It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Saturday, November 22, 2025
Discovering America’s ‘epilepsy belt’: First-of-its-kind national study reveals US regions with high epilepsy rates among older adults
Insufficient sleep, extreme heat, physical inactivity, healthcare access and low vehicle access linked to higher disease risk
A first-of-its-kind nationwide study has mapped epilepsy incidence rates among older adults in the United States and identified key social and environmental factors associated with the neurological condition. Published recently in JAMA Neurology, the study is a collaborative effort between researchers at Houston Methodist Research Institute and Case Western Reserve University. The analysis revealed that epilepsy cases among adults aged 65 and older were significantly higher in parts of the South—including Louisiana, Mississippi, East Texas and central Oklahoma—compared to other regions.
Epilepsy affects an estimated 3.3 million people in the United States, according to the U.S. Centers for Disease Control and Prevention. In 2019, health care spending on epilepsy and seizures reached $24.5 billion.
Against this backdrop, the study’s lead investigator, Weichuan Dong, Ph.D., assistant professor at the Houston Methodist DeBakey Heart & Vascular Center and adjunct assistant professor at Case Western Reserve University, said the research offers critical insight into how epilepsy impacts older adults nationwide—revealing geographic patterns that could reshape how communities approach prevention and care for this neurological condition.
“Until now, we didn’t have a national picture of where epilepsy affects older adults the most,” Dong said. “By applying advanced geospatial mapping to Medicare data, we revealed striking clusters of high epilepsy rates across parts of the South — what we call the ‘epilepsy belt.’ Understanding where the burden lies is the first step toward uncovering why and helping communities reduce risk.”
The study also found that the most influential factors linked to higher epilepsy incidence included insufficient sleep (fewer than seven hours per night), extreme heat (more days with heat index above 95 degrees), lack of physical activity, lack of health insurance among younger adults (suggesting delayed diagnosis until Medicare eligibility) and limited access to a household vehicle. These conditions, often shaped by local environments and socioeconomic status, were more prevalent in regions with the highest epilepsy rates.
“This is the first study documenting such a strong association between extreme heat and incident epilepsy in older adults across the U.S., highlighting the importance of climate change in emergency preparedness, especially given the graying of the population,” said Siran Koroukian, Ph.D., professor in the Department of Population and Quantitative Health Sciences at Case Western Reserve University School of Medicine.
Using advanced geospatial machine learning algorithms, researchers analyzed data from 4.8 million Medicare beneficiaries between 2016 and 2019. Data sources included the U.S. Medicare Master Beneficiary Summary File and the Agency for Healthcare Research and Quality. Alaska and Hawaii were excluded due to incomplete data from the Social and Environmental Determinants of Health report.
The study uncovered patterns previously invisible in national data, showing how factors like neighborhood sleep habits, heat exposure, health care access and household vehicle access can shape health outcomes. Other strong predictors included obesity prevalence and availability of primary care physicians.
Collaborators on the study included Alex Cabulong, Long Vu, Hannah Fein, Nicolas Schiltz and Martha Sajatovic from Case Western Reserve University; Sadeer Al-Kindi from Houston Methodist Heart and Vascular Center; David Warner from University of Alabama at Birmingham and Bowling Green State University; and Gena Ghearing from Mount Sinai Health System.
This work was supported in part by a grant from the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (U48 DP006404-03S7) and the Center for Family and Demographic Research, Bowling Green State University (P2CHD050959). Additional support was provided by the Health Systems Management Center Leadership Fund from Case Western Reserve University.
Tampa, FL, USA, November 20, 2025: The Global Virus Network (GVN), a coalition of leading human and animal virologists in more than 40 countries dedicated to advancing pandemic preparedness through research, education and training, and global health solutions, today issued a statement on the emergence of a new influenza A (H3N2) variant known as H3N2 subclade K that is spreading rapidly and may contribute to a more intense flu season worldwide. Public health agencies in the United Kingdom, several countries across Europe, Japan, and parts of North America have reported sharp week-over-week increases in cases driven by this subclade, signaling accelerated global spread.
GVN experts report that H3N2 subclade K represents an evolved branch of the seasonal H3N2 viruses that circulate each year. The strain has accumulated several mutations that may increase transmissibility and enable partial immune escape, contributing to earlier and more widespread influenza activity in multiple regions. Surveillance data show particularly rapid growth in the UK and Western Europe, with rising detections in Canada and the northeastern United States, as well as increased influenza activity across East Asia. Although this year’s vaccine is imperfectly matched to the new variant, available evidence indicates it still provides meaningful protection, particularly against severe illness and hospitalization.
Peter Palese, PhD, pioneering influenza virologist, GVN Center of Excellence director at the Icahn School of Medicine at Mount Sinai, and National Academy of Sciences member, explained that “this new H3N2 subclade K variant is not an entirely new virus but a further evolved form of the influenza strains we confront every year. What we are seeing is genetic drift, meaning the virus has gradually accumulated small mutations in its surface proteins over time. These subtle changes can make it harder for the immune system to fully recognize the virus, even in people who were previously infected or vaccinated. Even with this drift, vaccination remains our most effective measure to prevent severe disease and reduce pressure on hospitals, which is why continued investment in influenza research, including efforts toward universal vaccines, is so important.”
Building on this assessment, Sten H. Vermund, MD, PhD, GVN chief medical officer and dean of the University of South Florida College of Public Health, noted that “influenza’s evolution this season highlights the reality that viral threats never occur in isolation. We are monitoring not only this drifted H3N2 subclade K variant but also ongoing avian influenza activity, including infections caused by H5 viruses in both animals and humans. This moment calls for a renewed commitment to vaccine uptake and early antiviral treatment. Global vigilance is supported by strong surveillance systems and responsible communication.”
What the New Strain Means for Global Health
• H3N2 subclade K is a mutated form of circulating H3N2 viruses that is spreading more efficiently and partially evading existing immunity. This pattern of change is known as viral “drift,” in contrast to the more extreme “shift” that can precede pandemic spread. • Despite the drift, the current seasonal vaccine still offers protection, especially against severe disease.
• Countries reporting the steepest increases include the UK, France, Germany, Japan, and Canada, with additional growth now observed in the northeastern United States.
• Several countries are reporting an earlier and stronger start to flu season, raising concern about increased strain on health systems. • Avian influenza viruses, including H5 and H9 lineages, continue to cause sporadic human infections, underscoring the need for strong One Health surveillance.
GVN Recommendations
In alignment with its mission to strengthen pandemic preparedness through research, education, and global health solutions, the GVN urges governments, clinicians, and communities to:
• Strengthen influenza vaccination campaigns, particularly for high-risk groups such as older adults, young children, pregnant individuals, people with chronic conditions, and those with weakened immune systems. • Increase access to rapid diagnostics and early antiviral treatment. • Enhance integrated One Health surveillance across human, animal, and environmental sectors. • Invest in next-generation and broadly protective influenza vaccines. • Maintain timely and transparent data-sharing across regions.
Dr. Vermund emphasized that “influenza teaches us every year that preparedness cannot be seasonal. It must be continuous, globally coordinated, and grounded in science, surveillance, and strong public health systems.”
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About the Global Virus Network
The Global Virus Network (GVN) is a worldwide coalition comprising 90+ Virology Centers of Excellence and Affiliates across 40+ countries, whose mission is to facilitate pandemic preparedness against viral pathogens and diseases that threaten public health globally. GVN advances knowledge of viruses through (i) data-driven research and solutions, (ii) fostering the next generation of virology leaders, and (iii) enhancing global resources for readiness and response to emerging viral threats. GVN provides the essential expertise required to discover and diagnose viruses that threaten public health, understand how such viruses spread illnesses, and facilitate the development of diagnostics, therapies, and treatments to combat them. GVN coordinates and collaborates with local, national, and international scientific institutions and government agencies to provide real-time virus informatics, surveillance, and response resources and strategies. GVN's pandemic preparedness mission is achieved by focusing on Education & Training, Qualitative & Quantitative Research, and Global Health Strategies & Solutions. The GVN is a non-profit 501(c)(3) organization. For more information, please visit www.gvn.org
Uncovering the source of widespread ‘forever chemical’ contamination in North Carolina
Story behind the discovery in North Carolina’s Haw River watershed offers insights and raises concerns for other communities dealing with high levels of PFAS
Lee Ferguson loads a water sample into one of his laboratory’s powerful mass spectrometers, which are used to discover chemicals and contaminants in environmental samples.
An environmental chemistry laboratory at Duke University has solved a longstanding mystery of the origin of high levels of PFAS—so-called “forever chemicals”—contaminating water sources in the Piedmont region of North Carolina.
By sampling and analyzing sewage in and around Burlington, NC, the researchers traced the chemicals to a local textile manufacturing plant. The source remained hidden for years because the facility was not releasing chemical forms of PFAS that are regulated and monitored. The culprit was instead solid nanoparticle PFAS “precursors” that degrade into the chemicals that current tests are designed to detect.
Incredibly, these precursors were being released into the sewer system at concentrations up to 12 million parts-per-trillion—approximately 3 million times greater than the Environmental Protection Agency’s recently-enacted drinking water regulatory limit for certain types of PFAS.
While precursors typically degrade slowly over time into types of regulated PFAS, Burlington’s atypical wastewater treatment practices were turbocharging the transformation. With these chemicals especially concentrated in sewage sludge and the resulting biosolids commonly used as fertilizer across the region, the findings indicate PFAS will continue leaching into the region’s soils and waterways for decades to come.
Published November 18 online in the journal Environmental Science & Technology Letters, the findings provide both a warning and playbook for others worried about the worldwide spread of these forever chemicals.
“We have some of the most sophisticated instruments in the world for PFAS analysis, and we couldn’t detect these until we dramatically changed our approach,” said Lee Ferguson, professor of civil and environmental engineering at Duke, who led the years-long effort. “Sometimes we don’t know what we don’t know, and there is a lesson to be learned about blind spots in our analyses when it comes to looking for new PFAS in the environment.”
In the early 2010s, it was discovered that per-and polyfluoroalkyl substances, or PFAS, are both harmful to human health and nearly impossible to degrade in the environment. With many different formulations, this class of chemicals have long been used in nonstick frying pans, water–repellent sports gear, stain–resistant textiles, cosmetics, firefighting foam and countless other consumer products since the 1940s.
These forever chemicals made headlines in North Carolina in 2015 when a study from the EPA found GenX and other forms of PFAS at high levels in the Cape Fear River. The discovery set off a domino effect, with study after study finding PFAS compounds in places they shouldn’t be, such as the Wilmington public water supply and hundreds of local wells.
Funded by an initial $5 million grant from the NC General Assembly in 2018, the state of North Carolina created an ambitious statewide testing network to monitor PFAS levels in the state’s drinking water. Led by Ferguson and colleagues from North Carolina State University and the University of North Carolina at Chapel Hill, the network represents a wide–ranging attempt to monitor the compounds’ presence in drinking water supplies in 405 municipalities across the state.
“There’s never been a large-scale chemical pollutant source and distribution study done like this before anywhere in the country,” said Ferguson.
One such locale of unacceptably high levels of PFAS was the town of Pittsboro, NC. Early results from the statewide testing network indicated that the contamination was likely coming from upstream in the Haw River, from which the town gets its drinking water. This led researchers to Burlington’s wastewater treatment plant, which releases its treated water into the river upstream of Pittsboro.
Confusingly, tests showed much higher levels of PFAS coming out of the facility than going into it. This indicated that PFAS precursors that do not show up on routine tests were entering the plant and being transformed during treatment. Burlington was at the time using a treatment method produced by Zimpro that uses heat and pressure to break down complex organic compounds. The process, unfortunately, was also converting these PFAS precursors into more dangerous forms of these forever chemicals.
“As soon as they shut that process off, the measurable PFAS levels in the wastewater came way down,” said Ferguson. “But the precursors were still coming into the facility and being concentrated into sludge that is eventually spread on agricultural fields, where they will transform to regulated forms of PFAS over time. We needed to find the source.”
Led by Patrick Faught, a PhD student in Ferguson’s lab, the researchers began the hunt. Faught worked with the City of Burlington to obtain samples of wastewater and raw sewage from dozens of places upstream of the wastewater treatment plant. But the samples’ levels of known PFAS precursors were far too low to explain the measurements taken at the treatment facility. Undaunted, Ferguson suggested putting the samples through a process that mimics the facility’s former treatment technology.
“After turning all the available PFAS precursors into measurable forms of PFAS, the levels in one textile manufacturer’s wastewater jumped 50,000 to 80,000 percent,” Faught said. “I jumped out of my chair when I saw the results.”
“It’s the most dramatic result I’ve ever seen in my lab,” Ferguson added. “It contaminated all of our instruments for over a week.”
Faught and Marzieh Shojaei, a postdoctoral researcher in the Ferguson lab, spent the next six months trying to pin down which precise PFAS precursors were in the samples. But time and again, they came up empty. Eventually, the team thought to look for particulate forms of PFAS precursors suspended in the textile wastewater rather than dissolved chemicals. After a complex process of filters and centrifuges, they discovered insoluble nanoparticles made of side-chain fluorinated polymers that nobody had reported in an environmental sample before.
What’s more, a colleague in the department of textile engineering, chemistry and science at North Carolina State University provided a sample of a water and stain repellant fabric treatment similar to those used by textile manufacturers discharging to the Burlington sewer. The results from that sample matched almost perfectly with what the team had just discovered in a specific manufacturer’s wastewater discharged to the city’s sewage.
With this information in hand, the town of Burlington worked with that textile manufacturer to change their process and bring down the concentrations of these nanoparticles using its pretreatment authority outlined in the Clean Water Act. Ever since, the amount of PFAS precursors coming into Burlington’s wastewater treatment facility has been orders of magnitudes lower.
“Every system downstream of that facility is also now seeing a significant drop in the amount of PFAS in their drinking water,” Ferguson said.
This drop in PFAS, Ferguson said, is a great indicator that these issues can be taken care of at their source rather than through new treatment processes that get rid of the difficult-to-destroy PFAS molecules. But he also cautions that this story is not yet completely told.
These PFAS precursor nanoparticles have been accumulating in treatment-plant-derived biosolids used as fertilizer across eastern North Carolina for years. This explains another longstanding mystery of why the town of Chapel Hill’s raw drinking water has had elevated levels of PFAS: The PFAS precursor nanoparticles in this biosolids fertilizer essentially act as a slow-release source of PFAS and will continue to do so for many decades to come.
It's an issue that the researchers say many other communities across the country will now have to consider.
“We don’t really understand how long it takes these PFAS precursor nanoparticles to transform in wastewater and biosolids and seep into the surrounding environment,” Ferguson said. “That is an area that still needs more funding and research for us to fully understand.”
This work was performed in collaboration with the Southern Environmental Law Center and the Haw River Assembly. It was conducted through the North Carolina PFAS Testing Network, supported by an award from the North Carolina Collaboratory with funding appropriated by the North Carolina General Assembly.
“Colloidal Side-Chain Fluorinated Polymer Nanoparticles Are a Significant Source of Polyfluoroalkyl Substance Contamination in Textile Wastewater.” Patrick W. Faught, Marzieh Shojaei, Abigail S. Joyce, and P. Lee Ferguson. Environmental Science & Technology Letters, 2025. DOI: 10.1021/acs.estlett.5c01014
Patrick Faught was instrumental in taking samples from sewersheds and testing them for PFAS to track down the source of Burlington’s elevated levels of “forever chemicals.”
