“Always finish your antibiotics” is no longer considered medical best practice for all conditions.

Surprised? You’re not alone.

A new study has found that almost 90% of Americans believe that it’s always best to take the full course of antibiotics, even when you feel better—consistent with long-running but now outdated health campaigns. The reality is more complicated. Sometimes shorter courses are safer, and sometimes longer courses are best.

The survey demonstrates a need for better communication between doctors and patients about what’s healthiest.

“Historically, there was very strong guidance by major health organizations and clinicians that you must always finish the course,” says Alistair Thorpe, PhD, research assistant professor of population health sciences at University of Utah Health and first author on the study. “Now, we’re seeing a growing body of evidence saying that that is not always the case. And oftentimes, shorter durations of antibiotics are as effective and safe as longer alternatives.”

The results are published in Open Forum Infectious Diseases.

A complex reality

The research team surveyed 1,475 people across the country on their attitudes about antibiotic course length. They asked participants whether they’d feel more comfortable taking a three- to five-day course of antibiotics if they had pneumonia, as is recommended by current guidelines, or if they’d prefer an antibiotic course of a week or more, which is recommended by outdated guidelines. While shorter courses of antibiotics are as effective and safer for pneumonia than longer ones, about 60% of people said they’d rather take the longer course.

One of the main reasons people gave for preferring longer antibiotic courses was that they had been told to “always finish their antibiotic course”—88% of respondents had heard of, and agreed with, this common mantra. Most had been told this by their clinician, and many had also heard it via a public health campaign.

A strong body of scientific evidence shows that, for many common infections, shorter courses of antibiotics work as well as longer courses and are less likely to cause side effects. Still, there are some cases, like tuberculosis, where longer courses are most effective.

The study authors suggest that doctors and public health campaigns use several evidence-informed strategies to better communicate the complex reality of antibiotic course length—for instance, avoiding overly simplistic claims that either shorter or longer courses are universally better, and acknowledging that as scientific evidence accumulates over time, health recommendations can change.

To patients who have been prescribed antibiotics, Thorpe recommends having an open conversation with your doctor about the appropriate course length and adherence plan to get health advice that’s specific to your situation.

“Discuss with your clinician what the right duration is for you and when the right time is to stop your course,” Thorpe says. “Getting advice directly from a clinician on a one-to-one basis about what is most appropriate for you in that situation is the right way to go.”

Thorpe emphasizes that the changing recommendations are a positive outcome of increasing knowledge.

“Evidence is growing and guidance is evolving on antibiotic use, which is a normal process and a good sign that we are working to improve how we provide care,” he says. “Our knowledge about how best to use antibiotics has changed, but it has changed because we’re learning more, and it’s important that we make sure we are communicating this well to the public.”

This research is published in Open Forum Infectious Diseases as “US Adults’ Perspectives on Antibiotic Durations and Adherence to Therapy for Common Bacterial Respiratory Infections: A National Survey.”

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Studies in humans show that disrupting the body’s internal clock can weaken immune responses and increase susceptibility to infections. During the COVID-19 pandemic, a study in UK found that sleep disturbances were linked to a higher risk of SARS-CoV-2 infection. “However, no previous study had evaluated whether disrupting the body’s biological clock also increases the risk of developing long COVID”, says first author Kyriaki Papantoniou, Associate Professor at the Medical University of Vienna and Associated Researcher at ISGlobal.

Night shift workers at increased risk of long COVID

In this study, the research team followed 2,941 adults in the population-based COVICAT cohort in Catalonia between 2021 and 2023. Among the 1,899 participants who became infected with SARS-CoV-2, 284 developed long COVID – defined as having persistent symptoms lasting for more than three months after the infection – during the 2-year follow-up.

Compared with day workers, those working night shifts had an 88% higher risk (i.e. almost double) of developing long COVID after accounting for other risk factors such as vaccination history or chronic diseases. This association was stronger in night workers with obesity. Moreover, the increased risk was observed both in current and former night workers, suggesting that it reflects longer-term effects of circadian disruption rather than short-term changes.

In contrast, night shift work was not associated with a higher risk of becoming infected, suggesting that disruption of the biological clock may influence how the body recovers from infection rather than the likelihood of catching the virus.

“Our findings suggest that circadian disruption plays a role in the transition from acute infection to persistent symptoms,” says ISGlobal researcher Manolis Kogevinas, who coordinated the study.

Poor sleep further amplifies the risk

The researchers found that chronic insomnia also increased the risk of long COVID by 42%, independently of night shift work. Together, the two factors had a synergistic effect: night shift workers with chronic insomnia were 2.7 times more likely to develop long COVID than day workers without insomnia.

The biological mechanisms involved are not yet fully understood, but the time of day when the body encounters a pathogen may influence the immune response. In addition, disruption of the body’s biological clock can impair the immune system’s ability to clear the infection.

Improving sleep as a preventive strategy

Given the increase of insomnia prevalence in the general population, the authors underline the need to understand the short and long-term effects of disturbed sleep on infection-related outcomes. In any case, the findings point to sleep as a potentially modifiable factor in preventing long COVID and other post-infectious conditions.

“Promoting healthy sleep habits and minimising circadian disruption could represent simple, low-cost strategies to reduce the long-term consequences of viral infections, particularly among people who work night shifts,” concludes Kogevinas.

The researchers note that the study’s strengths include the use of a well-characterised population-based cohort with detailed information on work schedules, sleep habits and health, as well as an internationally recognised definition of long COVID. However, the participants were aged 40 to 65 years, so the findings may not necessarily apply to younger or older populations, and other occupational factors, such as work-related stress, cannot be completely ruled out.

Reference

K. Papantoniou, A. Espinosa, M Karachaliou, C Lassale, G Castaño-Vinyals, B Harding, De Matteis S, Straif K, E Alonso, C Dobaño, G Moncunill, N Blay, S Iraola-Guzmán, R de Cid, J Garcia-Aymerich, M Kogevinas. Night work, sleep disruption and long-COVID risk: a population-based cohort study. SJWEH. 2026. Doi: 10.5271/sjweh.4318

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Q: What challenges or unmet needs make this study important?

Survival among people with HIV in the United States continues to improve due to highly effective antiretroviral therapy (ART), a lifelong treatment. As a result, costs to Medicare are expected to rise substantially as more adults with HIV live long enough to age into the program. However, it’s been largely unknown just how extensive the increase in Medicare beneficiaries may be over the next decade and how much the program’s spending could rise.

Q: What central question(s) were you investigating?

Our team used simulation modeling to answer these three main questions:

• Over the next decade, how many people with HIV (who are receiving HIV care) over the age of 65 are likely to be enrolled in Medicare?
• How much is Medicare estimated to spend on this population over this time period?
• How might policies or strategies to reduce the cost of ART impact these projections?

Q: What methods or approach did you use?

We developed and populated a new model called CHARMED with projections from the previously validated CEPAC model, Medicare claims data, and publicly available data. Our aim was to simulate a population of Medicare beneficiaries with HIV, aged 65+ and being treated with ART, and their associated costs.

To address uncertainty in model estimates and trends, we examined scenarios where the size and associated costs of this group varied—for example, by assessing the potential impact of policies to reduce the cost of ART. Such policies included the Inflation Reduction Act (IRA), which allows Medicare to negotiate the cost of Biktarvy, the most prescribed ART regimen in the United States, with lower prices to take effect in 2028. Additionally, generic dolutegravir is expected to become available in 2031, thereby enabling a highly effective, well-tolerated, fully generic ART regimen.

Q: What did you find?

Our projections show that nearly 122,000 older adults receiving HIV care may be enrolled in Medicare by the end of 2026—a number that may increase to about 193,600 by the end of 2035. We also estimated that annual Medicare spending for this population may increase from $10.9 billion at the end of 2026 to $27.3 billion at the end of 2035.

Cumulative 10-year costs may reach $187.2 billion, with 63% attributable to ART costs alone. If ART costs were reduced by 60%, Medicare could potentially save $70.3 billion over the next decade. Moreover, if current prescribing patterns remain unchanged, policies such as the IRA and the availability of generic HIV medications could save Medicare approximately $19 billion between 2026 and 2035.

Q: What are the real-world implications, particularly for patients?

Our findings demonstrate that the number of older adults living with HIV is likely to increase substantially over the next decade, driving up Medicare enrollment. Clinicians and healthcare systems must be prepared to address the medical needs of this growing population through comprehensive, person-centered care—especially given these individuals’ increased risk of comorbidities and polypharmacy (taking several medications regularly).

We also conclude that policymakers for Medicare and other public programs will likely seek out ways to reduce the cost of HIV care. While recent proposals have included higher Medicare premiums, drug coverage reductions, and stricter eligibility for drug assistance programs, our paper points to other promising strategies to reduce ART costs without increasing patient costs or limiting access.

Authorship: In addition to Hyle and Freedberg, Mass General Brigham authors include Luke Ang, Grace Luu, Florence Ebem, Satoshi Koiso, Paul E. Sax, John Giardina, E. John Orav, Anne M. Neilan, and Jose F. Figueroa. Additional authors include Parastu Kasaie, Dannie Dai, Jessica Phelan, Ciara Duggan, Elizabeth Humes, Dori Molozanov, Lucas Gerace, Tim Horn, Ankur Pandya, and Keri N. Althoff.

Paper cited: Hyle, EP., et al. “Ten-Year Cost Projections for Medicare Beneficiaries 65 Years or Older with HIV.” JAMA Network Open. DOI: 10.1001/jamanetworkopen.2026.21966

Funding: This research was funded by the National Institutes of Health (R01 AG069575, R01 AI042006, R01 AG081151, U01 AI069918, R01 AG053100, R01 AI179776) and the Massachusetts General Hospital Jerome and Celia Reich HIV Scholar Award.

Disclosures: Hyle, Humes, Giardina, Neilan, Figueroa, Althoff and Freedberg reported receiving grants from the National Institute of Health (NIH).

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‘It’s very important that the problem is recognised and that we show that it can be measured by objective testing,’ says Prof Neil Lagali, professor of experimental ophthalmology at Linköping University, who led the study published in Nature Communications. ‘Patients don’t have access to that [testing] today. We’ve studied people in Sweden, but believe that many people around the world are experiencing these problems.’

The study originated with people seeking care for eye problems following a mild COVID-19 infection. They were experiencing a lot of discomfort, sensitivity to light and in many cases severe eye pain, difficulty reading and focusing their gaze.

The researchers examined 100 people with eye problems following COVID-19 who had not been hospitalised. They had suffered from eye problems for between three months and three years, and one in three were on full or part-time sick leave. The researchers compared the affected group with a control group of 32 people, who had also had mild COVID-19 but without eye problems.

‘We found that the problems experienced by those affected were not detectable by standard tests. We had to perform specialised examinations to detect deviations. The puzzle pieces then fell into place, and we found explanations for the symptoms,’ says Neil Lagali.

In their study, the researchers found long-term inflammation and deterioration of several eye functions controlled by the nerves in the brain.

One of the advanced tests involved proteomics, where a variety of proteins in the tear fluid are analysed. In those with eye problems, the researchers found an abnormal pattern of proteins regulating nerves and immune cells, so-called T cells. The findings were consistent with advanced eye microscopy that they used to measure the T cells and nerves in the eye. Strikingly, the same protein pattern has been found in blood and tissue in cases of severe and fatal COVID in other studies.

‘Our findings suggest that these people have suffered a severe reaction to COVID-19 manifested in the eyes, with long-term inflammation and an impact on the nerves that control multiple eye functions,’ says Dr Petros Moustardas, senior research associate at Linköping University and lead author of the study.

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The study explored whether prophylactic (shortly before or after exposure) administration of the recently developed clinical candidate GHP-88310 (described in Science Advances²), a broad-spectrum inhibitor of the viral polymerase, prevents virus transmission through close contact or through the air. The results demonstrate that GHP-88310 efficiently blocks both forms of viral spread. In addition, the study showed that treatment of infected animals shortened the time period in which infected animals could transmit the virus.

“Silencing measles outbreaks quickly is essential to reestablish control over the virus,” said senior author Richard Plemper, a Regents’ Professor and director of the CTAR. “This study follows our recent development of the drug candidate GHP-88310. It demonstrates that the drug is suitable to augment traditional ring vaccination against measles.”

Since 2025, measles has reemerged in the United States with thousands of cases across multiple states, hundreds of hospitalizations and three confirmed deaths. Large outbreaks in Canada and Mexico with multiple deaths have challenged the measles elimination status of North America.

“We were very excited to see that GHP-88310 given by mouth completely prevented airborne transmission in our ferret model of measles,” said first author Carolin Lieber, a senior postdoctoral fellow in the Plemper lab. “This finding is unprecedented for a viral polymerase inhibitor and demonstrates the extraordinary antiviral potency of this drug.”

To explore relevant conditions of viral transmission, the researchers developed a system that allowed them to pair infected and uninfected animals in direct physical contact or shared airspace, each under controlled environmental parameters.

“We designed the study to recapitulate viral spread between people with direct contact, for instance in a household, and between more distant social contacts, for example in classrooms or other indoor settings that bring people into proximity without direct interaction,” said Plemper. “In addition to this prophylactic benefit, GHP-88310 used therapeutically shortened the duration of disease in our model. If equally applicable to human hosts, it may shorten the severe social and economic burden of prolonged quarantine of patients and further aid outbreak management.”

The investigators are now readying GHP-88310 for formal clinical testing.

Additional authors of the study include Josef Wolf, Claire Ruckel and Lauren Harrison of the Center for Translational Antiviral Research in the Institute for Biomedical Sciences at Georgia State.

The study was funded by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH).

To read the studies, visit

¹ DOI 10.1038/s41564-026-02419-y. Once published online, it will be available at URL: https://www.nature.com/articles/s41564-026-02419-y

² DOI: 10.1126/sciadv.aef1594. URL: https://www.science.org/doi/10.1126/sciadv.aef1594?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

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The study, published in The Lancet Infectious Diseases journal and funded by the National Institute for Health and Care Research (NIHR), involved nearly 800 adults in England with long Covid who were randomly assigned either usual care or one of three types of drugs: a combination of antihistamines (allergy medicines), an anti-inflammatory drug called colchicine (used to treat gout), or a blood thinner called rivaroxaban (typically used to prevent blood clots and strokes).

The research team found that all groups experienced a meaningful reduction in their self-reported fatigue over 12 weeks (improving an average of 4.3 points on a 40-point scale), supporting the idea that specialist long Covid care can lead to important improvements in symptoms.

Those taking antihistamines and colchicine, but not the blood thinner rivaroxaban, saw a small additional benefit in fatigue reduction at 12 weeks (an extra 1.5 point improvement on the scale). However, this benefit was not sustained at 24 weeks (12 weeks after the participants stopped taking the drugs).

The trial was conducted by a national team of researchers, clinicians and patients across 12 clinics in England and Scotland led by co-chief investigators Professor Amitava Banerjee at UCL and Dr Melissa Heightman at UCLH. More than 30 organisations were involved, with UCLH recruiting around half the patients on this trial and the University of Lancashire Clinical Trials Unit co-ordinating all of the recruiting sites.

Professor Banerjee (UCL Institute of Health Informatics), the corresponding author, said: “We tested potential medicines based on the most promising theories of how to improve long Covid when we started out in 2021. Our findings suggest these drugs alone are unlikely to be the answer to long Covid fatigue. Antihistamines and the anti-inflammatory drug, colchicine, did provide a small benefit, but this did not last once participants stopped taking them and so they are unlikely to improve symptoms over the long term on their own.

“Both antihistamines and colchicine affect the immune system and it may be that they address the immune dysregulation that long Covid has been linked to, but further research is needed to understand the possible mechanism.

“The blood thinner, rivaroxaban, had no benefit and so our results do not support the use of anti-coagulation medicine for long Covid.”

Dr Melissa Heightman, clinical lead for the post-Covid service at UCLH, said: “It is heartening that people had a significant reduction in fatigue across all arms of the trial. This is more than you would expect based on time alone, given that participants had severe fatigue at recruitment and been ill for more than a year on average.

“This level of improvement shows the importance of specialist long Covid care. These services in England offer integrated care from a range of specialties with community-based rehabilitation to develop a plan for a person based on their symptoms and all of the ways the condition affects them.”

Participants of the trial were adults with long Covid who had not been hospitalised. The 12 long Covid clinics ranged from Hull and the Highlands to Leicester and London. Fatigue was assessed with a questionnaire at the start of the trial and then after 12 and 24 weeks.

The trial was open-label, meaning participants knew which drug they were taking (there was no placebo in the non-drug group), and so the researchers were unable to rule out a placebo effect. However, they said the benefit seen in two of the drug groups was unlikely to be caused by placebo alone, given that no such benefit was found for the other drug group (rivaroxaban).

Professor Banerjee said: “We have shown it is possible to conduct a large clinical trial for long Covid and to test treatments as we would for any other condition.”

Professor Danny McAuley, Scientific Director for NIHR Programmes, said: “The NIHR is proud to have funded this vital trial, which highlights the value of specialist care in delivering meaningful relief for long Covid patients. Finding even modest benefits for these inexpensive drugs, which are safe and commonly used for other conditions, is incredibly important to improve the evidence-based treatment of this complex condition. By providing the high-quality data needed to refine clinical approaches, this research ensures that the NIHR is helping to build a clearer, safer path forward for patient care which can be provided in the community.”

Professor Emma Wall, Clinical Research Group Leader at the Crick, Professor of Infectious Diseases at Queen Mary University of London, and academic consultant in Infectious Diseases and Acute Medicine for UCLH, said: “Because long Covid is such a new and complex condition, when it came to designing the trial, we started by listening to what patients were telling us about their symptoms and experiences, then looking for biological signals that might explain them and treatments that might help.

“The value of these results is not only that they suggest a potential treatment approach, but that they help us understand the biology of long Covid itself. Every signal we see in the trial helps us refine our understanding of the immune and inflammatory mechanisms that may be driving the disease, to develop new, better targeted treatments for future trials.”

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Robert Fletcher of the University of Cambridge, Health Data Research UK and The George Institute, and study co-lead says:

“Levels of obesity in England have worsened since the pandemic, with nearly one in three people now affected.

“We’re also seeing large disparities across the country: the percentage of adults affected by obesity in northeast England is six times higher than in central London. Differences on this scale are rarely seen in other areas of public health. The rise in new cases among young adults of childbearing age is especially concerning. Beyond the implications for their own long-term health, obesity is associated with infertility, adverse pregnancy outcomes, and child obesity, which may perpetuate intergenerational cycles of health inequality.”

Key findings:

Obesity is rising: Rates of new obesity cases increased overall by 4% in 2025 compared with before the COVID-19 pandemic.

Young adults hit hardest: The largest increases over time were seen in younger adults. Rates of new obesity cases rose by almost 20% in those aged 30-39, and by 16% in those aged 20-29, while rates fell among adults aged 60-79.

Risk rises with deprivation: Over the study period, rates of new obesity cases were 35% higher for people with the highest socioeconomic deprivation (those with the lowest incomes, highest unemployment, and poorest housing) compared with people with the lowest socioeconomic deprivation. The gap was wider still for women, where new cases were 54% higher among the most deprived, and widest for Asian women, at 94% higher.

Ethnicity and deprivation compound: The percentage of people living with obesity ranged from 4% among the most affluent White men aged 18–19 to 66% among the most socioeconomically deprived Black women aged 60–69 – nearly double the figure for the least-deprived White women of the same age.

Large geographical differences: The percentage of people affected by obesity in some areas of northeast England (48%) was nearly six times higher than that seen in the most affluent parts of central London (8.5%). The steepest increases over time were seen in areas with the lowest GDP per capita.

The person-level data analysed in this study has all direct identifiers such as names and NHS numbers removed before researchers access the data, which is then only accessible within NHS England’s Secure Data Environment. The data is only accessible by approved researchers working on approved, COVID-19 related research projects.

The researchers’ definition for obesity was a recorded body-mass index (BMI) of 30 or above, or a clinician’s diagnosis of obesity in a person’s health records. Their findings from this electronic health record study correspond well with the NHS Health Study for England, which samples households across the country, giving confidence in the extra depth of the insights this study is able to provide.

They looked at rates of new cases of obesity (incidence) and the percentage of people with obesity (prevalence) in the general population, as well as differences across sociodemographic groups and geographical regions.

Obesity is now more common than hypertension (high blood pressure) in the UK, and nearly three times as common as smoking. It is a chronic, complex disease linked with a whole host of conditions, including heart disease, stroke, cancer, diabetes, and kidney failure. As well as affecting individuals’ mental wellbeing, and placing growing pressure on both the healthcare system and the economy. These findings highlight the scale and urgency of the obesity crisis, and how it has worsened since the COVID-19 pandemic.

GLP-1 receptor agonist drugs, like Ozempic/Wegovy and Mounjaro, are known to be effective in managing obesity and are being more widely prescribed and used. The study did not set out to examine their impact.

“We don’t see any obvious reduction in obesity in our data following the introduction of GLP-1 receptor agonists, at least not within the current study period,” says Robert Fletcher. “However, the drugs on their own are unlikely to be the answer. At present, the majority are privately prescribed and the jabs are expensive, which poses a barrier for people from disadvantaged backgrounds. We need deep-seated change to the many social and economic factors that drive obesity in the first place.”

Naveed Sattar, one of the co-authors, Professor of Cardiometabolic Medicine at the University of Glasgow and Chair of the Obesity Health Care Goals Programme, agrees:

“Obesity is not primarily about will power. These new, powerful data indicate that those most at risk frequently reside in the most obesogenic environments and likely have the least agency to withstand such environments. To achieve lasting change, the UK must expand access to new treatments faster but also fundamentally reshape food and activity environments so that healthier choices occur with minimal conscious effort. Failure to act will drive further rises in multimorbidity and human suffering, with profound consequences for the NHS and the wider economy.”

Study co-lead Angela Wood, Professor at the University of Cambridge and Associate Director at the British Heart Foundation Data Science Centre, says:

“The COVID-19 pandemic has had a lasting impact on health and lifestyle behaviours. By analysing electronic health records from the entire adult population of England before, during, and after the pandemic, we have generated the most comprehensive evidence to date on how obesity risk and burden are increasingly diverging across multiple dimensions of inequality. These findings underscore the critical importance of secure access to whole-population health data to enable research, surveillance, and timely action to address widening health inequalities.”

The study, funded by the Wellcome Trust, Health Data Research UK, the British Heart Foundation, the National Institute for Health and Care Research Cambridge Biomedical Research Centre, the Cambridge British Heart Foundation Centre of Research Excellence, has been published in The Lancet Diabetes & Endocrinology.

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In a study published June 19 in Science Immunology, researchers evaluated a two-part vaccination against genital herpes. With the technique, the first part — a typical intramuscular injection like you would receive for a flu shot, for example — is followed by the introduction of nanoparticles to the vagina, where herpes infection occurs in women.

The idea is the initial injection “primes” the immune system while the second localized treatment “pulls” immune activity right to where infection takes place. This study extends the original “prime and pull” approach by developing a new nanoparticle that effectively induces local immunity.

“We’ve found that, in preclinical experiments, this approach is a safe way to recruit the right immune cells in the right place to generate protective immunity,” said senior author Akiko Iwasaki, Sterling Professor of Immunobiology at Yale School of Medicine.

A two-pronged vaccine for genital herpes immunity

Efforts to develop a genital herpes vaccine have uncovered a key limitation of typical intramuscular injections: They do not establish robust immune cell populations or antibodies against the herpes virus at the vaginal lining where the virus is introduced in women. This limits the extent of immune attack against the herpes virus.

To address this challenge, the Iwasaki lab has explored methods to “pull” an immune response to the vaginal lining. They first tested whether introducing chemokines — proteins that can direct immune cells — to the vagina could establish immunity there. That technique led to only partial protection against herpes as it did not engage necessary immune cells called B cells.

They then evaluated a DNA molecule that stimulates the immune system. While it did reduce the amount of virus at the vagina, it also caused inflammation.

So the researchers wondered if combining the two methods might yield the best of both worlds.

“We had these two really promising strategies in the lab, but each had some shortcoming,” said Sachin Bhagchandani, a postdoc in Iwasaki’s lab and lead author of the study. “So we set out to formulate a particle that could overcome those shortcomings.”

Nanoparticles prevent herpes infection

The result of that work is BEACON (Bioactive Enhanced Adjuvant Chemokine Oligonucleotide Nanoparticles). The researchers made these nanoparticles by linking a piece of immunostimulating DNA to a chemokine.

“Sachin led this work, creating a nanoparticle that was stable and effective, which was no small feat,” said Iwasaki, who is also a professor of dermatology and of epidemiology, as well as an investigator with the Howard Hughes Medical Institute.

For the study, the researchers first primed female mice with an intramuscular vaccination against the herpes virus and then applied BEACON and virus antigen intravaginally. They found that BEACON established strong immune cell and antibody responses against the herpes virus in the vaginal tissue and that it lasted long term, at least six months.

When exposed to the herpes virus, mice given the “prime and pull” treatment were highly resistant to infection: 80% displayed no signs of disease over six months. That’s compared with just 40% of mice that received the intramuscular injection alone.

“That showed us that this approach could be profoundly impactful, establishing local immune responses for a significantly long period of time,” said Bhagchandani.

Further, BEACON enabled the researchers to target the right cells for generating immunity, rather than broadly affecting all cells. This meant they needed less of the DNA molecule than they used in previous experiments, and this smaller amount prevented the development of inflammation.

“This formulation is quite remarkable in that way,” said Iwasaki.

A vaccine for humans

The researchers are now evaluating whether this “prime and pull” method can be used to treat infection as well as prevent it. They’re also thinking about what this might look like for people.

“We’re collaborating with the Appel lab at Stanford to see if we can turn BEACON into translatable formulation, such as a vaginal suppository,” said Bhagchandani. “We’re also exploring a nasal approach wherein the ‘pull’ happens in the nose, which would allow this kind of treatment to work for men as well.”

While further down the road, the researchers aim to test this method in human clinical trials, because ultimately, the goal is to develop a vaccine for humans.

“A lot of the suffering patients go through is not just physical; it’s mental and societal,” said Iwasaki. “But viruses are the same — whether it’s the flu or Epstein-Barr virus or herpes simplex, it’s not the person’s fault that they caught it. And yet there’s a lot of stigma. We hope that this kind of strategy will prevent diseases that affect people in a profound way.”

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Two succinct articles in CMAJ (Canadian Medical Association Journal) provide information about each disease for clinicians.

Hantavirus:

1. A nationally notifiable disease in Canada — In Canada, 4 to 5 cases are confirmed every year and must be reported. These are usually acquired from rodents in agricultural settings in Manitoba, Saskatchewan, Alberta, and British Columbia. The Andes strain is unique as it can be transmitted from person to person.
2. Causes 2 clinical symptoms — Strains in the Americas, which include the Andes virus featured recently in the news, cause hantavirus cardiopulmonary syndrome. The European and Asian strains cause hemorrhagic fever and kidney dysfunction. Both forms take about 2 to 4 weeks to incubate, and symptoms include fever, headache, muscle aches, and abdominal pain.
3. Serology and polymerase chain reaction (PCR) tests are diagnostic — The National Microbiology Laboratory in Winnipeg performs these tests.
4. Supportive treatment — As there is no specific antiviral treatment or vaccine for hantavirus, treatment is supportive to help alleviate symptoms.
5. IPAC protocols are essential — Patients with suspected Andes strain infection must be isolated with airborne, droplet, and contact precautions, with infectious diseases experts involved and public health notified.

Ebola virus disease:

1. Sporadic outbreaks have occurred in Central and West Africa since 1976 — There are 3 main viruses that can infect humans, and evidence suggests they come from fruit bats. Ebola virus is spread via person-to-person contact through bodily fluids like vomit, sperm, diarrhea, and blood, as well as by touching infected surfaces or objects. The current outbreak in the Democratic Republic of Congo is Bundibugyo ebolavirus, with a fatality rate of 30% to 50%.
2. Fewer than 50% of patients have hemorrhagic symptoms — Symptoms include fever of 38°C or higher, fatigue, muscle pain, and gastrointestinal distress. Incubation is 2 to 21 days, and diagnosis is made with PCR testing.
3. People with potential symptoms and exposure risk should be tested — People who have travelled to countries with Ebola virus disease or who have been in close contact with infected people or bats, primates, or game from the affected areas should be tested.
4. Stringent IPAC must be used for suspected cases — Health Canada has a detailed process for screening, assessment, and IPAC precautions, which must include a fit-tested N95 respirator, face shield, gloves, and fluid-impermeable gear for full protection.
5. Important advances in prevention and management of the disease have been made — Vaccines to prevent Zaire ebolavirus are very effective, and 2 antivirals can reduce mortality from 50% to 35%. However, there are no current vaccines or medications to prevent or treat Bundibugyo ebolavirus, for which supportive care is the main approach.

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The findings, published in the Journal of Emergency Medicine, suggest that EDs could play an important role in increasing vaccine coverage, particularly among medically underserved populations.

Led by Dr. Robert Rodriguez, a professor of medicine in the UCR School of Medicine, the researchers surveyed 3,285 adult patients at 10 emergency departments in eight U.S. cities between April and December 2024. Nearly all participants (96%) had heard of the influenza vaccine, and 77.6% reported receiving a flu vaccine at some point in their lives. However, 58.4% had not received a flu vaccine within the past year and were therefore not up to date with current recommendations.

The study also identified significant disparities in vaccination status. Patients without a primary care provider were more than twice as likely to be behind on influenza vaccination, with lower vaccination rates also seen in patients lacking insurance and African American patients.

Among participants who were not up to date on their flu vaccination, 37% said they would accept a flu shot if it were offered during their emergency department visit.

“Emergency departments are often the only point of contact with the health care system for many patients,” said coauthor Dr. Rajesh Gulati, a professor of medicine in the UCR School of Medicine. “Our findings show that there is a substantial opportunity to reach people who may not have access to primary care and help close important gaps in influenza vaccination coverage.”

Influenza remains a major global public health threat, contributing to an estimated 650,000 deaths worldwide each year. Despite longstanding recommendations for annual vaccination, fewer than half of U.S. adults received a flu vaccine during the 2023–2024 season.

The researchers found that lack of primary care access was the strongest predictor of being behind on influenza vaccination. More than one in five study participants reported not having a primary care provider.

“The message from this study is clear: many patients who are either unaware of or not receiving preventive care elsewhere are willing to be vaccinated when given the opportunity,” said Sanya Dhama, first author of the paper and a medical student at UCR. “Emergency departments can serve as a critical public health safety net — not only for acute care, but also for preventive services such as influenza vaccination.”

Among patients who declined vaccination in the emergency department, the most common concerns were fear of vaccine side effects, a desire for more information about vaccines and influenza, and feeling too ill at the time of the visit.

“These findings suggest that educational messaging and targeted outreach could further improve acceptance,” Rodriguez said.

The cross-sectional study was conducted at EDs in Chicago, Detroit, Durham, Philadelphia, Fresno, Los Angeles, San Francisco, and Sylmar. The researchers surveyed adult patients regarding their knowledge of influenza vaccination, vaccination status, willingness to receive a flu shot in the emergency department, and reasons for vaccine acceptance or refusal.

“Emergency departments represent an underutilized venue for influenza vaccination surveillance, education, and vaccine delivery,” Rodriguez said. “Expanding ED-based vaccination programs could help reduce influenza-related illness, hospitalization, and death, particularly among populations with limited access to routine health care.”

The study was supported in part by the National Institute of Allergy and Infectious Diseases.

Rodriguez, Gulati, and Dhama were joined in the study by Shaokui Ge at UCR; Dr. Jesus Torres at UCLA; Dr. Brian Chinnock at UCSF Fresno; Dr. Michael Gottlieb at Rush University Medical Center, Illinois; Dr. Vijaya Arun Kumar at Wayne State University, Michigan; Dr. Kristin L. Rising and Dr. Efrat Rosenzweig Kean at the Thomas Jefferson University Hospital, Pennsylvania; Dr. Stephanie Eucker, at the Duke University School of Medicine, North Carolina; Dr. Melanie F. Molina at UC San Francisco.

The title of the paper is “Up to Date Status and Acceptance of the Influenza Vaccine among a National Sample of Emergency Department Patients.”

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“In the United States, that’s hundreds of thousands, if not a million cases of flu that we can avoid each year,” said senior study author Anupam Jena, the Joseph P. Newhouse Professor of Health Care Policy in the Blavatnik Institute at HMS. “That’s a huge effect size.”

The findings provide additional support for the flu vaccine at a time when childhood vaccines have come under scrutiny in the United States. This January, the U.S. Centers for Disease Control and Prevention removed the annual influenza vaccine, as well as several others, from its childhood schedule of recommended vaccines. That change, which was widely condemned by medical societies and public health organizations, was blocked by a U.S. District Court in March.

“The federal government cited an absence of evidence that they want to see, and so we have provided that,” said Christopher Worsham, HMS assistant professor of medicine at Massachusetts General Hospital and first author on the study. “We have randomized data, and it shows that flu vaccines are effective for these young children.”

Sorting by birthday

Young children typically have an annual visit to the doctor scheduled around their birthday. For children born in the fall, those visits are a convenient time to get the flu vaccine. But children born in the summer will likely have appointments before the flu vaccine becomes available — they need an additional appointment to get vaccinated.

In previous research, Jena and Worsham found that the additional burden on caretakers results in lower flu vaccination rates in summer-born children. This creates a natural experiment, randomly sorting children into more- or less-vaccinated groups based on the happenstance of when they were born.

The researchers compared insurance claims data for summer-born and fall-born children between the ages of 2 and 5 over five flu seasons between 2016 and 2023. (They skipped the 2020-2021 and 2021-2022 seasons because of confounding factors from COVID-19.)

In each season, fall-born children were more likely to be vaccinated and less likely to catch the flu.

The vaccination rates for children with fall birthdays were between 8.6 and 12.5 percentage points higher than those with summer birthdays and the influenza diagnosis rates were 1.0 to 1.4 percentage points lower.

“Across these five seasons, we see that for every hundred kids who are randomly vaccinated because of when their birthday falls, somewhere between nine and 14 of them avoid a case of the flu that they otherwise would have caught,” said Jena, who is also a professor of medicine at Mass General.

For other illnesses that do not have vaccines, such as the common cold or gastrointestinal viruses, there was no difference in the infection rates of the two groups.

“It comes down to: vaccines work,” Worsham said.

More natural experiments

As children get older, birthdays and doctor’s appointments stop being so closely aligned. The researchers note that after about age five, the influenza diagnosis rates between fall- and summer-born children start to even out.

“The randomized data we have is limited to these very young children because their doctor appointments are tied to their birthday,” Worsham said.

That doesn’t mean that the vaccine isn’t effective in older children, teenagers, or adults — it definitely is, Worsham said. But after a certain age, birthdays are no longer good indicators of whether someone is more or less likely to have received the flu vaccine, so this experiment can’t capture vaccine effectiveness in older groups.

This work is just one example of a randomized experiment that can be found in existing data — there are many similar opportunities across different fields of medicine, the researchers said. Jena and Worsham are frequent collaborators and have co-authored a book, Random Acts of Medicine, on the subject.

“It is impossible to do a randomized controlled trial for every single thing that we want to know and understand,” Jena said. “But we have an incredible amount of data out there and there are randomized experiments like this sitting in that data, waiting to be uncovered.”

Authorship, funding, disclosures

Charles F. Bray, HMS hourly research assistant in health care policy and master’s student at Havard T.H. Chan School of Public Health, is co-author of the study.

This research was not directly supported by any funders.

The authors report no conflicts of interest related to this work. A full list of disclosures can be found in the paper.

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The initiative is part of a wider effort to support clinicians and the public in understanding the robust regulatory system that underpins vaccine safety. It shows how regulators require strong evidence to approve vaccines, but also highlights how real-world evidence is collected from millions of doses after vaccines become available to the public.

The first Vaccine Essentials publication focuses on Meningococcal group B vaccines (MenB). MenB vaccines were chosen in part because the story of how they are regulated illustrates the value of combining immunogenicity data (which shows that the vaccine induces an immune response) with real-world effectiveness studies that determine impact of a vaccine in a clinic.

‘In the case on MenB vaccines, by supplementing the initial evidence (pre-approval) with additional data (post-approval), regulators were able to further confirm the vaccines’ safety, effectiveness, as well as their favourable benefit/risk balance,’ the EMA says.

The MenB factsheet was developed with the European Academy of Paediatrics and based on a peer-reviewed publication. ‘MenB vaccines represent a success story on the prevention of a very serious disease mainly affecting infants and teenagers,’ said Dr Hans J. Dornbusch of the European Academy of Paediatrics. ‘In clinical practice, in a child with fever, if all meningococcal immunisation is up to date, the risk of severe illness including meningitis is really low.’

The Agency has also assembled a new advisory group on vaccine confidence, bringing together international experts to advise on how to build and maintain trust in the regulatory system. Rather than championing vaccines per se, the regulator seeks to ensure that important health decisions are taken based on evidence and a sound understanding of science.

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