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Contagion® Editorial Advisory Board member, Khalid Eljaaly, PharmD, BCPS, CAPP, discusses key updates in the Infectious Diseases Society of America and the American Thoracic Society recommendations.

Changes in Therapy Guideline for Nosocomial Pneumonia

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

 species are the leading cause of fungal infections in hospitalized patients, contributing significantly to morbidity and mortality. Invasive candidiasis, including candidemia, primarily affects immunocompromised or critically ill individuals, while mucocutaneous candidiasis, such as oral thrush and vulvovaginal candidiasis, can occur in otherwise healthy individuals. While mucocutaneous forms are not typically life-threatening, they can cause discomfort and complications, especially in patients with underlying conditions like diabetes or those on immunosuppressive therapies.

New host factors and antifungal resistance drive the rise of difficult-to-treat 

 parapsilosis pose global health risks. Recent taxonomic revisions have reclassified several 

 species, leading to potential confusion in clinical practice. Current management guidelines are limited in scope, with insufficient coverage of emerging pathogens and new treatment options.

In an email interview with Oliver A Cornely, professor of translational research at Cluster of Excellence, University of Cologne, he discussed how healthcare providers can best address the rise of 

 parapsilosis, especially in immunocompromised patients. He said, "HCW cannot decolonize patients, so we focus on appropriate treatment. If 

 causes invasive infection, ie candidemia or organ involvement, treatment should start based on a microscopic result. It must be with echinocandins to have the highest likelihood to hit the yeast hard and early. As soon as susceptibility testing results become available, they need to be reviewed versus the chosen treatment." He added, "We actually regard all patients with candidemia or invasive candidiasis as immunocompromised."

To minimize confusion due to recent taxonomic revisions of Candida species, Cornely emphasized the need for microbiology labs to report both the old and new names for Candida species. He stated, "There is only one way: we need reports from the microbiology lab that carry both names – old and new. For the majority of physicians, Candida infection is a rare disease, so a period of such reporting needs to be very long, five years minimum."

When managing invasive and mucocutaneous candidiasis in patients with underlying conditions, such as diabetes or those on immunosuppressive therapies, Cornely said, "A key consideration is the duration of therapy, immunosuppression means more treatment days. Another consideration is drug-drug interactions as many of the patients in these groups will be on multiple medications."

Regarding antifungal resistance, Cornely noted that it is increasing rapidly. He explained, "Resistance is on the rise, and it gains speed. Just a few years ago, we knew azole-resistant 

 parapsilosis only from literature; now we all see them frequently. 

 comes with resistance towards azoles, and some clades towards echinocandins. Pan-resistance has been found, too. Our treatment options are rapidly narrowing; we need new drugs, eg, ibrexafungerp and fosmanogepix for systemic infection."

Cornely emphasized the critical need for reliable assays to trigger treatment, stating, "We lack reliable assays to trigger treatment, fever is too unspecific, and a positive blood culture appears to occur later in the development of invasive disease." He also advocated for more research into outbreaks, "We need to intensely study outbreaks, which are often overlooked, as they may involve more than one hospital. Infection control measures can help avoid transmissions and end outbreaks; however, they were not studied to the extent necessary. We transfer evidence from bacterial infections, which is not appropriate." He finished, "Overall, there was almost no public funding available over the last 25 years. That led to a lack of research that we are now facing."

Cornely OA, Sprute R, Bassetti M, et. Al. Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM. Lancet Infect Dis. 2025 Feb 13:S1473-3099(24)00749-7. doi: 10.1016/S1473-3099(24)00749-7. Epub ahead of print. PMID: 39956121 

Oliver A Cornely shares guidance on tackling Candida infections in an evolving landscape, including rising resistance and taxonomic changes.

Addressing the Threat of Candida Infections Through Resistance and Management

Su H Wang, MD, FACP, MPH warns that the US withdrawal from the WHO and cuts to essential health programs could undo decades of progress in global health, particularly for vulnerable populations.

US Health Policy Changes Threaten Global Public Health Cooperation

Recent changes in US health policy have raised serious concerns within the global health community. In a recent Lancet correspondence, Su H Wang, MD, FACP, MPH, and fellow clinicians and public health experts highlighted the alarming impact of the US administration’s decisions to withdraw from the World Health Organization (WHO), halt vital CDC communications, and freeze foreign aid. These actions have placed international health partnerships at risk and threaten progress made in disease control, particularly for vulnerable populations worldwide.

Experts agree that swift action is needed to restore these programs and safeguard the progress made in global health. The freezing of foreign aid, particularly programs like PEPFAR, which supports more than 20 million people, is of particular concern. The current situation is a stark reminder of how interconnected the world’s health systems are and how vulnerable these systems are to political shifts.

The US, traditionally a key player in global health, is no longer participating in critical collaborations with the WHO.

 Wang, a medical director for the Chinese Medical Program and the Viral Hepatitis Programs at Cooperman Barnabas Medical Center spoke out about the implications of this withdrawal. "The US not only is a member state of the WHO, but there is also a lot of work done between the CDC and the WHO," Wang said. "We wanted to make sure people realized that our global health ecosystem really relies so importantly on these international collaborations— between different countries— but also that different countries support a lot of the work that the WHO actually sponsors or has many committees that require input from people of all different countries."

Wang explained that without the CDC’s participation in WHO meetings, critical communication channels have been severed, delaying the exchange of timely information on epidemics such as monkeypox and avian influenza. Countries affected by outbreaks rely on the CDC's guidance to manage disease control, and the absence of that collaboration could have global consequences.

 "Countries that are having outbreaks rely on the CDC for information and for timely responses. A lot of the labs actually provide services abroad so that, as a global community, we can identify outbreaks and respond quickly, preventing them from going out of control."

Another concern raised in the correspondence is the freezing of CDC communications, particularly the suspension of essential reports like the Morbidity and Mortality Weekly Report (MMWR).

 These reports, a cornerstone of public health monitoring, have been vital in tracking diseases such as the flu and avian influenza. Wang emphasized the importance of these reports, “The MMWR, which has been around since the 1800s but has been published weekly since the 1950s, did not have a publication for the first time. This was concerning because that publication is used to convey important, timely things that are happening— like avian influenza. We were kind of expecting the flu report, and many of us use this to track what's happening."

As the availability of other CDC resources diminished, Wang expressed concern about the broader implications for public health. Databases containing critical data on infectious diseases, sexual health, and other pressing medical issues have been removed or reformatted.

 "Some of this data was taken offline, and some of it is being reformatted. The good news is that we’ve heard that some scientists have actually archived a number of these pages so that we have them for reference," Wang said. "But as a scientific and medical community, we have to stay on top of these things."

Wang highlighted that vulnerable populations, including those in need of reproductive health services and gender equity programs, could be disproportionately affected. Clinics that serve marginalized communities may face funding cuts, leaving patients without access to essential care.

 “A lot of the work that addresses gender equity, LGBTQ care, reproductive rights, as you mentioned, and gender issues— I think these are all really being targeted. I think a lot of those resources and the support of care for such marginalized populations is really going to be affected.”

She also stressed the need for healthcare providers to be proactive in filling the gaps left by these policy changes. "Some clinics are not getting funding. Those of us who can provide care may not be affected by the funding freezes. I think we need to be open and realize that we may not traditionally provide care for these individuals, but let’s open up our doors and make sure that we can be available for patients so that they don’t completely lose care," Wong expressed. "So, equity is important because those people who are already having difficulty accessing care may be more likely to not come, right? If there are some immigration issues, and so I think there are some informal networks that are happening in order to make sure patients feel safe accessing healthcare."

As the global community grapples with these challenges, the hope is that these health programs will be reinstated and that global collaboration will once again be prioritized. Wang closed off the first part of our interview by stating, "Our health security depends on our ability to work together as a global community. If we don’t restore these collaborations, we risk undoing decades of progress in health equity and disease control."

Science Is Science: Navigating Clinical Trust Amid Political Shifts

1. Wang S, Harrington M, Graham CS, Downs LO, Kagwanja N, Etyang AO, Iwuji C, Ndung'u T, Cowie BC, Kabagambe K, Matthews PC. Pathogens don't respect politicians: US federal disruption poses a new threat to global public health. Lancet Gastroenterol Hepatol. 2025 Feb 6:S2468-1253(25)00045-7. doi: 10.1016/S2468-1253(25)00045-7. Epub ahead of print. PMID: 39923777

United States of America: Partner in global health

. World Health Organization. Updated December 23, 2024.  Accessed February 14, 2025. 

https://www.who.int/about/funding/contributors/usa 

3. Stobbe M. CDC ordered to stop working with WHO immediately, upending expectations of an extended withdrawal. 

. January 27, 2025.  Accessed February 14, 2025. 

https://apnews.com/article/cdc-who-trump-548cf18b1c409c7d22e17311ccdfe1f6

4. Stein R. Under communications freeze, CDC updates some important health data but not others. 

. January 24, 2025. Accessed February 14, 2025. 

https://www.npr.org/sections/shots-health-news/2025/01/24/g-s1-44613/cdc-nih-hhs-health-data-mmwr

5. Dall C. Removal of pages from CDC website brings confusion, dismay. Inside Medicine. February 3, 2025. Accessed February 14, 2025. 

https://www.cidrap.umn.edu/public-health/removal-pages-cdc-website-brings-confusion-dismay

Su H Wang, MD, FACP, MPH, cautions that the US withdrawal from the WHO and cuts to critical health programs may reverse progress in global health, with vulnerable populations being particularly at risk.

In Part 2 of our interview, Su H Wang discusses combating vaccine misinformation, preventing outbreaks, and highlight global health interconnectedness

Recent changes in US health policy have raised serious concerns within the global health community. In a recent Lancet correspondence, 

, and fellow clinicians and public health experts highlighted the alarming impact of the US administration’s decisions to withdraw from the World Health Organization (WHO), halt vital CDC communications, and freeze foreign aid. These actions have placed international health partnerships at risk and threaten progress made in disease control, particularly for vulnerable populations worldwide.

In Part 2 of our interview with Wang, the discussion shifted to the impact of these policy changes on vaccine strategies

 and public health communication, with a focus on maintaining public trust in vaccines. Wang highlighted the role of clinicians in combating vaccine misinformation and reinforcing the importance of vaccines as life-saving tools. “We’ve seen time and time again that it’s not always the facts that sway people, but the messages they hear from friends and family,” Wang explained. “Clinicians need to be ready to counter misinformation with stories that show how vaccines have saved lives.”

Wang offered examples of how the MMR vaccine has played a key role in preventing devastating diseases like measles encephalitis

, and how the Hepatitis B vaccine has contributed to a significant decline in liver cancer rates.

 "Vaccines prevent more than just immediate diseases—they prevent long-term health complications that can affect entire generations. The Hepatitis B vaccine alone has made incredible strides in reducing liver cancer rates, and reversing that progress would be catastrophic,” Wang said.

The conversation then turned to the average American's potentially nonintentional lack of awareness about global health systems and how they contribute to the consequences of these policy shifts. Wang pointed out that many people in the US fail to recognize the broader systems that support public health—systems that rely on international cooperation and funding. “What we’re seeing is that there’s a sense that if it doesn’t happen in my neighborhood, within my country’s boundaries, it doesn’t affect me,” Wang said. “But the reality is, global health is interconnected. Epidemics in one part of the world can, and do, affect us here in the US in ways we don’t often realize.”

“If you go into a hospital, all the devices you use have been approved, and there are complex systems in place to ensure your safety, from blood donation screenings to medication approvals,” Wang explained. “These systems, though often invisible, are crucial to our well-being. And when we ignore them, we risk undermining the very protections that keep us safe.”

Wang also emphasized the importance of clear communication in maintaining public trust, particularly in times of political uncertainty. “At times like these, good reporting and journalism are more important than ever. It's crucial that we share information from reputable sources and make sure the truth gets out to wider audiences. But it’s not just the media’s job—each of us has a role to play in our own spheres, whether it's within our families, communities, or patient populations.”

Addressing the growing vaccine hesitancy in the US, Wang warned of the potential consequences of reversing vaccination progress. “If we backslide, we’ll see outbreaks of diseases we thought were eradicated. Polio, measles, and Hepatitis B will make a comeback,” she said. "Our children, our future generations, will bear the brunt of this. We've made so much progress, especially with vaccines like Hepatitis B, which has dramatically reduced acute cases and prevented liver cancer. Reversing that progress would be disastrous.”

WHO reported that measles cases increased globally from 8·6 million in 2022 to 10.3 million in 2023.

 Now, concerns about the ongoing measles outbreak in Texas, where children have fallen ill.

 “Measles is incredibly transmissible, and this outbreak is a stark reminder of the consequences of vaccine reluctance,” she said. “These outbreaks could be avoided if we stay vigilant and continue to communicate the importance of vaccines.”

Wang summarized, "Some of what’s happening in politics is politics. But we must keep science, science. We need to reassure people that vaccines are safe, and that science stands firm even in the face of political transitions."

Listen to the first part of our interview here: 

2. Seitz A. Vaccine skeptic Robert F. Kennedy Jr. is sworn in as Trump’s health chief after a close Senate vote. 

. February 13, 2025. Accessed February 14, 2025. https://apnews.com/article/rfk-trump-health-secretary-vote-5dbefeef0537dc241e6fb33b8f2a748b

3. Di Pietrantonj C, Rivetti A, Marchione P, Debalini MG, Demicheli V. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev. 2021;11(11):CD004407. Published 2021 Nov 22. Accessed February 14, 2025. doi:10.1002/14651858.CD004407.pub5

4. Flores JE, Thompson AJ, Ryan M, Howell J. The Global Impact of Hepatitis B Vaccination on Hepatocellular Carcinoma. Vaccines (Basel). 2022;10(5):793. Published 2022 May 17. doi:10.3390/vaccines10050793

5. World Health Organization. Measles cases surge worldwide, infecting 10.3 million people in 2023. WHO. Published November 14, 2024. Accessed February 14, 2025. https://www.who.int/news/item/14-11-2024-measles-cases-surge-worldwide–infecting-10·3-million-people-in-2023

6. Texas Department of State Health Services. Measles Outbreak–Feb. 14, 2025. Texas Department of State Health Services. Published February 14, 2025. Accessed February 14, 2025. https://www.dshs.texas.gov/news-alerts/measles-outbreak-feb-14-2025

Su H Wang, MD, FACP, MPH discusses combating vaccine misinformation, preventing outbreaks, and highlighting global health interconnectedness





 has revealed how genetic variations within 

, the pathogen responsible for cryptococcal meningitis, impact patient outcomes. Using a mouse model, the researchers focused on the sequence type 93 (ST93) clade, which includes two subpopulations: ST93A and ST93B. The findings highlight how genetic differences between these subpopulations influence virulence and immune system interactions.

The study reveals that there is linkage disequilibrium (LD) among single nucleotide polymorphisms (SNPs) in both subpopulations, with ST93B exhibiting stronger LD compared to ST93A. LD, a measure of how genes are inherited together, suggests that while some SNPs linked to virulence are found in long-range LD, others evolve independently, providing insight into how these mutations contribute to the pathogen's evolution and ability to cause disease.

In addition to genetic analysis, the team employed contour-clamped gel electrophoresis and long-read sequencing to examine the karyotypes of both subpopulations. Their findings show that the LD observed was not due to chromosomal rearrangements, further validating the role of SNPs in virulence.

, Kirsten Nielsen, PhD, professor of microbiology and immunology at Virginia Tech’s department of biomedical sciences and pathobiology, shared insights into the study and its implications. Nielsen and her team used a mouse model to investigate how genetic differences in 

 influence the severity of infection. Their research found that certain strains of 

 caused an overproduction of interferon gamma, a cytokine typically associated with beneficial immune responses. However, excessive production of interferon gamma worsened the disease outcome in the mouse model.

 is a fungal pathogen that causes disease, primarily in immunocompromised individuals,” Nielsen explained. “Although we can also see disease in immunocompetent individuals, our study focused on how genetic differences—specifically gene alleles—of 

The study built upon previous research using human clinical data, where variables such as patient genetics and disease severity made it difficult to draw definitive conclusions. By using a controlled mouse model, the researchers were able to pinpoint specific genes in the pathogen that influenced the immune response and disease progression.

Implications for Fungal Evolution and Treatment Strategies

The study has significant implications for understanding how 

 has evolved to infect different hosts, including humans. According to Nielsen, 

 is believed to have initially evolved to cause disease in single-celled organisms, using similar pathogenic mechanisms in humans. The study aims to differentiate between environmental strains of 

 that cause more lethal infections and those that do not lead to severe disease when infecting humans.

 is an organism that has evolved to cause disease,” Nielsen said. “We think it originally evolved to cause disease in single-celled organisms. However, it uses some of the same mechanisms in humans, though it’s primarily an environmental organism.”

The research also focuses on understanding the factors that differentiate strains of 

 acquired from the environment that cause more lethal disease and those that do not. "What we're trying to understand is how we can differentiate between strains that are acquired from the environment, which cause more lethal disease, and isolates that come from the environment but, when they infect humans, do not lead to significant disease,” Nielsen noted.

“We have treatments that can reduce the growth of 

 in the host, but these treatments are not fully effective,” she continued. “So, we're looking for ways to optimize the immune response, since the host immune system is generally very good at controlling 

The ultimate goal is to improve the human immune response to 

 infections. By identifying which components of the immune system are critical for controlling infection, and understanding how the pathogen manipulates the host immune system, researchers hope to develop targeted therapies that can better address the specific genetic variations of both the pathogen and the patient.

Moving Toward Better Diagnostics and Treatment Plans

In addition to exploring immune responses, the study also opens the door for improved diagnostics and personalized treatment strategies. “We’re working on diagnostics that target some of the genes we’ve identified,” Nielsen explained. “The goal is to develop diagnostic tools that can differentiate between strains that might be very hard to treat in patients and those that would likely respond to standard treatments.”

She added, “and the hope is that by better understanding the biology of how these genetic differences change how 

 interacts with the host, we will be able to develop additional treatment strategies targeting some of these processes we’ve identified, which are driven by the underlying genetics.”

Kirsten Nielsen, PhD, discusses how her team’s research could lead to better understanding and treatment of cryptococcal meningitis.


Khalid Eljaaly, PharmD, BCPS, CAPP

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