E marmotae’s reduced motility, misidentification as E coli, and the diagnostic tools closing the gap.

Conferences

How Temperature-Sensitive Traits Could Explain Why E coli's Lookalike Goes Undetected

 continues to share how vector-borne infections may trigger psychiatric symptoms not through direct brain infection, but by disrupting immune signaling and gene expression.

A Psychiatrist’s View on the Immune-Brain Connection

For over five decades, psychiatrist Robert C Bransfield, MD, has treated patients with some of the most complex psychiatric conditions, many of whom failed to respond to standard therapies. Over time, a striking pattern emerged: a notable number of these patients had a history of infectious disease, particularly Lyme disease and other vector-borne infections. His observations challenge entrenched paradigms in both psychiatry and infectious disease medicine.

In the fourth part of his 4-part series, we discussed one pathogen that continues to draw attention in Bransfield’s work 

 vector-borne bacterium that has been increasingly recognized for its potential neuropsychiatric impact. “Bartonella seems to be a significant vector-borne infection,” Bransfield explains, likening it to opportunistic infections seen in immunocompromised patients, such as those with HIV. In healthy individuals, the immune system may suppress the infection. However, when another illness—like Lyme disease—disrupts immune function, latent Bartonella may emerge as a clinical problem.

While debate remains about whether Bartonella is truly tick-borne, Bransfield emphasizes its interactive nature: “You may acquire Bartonella another way, then get Lyme, and Lyme weakens the immune system, allowing Bartonella to cause symptoms it hadn’t before.”

He describes this as an example of "complex, interactive infections," where symptoms are often less about the presence of pathogens themselves and more about the immune system’s response.

Infection and the Brain: A Complex Relationship

When it comes to neurological symptoms, Bransfield says it's essential to look beyond the conventional infectious disease model. The brain, he notes, is uniquely complex, and understanding how infections influence psychiatric function involves tracking immune and gene activity over time.

In many cases, patients improve with treatment, but then relapse when medication is withdrawn. “That’s because different genes—often immune-related—upregulate or downregulate during illness and recovery,” Bransfield explains. Communication between nerve cells involves not only neurotransmitters but also “immune transmitters,” which are often overlooked but crucial in this context. This mechanism also explains why psychiatric treatments like antidepressants or mood stabilizers take weeks to show efficacy, they must influence long-term genetic and immune signaling pathways, not just brain chemistry.

Three Ways Infections Affect Brain Function

Bransfield outlines three primary ways infections can influence psychiatric symptoms:

: Infections in the body trigger immune signaling molecules that affect brain function.

: Some infections may damage or inflame brain blood vessels.

: Though less common, some infections like neuroborreliosis (

While direct brain infections can be confirmed in autopsy studies showing 

 spirochetes inside neurons, Bransfield says this is relatively rare. The majority of cases involve immune signaling from the body affecting brain function.

Autoimmunity and Abrupt Neuropsychiatric Symptoms

Another serious concern is infection-triggered autoimmunity. “In some cases, there’s no adaptive immune resolution, and instead, the immune system begins attacking nerve tissue,” Bransfield explains. This is seen in conditions like PANS and PANDAS, first identified in children after strep infections but now linked to other pathogens as well.

These autoimmune reactions can lead to dramatic psychiatric symptoms, sudden-onset OCD, motor tics, aggression, confusion, or delirium. “I’ve seen patients try to jump out of windows or attack siblings,” Bransfield says. “But once treated, they can return to normal. That’s the power—and danger—of immune-driven brain disorders.”

Bransfield’s work continues to bridge the gap between psychiatry and infectious disease, advocating for increased awareness of how infections and the immune system’s response to them can underlie treatment-resistant psychiatric symptoms. As the medical community continues to uncover the immune-brain connection, Bransfield’s findings highlight the need for a more integrated and nuanced approach to mental health.

Robert C Bransfield, MD, continues to share how vector-borne infections may trigger psychiatric symptoms not through direct brain infection, but by disrupting immune signaling and gene expression.

Part 3 with Robert C. Bransfield: on missed diagnoses, flawed tests, and the decades-long path from infection to mental health crisis

For over 50 years, psychiatrist Robert C Bransfield, MD, has focused on treating patients with some of the most difficult psychiatric conditions, those resistant to conventional therapies. Over time, his clinical work led him to a surprising pattern: many of these patients had a history of infectious disease, particularly Lyme and other tick-borne illnesses. What he found challenges assumptions in both psychiatry and infectious disease.

“I did a study of Lyme, tick-borne disease patients and the average patient, and these were well-confirmed CDC-positive cases. The average patient was nine years post-infection when they ended up in my office seeking treatment for psychiatric symptoms,” Bransfield explained.

Among the patients in his study, the progression from infection to psychiatric issues varied widely. “Now in that group, there would be some that would show rapid progression, and maybe in a year or two, and others that showed up 40 years after infection. So there was a big variability, and some patients had a rapid downhill course. Some patients did well, and then they had some traumatic event, car accident, sometimes delivery or something that was triggered. Maybe was a latent infection that then was reactivated.”

Bransfield added, “And sometimes it's a remitting course that they have, because there's such a long delay between the initial infection, or tick-borne infection, and then the manifestation of symptoms. And it may not be tick-borne, it may be some other way, vector-borne, or some other way the infection began.”

Because the delay between infection and symptoms can span years or decades, many patients go undiagnosed or misdiagnosed. “It can often be hard to connect the dots to show in a connection between infection and the mental illness or mental impairment,” he said.

“It usually follows a pattern where, when, let's say, for example, with tick borne infections, there may or may not be a rash, it may or may not be noticed that, just like with syphilis, the rash you see first and then you can have a some people, then they may get nor aligned with a rapid progression neurological symptoms.”

He added, “Those people usually do pretty well because it's obvious and they get aggressive treatment early. Problem is when people overlook it, they don't see the connection, or they get inadequate treatment early.”

Bransfield is critical of early treatment protocols that fail to consider long-term outcomes. “For example, they get one dose of doxycycline. And if you looked at that study, there wasn't a long follow-up to determine whether that was effective with long-term symptoms or not, it just reduced the rash. And rash isn't the problem the long-term impairments of the problem.”

Many patients also receive incomplete treatment for complex infections involving multiple pathogens. “Or they may have had a partial treatment, and they may have had an infection with more than one pathogen, an antibiotic that they got may be protected against one pathogen but not another.”

“Many of these infections that are more serious are a combination of Borrelia of different species, Bartonella of different species, Babesia of different species, and often not tested by the usual testing,” he said. “And the tests are of limited value.”

Bransfield emphasized that psychiatry, more than many other specialties, is uniquely equipped to recognize these patterns, if clinicians are looking for them. “A big thing in making the diagnosis is the clinical presentation. And in psychiatry, we rely particularly on the clinical presentation. If someone has depression or panic attacks, we look at the history, the symptoms, and that's how we make our diagnosis.”

“In other fields of medicine, sometimes there's more of an emphasis on blood work. If someone presents me with panic attacks, I don't say, I'll do blood work. And if it's positive, then you have it. If it's negative, you don't you have to look at all the evidence in making a diagnosis.”

Flawed Testing and the Need for Clinical Judgment

Bransfield warns against relying too heavily on lab tests, especially those designed around immune markers. “Right now, the lab tests are flawed. They're very limited. One basic problem is Lyme has evidence of being immunosuppressant and immunoevasive, and therefore there's a certain limitation of using an immune-based test with an infection that's immunosuppressant, and they were never standardized for late-stage disease begin with.”

“Therefore we have to look more at direct testing antigen or culture which or PCR, which usually isn't done. So a lot of times the diagnosis is missed.”

A Multi-System Illness with Lingering Effects

Tick-borne diseases don’t just affect one system of the body. “I think when it's like a Lyme case, often it's multi-system. You have the cognitive, the emotional, the general medical ,you may have the musculoskeletal symptoms, but those are easier to treat than a neuropsychiatric.”

“Partial treatment may eliminate the musculoskeletal treatments or significantly reduce it, but it may not be enough treatment to prevent later developing neuropsychiatric symptoms,” he said. “That's the problem is the later development of these symptoms, where there's often difficulty seeing the connection of how this evolves over time.”

Ultimately, Bransfield believes that understanding how these diseases affect patients over time requires physicians to rely on fundamentals. “You have to look at a timeline of how things evolved. What was a person's state of health before they had this initial infection, and how did that progress over time?”

His advice is simple but important: listen to patients, look beyond the labs, and don’t ignore the possibility that psychiatric symptoms may have infectious roots.

Bransfield RC. Aggressiveness, violence, homicidality, homicide, and Lyme disease. 

. 2018;14:693-713. Published 2018 Mar 9. Accessed June 18, 2025. doi:10.2147/NDT.S155143

Part 3 with Robert Bransfield, MD, explores treatment-resistant mental health issues linked to infection history and diverse progression patterns.

Psychiatric Symptoms Emerging Years After Infections Like Lyme and Tick-Borne Infections

Andrew Handel, MD, discusses prevention, how to remove ticks, and the burden of Lyme disease in certain populations. 

‘Tis the Season: Addressing Tick-Borne Illnesses

With the warm weather brings the return of people being outside and the possibility of contracting tick-borne diseases. According to the Centers for Disease Control and Prevention (CDC), more than 89,000 cases of Lyme disease were reported in 2023 by state health departments and the District of Columbia. However, these numbers come from routine national surveillance and may underrepresent the actual burden. 

CDC also estimates that approximately 476,000 people in the US are diagnosed with Lyme disease each year using other data collection methods. This number likely includes patients who are treated based on clinical suspicion but do not actually have Lyme disease, according to the federal agency.

 provides critical insights into the emergence of babesiosis—another tick-borne illness—in the Mid-Atlantic region. Babesiosis can be more severe than Lyme disease, and can become a life-threatening disease for the elderly. 

With this possibility, it is important for clinicians and the general public to consider tick-safety when outside in areas where they live.

“Ticks tend to live on tall grasses and brush in forested areas, so if you go out and you hiking and you know you're going to be in exposed areas where ticks like to live, you want to make sure to stay in the middle of that path, far away from the sides where the ticks are hanging out on the tall grass waiting to grab onto you,” Andrew Handel, MD, said. 

Handel is a pediatric infectious diseases physician at Stony Brook Children's Hospital and at Stony Brook’s Regional Tick-Borne Disease Center in Hampton Bays, NY

 which is the first and only dedicated tick clinic in the Northeast. The center offers tick removal, diagnosis, and treatment. It can test for tick-borne illnesses as well as counsel patients on tick bite prevention and tick identification.

Handel explains that along with trying to stay clear of areas where the ticks live, there are several other strategies to stay tick-free. These include:

Wear light-colored, long-sleeve shirts and pants to make ticks more identifiable.

Tuck your pants into your socks so the ticks don't have access to your skin

Perform routine tick checks when coming from the outdoors or nightly tick checks

Check unexpected and common places on your body for ticks. Ticks love to hide in the beltline, behind the ears, hairline, and in skin folds

If outdoors for an extensive time, consider treating clothes with permethrin, which kills ticks on contact

Put your clothes in the dryer for 10 minutes on high heat to kill any ticks

Handel says it is important to check for ticks after being out in nature, and for those who live in endemic areas such as the northeastern part of the US. In these latter areas it is a good habit to get into even when just out in the yard. He offers some guidance on checking for them.

“You want to really inspect all of your skin, head to toe, looking for any small ticks—many of them look like just the size of poppy seeds. Areas that are really important to check are behind the ears, along the beltline, and in skin folds,” Handel said. “Ticks really like to get into the skin folds, so whether that's in the armpit or the groin, and hide there, making it difficult to find them. And any areas that have hair you want to search really well there too, because again, the ticks have a way of getting underneath the hair and making it really difficult to find. So if you're not thorough, you might miss one.”

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