Friday, April 04, 2025

 

How a small number of mutations can fuel outbreaks of western equine encephalitis virus



Study shows how spike protein changes determine the risk of viral outbreaks




Harvard Medical School



New research shows how small shifts in the molecular makeup of a virus can profoundly alter its fate. These shifts could turn a deadly pathogen into a harmless bug or supercharge a relatively benign virus, influencing its ability to infect humans and cause dangerous outbreaks.

This is the latest finding in a series of studies led by Jonathan Abraham, associate professor of microbiology in the Blavatnik Institute at Harvard Medical School, and his team that aim to understand the risk of western equine encephalitis virus and related viruses. The work, which was supported by federal funding, is published in Cell on April 4.

The findings, the research team said, offer important insights that could help researchers and public health experts better anticipate the likelihood of future outbreaks.

Historically, WEEV has caused large and dangerous outbreaks of encephalitis (a serious type of brain inflammation) among humans and horses throughout the Americas.

The virus circulates mainly between mosquitoes and birds. Since the turn of the century, WEEV has disappeared as a pathogen in North America. In South America, the virus occasionally spilled over to sicken small numbers of humans and mammals. However, in 2023, WEEV caused the first major human outbreak in four decades in South America, involving thousands of horses and over a hundred confirmed human cases.

How did the virus lose its ability to infect humans in North America? Why did the virus persist as a pathogen in South America and re-emerge to cause a major outbreak? The secret lies in alterations in its molecular makeup, the new study found.

Using an advanced imaging technique, the researchers determined how the spike proteins on the surface of WEEV strains isolated over the past century interact with a type of cell receptor known as PCDH10 that is shared by humans and birds.

The virus enters its host and causes infection by attaching one of its spike proteins to a receptor on the surface of the host cell. In order to cause infection, the spike protein and receptor need to fit each other, like matching pieces of a jigsaw puzzle.

In a strain from 1958, when deadly WEEV outbreaks happened regularly, the virus was a good fit for both human and bird cell receptors.

However, a North American WEEV strain isolated from mosquitoes in California in 2005 was a good fit for bird cell receptors but not for mammals.

The researchers found that a single mutation in the virus’s spike protein was enough to prevent it from attaching to human and horse cells. The mutation, however, still allowed the virus to enter and infect cells using the bird receptor.

Strains isolated in South America over the past century, including the 2023–2024 outbreak strains, had never acquired the single mutation that would prevent them from attaching to the human and horse cell receptors.

The researchers also observed that a single change in the viral spike protein enabled WEEV strains to attach to a different receptor called VLDLR, found on mammalian brain cells. This same receptor is shared by WEEV’s cousin, eastern equine encephalitis virus (EEEV), which is the most virulent alphavirus and has continued to cause outbreaks in North America. In the past, highly virulent, ancestral forms of WEEV were capable of invading host cells through VLDLR.

Notably, when researchers blocked this key receptor using a decoy VLDLR protein, animals infected with the older, more dangerous WEEV strain were protected against the deadly brain inflammation caused by these virulent strains.

The new findings offer critical clues for pandemic preparedness because they provide insights on the first major human outbreak of WEEV in four decades in South America and could help efforts to monitor North American WEEV strains for their potential to cause large outbreaks.

Additionally, the virus’s rapid ability to shift from a harmless reservoir in insects and wild birds to a dangerous human pathogen highlights the importance of surveillance efforts to monitor for potential outbreaks and emerging diseases.

“The more we understand about this important group of emerging viruses before a serious threat emerges, the better,” Abraham said.

 

Authorship, Funding, Disclosures

Additional authors include Xiaoyi Fan, Wanyu Li, Jessica Oros, Jessica A. Plante, Brooke M. Mitchell, Jesse S. Plung, Himanish Basu, Sivapratha Nagappan-Chettiar, Joshua M. Boeckers, Laurentia V. Tjang, Colin J. Mann, Vesna Brusic, Tierra K. Buck, Haley Varnum, Pan Yang, Linzy M. Malcolm, So Yoen Choi, William M. de Souza, Isaac M. Chiu, Hisashi Umemori, Scott C. Weaver, and Kenneth S. Plante.

This work was supported by NIH awards R01 AI182377, T32AI700245, T32GM144273, T32GM008313, T32AG000222-33, R24 AI120942, T32AG000222-32, and R01 MH125162; the Jackson-Wijaya Fund; Wellcome Trust grant 226075/Z/22/Z; a Burroughs Wellcome award; a Vallee Scholar award; a Smith Family Foundation Odyssey award; a Charles E.W. Grinnell Trust award; and a G. Harold and Leila Y. Mathers Foundation award. Cryo-EM data were collected at the Harvard Cryo-EM Center for Structural Biology at Harvard Medical School.

 

Research uncovers hidden spread of one of the most common hospital-associated infections



University of Utah Health
Personal protective equipment 

image: 

A health care provider cleans their hands. Hand hygiene is a crucial measure to prevent the invisible spread of C. difficile and other infections.

view more 

Credit: Charlie Ehlert / University of Utah Health




Key Points:

  • C. difficile is one of the most common and contagious hospital-acquired infections.
  • Research has found that C. diff spreads more than three times more than previously thought.
  • C. diff can spread covertly from surface to surface and remain undetected for weeks until it infects a patient.

IMPACT: The results could spur more rigorous preventive measures that stop hidden spread of the disease.

One of the most common health care-associated infections spreads within intensive care units (ICUs) more than three times more than previously thought, new research has found.

Clostridium difficile infection—commonly called C. diff—causes diarrhea, abdominal pain, and fever and is lethal in about 6% of cases in the U.S. The disease is highly contagious, but in previous research, direct patient-to-patient transmission seemed to occur rarely. Now, by tracking the bacterium through the hospital environment, rather than on patients alone, scientists have uncovered previously undetected movement of C. diff bacteria through hospital settings.

“There's a lot going on under the hood that we're just not seeing,” says Michael Rubin, MD, PhD, epidemiologist and infectious diseases specialist in the Spencer Fox Eccles School of Medicine at the University of Utah and senior author on the study. “And if we ignore that, then we’re potentially putting patients at unnecessary risk.”

The results are published in JAMA Network Open.

 

Bacterial movement within the environment is common

To track infections throughout the health care setting, the researchers sampled for C. diff from nearly 200 patients across two intensive care units (ICUs), as well as collecting thousands of samples from hospital room surfaces and health care providers’ hands.

The researchers used whole genome DNA sequencing to precisely track bacterial movement. Different bacterial samples have genetic differences, which the researchers measured to track movement of C. diff around health care facilities. The team was even able to use these differences to determine if two bacterial samples came from the same patient, rather than being acquired independently from a source outside the hospital.

The team detected the bacteria in 10% of patient ICU stays—either on the patient’s body or in their immediate room environment. And in most of those cases, the bacteria were genetically identical to those found in another patient or another patient’s room, suggesting that the bacteria originated from the same patient rather than coming from two different sources.

“We find about the same amount of patient-to-patient transmission as previous studies,” explains Lindsay Keegan, PhD, research associate professor in epidemiology at U of U Health and first author on the study. “But what we find that’s novel is that there is a lot more movement of C. diff between surfaces, from surface-to-patient, and from patient-to-surface than previously found.”

 

Revealing long-term spread

By simultaneously tracking different bacterial varieties on patients, health care providers’ hands, and in the environment, the researchers uncovered cases of potential transmission that wouldn’t have been caught with other methods.

Notably, the team discovered that for more than half of potential transmission events, the two patients involved were never even in the hospital at the same time—sometimes being separated by weeks. The key to this paradox is the exceptional hardiness of C. diff: the bacteria can survive for a long time outside the body, withstanding common antibacterial measures such as alcohol-based cleansers. Bacteria from one person could be inadvertently transferred to surfaces in a different room, where they could lie in wait for another patient, undetected.

Importantly, not all C. diff bacteria cause disease, and most of the C. diff spread the researchers observed involved harmless bacterial varieties. However, the researchers say that the spread of non-disease-causing C. diff suggests that similar transmission of disease-causing C. diff could be going undetected.

 

How to prevent infection

The researchers say that they hope their results lead to stronger precautions to prevent the spread of disease within hospitals.

“What I'm hoping we get from this paper is that health care providers put a greater emphasis on infection prevention measures and adhere to them as much as they possibly can,” Rubin says. Using personal protective equipment such as gloves and gowns, as well as practicing rigorous hand hygiene, are crucial, he adds. “Those are the measures that can help interrupt this type of invisible transmission.”

 

###

The results published in JAMA Network Open as “Environmental and Health Care Personnel Sampling and Unobserved Clostridium difficile Transmission in ICU.”

The study was funded by the National Institutes of Health / National Institute of Allergy and Infectious Diseases grant 1K01AI159519 and the Centers for Disease Control and Prevention grants 5U01CK000585 and HHSD-200-2011-42039. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keegan reported receiving grants from the US Centers for Disease Control and Prevention (CDC) Center for Forecasting and Outbreak Analytics outside the submitted work. Karim Khader, PhD, reported receiving grants from the Department of Veterans Affairs (VA) and bioMerieux outside the submitted work. Rubin reported receiving grants from the CDC and the VA outside the submitted work.

 

Exposure to wildfire smoke linked with worsening mental health conditions



Harvard T.H. Chan School of Public Health




Key points:

  • Short-term exposure to fine particulate air pollution (PM2.5) from a wildfire may increase the risk of emergency department visits for mental health conditions, especially for women, youth, racial minorities, and Medicaid enrollees.
  • The study is among the first to examine the relationship between wildfire-specific PM2.5 and mental health.
  • According to the researchers, the findings highlight the need for targeted interventions to prevent and address increased mental health distress during wildfire seasons, especially for vulnerable populations.

Boston, MA—Exposure to fine particulate air pollution (PM2.5) from wildfire smoke was associated with increased visits to emergency departments (ED) for mental health conditions, according to a new study led by researchers at Harvard T.H. Chan School of Public Health.

“Wildfire smoke isn’t just a respiratory issue—it affects mental health, too,” said corresponding author Kari Nadeau, John Rock Professor of Climate and Population Studies and chair of the Department of Environmental Health. “Our study suggests that—in addition to the trauma a wildfire can induce—smoke itself may play a direct role in worsening mental health conditions like depression, anxiety, and mood disorders.”

The study will be published April 4 in JAMA Network Open.

The study is the first to isolate the short-term impact of wildfire-specific PM2.5, offering more precise insights into its impacts on mental health. A growing body of research suggests that PM2.5 may influence mental health outcomes, but few studies have investigated the effects of wildfire-specific PM2.5. Most studies of wildfire-specific PM2.5 have focused on its relationship to respiratory and cardiovascular outcomes.

The researchers analyzed data on wildfire-specific PM2.5 levels and emergency department visits for mental health conditions throughout California between July and December 2020, a period covering the state’s most severe wildfire season on record. Daily wildfire-specific PM2.5 levels and visits to the ED for mental health conditions—including psychoactive substance use disorders, psychotic disorders, mood-affective disorders, depression, and anxiety—were ascertained for each zip code in the state.

Throughout the study period, there were 86,588 mental health ED visits. The average daily concentration of wildfire-specific PM2.5 was 6.95 micrograms per cubic meter of air (μg/m3), a level that rose to 11.9 μg/m3 during peak wildfire months and to 24.9 μg/m3 during the highest peak in September. 

The study found that exposure to wildfire smoke substantially increased mental health ED visits. A 10 μg/m3 increase in wildfire-specific PM2.5 was linked to a higher number of visits, including for depression, anxiety, and other mood-affective disorders, for up to seven days post-exposure. Women, children and young adults, Black and Hispanic individuals, and Medicaid enrollees showed the highest risk of mental health ED visits from exposure to wildfire-specific PM2.5.

“The disparities in impact by race, sex, age, and insurance status suggest that existing health inequities may be worsened by wildfire smoke exposure,” added lead author YounSoo Jung, research associate in the Department of Environmental Health. “We need to make sure everyone has access to mental health care during wildfire seasons, particularly the most vulnerable groups and particularly as wildfires become more frequent and severe as a result of climate change.”

Other Harvard Chan authors included Mary Johnson and Caleb Dresser.

The study was supported by the National Heart, Lung, and Blood Institute (grant P01HL152953).

“PM2.5 from 2020 California Wildfires and Mental Health-Related Emergency Department Visits,” YounSoo Jung, Mary M. Johnson, Marshall Burke, Sam Heft-Neal, Melissa L. Bondy, R. Sharon Chinthrajah, Mark R. Cullen, Lorene Nelson, Caleb Dresser, Kari C. Nadeau, JAMA Network Open, April 4, 2025, doi: 10.1001/jamanetworkopen.2025.3326

Visit the Harvard Chan School website for the latest news and events from our Studio.

###

Harvard T.H. Chan School of Public Health is a community of innovative scientists, practitioners, educators, and students dedicated to improving health and advancing equity so all people can thrive. We research the many factors influencing health and collaborate widely to translate those insights into policies, programs, and practices that prevent disease and promote well-being for people around the world. We also educate thousands of public health leaders a year through our degree programs, postdoctoral training, fellowships, and continuing education courses. Founded in 1913 as America’s first professional training program in public health, the School continues to have an extraordinary impact in fields ranging from infectious disease to environmental justice to health systems and beyond.

Fine particulate matter from 2020 California wildfires and mental health–related emergency department visits




JAMA Network Open




About The Study: 

Wildfire smoke exposure was associated with significantly increased odds of subsequent emergency department visits for mental health conditions in this cross-sectional study, with varying lag times for different subconditions and demographic groups. Health care professionals and systems should prepare for a possible increase in demand for mental health–related emergency services during wildfire events.



Corresponding Author: To contact the corresponding author, Kari C. Nadeau, MD, PhD, email knadeau@hsph.harvard.edu.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2025.3326)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

#  #  #

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2025.3326?guestAccessKey=c0957767-f5eb-4d6d-88a4-15c747418b57&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=040425

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

Gender inequity in institutional leadership roles in US academic medical centers




JAMA Network Open






About The Study: 

This systematic scoping review suggests that even though emphasis has been placed on addressing gender inequities in academic medicine, considerable disparities remain at the leadership level. While certain positions and specialties have been observed to have more female leaders, niches of academic medicine almost or completely exclude women from their leadership ranks. Importantly, even female-dominated specialties, such as obstetrics and gynecology, have substantial inequity in leadership roles. It is past time for organizational and systems-level changes to ensure equitable gender representation in academic leadership.




Corresponding Author: To contact the corresponding author, Marilyn Huang, MD, MS, email msh8f@uvahealth.org.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2025.2829)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

#  #  #

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2025.2829?guestAccessKey=c0957767-f5eb-4d6d-88a4-15c747418b57&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=040425

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

Coseismic surface ruptures of 2023 Türkiye earthquake doublet, and seismic hazard assessment of the East Anatolian Fault Zone




Science China Press
Coverage of post-earthquake high-resolution satellite images and map of coseismic surface ruptures that resulted from the 2023 Türkiye earthquake doublet 

image: 

1:250,000 active faults were obtained from Emre et al. (2012). The seismogenic faults of historical earthquakes were sourced from Duman and Emre (2013). Earthquake catalog was obtained from USGS (2023).

view more 

Credit: ©Science China Press





This study is led by Prof. Yue-Ren Xu at the Institute of Earthquake Forecasting, China Earthquake Administration (IEF, CEA). This article focuses on using high-resolution satellite data to rapidly assess surface ruptures caused by strong international earthquakes. Post-earthquake high-resolution satellite images have become invaluable in mapping coseismic surface ruptures induced by strong earthquakes. This study took the 2023 Türkiye earthquake doublet as an example. On February 6, 2023, twin earthquakes shook southeastern Türkiye and northwestern Syria. The first earthquake, known as the Pazarcık earthquake, occurred at 1:17 A.M. GMT (4:17 AM local time) with a moment magnitude of MW7.8 and a focal depth of 10 km. The second strong earthquake, the Elbistan earthquake, occurred 9 hours later, with MW7.5 (37.196°E, 38.011°N) and a focal depth of 7.4 km.

After the mainshocks, various post-earthquake high-resolution satellite data covered the epicenter area, providing valuable information for rapidly assessing surface ruptures. Xu’s group utilized multiple images, including the Chinese GF-series satellites (GF-2/7), the Beijing satellites (BJ-2/3), and the Maxar satellites. The spatial resolution of those images ranges from 0.3 to 0.8 m. The interpretations based on those data yielded the results: the two strong earthquakes had separate rupture zones. The first earthquake generated an approximately 280 km coseismic surface rupture along the southwestern segment of the main East Anatolian Fault (EAF), with 241 left-lateral displacements reaching up to 6.8 ± 0.68 m, particularly 40 km northeast of the epicenter. The second earthquake produced a roughly 110 km surface rupture on an east-west branch of the EAF, with maximum displacements of 7.2 ± 0.72 m. The group also compared the distribution of the surface ruptures and offsets derived from these high-resolution satellite images with the results obtained from InSAR and field measurements. They think that rapid assessment based on high-resolution remote sensing data can help scholars quickly understand the characteristics of surface ruptures caused by strong earthquakes abroad.

Based on the MW7.8 earthquake’s cascading rupture pattern, the group found that surface rupture might not always follow established recurrence intervals. During cascading ruptures, the maximum surface slip was constrained by the accumulated stress energy of individual fault segments. Despite the magnitude of the MW7.8 earthquake, its maximum surface offset was smaller than that of the MW7.5 earthquake. Xu also pointed out in this article that “the 1822 MS7.5 earthquake likely occurred on the Yesemek segment rather than the Amanos segment, preventing rupture and aftershocks from extending southward along the Narlı segment during the MW7.8 earthquake”.

Finally, the group argued that the Malatya Fault and specific EAF segments, such as the Palu, Karlıova, and Amanos segments, may pose seismic risks in the future. Hence, focusing on enhanced seismic fortification efforts in the valley regions near these fault segments is crucial.


(a) comparison of coseismic surface displacements induced by the MW7.8 earthquake extracted in this study (based on high-resolution satellite image interpretation and field surveys) and those reported by Karabacak et al. (2023) and Meng et al. (2024). (b) coseismic surface displacements induced by the MW7.5 earthquake extracted based on high-resolution satellite image interpretation and field surveys conducted in this study.

Credit

©Science China Press