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These pathogens can cause unique challenges for clinicians.

5 Emerging Infections to Watch Out For in 2018

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

Matthew Hepburn, MD, executive vice president of Research and Development at Panther Life Sciences, discusses the technology and its potential usage.

Panther's Microarray Patch Offers Novel Therapy Delivery System for Potential Infectious Disease Applications

In a previous life, Matthew Hepburn, MD, an infectious disease physician,  worked with the Biden and Trump Administrations, and held the role of vaccine development lead for Operation Warp Speed, which was instrumental in developing COVID-19 vaccines in less than a year. This task was monumental considering it typically takes years to develop vaccines, and the pandemic was causing such a large human toll. 

Prior to that position, he has had a variety of roles in the Army and government including his 6-year tenure as a program manager at DARPA. Prior to joining DARPA, Hepburn served as the director of Medical Preparedness on the White House National Security Staff. His service in the Army included deployments to Iraq as a hospital Chief Medical Officer and numerous international engagements in establishing public health and clinical research partnerships.

With a long track record in government service, he recently transitioned to the private sector. In his current role as executive vice president of Research and Development at Panther Life Sciences, he will drive the company’s efforts to commercialize its patented Microarray Patch (MAP) technology, with a primary focus on reducing time-to-market and delivering the first commercial product to customers within the next 2 years. Panther is a start-up life sciences company based in New York City. 

“I have a massive newfound respect for people that are part of the startup community, because it is so challenging to be successful. It is such a commitment,” Hepburn said. “What I love about it is it reminds me a lot of that commitment we had at Operation Warp Speed, where everybody on your team is committed to the goal of making a big vision real.”

The patch platform is a novel technology which incorporates transdermal drug delivery systems. This consists of an array of tiny needles—each just hundreds of microns long—designed to pierce the outermost layer of the skin without reaching the deeper pain receptors, resulting in a virtually pain-free experience. Upon application, the biocompatible tips, which are loaded with therapeutic agents or vaccines, begin to dissolve within the interstitial fluid of the skin, releasing the medication directly into the epidermis and dermis.

“Micro needles are much shorter than the needle you get with a shot, but they go into your skin at the level where you can get a really effective immune response or use it to treat something,” Hepburn said. “So this idea of precision medicine—putting the right amount of material at the right time for the right patient—you can achieve a magnificent effect. And the design of these needles are such that you can put the vaccine or the drug on them. You surround them with these micro needles that are formed of polymers that just dissolve right underneath your skin. And they stay stable at room temperature."

He says this last part about the patch being able to deliver treatments or vaccines at room temperature as opposed to very cold freezer temperatures is an attractive component, and is a lesson they learned from COVID-19. 

"We know that with the COVID vaccines, as example, we had an amazing logistics team with the army and with the CDC to get the COVID vaccines out to people, but because the vaccines had to be kept at really, really cold temperatures, the logistical challenges were absolutely massive, and our team did our best to overcome those," Hepburn said. "But what we saw, especially for worldwide distribution, that sometimes maintaining those vaccines at that very cold temperature was essentially impossible to do so that access for people to receive their COVID vaccines—that was the biggest limitation. And it's a big limitation for lots of other vaccines and for therapeutic products as well." 

Although the technology is in its earliest stages, Hepburn does see it being utilized for infectious disease. He says right now they are working on the proof of concept first before they can pivot to specific disease states and applications.

This is part 1 of a 2-part interview. In the second installment, Hepburn will offer some insights on his time working on Operation Warp Speed. 

Reference
1.Operation Warp Speed Leader Tapped as Panther Life Sciences’ New R&D Chief. EIN Presswire. March 24, 2025. Accessed April 18, 2025.
https://www.einpresswire.com/article/796443993/operation-warp-speed-leader-tapped-as-panther-life-sciences-new-r-d-chief

Matthew Hepburn, MD, executive vice president of research and development at Panther Life Sciences, discusses the technology and its potential usage.

Sarah Rowan MD on minimal lab testing, Hep B screening flexibility, peer navigation and state‑specific strategies to overcome outreach and reimbursement hurdles

Simplified Hepatitis C Protocols Raise Treatment Uptake and Cure Rates

 highlights the success of integrating Hepatitis C treatment into syringe services programs, leading to higher treatment initiation and cure rates among people who inject drugs, who often face significant care access barriers.

The review examined 13 US-based studies, including randomized trials, cohort studies, and qualitative evaluations, and found that integrated treatment models outperformed traditional referral-based care in terms of patient outcomes. The programs varied in approach, with some operating in mobile units and others in fixed settings, offering care both in person and via telehealth, and differing in pretreatment evaluations, pharmacy access, peer support, and funding models.

In this second part of our interview with Sarah Rowan MD, infectious disease physician at Denver Health and co-author of the review, she discusses recent follow-up efforts, streamlined treatment models, outreach challenges, and the need for tailored solutions.

“Hepatitis C treatment has just gotten so much safer and more streamlined than it was even five years ago, now that we have this minimal lab testing model and we know how safe and effective the treatments are,” Rowan said.

She highlighted ongoing discussions around hepatitis B screening protocols, “We know that it’s important to know someone’s Hep B status when you’re treating Hep C. But whether we can use some prior lab results, or we can get the blood work and then as long as it’s pending, and as long as we have a way to find someone, then go ahead and start Hep C treatment and not wait for those results. That’s one thing that’s in discussion, engaging really, at the moment, at the present time.”

Rowan also emphasized the importance of outreach in finding and treating individuals, “Sometimes people go to a fixed site syringe service program, but sometimes they might not be, you know, working through working order syringe access programs. So how best to find people to communicate results and to deliver medication, that’s something else that’s really been coming up a lot.”

Regarding the role of patient navigators, Rowan noted, “The role of the patient navigator, or peer navigator, or peer advocate in kind of helping people to stay on the medication so that they can get through a full treatment course and then come back and get that test of cure, is crucial.”

Rowan also discussed the logistical hurdles tied to reimbursement for these services, “Doing something kind of outside of the traditional clinic based model is challenging because of the way that reimbursement works in this country with Medicaid and commercial insurance, it’s highly variable state to state. But looking at the numbers of people who use drugs who get Hep C treatment, you can see that we have a problem because the people who need treatment are often not getting it.”

Finally, she underscored the importance of innovative, state-specific solutions, “Looking at creative approaches to problem solving within your state and within your system is key to addressing these disparities.”

Yoder T, Hirose K, Tsui JI, et al. Approaches to offering hepatitis C treatment at syringe services programs in the United States: a scoping review. Open Forum Infect Dis. 2025;ofaf211. doi:10.1093/ofid/ofaf211

Sarah Rowan, MD, on minimal laboratory testing, Hepatitis B screening flexibility, peer navigation, and state‑specific strategies to overcome outreach and reimbursement hurdles

Sarah Rowan MD says tailored models within syringe service programs can overcome barriers and improve cure rates in underserved populations

Integrated Hepatitis C Care in Syringe Service Programs Improves Outcomes for People Who Inject Drugs

 shows that integrating Hepatitis C virus (HCV) treatment into syringe services programs significantly improves treatment initiation and cure rates among people who inject drugs. This population has historically faced major barriers to accessing care.

The review analyzed 13 studies from across the United States. These included randomized controlled trials, cohort studies, and qualitative evaluations of treatment models located within syringe service programs. Compared to traditional referral-based models of care, the integrated approaches consistently showed better outcomes.

The programs used a variety of approaches. Some were based in mobile units, while others operated in fixed clinical settings. Providers delivered care in person or through telehealth. The programs also differed in how they handled pretreatment evaluations, pharmacy access, peer support, and funding.

Sarah Rowan, MD, infectious disease physician at Denver Health and a co-author of the study, explained that success often depended on tailoring the model to the needs of each program and community, “We did look at different models, and some of the models use on site providers at syringe access programs. Some of the syringe access programs are brick and mortar and others are mobile units,” Rowan said.

“And then there are different approaches to where the provider was. Sometimes a provider was on site, seeing patients, person to person, face to face. Other times, the provider was available via video visit so through like a telehealth model, and really both approaches, or sort of all the variety of approaches had their pros and cons, but in general, they really were tailored to fit the situation for the program and the clients and the providers and the state.”

Rowan gave her key takeaway, “I think the kind of take home message was that various approaches can all work very well as long as they're kind of developed in concert with the folks at the syringe access center and the clients that you'll be serving,” she said.

Rowan also pointed out ongoing barriers that limit access to Hepatitis C treatment for people who inject drugs, “I think the main barrier for people who inject drugs is access to providers. So right now, the current models generally request that people go to a clinic, and it's often an infectious disease clinic or a gastroenterology clinic, and that has not worked very well for a lot of people who just don't have the bandwidth in their lives,” she said. “The traditional model involves scheduled appointments, insurance, transportation needs. The barrier of the traditional system is what the problem is.”

Rowan described how barriers show up at multiple stages of care, “Sometimes the barrier is follow up labs, finding someone to share results, and then getting the medication to people, ensuring that they can get their full supply of medication. So sometimes people will get medication and then it's stolen or lost. So, having a safe place to store medication has been a big barrier, and then getting the follow up test of cure results that all of those have been really pretty big barriers in the traditional systems,” she said.

Yoder T, Hirose K, Tsui JI, et al. Approaches to offering hepatitis C treatment at syringe services programs in the United States: a scoping review. 

Sarah Rowan, MD, says tailored models within syringe service programs can overcome barriers and improve cure rates in underserved populations.










Canine serologic testing data indicate a broader geographic distribution of coccidioidomycosis (Valley fever) in the United States than previously recognized, suggesting that current human surveillance may underestimate the true burden of the fungal disease.

Researchers analyzed 834,899 serologic test results from dogs across the US between 2012 and 2022, using data from all known diagnostic laboratories performing anti-

 antibody testing in dogs. The overall seropositivity rate was 37.6%, with substantial variation by state. Among states with ≥0.5 tests per year per 10,000 households, average seropositivity ranged from 35.4% in Texas to 74.1% in Montana.

Estimated annual canine incidence per 10,000 households was highest in Arizona (87.8), followed by New Mexico (.89), Nevada (.79), California (.75), and Montana (.63). Positive correlations were observed between canine and human incidence in Arizona (ρ = .75) and California (ρ = .65), based on surveillance data from 2012 to 2022.

The distribution of seropositive dogs expanded significantly over the past decade, increasing from 76 counties in 2012 (2.4% of US counties) to 390 counties in 2022 (12.4%). This trend may reflect both the spread of 

 spp. and improvements in veterinary testing availability.

Due to challenges such as inconsistent soil detection, underdiagnosis, and non-mandatory human case reporting, canine seroprevalence may serve as a valuable proxy for environmental risk. The findings support the need for enhanced human diagnostic capacity and clinician awareness to improve recognition of this emerging fungal infection.

The investigators, including Jane E Sykes, BVSc(Hons), MPH, MBA, PhD, from school of veterinary medicine, University of California-Davis, and Simon K Camponuri, MPH, division of environmental health sciences, School of Public Health at Berkeley, emphasize the value of canine seroprevalence as a proxy for environmental risk, given challenges such as inconsistent soil detection, underdiagnosis, and non-mandatory human case reporting. 

"The dog serologic data analysis showed that the incidence in dogs closely follows that in humans, at least in California and Arizona," said Sykes. "We are currently performing additional studies with the data to extrapolate where unrecognized disease might be occurring in humans-both in locations where reporting is required and in other parts of the country."

Sykes further explained that stronger reporting mechanisms for dog cases could improve monitoring of the disease's spread in both dogs and people. "Currently there is no requirement that dog cases be reported and no infrastructure to support such an activity. If there was a requirement for reporting of cases in dogs, we would be better prepared to monitor the spread of the disease in both dogs and people."

Sykes noted that the data could also inform occupational health strategies, "Human health care providers could be educated on the disease, and there may be implications for occupational exposure reduction, such as education of construction workers, military personnel, agricultural workers, or wildfire fighters regarding the need for PPE and dust avoidance," she said.

With the increasing distribution of seropositive dogs, Sykes stressed the importance of enhancing diagnostic infrastructure and provider knowledge in regions with expanding risk for coccidioidomycosis. "Educational materials on Valley fever and risk factors for Valley fever for providers, mandatory training in highly endemic regions for workers with occupational exposure, raising awareness with awareness days/weeks etc.," she added. "Another thing that is badly needed is inclusion of companion animals in census data, because currently we lack a good denominator for studies like this one."

Finally, Sykes highlighted the potential of a One Health approach, integrating animal and human health data, to help address emerging infectious diseases. "When all laboratories are willing to pitch in their results, we can overcome the spatial bias that occurs when only one laboratory participates," she said. "There are so many other emerging diseases where companion animals can be sentinels for human diseases."

This study highlights the need for improved surveillance and diagnostics to better track Valley fever, as canine serologic data reveals the disease is more widespread in the US than previously recognized. Current human surveillance may underestimate the true burden, particularly in the southwestern US.

Jane E Sykes, Simon K Camponuri, Amanda K Weaver, George R Thompson, Justin V Remais, Use of dog serologic data for improved understanding of coccidioidomycosis: A One Health approach, The Journal of Infectious Diseases, 2025;, jiaf184, 

Jane E. Sykes, BVSc (Hons), PhD, MPH, MBA, discussed how her study revealed a wider geographic distribution of valley fever, highlighting the need for improved human surveillance.

Canine Serology Sheds Light on Underreported Human Coccidioidomycosis Spread

 is highlighted as an emerging multidrug‑resistant yeast that has drawn urgent attention from global and UK health authorities amid rising outbreaks and antifungal resistance. A pathogen once obscure, it now symbolizes the broader crisis in fungal infections driven by scientific gaps, diagnostic delays, and agricultural practices.

 has rapidly spread to more than 60 countries. New data from the UK Health Security Agency (UKHSA) show that England reported 637 cases between 2013 and 2024, with 178 occurring in 2024 alone, the highest annual count to date. Most detections were colonizations, but the yeast can cause invasive infections with high mortality in immunocompromised patients.

 frequently resists azoles, like fluconazole, echinocandins, and polyenes, with resistance arising intrinsically or during therapy. In 2022, the WHO designated 

 a critical priority pathogen, a status previously limited to drug‑resistant bacteria.

 cases in England, particularly after COVID‑19 travel restrictions lifted, has been linked to prolonged hospital outbreaks that exposed lapses in routine screening, species‑level identification, and reporting. In response, UKHSA updated its guidance and, beginning April 2025, will require all diagnostic labs to notify on 

Globally, fungal infections now cause an estimated 3.8 million deaths per year, a figure that has nearly doubled over the past decade, yet they remain underfunded in antimicrobial resistance agendas. Fungal cells’ similarity to human cells complicates drug development. Resistance mechanisms in fungi differ from those in bacteria, so only three antifungal agents targeting priority pathogens are in late‑stage trials. The 

 editorial calls for multicenter clinical‑trial networks to advance these scarce candidates.

Environmental factors amplify the threat. Agricultural azole fungicides resemble clinical antifungals, driving cross‑resistance. India has banned certain agricultural azoles, and both the US Environmental Protection Agency and EU agencies are tightening approval criteria and waste‑management standards to protect human‑use drugs.

 infections within Florida’s Jackson Health System, a large academic medical center. Over five years (2019–2023), clinical cases surged from just five in 2019 to 115 in 2023, a staggering 2,200% increase. Most infections were bloodstream-based, but in recent years, cases originating from soft tissue and bone also rose sharply. All sequenced isolates belonged to clade III (South African), showing resistance to fluconazole but susceptibility to echinocandins and amphotericin B.

 These findings reflect the broader national trend, with the CDC reporting 4,514 clinical 

1. High time to tackle drug-resistant fungal infections. 

2. UK Health Security Agency. Increase in 

) auris reports in England, linked to hospital outbreaks. 

 Updated March 31, 2025. Accessed April 18, 2025. https://www.gov.uk/government/publications/health-protection-report-volume-19-2025/hpr-volume-19-issue-3-news-27-march-2025#:~:text=From%20April%202025%2C%20C.,Protection%20(Notification)%20Regulations%202010

3. Rosa R, Baptista RP, Tran TT, et al. Changing Trends in the Sources and Volumes of Clinical Cultures with Candida auris at a Large Health System, 2019-2023. 

. March 17, 2025. Accessed April 18, 2025. doi:10.1016/j.ajic.2025.03.013

4. Tracking C. auris. CDC. December 9, 2024. Accessed April 18, 2025.
https://www.cdc.gov/candida-auris/tracking-c-auris/index.html?2023=2023

Six hundred thirty-seven cases in England, 4514 US clinical cases in 2023, and only 3 late‑stage antifungal drugs reveal surveillance and treatment gaps.

KRISTEN L. BUNNELL, PHARMD, BCCCP

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