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Recognition of chronic Lyme disease and the role of long-term antibiotic treatment for persistent symptoms continue to be controversial among researchers, providers, patients, and advocates.

Diagnosis and Treatment of Chronic Lyme Disease: A Complex Issue

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

Morbidity and Mortality Weekly Report (MMWR)

, investigators reported that the state of Alaska saw reductions in incidence rates of hepatitis C. “The average annual rate of newly reported chronic hepatitis C (cases per 100,000 adults) during 2016–2023 was 121; the rate decreased a relative 30% from 142 (2016–2019) to 99 (2020–2023).”

The investigators noted that most groups saw decreases, but rates were higher overall in males, people aged 18–39 years, people who live in rural areas, and American Indian or Alaska Native persons.

“A majority of the cases were among males (66%) and adults aged <40 years (61%). Overall, 25% of cases were reported among women of reproductive age (18–44 years). Median age of newly reported cases was 38 (IQR = 29–54) years in 2016 and 35 (IQR = 30–45) years in 2023,” the authors wrote.

Looking at the incidence rate amongst American Indian or Alaska Native persons, the Centers for Disease Control and Prevention (CDC) statistics previously reported these populations have been especially burdened by hepatitis C especially with mortality rates.

“Compared to the overall population, non-Hispanic American Indian/Alaska Native (AI/AN) persons had a much higher age-adjusted hepatitis C-related death rate in 2021 (3.18 vs. 9.99 per 100,000, respectively). Although the death rate among non-Hispanic AI/AN persons decreased slightly from 10.24 per 100,000 population in the 2017 baseline year, the rate of 9.99 in 2021 remains above the target rate of 8.19.”

Across the state, a total of 5,352 newly confirmed cases of chronic HCV among adults were reported during 2016–2023.

“Rates of newly reported chronic hepatitis C among Alaska adults aged <40 years during the surveillance period were approximately double the national rates reported during 2018 and during 2019–2022,” the authors wrote.

AASLD/IDSA Develop a New Algorithm for Hepatitis C Point of Care Testing and Treatment

The authors point the need to have a greater adoption of the CDC’s updated guidance to use single-provider visits to obtain blood samples for both steps in HCV testing and facilitate getting people started on therapy. “The point-of-care HCV RNA test, which was approved in June 2024, could help complement existing test-and-treat strategies, such as for populations in remote areas without road access and for those who use injection drugs,” the authors wrote.

, Andrew Aronsohn, MD, associate professor of Medicine, University of Chicago Medical Center, discusses this concept of both screening and getting confirmed HCV patients, treatment all in 1 visit.

“These are folks that may be struggling with addiction; these are folks that may have difficulty with transportation or navigating huge health systems, or maybe undomiciled,” Every time you set up another step for them to have to follow-up, you risking losing them to follow-up. There's a lot of data in HIV and even in hep C, that if you put this all into 1 visit and you can work on some education and actually give them medication in hand before they go out the door it is beneficial," Aronsohn said. 

The CDC’s hepatitis C screening recommendations continue to be for all adults, pregnant women for each pregnancy, and people with certain risk factors, such as IV drug users. The 

 authors stress the importance of continued HCV vigilance to help determine groups at risk.

“Hepatitis C surveillance can help monitor health outcomes and identify groups needing tailored testing and treatment interventions aimed toward hepatitis C elimination,” the authors wrote.



References
1. Scobie HM, Allison J, Masters N, et al. Newly Reported Chronic Hepatitis C Among Adults — Alaska, 2016–2023. MMWR Morb Mortal Wkly Rep 2025;74:161–166. DOI: http://dx.doi.org/10.15585/mmwr.mm7410a1
2. Reduce reported rate of hepatitis C-related deaths among non-Hispanic American Indian/Alaska Native persons by 30% or more. CDC. Last reviewed August 8, 2023. Accessed April 11, 2025.
https://www.cdc.gov/hepatitis/policy/npr/2023/NationalProgressReport-HepC-ReduceDeathsAIAN.htm



Although there have been decreases in newly reported chronic hepatitis C cases across many demographics, the need to get people screened and given therapy in the same visit remains vital. 

Alaska Sees HCV Reduction, But Need For Greater Test-And-Treat Adoption Remains

Boston-based Atea Pharmaceuticals announced it had dosed the first patient for its C-BEYOND phase 3 trial in the US and Canada. The study will evaluate the regimen of bemnifosbuvir and ruzasvir for the treatment of adults with chronic hepatitis C virus (HCV) compared to the combination regimen of sofosbuvir and velpatasvir.

“Dosing the first patient in our global phase 3 program is a major advancement as we work to deliver a differentiated, next-generation therapy for HCV,” Atea CEO Jean-Pierre Sommadossi, PhD, said in a statement.

Along with the C-BEYOND trial in the US and Canada, the company is conducting its C-FORWARD, an international trial. Each trial will enroll approximately 880 treatment-naïve patients, including those with and without compensated cirrhosis.

The regimen of bemnifosbuvir and ruzasvir will be administered orally once-daily for 8 weeks (in patients without cirrhosis) or 12 weeks (in patients with compensated cirrhosis) while the regimen of sofosbuvir and velpatasvir will be administered orally once-daily for 12 weeks for all patients with or without compensated cirrhosis.

The primary endpoint for each trial is HCV RNA < lower limit of quantitation (LLOQ) at 24 weeks from the start of treatment and encompasses sustained virologic response 12 weeks post-treatment (SVR12) in each arm. Measurement at 24 weeks from the start of treatment is to ensure the primary endpoint occurs at the same relative timepoint from the start of treatment in all patients. While C-BEYOND and C-FORWARD are both open-label trials, Atea has put measures and processes in place that are designed to blind Atea personnel to patient treatment assignments.

At last year’sThe Liver Meeting, Atea presented a poster that demonstrated the combination therapy achieved a 97% sustained virologic response at 12 weeks post-treatment (SVR12) in a phase 2 lead-in cohort. According to the investigators, the analysis supported a short 8-week treatment with bemnifosbuvir and ruzasvir for chronic HCV.

The modeling results provided insight on the mechanism of action and demonstrated that the combination of bemnifosbuvir and ruzasvir was highly effective in blocking both viral replication and viral assembly/secretion in HCV-infected patients, independent of genotype, age, sex, or fibrosis score.

 studies to be approximately 10-fold more active than sofosbuvir (SOF), against a panel of laboratory strains and clinical isolates of HCV GT 1–5. 

 studies have also demonstrated bemnifosbuvir remained fully active against SOF resistance-associated substitutions (S282T), with up to 58-fold more potency than SOF.

The pharmacokinetic (PK) profile of bemnifosbuvir supports once-daily dosing for the treatment of HCV. Bemnifosbuvir has been shown to have a low risk for drug-drug interactions. Bemnifosbuvir has been administered to over 2,200 subjects and has been well-tolerated at doses up to 550 mg for durations up to 12 weeks in healthy subjects and patients.

The other half of the combination, ruzasvir, has demonstrated highly potent and pan-genotypic antiviral activity in preclinical (picomolar range) and clinical studies. Ruzasvir has been administered to over 1,500 HCV-infected patients at daily doses of up to 180 mg for 12 weeks and has demonstrated a favorable safety profile. The PK profile of ruzasvir supports once-daily dosing.

We believe our regimen, which combines key features of short treatment duration, low risk for drug-drug interactions, and convenience with no food effect, if successfully developed, has best-in-class potential and the opportunity to improve patient outcomes and to expand the number of patients treated,” Sommadossi said.

References
1. Atea Pharmaceuticals Announces Dosing of First Patient in C-BEYOND, Phase 3 Study Evaluating Regimen of Bemnifosbuvir and Ruzasvir for Treatment of Hepatitis C Virus. Atea Pharmaceuticals press release. April 9, 2025. Accessed April 9, 2025.

2. Ribeiro R. Multiscale Modeling of Lead-in Results from a Phase 2 Study of an 8-Week Combination Regimen of Bemnifosbuvir and Ruzasvir in Patients with Chronic Hepatitis C Virus Infection. Poster #1467 presented at The Liver Meeting. November 15-19, 2024. San Diego, CA

This open-label trial will compare the combination of the company’s therapies,  bemnifosbuvir and ruzasvir, with another hepatitis C combination regimen. 

Atea Pharmaceuticals Doses First Patient in Phase 3 Trial  for Chronic Hepatitis C 

With the Trump Administration’s plans to cease funding for Gavi, the Vaccine Alliance as well as to reduce HHS personnel, public health both domestically and internationally are going to be widely affected.

Sweeping Public Health Changes Creates US and Global Turmoil

The Trump Administration’s proposed public health policy changes are occurring on 2 fronts: domestically and internationally. And these sweeping changes that are happening are widespread enough that they will affect everyone’s health to some degree.

One example on the international front is the administration’s plan to stop funding Gavi, the Vaccine Alliance. Last month, the US State Department detailed its planned cuts to foreign aid, and as part of that, it decided to cancel its over $1 billion grant to Gavi. The organization is a public-private partnership that helps vaccinate more than half the world’s children against some of the deadliest diseases. Gavi brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Gates Foundation, and other private sector partners.¹

Through Gavi’s vaccine programs, 1.1 billion children have been immunized through routine programs; an estimated 18.8 million future deaths have been prevented; 1.9 billion vaccinations have been administered through preventative campaigns; and $250 billion in economic benefits have been estimated for participating countries.²

The US is one of the 3 largest governmental donors to Gavi, along with the United Kingdom and Norway.³ This loss of funding will greatly impact global vaccination efforts.

“This could lead to things like an uptick in diseases and deaths in some of the poorest countries. And these effects could actually be quite staggering,” said Janeen Madan Keller, policy fellow and deputy director of the Global Health Policy program at the Center for Global Development (CGD). “Some back-of-the-envelope calculations that my colleagues here at the Center for Global Development did suggest that the US terminating its support of Gavi—as well as clawing back some of its bilateral funding for global immunization efforts—could actually result in as many as 20,000 to 500,000 more deaths globally from vaccine-preventable diseases each year.”

Madan Keller covered this subject recently in a CGD blog. During Trump’s first term, the administration supported Gavi by pledging $1.16 billion to the alliance—a slight increase from the previous US pledge. The Biden Administration later pledged at least $1.58 billion to Gavi’s replenishment round.⁴

Closer to home, the Department of Health and Human Services (HHS) recently announced it would reduce its workforce by laying off 10,000 full-time employees. Combined with other efforts, HHS expects to downsize its workforce by 20,000 employees overall. This restructuring would reduce the agency’s size from 82,000 to 62,000 full-time employees.⁵

Again, these domestic and international public health actions are confounding, particularly given how drastically they contrast with previous policies and commitments.

“The Trump administration's actions are really hindering the work of HHS—federal agencies as well as global organizations—through potential funding cuts to Gavi and decisions such as the withdrawal from the World Health Organization,” Madan Keller said. “All of these organizations play a central and pivotal role in monitoring, preventing, and stopping the spread of outbreaks and other biological threats before they reach us here in the United States. I would argue that, taken together, these sweeping changes are going to have significant consequences. And I think what they will boil down to is making us much less safe. They’re also going to have very important consequences and ramifications for people's health and safety all around the world.”

References
1. Gavi supports Côte d'Ivoire's largest HPV vaccination campaign targeting over 3 million girls. Gavi. April 7, 2025. Accessed April 9, 2025.


https://www.gavi.org/news/media-room/gavi-supports-cote-ivoires-largest-hpv-vaccination-campaign


2.Gavi’s Impact. Gavi. Accessed April 9, 2025.
https://www.gavi.org/
3. The US Government and Gavi, the Vaccine Alliance. KFF. July 17, 2024. Accessed April 9, 2025. https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-gavi-the-vaccine-alliance/
4. Madan Keller J, Kenny C. Why the Trump Administration's Plan to Cut Funding to Gavi Is Shortsighted. CGD. March 27, 2025. Accessed April 9, 2025.


https://www.cgdev.org/blog/why-trump-administrations-plan-cut-funding-gavi-shortsighted


5. HHS Announces Transformation to Make America Healthy Again. HHS press release. March 27, 2025. Accessed March 31, 2025.



With the Trump administration’s plans to cease funding for Gavi, the Vaccine Alliance, as well as to reduce the US Department of Health and Human Services personnel, public health, both internationally and domestically, is going to be widely affected.

Sweeping Public Health Changes Create US and Global Turmoil

she discussed AI as a tool designed to assist pharmacists and clinicians in making more informed patient care decisions.  AI is designed to consolidate patient information

In this final part of our conversation with Sharmeen Roy, PharmD, BCPS, chief strategy and science officer at DoseMe, she discussed AI as a tool designed to assist pharmacists and clinicians in making more informed patient care decisions. According to Roy, AI is designed to consolidate patient information, aiding clinicians in their decision-making process without replacing their judgment.

"It should be a tool for pharmacists or any clinicians, not necessarily replacing their judgment, but really helping them make the best decision with the most information," Roy explained. "You’re not spending time gathering patients’ charts are complex. I don’t know if you’ve ever seen them, but they have a lot of information. There’s a lot of data, and there’s a lot of assessment going on, and that all takes time. The tool aims to consolidate that information so that clinicians can focus on making the best decisions for their patients."

A significant area of focus for AI is antimicrobial resistance (AMR), which remains a major global health concern. "As far as AMR goes, one of the mechanisms by which we see resistance emerge is subtherapeutic exposure to medication," Roy said. "What our tool allows is ensuring that you're getting the appropriate target quicker, so there’s less time spent with subtherapeutic levels that expose the bacteria, helping prevent the cycle of resistance."

While AI plays a significant role, Roy emphasized that it is designed to be supportive rather than replace clinicians. "The AI component is going to have to be more of a guardrail, supporting the clinician rather than replacing their functions," she noted. "Reducing administrative burdens and gathering information is where it’s going to be most beneficial."

Reducing adverse drug events (ADEs) is another crucial area where the AI tool can have a positive impact, especially in preventing acute kidney injury (AKI), which is a common and costly outcome of antimicrobial treatment. Roy highlighted that March 24 marked National Adverse Drug Event Awareness Day, underscoring the fact that ADEs are among the leading causes of death in the United States.

"Adverse drug events are the fourth or some references say the third leading cause of death in the US," Roy said. "And many of them are related to medication. You can imagine why it's an important cause for us to address. Our tool allows for the reduction of adverse events, specifically with antimicrobials."

Roy explained that one of the most critical ADEs, AKI, can lead to a cascade of complications, from prolonged hospital stays to the need for renal replacement therapy. "You can imagine the healthcare costs associated with any acute kidney injury, starting from an increased length of stay to patients ultimately needing renal replacement therapy," she said.

In addition to addressing adverse events, Roy also discussed the importance of real-world evidence in patient dosing, particularly for pediatric populations. Roy, who has a background in pediatric critical care, emphasized the challenges unique to treating pediatric patients, who range from infants with immature organ function to adolescents nearing adulthood.

"We are going to be presenting a poster at ESCMID this year, and that’s looking at a special cohort: pediatrics," she said. "This is special to me because I’m a pediatric critical care-trained pharmacist, so that’s where my practice was as a clinician. I know the challenges in that patient population. You have patients ranging from birth to adolescence to 18-year-olds, so you're looking at a spectrum of patients with very immature organ functions to adulthood."

The upcoming poster presentation at ESCMID will highlight the impact that Bayesian dosing has on target attainment in the pediatric cohort, using real-world data to guide clinical practice. "What we’re going to be presenting at ESCMID is our data and real-world evidence on the pediatric cohort and the impact that Bayesian dosing has in target attainment," Roy shared. "It’s all about guiding practice using real-world data."

Sharmeen Roy, PharmD, BCPS, on artificial intelligence (AI) in improving decision-making, reducing adverse drug events on National Adverse Drug Event Awareness Day, and upcoming research on pediatric dosing at the the Congress of the European Society of Clinical Microbiology and Infectious Diseases.

AI as a Tool to Support Clinicians, Not Replace Them

A number of Washington insiders remain uncertain of what’s next. Carl Schmid, executive director, HIV + Hepatitis Policy Institute, speaks to these closings.

With Federal Offices Related to Fight Infectious Disease Closing, Who Will Pick-Up the Slack?

Within the last couple of weeks, the Trump administration has continued its closure and restructuring of federal agencies and offices related to infectious diseases. The administration dismissed the entire staff of the HHS Office of Infectious Diseases & HIV Policy, along with staff from other offices including the HHS Office of Minority Health and the Policy and Data Division supporting the Ryan White HIV/AIDS Program. Additionally, hundreds of employees at the Health Resources and Services Administration’s (HRSA) Bureau of Primary Health Care were let go, including those who support the 

Carl Schmid, Executive Director of the HIV + Hepatitis Policy Institute, released a statement after news of the agency changes broke.

“Today the Trump administration continued its decimation of our nation’s response not only to HIV, but to hepatitis and STIs. While we wait to learn specifics on how many staff who support CDC’s HIV and hepatitis prevention programs will be eliminated, all staff at the government’s central coordinating office—which develops strategic plans, coordinates agency actions, collects and communicates vital data, administers the 

 initiative, and oversees the Presidential Advisory Council on HIV/AIDS—have been fired,” Schmid said in the statement.

Schmid noted that HRSA may step in to fill the role of the Office of Infectious Diseases & HIV Policy, but nothing has been confirmed.

“We are hearing that office may be resurrected at HRSA, but we don't know. A lot of these cuts are just happening. And they say it's all for government efficiency, but we don't think there's a lot of logic behind it,” Schmid told 

HRSA is the primary federal agency focused on improving access to healthcare services for people who are uninsured, isolated, or medically vulnerable—including those in rural areas and those with HIV/AIDS. It is part of the U.S. Department of Health and Human Services.

The Ending the HIV Epidemic initiative was established in 2019 during the first Trump administration—with the goal of reducing new HIV infections in the United States by 75% within 5 years and by 90% within 10 years. This abrupt reversal in HIV policy is both confusing and concerning.

“Hopefully, they will realize their wrongs and correct them, but we are very concerned that they're targeting the populations most impacted by HIV,” Schmid said. “So we are rather surprised by the 180, but we're not losing hope yet. Through public awareness, Congress, and other means, we hope advocacy will pay off and that they will get back on track so we can end HIV. Without this government funding, and with the loss of all the staff support and research, we're definitely going to go backward—and that’s really sad.”

Reference
1.Statement on elimination of HHS Office of Infectious Diseases & HIV Policy & Other HHS staff cuts. HIV+Hepatitis Policy Institute press release. March 28, 2025. Accessed April 11, 2025. 
https://hivhep.org/press-releases/statement-on-elimination-of-hhs-office-of-infectious-diseases-hiv-policy-other-hhs-staff-cuts/

Carl Schmid, executive director, HIV+Hepatitis Policy Institute, speaks to these closings.

Gina Battaglia

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