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Despite the availability of highly active agents against HCV, HIV-infected patients require special considerations for drug interactions when considering treatment options.  

Treating HCV in HIV-Coinfection: Still a Therapeutic Dilemma?

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

As the world focuses on combatting COVID-19, we are reminded once again that dozens of outbreaks of other infection diseases continue to occur. Many of these diseases are endemic like 

 in the Democratic Republic of the Congo (DRC) and can reemerge at any given time. In February, there were 2 Ebola outbreaks, one in the DRC and another in Guinea. The outbreak in the DRC was declared over on May 3, and according to the World Health Organization, Guinea began a 42-day countdown to declaring an end to the EVD outbreak in early May.

Both of this article’s authors are part of a special pathogens team tasked with ongoing preparedness and maintaining a state of readiness in health care for Ebola. This team is made up of physicians, nurses, technicians, infection preventionists, emergency management coordinators, administrators, and more.

What follows are their 10 core pillars to an effective Ebola-outbreak response.

1. The 3 Cs: Communication, Coordination, and Collaboration

The need for clear, concise, consistent, transparent, and science-based communication is essential, both for outbreak responders and for the public. For those involved in Ebola response, ongoing communication, coordination, and collaboration must occur at all levels—from local to international. Given the multilevel, multisectoral, and multidisciplinary rapid response teams needed to combat Ebola, from local nongovernmental organizations to international medical assistance institutions, ensuring that all parties have up-to-date information—sharing scientific and medical knowledge as well as data—in a coordinated fashion helps with rapid response.

2. Box in the Virus: Testing, Case Finding, and Contact Tracing

To contain the virus, rapid and ongoing laboratory services to accurately diagnose individuals, identification of cases coupled with isolation, and contact tracing to find and quarantine exposed persons are critical to prevent transmission. The ability to conduct contact tracing relies on trust and cooperation from the public—hence the need for risk communication and community engagement. Previous epidemics of Ebola have been contained through successful contact tracing, isolation, and quarantine, which break the chain of infection.

A public health surveillance system should be in place to immediately detect and report cases of illness compatible with Ebola. Strong surveillance systems to track all suspected and confirmed cases of disease will allow for detection of new cases and monitoring spread. Upon detection of a possible Ebola event, a rapid-response team should investigate and implement initial mitigation measures, including systematic contact tracing.

Technological advances can supplement traditional surveillance methods to accrue information in real time, offering the possibility of better outbreak management.

All efforts should be made to provide usual standard of care to patients with suspected or confirmed Ebola. While such care should be provided in a safe and logical manner, planning and education should result in avoidance of altered standards of care due to the perceived risk to providers. Lastly, there should be synchrony between the multiple disciplines involved in the care of a patient with EVD, including physicians, nurses, laboratory personnel, environmental services, and infection control.

10 Key Pillars to an Effective Ebola Response

10 Pillars to Ebola Response

The core of every Ebola response is basic infection prevention and control. This includes a combination of measures to prevent and minimize the transmission of Ebola, such as administrative controls and safer work practices (eg, protocols, processes for screening, limiting individuals who come in contact with suspected or confirmed persons with Ebola); engineering controls to prevent or minimize exposures (eg, physical barriers or designated rooms for patient care and designated equipment and supplies); and use of personal protective equipment to prevent and minimize exposure. This also includes safe and dignified burial practices and other environment-of-care strategies (eg, cleaning and disinfecting, waste management).

6. Social Mobilization and Community Engagement

Outbreak response starts and ends with the people. For people to change any behaviors (eg, burial rituals) and follow public health guidance, there must be community engagement. This starts with grassroots, boots-on-the-ground messengers who are part of the community and can serve as trusted emissaries. In previous and current Ebola outbreaks, community engagement has served as the backbone of successful responses.

Risk communication refers to effective communication during an emergency.

 Effective risk communication helps the public make informed decisions regarding the event and helps rapid-response teams understand behavior changes to mitigate risks. Risk communication can occur through multiple channels including social media, government briefings, and press releases. Given the misinformation and disinformation that occur during Ebola outbreaks, which can result in mistrust and hostility toward responders,

 having experts who are trusted messengers provide ongoing risk communication (with science- and evidence-based information) is essential.

8. Epidemiological and Outbreak Analytics

Effective Ebola response relies on good data and analytics to provide information on current and projected case counts and where the outbreak is headed in terms of trajectory, map current progress and spread, assess populations at risk, and help with early detection and control of viral spread. Epidemiological and outbreak analytics are complex and multifaced and require collecting, analyzing, interpreting, modeling, and reporting of data. Effective data collection and analysis inform the outbreak response and help decision makers determine next steps (eg, mobilization of resources).

9. Logistics Management and Incident Command

All Ebola outbreaks require resources including personnel, treatment centers, equipment and supplies, vaccines and therapeutics, and more. The assistance of an incident management structure can facilitate planning, logistic management (eg, supply chain), and the ability operationalize a response. The complex task of coordinating and dispatching needed supplies, equipment, and human resources and maintaining a safe and hygienic environment is a massive undertaking that often requires all hands on deck.

Leadership and governance can make or break Ebola response. A successful strategy requires responsiveness, accountability, and the ability to galvanize rapid response. Regions with civil unrest and unstable public health and health care systems pose additional challenges, but these hurdles can be overcome by effective leadership with trust between government and citizens.

Syra Madad, DHSc, MSc, is senior director of the System-Wide Special Pathogens Program at NYC Health + Hospitals and core faculty at the National Emerging Special Pathogens Training and Education Center (NETEC) in New York, New York.

Vikram Mukherjee, MD, is an assistant professor NYU Grossman School of Medicine; director of the Medical Intensive Care Unit and Special Pathogens Unit at Bellevue Hospital Center; and coprincipal investigator at NETEC in New York, New York.

Saurabh S, Prateek S. Role of contact tracing in containing the 2014 Ebola outbreak: a review. 

. 2017;17(1):225-236. doi:10.4314/ahs.v17i1.28

Ebola publications: surveillance, contact tracing, laboratory. (2021). World Health Organization. Accessed May 7, 2021. 

https://www.who.int/csr/resources/publications/ebola/surveillance/en/

Woolhouse ME, Rambaut A, Kellam P. Lessons from Ebola: improving infectious disease surveillance to inform outbreak management. 

. 2015;7(307):307rv5. doi:10.1126/scitranslmed.aab0191

Crisis & Emergency Risk Communication (CERC). CDC. Updated January 23, 2018. Accessed May 7, 2021. 

Allgaier J, Svalastog AL. The communication aspects of the Ebola virus disease outbreak in Western Africa--do we need to counter one, two, or many epidemics? 

. 2015;56(5):496-499. doi:10.3325/cmj.2015.56.496

EVD outbreaks this year serve as a reminder of the virus’ severity and the importance of having a containment strategy in place.

Publications

Sarah Madad, DHSC, MSc, MCP, CHEP, outlines early surveillance systems and diagnostic innovations for enhancing pandemic management and response.

Strategies for Improving Pandemic Preparedness 

At the World AMR Congress last week, Syra Madad, DHSC, MSc, MCP, CHEP, chief bio preparedness officer for New York City Health and Hospitals, underscored the role of early surveillance systems in managing pandemic risks, and the need for integrating public health and healthcare surveillance to enhance preparedness and response.

Madad highlighted the development of an early syndromic surveillance system that monitors various conditions, including influenza-like illnesses, gastrointestinal and skin conditions, asthma, and other syndromes. “One of the tools that I've been helping develop with my team, along with other departments within NYC Health and Hospitals, is this early syndromic surveillance system. We currently track four conditions: influenza-like illness (ILI), gastrointestinal and skin conditions, and asthma. This system provides an early indicator if we see an increase in patients presenting with symptoms like influenza or rash outside of typical flu seasons or during an mpox outbreak,” Madad explained. She emphasized that these early detection tools are vital and can be complemented by methods such as wastewater surveillance for more effective outbreak detection and response.

Madad also highlighted the importance of having diagnostic tools readily available at the bedside for rapid identification of new infectious diseases. “What's even more important is having it at the bedside. When we talk about novel infectious disease outbreaks, oftentimes it's that astute clinician that suspects that this patient has this novel infectious disease. They call their local health department, and then they send samples over for testing, and many times, those samples are routed to CDC for confirmatory testing. What we need to do is bring much of that testing closer to the bedside, so that way we're not going through this very long process of sending samples to public health and sending it to the CDC at the federal level,” she said. The more we can bring better diagnostic and faster diagnostics to the bedside, the better.

She provided an example of diagnosing novel infectious diseases like bird flu or Ebola, noting the current process of sample routing to external agencies and advocating for in-house diagnostic capabilities to streamline the process. Backing up her point that bringing diagnostic testing closer to the bedside within the healthcare setting would be more effective and efficient, reducing the time involved in sending samples to external agencies for confirmation.

Madad also emphasized the need for improved preparedness strategies, including effective diagnostic tools, robust surveillance systems, and strong science and health communication. She pointed out that while COVID-19 remains a concern, its impact has lessened from being the fourth leading cause of death in the US to the tenth.

Furthermore, Madad underlined the significance of public health communication, data transparency, and cross-governmental collaboration to improve preparedness and response, drawing on insights gained from recent epidemics such as COVID-19 and the triple threat of COVID-19, RSV, and flu, “Epidemics and outbreaks are managed by people, and if the public doesn’t understand that a virus is circulating, or doesn’t know about effective vaccines or treatments, they might not take necessary precautions, like getting vaccinated or using therapeutics, which increases their risk of infection,” Madad noted.

She advocated for a holistic approach that integrates public health and healthcare responses while actively engaging the general public. “Studies show that misinformation spreads six times faster than accurate information, so we often find ourselves trying to catch up. By being proactive and educating the public, we can help them understand the value of measures like vaccines, therapeutics, and testing, and encourage them to take effective actions to reduce transmission,” Madad concluded.

In conclusion, Madad highlighted the need for advanced surveillance and diagnostic systems. Her focus on early syndromic surveillance tools and bedside diagnostics aims to improve outbreak detection and response. She emphasized the importance of effective public health communication and addressing misinformation to enhance pandemic preparedness and response.

Syra Madad, DHSC, MSc, MCP, CHEP, outlines early surveillance systems and diagnostic innovations for enhancing pandemic management and response.

World Anti-Microbial Resistance Congress

Conferences

Jason Barker, ND, explains how standard testing can miss co-infections and how Vibrant’s microarray improves sensitivity and efficiency in a single test.

A newly developed multiplex protein microarray platform promises to improve the diagnosis of tick-borne diseases by allowing the detection of multiple pathogens in a single test. Published in 

 in January 2025, the study highlights the effectiveness of this tool in enhancing both sensitivity and specificity for diagnosing tick-borne and other infectious diseases.

Tick-borne infections, including Lyme disease, are the most common vector-borne diseases in the United States and Europe. Although, current diagnostic methods often fail to detect multiple pathogens at once and are prone to misdiagnosis due to overlapping symptoms and varying tick populations.

The new multiplex protein microarray, developed by Vibrant Wellness, addresses these limitations by enabling clinicians to test for multiple pathogens in one run. The platform can detect antibodies against 400 different antigens, including those for 

, the spirochete responsible for Lyme disease, as well as a variety of other microbes.

In part 1 of our interview with Jason Barker, ND, clinical lab educator at Vibrant Wellness, he discussed the limitations of current diagnostic methods and how Vibrant’s technology offers improvements. “Kind of the standard testing today we refer to as the standard two-tier testing. If you go to a big, one of the main commercial labs, they'll run what's called an ELISA, and they're looking for one very specific protein to the bacteria that spreads Lyme disease, which is 

. And then if that test is what you'd call equivocal kind of looks positive and/or positive, then they'll run something called a Western Blot, or an immunoblot, and that methodology attempts to separate several different proteins that that bacteria can carry. So we're looking for antibody binding to these antigens or the proteins from the bug.”

He also pointed out the complexities of tick-borne infections, “Lyme disease proper is caused by the bacteria 

, a cousin or relative of that burgdorferi. But the problem is, it's rare that if a person is bitten by a tick that they're going to be infected by just 

. They may have several other versions or different species of 

Barker elaborated further on how Vibrant’s microarray improves diagnostic capabilities, “With Vibrant’s technology, we can actually run 100 different antigens on one single little pillar. We can look at all the different parts of the 

 bacteria. We can look at the co-species. We can look at the co-infections. We also look at opportunistic infections like Epstein-Barr and cytomegalovirus and toxoplasmosis because all this other stuff that people may very well be infected with as well.”

Barker concluded by highlighting the advantages of Vibrant’s approach: “It’s just a more efficient test. It’s more cost-effective, and it’s a lot more sensitive than that standard two-tier technology.”

Stay tuned for more details and the full interview with Barker in the next few video installments coming soon, where he will discuss the broader impact of Vibrant’s technology on tick-borne disease diagnosis.

Krishnamurthy, H.K., Jayaraman, V., Krishna, K. et al. A customizable multiplex protein microarray for antibody testing and its application for tick-borne and other infectious diseases. Sci Rep 15, 2527 (2025). https://doi.org/10.1038/s41598-024-84467-0

Jason Barker, ND, explains how standard testing can miss coinfections and how Vibrant’s microarray improves sensitivity and efficiency in a single test.

New Microarray Platform Aims to Improve Tick-Borne Disease Diagnosis

Warmer Winters Are Fueling a Surge in Tick-Borne Illnesses

Tick-borne illnesses like Lyme disease are on the rise across the Northeast, fueled by shifting seasonal patterns and warming temperatures. As winters become shorter and milder, blacklegged ticks (commonly known as deer ticks) are staying active well beyond traditional risk windows, posing an extended public health threat to people in affected areas.

Andrew Lover, MPH, PhD, MS, deputy director of the 

New England Center of Excellence in Vector-Borne Diseases

, says the lengthening of tick season is one of the most striking developments in recent years.

"The tick season is changing a lot in terms of the winters are less cold and potentially shorter, so ticks are active later in the fall and earlier in the spring than they have been historically," Lover said. "That really changes where people's risk perception should be. Not everyone thinks about ticks at Thanksgiving time here in the Northeast, but they're still active."

This extended activity is compounded by geographic expansion. Ticks are now becoming more prevalent in northern states like Vermont, New Hampshire, and Maine, regions that historically saw only sparse tick populations.

"The ticks are also spreading north through Vermont and New Hampshire and Maine, which historically had really small numbers in just a few isolated places for deer ticks, blacklegged ticks," Lover explained. "So the health systems in those three states are having to work really hard to start ramping up to deal with those health problems."

Tracking tick-borne disease incidence presents its own set of challenges. According to Lover, widespread presumptive treatment for Lyme—administering antibiotics based on symptoms or tick exposure alone—can obscure data and trends.

"One of the challenges, at least here in New England, is that at least Lyme disease is so common that there's a lot of presumptive treatment," he said. "So even without a diagnosis, people just get doxycycline if they have an attached tick. It's good for the patient level, but in terms of tracking health trends, it makes it a bit challenging."

Despite these difficulties, several promising prevention tools are in development. A resurgence of interest in Lyme vaccination is underway, and researchers are also testing passive immunization strategies.

"There’s a reinvigoration of that space to get a new or improved vaccine," said Lover. "And there's also some work trying to get some monoclonal antibodies, so you can get an injection at the start of the season which would really knock down the chances of Lyme disease."

He emphasized the continued importance of everyday prevention methods like EPA-approved repellents and frequent tick checks but noted that broader insights into exposure patterns may help target education efforts more effectively.

"There’s a lot of other work trying to understand exactly where people are getting most of their exposures, whether it’s around your house where you’re gardening or whether it’s during recreation," he said. "That will help to help people understand when they are at their highest risk and then take appropriate action."

As ticks continue to expand into new areas, even beyond the Northeast, researchers are keeping a close watch.

"Certainly the Upper Midwest has started to see more tick-borne disease in the last 20 years," Lover said. "Canada is also having some new places pop up. That’s just a general trend everywhere."

Yet one of the most critical and overlooked gaps in the fight against tick-borne illness lies in human behavior.

"A lot of people know they probably should use repellent and that long pants are a good idea, but it's challenging to do that every day whenever you're outside," Lover explained. "So I think that's really the big gap, trying to understand what types of interventions are easy to do, easy to remember, and work with people's lives on a day-to-day basis."

Andrew Lover,  PhD, MPH, discusses the shifting landscape of tick-borne illnesses during Tick-Borne Disease Awareness Month.

A measles outbreak in 3 states continues to grow and there are a smattering of cases in various parts of the country. The Centers for Disease Control and Prevention (CDC) reports that as of last Thursday, March 13, there were 301 cases of measles in the United States including the following jurisdictions: Alaska, California, Florida, Georgia, Kentucky, Maryland, New Jersey, New Mexico, New York City, New York State, Pennsylvania, Rhode Island, Texas, Vermont, and Washington.

CDC reports that of all the cases nationwide, 95% of individuals were considered unvaccinated or unknown, 3% had 1 MMR vaccine dose, and 2% had 2 MMR doses.

The largest number of cases are in Texas where the state’s health department is reporting 259 cases with 34 hospitalizations, and 1 death. Of the cases, 257 of them have been classified as unvaccinated/unknown, zero cases with 1 dose of the vaccine, and 2 cases in people with 2 plus vaccines.

According to the state’s health officials, the unvaccinated/unknown category includes people with no documented doses of measles vaccine more than 14 days before symptom onset.

They also reported on existing cases, and after securing more information into the details of cases, health officials said 3 cases previously classified as vaccinated were not vaccinated cases. And 2 of those cases got their vaccine doses 1 to 2 days before their symptoms started, after they had been exposed to the virus.

They point out that it takes the body about 14 days after vaccination to develop immunity to measles, so people aren’t considered vaccinated until that 14-day period has passed.

Cases in the US continue to increase, and a new analysis shows 2024 was the highest year for measles cases in Europe in 25 years.

AMY CHENG, PHARMD, AAHIVP

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