Top Infectious Disease News Stories Week of September 20-27

Kevin Ault, MD on ACIP Shared Decision-Making, Informed Consent, and Vaccine Policy

Kevin A. Ault, MD, vice president of the National Foundation for Infectious Diseases and former ACIP member, reviews the September ACIP meeting by clarifying that COVID-19 vaccination for people 6 months and older remains under shared clinical decision making, noting confusion around informed consent materials that fall outside ACIP’s purview, and emphasizing that prenatal hepatitis B testing has long been standard of care despite persistent implementation gaps. He reiterates that ACIP recommended separate MMR and varicella doses before age 4 to limit febrile seizure risk, cites long-standing data supporting the hepatitis B birth dose with large reductions in pediatric infections, and underscores that day-to-day clinical practice remains stable for obstetrics, pediatrics, and family medicine, with coverage expectations unchanged across major payers.

Taking a Cancer Treatment Approach to New Antibiotic Development

Victor Nizet, MD, of UC San Diego, proposes reorienting antibiotic development toward a cancer-style paradigm that integrates host immunity, arguing that standard in vitro susceptibility tests can underestimate clinical activity by ignoring drug–immune synergy. In a program spotlight, he explains that antibiotics damage protective microbiota and may carry long-term risks, and he advocates evaluating the full host–pathogen interaction to enable immunology-informed therapies. Nizet’s team, collaborating with the University of Texas at Tyler, showed that colistin retained activity against mcr-mediated resistant gram-negative bacteria under physiologic conditions, with efficacy demonstrated in human blood and murine models despite test-tube resistance, suggesting the need to modernize antimicrobial susceptibility testing and consider immune context when repurposing or advancing agents.

Food Insecurity Tied to Higher Long COVID Risk in US Adults

A US analysis of 21,631 adults from the 2022–2023 National Health Interview Survey found that food insecurity was associated with higher odds of current long COVID and lower odds of recovery after prior long COVID, after adjustment for confounders. Current long COVID, defined as symptoms lasting at least three months and present at interview, was more likely among food-insecure respondents (OR 1.73; 95% CI 1.39–2.15), while recovery was less likely (OR 0.70; 95% CI 0.54–0.92); weighted prevalence was 15 percent with food insecurity versus 7 percent without. Participation in SNAP and current employment were linked to lower risk in interaction tests, suggesting that access to nutrition and income support may mitigate vulnerability. Investigators emphasized that the data are observational and do not prove causality but support routine screening for food insecurity in clinical workflows, coding with Z codes, and referral to SNAP and local resources to address modifiable social needs that may influence long COVID development and persistence.

Clinical Guidelines, Stewardship Practices for Managing DTR Pseudomonas Infections

Pranita Tamma, MD, MHS, reviews observational data on difficult-to-treat resistant Pseudomonas aeruginosa, reporting no mortality difference between ceftolozane-tazobactam and ceftazidime-avibactam while noting higher resistance emergence with ceftolozane-tazobactam in one NIH-funded study (38% vs 25%). Clinically, Tamma advises testing both agents and selecting the active drug with close monitoring, while stewardship considerations favor using ceftolozane-tazobactam first when both test active to preserve ceftazidime-avibactam for metallo-β-lactamase producers and some carbapenem-resistant Enterobacterales. She cautions that resistance develops in at least one fifth of cases and cross-resistance is common, underscoring the need for prudent agent selection and ongoing surveillance.

Ecosystem Disruption, Infections, and Violence

Psychiatrist Robert C. Bransfield, MD, outlines how ecological disruption, zoonotic infections, and neurologic impairment may contribute to violent behavior, emphasizing that rapid environmental change can advantage fast-replicating pathogens and increase population vulnerability to emerging diseases. In Episode 2, Part 3, he references animal models such as rabies to illustrate infection linked aggression and lists human infections with neurobehavioral implications including Bartonella, Borrelia, malaria, toxoplasmosis, and herpes simplex virus. He notes historical associations between encephalitis lethargica and violence during the 1918 era and describes pathways in which infections alter brain circuits that govern fear and risk assessment. Clinically, he advises that some infections cause only physical symptoms while others affect cognition or behavior, reinforcing the need to consider infection history when evaluating violent or impulsive presentations.