Category: 8. Health

Gastrointestinal parasites in dogs such as Toxocara canis (roundworms) and Ancylostoma caninum (hookworms) in the USA are some of the most important and commonly diagnosed infections. In a study evaluating monthly prevalence data captured by the Companion Animal Parasite Council (CAPC) in the USA between 2012 and 2018, prevalence rates of A. caninum were reported to have increased yearly, with an overall 47% increase during this time [1]. Yearly prevalence rates for T. canis remained relatively consistent while Trichuris vulpis, whipworm, was found to have decreasing prevalence from 0.8% to 0.67% between 2012 and 2018 [1]. In Colorado, a study found the prevalence of canine hookworm increased by 137.3%, and roundworm increased by 35.6%, from 2013 to 2017, highlighting the important role dog importation plays in parasite and disease transmission, with many shelters and rescue organizations relocating dogs from the southeastern USA [2].

Dogs, the definitive host for T. canis, become infected via transplacental transmission (in utero) or by ingesting larvated eggs or infected paratenic hosts such as rodents, rabbits, chickens, and other birds [3,4,5]. Eggs shed in the environment require 2–4 weeks to develop to the infective third-stage larvae (L3) [6]. Roundworm eggs are extremely resistant to environmental changes, capable of surviving for many years owing to their thick outer shell, therefore timely removal of infected fecal material from the environment is key to reducing transmission [7, 8]. After ingestion of larvated eggs, roundworm penetrate the intestinal mucosa, migrate through the liver and lungs, are coughed up and re-ingested, finally residing in the small intestine and developing into sexually mature adult worms [6]. In adult dogs, many ingested roundworm larvae arrest in somatic tissues during migration and are then activated during pregnancy, infecting puppies in utero transplacentally and, to a lesser degree, through transmammary transmission while nursing [9].

Ancylostoma caninum infects dogs through ingestion of larvae from the environment, direct larval skin penetration, or ingestion of infected paratenic hosts such as rodents [10,11,12]. Hookworm eggs hatch and develop to L3 after approximately 2–9 days in the environment depending on the temperature and humidity, with hookworm being more susceptible to desiccation than roundworm. After ingestion, some L3 migrate through the lungs and arrest in somatic tissue, while other L3 remain in the alimentary tract and develop into sexually mature adults in the small intestine [13]. If infected by direct skin penetration, L3 migrate via the veins and lymphatics to the lungs, enter the trachea where the parasite is swallowed, and then develop in the small intestine to sexually mature adults [12]. In addition, transmammary infection can occur as arrested larvae in the tissues are reactivated during pregnancy and migrate to the mammary glands, thereby infecting puppies during nursing [14]. Arrested larvae in the somatic tissues can reactivate in dogs outside of pregnancy and can continuously migrate to the small intestine and develop to the adult stage leading to repeated repopulation of the intestine and prolonged egg shedding despite treatment, termed “larval leak” [15].

While many roundworm and hookworm infections in dogs may be asymptomatic, the most common clinical signs include diarrhea and vomiting, abdominal distention, and lack of growth in young dogs in roundworm infections, as well as anemia, malnutrition, and even death in severe hookworm infections [10, 16]. In addition, roundworms and hookworms are important zoonotic parasites. Infection in humans with T. canis can cause visceral larva migrans (VLM), ocular larva migrans, or neurotoxocariasis with resulting brain tissue damage, and infection with Ancylostoma spp. can induce cutaneous larva migrans (CLM) [17,18,19].

In order to properly diagnose and treat these important gastrointestinal parasites, CAPC currently recommends dogs receive fecal examinations at least four times in their first year of life and then at least twice annually thereafter, by fecal flotation with centrifugation. Puppies should be treated with anthelmintics at 2-week intervals, starting at 2 weeks of age until 8 weeks of age, and then administration of a year-round broad-spectrum anthelmintic thereafter to provide continuous protection [20]. In addition, prompt removal of feces from the environment is crucial to help prevent environmental contamination and future transmission. Drugs currently labeled for the treatment of T. canis and/or A. caninum by the US Food and Drug Administration (FDA) include fenbendazole, febantel, pyrantel, milbemycin oxime, and moxidectin, available in many different administration routes such as oral, topical, and injectable, and developed as both monotherapy and combination therapy formulations. Incorporation of combination therapy products in veterinary clinics has been demonstrated to increase the average number of monthly doses dispensed to clients as compared with monotherapy products, thereby increasing parasite coverage [21]. In addition, the ease of use of combination therapy products may increase owner compliance with timely and adequate administration.

The occurrence of drug resistance in A. caninum has been documented recently in racing greyhound and pet dog populations across the USA [22,23,24]. Fecal samples obtained from suspected A. caninum-resistant cases were evaluated for benzimidazole and macrocyclic lactone resistance in vitro using the egg hatch (EHA) and larval development (LDA) assays, and pyrantel resistance in vivo, demonstrating in vitro resistance ratios ranging from 6.0 to > 100 and 5.5 to 69.8 for the EHA and LDA, respectively. No reduction in fecal egg counts were observed post-treatment with pyrantel, providing additional confirmation these hookworm isolates were multidrug resistant [25]. The mechanism of action and corresponding mutations associated with benzimidazole resistance in A. caninum has been confirmed, with a commercial diagnostic test available to detect molecular markers in fecal samples (KeyScreen^® GI Parasite PCR, Antech Diagnostics, Inc.). This information is not yet understood for macrocyclic lactones and pyrantel, requiring in vitro EHA or LDA to identify macrocyclic lactone resistance and in vivo fecal egg count reduction testing to identify pyrantel resistance [23].

This real-world field study provides practical information on product performance for veterinarians and pet owners, especially given rising A. caninum resistance. The objective of the field study described below was to evaluate the efficacy and safety of a novel, oral chewable tablet containing lotilaner, moxidectin, praziquantel, and pyrantel (Credelio Quattro^™, Elanco Animal Health, Greenfield, IN, USA), against naturally occurring roundworm and hookworm infections in dogs in the USA.

Despite clear clinical guidelines recommending biomarker testing to guide targeted therapies in advanced cancers, a recent cohort study reveals suboptimal testing rates, though these are increasing over time. Importantly, comprehensive genomic profiling (CGP) did not result in higher overall health care costs during first-line therapy compared to non-CGP testing, while showing an increased likelihood of patients receiving appropriate targeted treatments.¹

These findings, published in JAMA Network Open, underscore the critical need to improve access to biomarker testing to optimize patient outcomes.

The retrospective study, leveraging claims data from 26,311 adults with newly diagnosed advanced breast, colorectal, gastric, non–small cell lung, ovarian, and pancreatic cancers, highlights a persistent gap between guideline recommendations and clinical practice. While 35% of patients had evidence of molecular testing before first-line therapy, this figure varied significantly by cancer type, ranging from a low of 17% in ovarian cancer to a high of 45% in non–small cell lung cancer (NSCLC). Although testing rates showed an upward trend from 32% in 2018 to 39% in 2021 to 2022, the overall proportion remains below guideline recommendations.

CGP Boosts Targeted Therapy Uptake

One of the study’s key findings is the association between CGP testing and increased receipt of targeted therapy. Patients with NSCLC and colorectal cancer (CRC) who underwent CGP testing were significantly more likely to receive targeted therapy during first-line treatment compared with those who received non-CGP testing or no testing. For NSCLC, the odds of receiving targeted therapy were 1.57 times higher for CGP-tested patients compared to those with non-CGP testing (P <.001). Similarly for CRC, CGP-tested patients had 2.34 times higher odds of receiving targeted therapy compared to the non-CGP group (P <.001). This suggests that comprehensive profiling offers a tangible benefit in identifying actionable mutations, thereby enabling more patients to access precision medicine.

Cost Neutrality and Clinical Implications

A crucial aspect addressed by the study is the economic impact of CGP. Analysis of per-patient per-month (PPPM) costs during first-line therapy revealed no statistically significant difference in all-cause health care costs between patients who received CGP testing and those who received non-CGP testing across all evaluated cancer types. For instance, the cost ratio for breast cancer was 1.03 (P =.63), for CRC 0.98 (P =.71), and for NSCLC 1.06 (P =.054). While both CGP and non-CGP groups generally had higher costs than the no-testing group, this is likely attributed to the downstream costs of targeted therapies, which are often more expensive but also more effective.

The cost neutrality of CGP is a vital consideration for health care systems and payers. Concerns about the expense of advanced genomic testing have sometimes been cited as barriers to wider adoption. This study provides real-world evidence that the initial investment in comprehensive profiling does not translate into a significant increase in overall first-line therapy costs, especially when considering the potential for improved clinical outcomes through optimized treatment selection.

Addressing the Testing Gap

The study underscores a persistent practice gap between clinical guidelines and the actual implementation of biomarker testing. Despite the growing number of FDA-approved biomarker-targeted therapies and their inclusion in standard treatment guidelines, a substantial proportion of patients with advanced cancer are not receiving recommended testing. This is particularly concerning given the well-established survival advantages associated with biomarker-matched targeted therapies.

“A large body of research has demonstrated the value of biomarker testing, especially for NSCLC,” study authors wrote. “Biomarker testing, when completed before first-line therapy, can meaningfully improve outcomes of patients with NSCLC.^1,2 National clinical guidelines recommend completing broad molecular profiling during the diagnostic evaluation and before initiation of first-line treatment. Despite this evidence, only 45% of patients with NSCLC had evidence of biomarker testing by the start of first-line therapy.”

One factor often cited as a barrier to CGP is inadequate insurance coverage. However, the study found that testing rates in Medicare Advantage beneficiaries were generally lower or comparable to commercial health plan patients, despite comprehensive genomic profiling being covered.¹ This suggests that factors beyond insurance coverage, such as lack of physician awareness, logistical challenges in ordering and processing tests, or delays in obtaining results, may also contribute to suboptimal testing rates.

Future Directions

The study acknowledges limitations inherent in using administrative claims data, such as the inability to capture specific biomarker test results or differentiate between squamous and nonsquamous NSCLC. However, the large cohort size and real-world setting provide valuable insights into current biomarker testing practices and their associated costs and targeted therapy uptake.

Moving forward, interventions are urgently needed to improve biomarker testing rates across all cancer types, especially as more targeted therapies emerge. Healthcare providers should prioritize early and comprehensive genomic profiling for patients with advanced cancers, in line with clinical guidelines. Education initiatives for clinicians, streamlined testing workflows, and improved access to molecular pathology services could all contribute to closing the testing gap. Given the potential for CGP to optimize tissue stewardship, detect genomic signatures like tumor mutational burden, and enhance eligibility for clinical trials, its increased adoption holds significant promise for improving patient outcomes without imposing a substantial additional financial burden.

REFERENCES:

1. DaCosta Byfield S, Bapat B, Becker J, et al. Association of Comprehensive Genomic Profiling and Non–Comprehensive Genomic Profiling With Targeted Therapy Use and Costs in Patients With Advanced Cancer. JAMA Netw Open. 2025;8(7):e2519963. doi:10.1001/jamanetworkopen.2025.19963.

2. Aggarwal C, Marmarelis ME, Hwang WT, et al. Association between availability of molecular genotyping results and overall survival in patients with advanced nonsquamous non-small-cell lung cancer. JCO Precis Oncol. 2023;7:e2300191. doi:10.1200/PO.23.00191

A new report by California health officials highlights the risks posed by consuming raw dairy products.

The report, published yesterday in Morbidity and Mortality Weekly Reports, describes an outbreak of Salmonella Typhimurium linked to raw milk from a California dairy farm. The outbreak, which stretched from October 2023 to March 2024, sickened 171 people in California and four other states, including 120 children and adolescents. Children were the most likely to be hospitalized among all age-groups.

The authors of the report say the outbreak, one of the largest foodborne outbreaks linked to raw milk in recent US history, is a reminder that commercially distributed raw dairy products continue to present a risk for enteric and other infectious diseases. In addition to Salmonella, unpasteurized milk has also been linked to outbreaks of Escherichia coli,Campylobacter, Brucella, and Cryptosporidium infections.

From 2009 through 2021, a total of 143 enteric disease outbreaks confirmed or suspected to be associated with consumption of raw milk were reported to the Centers for Disease Control and Prevention.

“Public health messaging should explain the risks associated with these products to consumers, especially those at risk for severe disease, including children,” the authors wrote.

Rapid detection led to timely recall

The outbreak first came to light on October 18, 2023, when health officials in San Diego County notified the California Department of Public Health (CDPH) of eight salmonellosis cases in people who reported drinking brand A raw milk produced exclusively by a licensed local dairy farm (dairy farm A) and commercially distributed throughout California. That notification, along with a report from another local health department (LHD) of a Salmonella Typhimurium infection in a person who drank raw milk from the same farm, prompted a statewide investigation.

Testing of 40 product samples (raw milk, heavy cream, cheese, and kefir) collected from dairy farm A, retail stores, and patient homes by CDPH and the California Department of Food and Agriculture (CDFA) detected Salmonella Typhimurium in three of the samples, including two from bottles of raw milk at the farm’s bottling facility and from a retail sample of raw milk. A sample of raw cheese aged for more than 60 days that was collected in January 2024 from the farm would also test positive for Salmonella.

Public health messaging should explain the risks associated with these products to consumers, especially those at risk for severe disease, including children.

Whole-genome sequencing (WGS) revealed the Salmonella Typhimurium isolates in the raw milk samples were indistinguishable from patients’ isolates. The dairy farm halted production on October 24, 2023, and voluntarily recalled its raw milk. Internal testing by the farm detected Salmonella in milk from a recently purchased cow, which was removed from the herd. Subsequent testing did not detect Salmonella.

“Rapid, accurate recognition of the likely outbreak source by an LHD and close collaboration between local and state health agencies resulted in an expedited and focused investigation and timely product recall; time from initiation of CDPH investigation to product recall was 1 week,” the authors wrote. “Enhanced surveillance sampling by CDFA and CDPH and WGS of milk and clinical isolates were critical to confirming the source of the outbreak and facilitating the recall.”

Children especially affected

Of the 171 salmonellosis cases identified, 140 (82%) occurred during September and October 2023; 167 were in California, with 1 each in New Mexio, Pennsylvania, Texas, and Washington state. The authors say the source of illness in the four non-California residents is unknown, since federal law prohibits the sale of raw milk across state lines. But they note that the law doesn’t apply to raw milk intended for pet consumption or raw cheese aged for more than 60 days.

The median case-patient age was 7 years, with 67 cases (39%) occurring in children ages 5 and under. Twenty-two patients were hospitalized, including 18 (82%) aged 18 and under.

Among the 159 case-patients with confirmed infections caused by the outbreak strain, 55 (70%) of those with exposure data consumed brand A raw milk or heavy cream.  The investigators say some cases linked to the outbreak might have resulted from person-to-person exposure, while some patients may have chosen not to disclose their consumption of raw dairy products.

The authors conclude that educational efforts emphasizing the risks of raw milk for consumers should focus on those at highest risk of complications from infection, including children (through their parents), pregnant women, and immunocompromised people. 

When was the last time you chatted to your friends about vaginal dryness? Or swapped tips on sexual health over a coffee? As we get older, we’re generally better at having healthy relationships, are more independent and know what we want. Yet while many of us are happy to be open about other aspects of our lives, talking about our intimate regions can still be taboo.

This silence is something that Dr Philippa Kaye, a GP and author of The M Word: Everything You Need To Know About The Menopause, thinks needs to end. ‘The words vulva and vagina should be words like elbow or nose,’ she says. ‘After all, if we can’t name our genitals, how can we look after them? And if we can’t look after them, how can we think of getting pleasure from them?’

Testosterone and the vagina

There’s been a 10-fold increase in prescribing testosterone for women in the last decade, writes Dr Sarah Jarvis. Testosterone cream is approved for use in the NHS by women with low sex drives if HRT isn’t enough and once other problems, such as painful sex due to dryness, have been excluded. However, despite widespread publicity, an international panel of experts confirms there’s no conclusive evidence that testosterone helps with depression, general wellbeing, cognition (mental abilities), body fat and body muscle or muscle strength around the menopause.

Menopause doesn’t cause testosterone to plummet in the way that oestrogen does – instead, levels gradually decline from our mid-20s and are usually stable around the menopause. However, Dr Juliet Balfour, a GP and menopause specialist at the British Menopause Society, says that when women are plunged into chemical menopause from chemotherapy, or surgical menopause because the ovaries are removed, testosterone levels can rapidly drop by up to half compared with women in natural menopause.

Women only need a pea-sized blob applied to the thighs once a day. The idea is to avoid side-effects, such as acne, developing a deeper voice or growing facial hair – we don’t yet have evidence on long-term safety. Most women on testosterone will be offered blood tests to monitor their levels and potential side effects. Women shouldn’t ever self-medicate by using more gel than they’ve been prescribed.

Effects of the menopause

Vaginal dryness affects up to four out of five women after menopause, and at least half suffer from genitourinary syndrome of menopause (GSM). Symptoms can develop years after hot flushes have disappeared and include loss of tone of the vagina; fragile, thinner tissue; itching and burning; incontinence; and dryness.

Dr Clare Spencer is an NHS GP, a registered menopause specialist and co-founder of the My Menopause Centre online clinic. She says, ‘Hormonal changes can cause the vagina to lose elasticity and even become shorter. Sex can become uncomfortable or perhaps painful. This, in turn, can sometimes lead to vaginismus, an involuntary contraction of vaginal muscles that can make penetrative sex impossible.’

“Vaginal oestrogen can reduce UTI risks”

HRT can help to reduce or prevent these symptoms, but if you can’t or don’t want to take HRT, or it’s not making enough difference, topical vaginal oestrogen is worth considering. It comes in the form of a cream, gel or pessary, applied up to five days a week, or as a vaginal ring, which disperses oestrogen over three months.

‘Although technically it’s a form of HRT, very little gets into your system,’ says Dr Kaye. ‘Using vaginal oestrogen for a year is the equivalent of taking two HRT tablets. That means there are no significant risks to taking it and it can be used lifelong.’

Dr Spencer adds: ‘Vaginal oestrogen is available on the NHS via your GP. You can also buy a type of vaginal oestrogen called Gina over the counter from a pharmacy or online.’

Vaginal oestrogen can reduce the risk of UTIs and, says Dr Kaye, ‘It can also normalise the vagina’s pH and microbiome, the healthy bacteria that live in the vagina. This is hugely important and may help to prevent gynaecological cancers.’

Vaginal moisturisers can also be the menopausal woman’s best friend, especially when it comes to soothing the itching caused by GSM. Dr Kaye advises, ‘Start by using them daily. After a week or two, you may be able to use them less frequently.’ Try Yes Vaginal Moisturiser or Regelle.

Protect yourself

Up to 60% of first marriages end in divorce. And while dating and new partners can bring renewed sexual energy to later life, there can be a downside. Dr Spencer says she’s seeing increasing numbers of midlife women who have contracted a sexually transmitted disease (STI) for the first time.

Any changes to your usual vaginal discharge, pain on urination, lumps or sores should be checked out. But many STIs have no symptoms. This means the only way to know for sure is to get tested. NHS sexual health clinics are the experts in testing and treating STIs.

You can usually walk into a sexual health clinic without an appointment, and you don’t have to give your real name. No information will be shared with your GP without your express consent, and you can ask to see a female nurse or doctor if you prefer. You may need to give a urine sample or have a painless swab using a small cotton bud. You don’t pay for prescriptions and some clinics even offer home testing for STIs.

The best way to prevent STIs is to use a condom during sex and to ensure shared sex toys are clean and covered with a condom. If you don’t want to do that, you should both get tested before having sex. The NHS website has lists of all the sexual health clinics in the UK, or you can contact the national sexual health helpline for free at 0300 123 7123.

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Monday, July 28, marks World Hepatitis Day, themed “Hepatitis: Let’s Break It Down,” which calls for urgent action to dismantle financial, social, and systemic barriers to eliminating hepatitis and preventing liver cancer.

World Hepatitis Day is recognized annually on the birthday of Baruch Blumberg, MD, PhD, the Nobel Prize–winning scientist who discovered hepatitis B and developed a diagnostic test and vaccine for the virus.¹ The World Health Organization (WHO) explains that the day provides an opportunity to raise awareness of viral hepatitis, an inflammation of the liver that causes severe liver disease and liver cancer.²

Understanding the Different Hepatitis Types

There are 5 main strains of the hepatitis virus, referred to as types A, B, C, D, and E.³ Although they all cause liver disease, they differ in modes of transmission, illness severity, geographical distribution, and prevention methods. Many people infected with hepatitis viruses experience mild or no symptoms; however, hepatitis A, B, and C can cause fever, loss of appetite, and jaundice.

In more serious cases, hepatitis infections may lead to chronic liver disease, which can progress to cirrhosis, liver cancer, and death. Hepatitis B and C are the most common causes of liver cirrhosis, liver cancer, and viral hepatitis-related deaths globally. About 354 million people are living with chronic hepatitis B or C, yet most lack access to testing and treatment.

Other hepatitis types can also lead to complications. Hepatitis D occurs only in people already infected with hepatitis B, and dual infection can result in more serious disease and poorer health outcomes, including an accelerated progression to cirrhosis. Meanwhile, hepatitis E typically begins with flu-like and gastrointestinal symptoms, which may progress to jaundice, liver tenderness, and, in rare cases, acute liver failure.

Vaccines are available to prevent hepatitis A, B, and E. The hepatitis B vaccine also protects against hepatitis D and, when administered at birth, greatly reduces mother-to-child transmission. Chronic hepatitis B can be treated with antivirals to slow disease progression, but not all infected individuals require treatment.

There is currently no vaccine for hepatitis C, but over 95% of infections can be cured with antiviral medications. Despite this, global access to diagnosis and treatment remains limited. In addition, hepatitis A, which is most common in low- and middle-income countries due to the higher risk of food and water contamination, is largely preventable with a vaccine. Most infections are mild, with many patients recovering fully and developing lasting immunity.

Breaking Down Barriers to End Hepatitis

This year’s World Hepatitis Day theme, “Let’s Break It Down,” calls for urgent action to dismantle financial, social, and systemic barriers that hinder hepatitis elimination and liver cancer prevention.⁴ The theme underscores the need to scale up, simplify, and integrate hepatitis services into national health systems, particularly testing and treatment.

“The campaign is a reminder that we must act now to expand access, integrate care, and end hepatitis as a public health problem by 2030,” the WHO states on its website.

The WHO spotlights 3 critical issues. First, hepatitis is a leading cause of liver cancer and a growing global killer. Chronic viral hepatitis causes 1.3 million deaths annually, mostly from liver cancer and cirrhosis. Despite them being preventable and treatable, there are 6000 new hepatitis B and C infections daily, with the disease burden continuing to rise, especially in regions with limited care access.

Second, the WHO adds that knowing one’s status is the first step to stopping liver cancer, as most people living with hepatitis are unaware of their infection. Therefore, testing and early diagnosis are considered critical to ending hepatitis because they allow individuals to access life-saving treatment and prevent liver cancer.

Lastly, the WHO emphasizes that hepatitis elimination is within reach if countries act now. Although there are vaccines, curative therapies, and proven tools to stop transmission, most cases go undiagnosed until it is too late. Because of this, the organization calls on countries to commit to ending the disease through smart investment and public health systems that embed hepatitis services into primary care.

Strategic Priorities for Hepatitis Elimination

The WHO has made several calls to action directed at the public, policymakers and governments, and national health authorities. It has instructed the public to get tested for hepatitis B and C and to vaccinate newborns with the hepatitis B birth dose within 24 hours. Individuals also are encouraged to talk with their health care provider about early testing and treatment. They should also learn the facts about hepatitis and help stop stigma by sharing accurate information.

In addition, the WHO has asked policymakers and governments to lead and fund awareness campaigns that link hepatitis care to liver cancer prevention, as well as to expand hepatitis B birth-dose vaccination, safe blood and injection practices, and harm reduction strategies.

The organization also highlights the need for more affordable, decentralized testing and treatment services integrated into primary care across health platforms. Consequently, the WHO suggests embedding hepatitis services in universal health coverage and national insurance schemes, engaging all stakeholders, and investing in strong data systems for accountability.

Lastly, the WHO recommends that national health authorities prioritize early diagnosis and treatment, focusing on high-burden and underserved communities. To do so, authorities should decentralize services to primary and district health centers, integrate hepatitis prevention into maternal and child health programs, ensure free or universal access to testing and treatment, mobilize sustainable funding, and use data to drive progress.

To learn more about World Hepatitis Day efforts to break down barriers and stigma preventing hepatitis elimination and liver cancer prevention, tune into the WHO’s global hepatitis webinar on Monday, July 28, from 7:30 to 9 AM EDT.

“This global webinar will include high-level ministerial remarks, presentations, and panel discussions,” the WHO shared online. “It will provide spotlights and country progress from communities and partners, as well as effective and innovative public health strategies to scale up country responses to reach the 2030 hepatitis elimination targets.”

References

1. World Hepatitis Day. World Health Organization. Accessed July 25, 2025. https://www.who.int/campaigns/world-hepatitis-day
2. World Hepatitis Day 2025. World Health Organization. Accessed July 25, 2025. https://www.who.int/campaigns/world-hepatitis-day/2025
3. Hepatitis. World Health Organization. Accessed July 25, 2025. https://www.who.int/health-topics/hepatitis
4. Key messages. World Health Organization. Accessed July 25, 2025. https://www.who.int/campaigns/world-hepatitis-day/2025/key-messages
5. Global hepatitis webinar – let’s break it down! World Health Organization. Accessed July 25, 2025. https://www.who.int/news-room/events/detail/2025/07/28/default-calendar/global-hepatitis-webinar-let-s-break-it-down!

Would you dab perfume on a six-month-old? Paint their tiny nails with polish that contains formaldehyde? Dust bronzer onto their cheeks?

An investigation by the Times has found that babies and toddlers are routinely exposed to adult cosmetic products, including fragranced sprays, nail polish and even black henna tattoos.

While these may sound harmless – or even Instagram-friendly – the science tells a more concerning story. Infant skin is biologically different from adult skin: it’s thinner, more absorbent and still developing. Exposure to certain products can lead to immediate problems like irritation or allergic reactions, and in some cases, may carry longer term health-risks such as hormone disruption.

This isn’t a new concern. A 2019 study found that every two hours in the US, a child was taken to hospital because of accidental exposure to cosmetic products.

Newborn skin has the same number of layers as adult skin but those layers are up to 30% thinner. That thinner barrier makes it easier for substances, including chemicals, to penetrate through to deeper tissues and the bloodstream.

Young skin also has a higher water content and produces less sebum (the natural oil that protects and moisturises the skin). This makes it more prone to water loss, dryness and irritation, particularly when exposed to fragrances or creams not formulated for infants.

The skin’s microbiome – its protective layer of beneficial microbes – also takes time to develop. By age three, a child’s skin finishes establishing its first microbiome. Before then, products applied to the skin can disrupt this delicate balance. At puberty, the skin’s structure and microbiome change again, altering how it responds to products.

The investigation found that bronzers and nail polish were being used on young children. These products often contain harmful or even carcinogenic chemicals, such as formaldehyde, toluene and dibutyl phthalate.

Toluene is a known neurotoxin, and dibutyl phthalate is an endocrine disruptor – a chemical that can interfere with hormone function, potentially affecting growth, development and fertility. Both substances can more easily pass through infants’ thinner, more permeable skin.

Even low-level exposure to formaldehyde, such as from furniture or air pollution, has been linked to higher rates of lower respiratory infections in children (that’s infections affecting the lungs, airways and windpipe).

Irritating ingredients

In the US, one in three adults experiences skin or respiratory symptoms after exposure to fragranced products. If adults are reacting, it’s no surprise that newborns and children with their developing immune systems are at even greater risk.

Perfumes often contain alcohol and volatile compounds that dry out the skin, leading to redness, itching and discomfort.

Certain skincare ingredients have also been studied for their potential to affect hormones, trigger allergies or pose long-term health concerns:

While many of these ingredients are permitted in regulated concentrations, some researchers warn of a “cocktail effect”: the cumulative impact of daily exposure to multiple chemicals, especially in young, developing bodies.

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Read more:
Scroll, watch, burn: sunscreen misinformation and its real‑world damage

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Temporary tattoos

Temporary tattoos, particularly black henna, are popular on holidays but they aren’t always safe. Black henna is a common cause of contact dermatitis in children and may contain para-phenylenediamine (PPD), a chemical approved for use in hair dyes but not for direct application to skin.

PPD exposure can cause severe allergic reactions and, in rare cases, cancer. Children may develop hypopigmentation – pale patches where colour is lost – or, in adults, hyperpigmentation that can last for months or become permanent.

Worryingly, children exposed to PPD may experience more severe reactions later in life if they use hair dyes containing the same compound. This can sometimes lead to hospitalisation or even fatal anaphylaxis. Because of these risks, European legislation prohibits PPD from being applied directly to the skin, eyebrows, or eyelashes.

‘Natural’ doesn’t mean harmless

Products marketed as “natural” or “clean” can also cause allergic reactions. Propolis (bee glue), for instance, is found in many natural skincare products but causes contact dermatitis in up to 16% of children.

A study found an average of 4.5 contact allergens per product in “natural” skincare ranges. Out of 1,651 “natural” personal care products on the US market, only 96 (5.8%) were free from contact allergens. Even claims like “dermatologically tested” don’t guarantee safety; they simply mean the product was tested on skin, not that it’s free from allergens.

Babies and young children aren’t just miniature adults. Their skin is still developing and is more vulnerable to irritation, chemical absorption and systemic effects: substances that penetrate the skin can enter the bloodstream and potentially affect organs or biological systems throughout the body. Applying adult-targeted products, or even well-meaning “natural” alternatives, can therefore carry real risks.

Adverse reactions can appear as rashes, scaling or itchiness and, in severe cases, blistering or crusting. Respiratory symptoms like coughing or wheezing should always be investigated by a medical professional.

When in doubt, keep it simple. Limit what goes on your child’s skin, especially in the early years.

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The Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM)study finding that combining, rather than switching antidepressants is more likely effective for late life treatment resistant depression (TRD) has been recently qualified by the investigators, after completing a preplanned analysis to assess moderators of therapeutic response.^1,2

In the original OPTIMUM study, augmentation of the current antidepressant with aripiprazole was superior to switching to bupropion in measures of psychological well being. In addition, more patients (albeit numerically rather than statistically) attained remission by augmenting with either aripiprazole or bupropion than by switching to bupropion.

In the current analysis, the investigators assessed whether any of 5 factors which have been negatively associated with antidepressant treatment outcomes in late life depression had moderated the effect of augmentation vs switching. The hypothesized moderators were age, executive dysfunction, comorbid medical burden, comorbid anxiety, and degree of treatment resistance.

“Identifying moderators that influence the effectiveness of these treatment strategies advances personalized medicine,” the investigators indicated. “For example, a moderator that can be assessed by a clinician, such as age, helps the clinician choose the optimal treatment strategy based on individual characteristics in day-to-day practice.”

Executive dysfunction was measured using the National Institutes of Health Toolbox fluid cognition composite, comorbid medical burden with the Cumulative Illness Rating Scale-Geriatric, and comorbid anxiety with the Patient Reported Outcomes Measurement Information System anxiety scale. The number of prior antidepressant trials, either augmentation or switching, that the participant had undergone without adequate response served as a proxy for the degree of treatment resistance.

Of the 5 factors, only severity of treatment resistance, corresponding to 3 or more unsuccessful antidepressant trials, was found to negate the advantage of augmentation that had been apparent across the OPTIMUM cohort. The investigators note that this finding was independent of specific medications or whether the previous trials involved augmentation or switching. They were not able to identify moderators for remission, as this was attained in less than a third of the study participants.

The study’s lead author, Helena Kim, MD, PhD, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada, discussed the finding and the implication for treating TRD in older patients with Psychiatric Times.

“Switching performed poorly in patients with late life treatment resistant depression regardless of the number of previous trials,” Kim noted. “Augmentation allowed patients to still benefit from pharmacotherapy, but only in those with less than 3 trials. This suggests that those with more trials should be considered for alternative treatments.”

Principal investigator Benoit Mulsant, MD, MS, also of the Department of Psychiatry, University of Toronto, suggested that these alternative treatments could include repetitive transcranial magnetic stimulation, ketamine, and electroconvulsive therapy.

Mulsant also suggested, however, that antidepressant selection, with consideration of tolerability, could enhance the likelihood of success in trials and obviate need to consider alternative treatments. An example would be sertraline first line; venlafaxine second line; venlafaxine plus aripiprazole, or venlafaxine plus either bupropion or nortriptyline third line.

“Psychotherapy can be used for milder depression as first line or added to antidepressant at any point,” Mulsant said. “Then, as a fourth step, consider alternative treatments.”

Mulsant pointed out that with a “trial and error” approach, the 4 steps could require 1 year or longer. “To accelerate response, we need to be able to identify subgroups of patients who are more or less likely to benefit from specific steps,” he said.

The investigators had not found moderation effect from the other hypothesized factors despite multiple methods of analysis. To assess possible effect of age, for example, they examined it as both a continuous variable, and by setting a threshold, eg, for “very old.” Similarly, executive dysfunction was assessed using the different thresholds of “impaired” and “very impaired.”

Kim and Mulsant indicate that they will be doing additional work using decision tree analysis to identify subgroups of patients who are more or less likely to benefit from various treatments, toward their goal of improving personalization of pharmacotherapy.

“I hope to see future research focused on ensuring that the identification of modifiers and predictors of antidepressant response becomes directly relevant to real-world clinical decision making,” Kim said. “Our work using decision-tree analyses is an example of how we can begin addressing these questions, with the ultimate goal of advancing personalized medicine in psychiatry.”

Dr Bender reports on medical innovations and advances in practice and edits presentations for news and professional education publications. He previously taught and mentored pharmacy and medical students, and he provided and managed pharmacy care and drug information services.

References

1. Lenze EJ, Mulsant BH, Roose SP, et al. Antidepressant augmentation versus switch in treatment-resistant geriatric depression. N Engl J Med. 2023;388(12):1067-1079.

2. Kim HK, Karp JF, Lavretsky H, et al. Moderators of antidepressant augmentation versus switch in the OPTIMUM randomized controlled trial. Br J Psychiatry. 2025:1-8.

For two decades, Washington, D.C., pediatrician Lanre Falusi has counseled parents about vaccine safety, side effects and timing. But this year, she said, the conversations have changed.

“For the first time, I’m having parents of newborns ask me if their baby will still be able to get vaccines,” Falusi said.

Throughout the U.S., pediatricians say anxious parents are concerned about access to routine childhood immunizations.

That’s especially true for those with children covered by Medicaid, the government insurance program for low-income families and people with disabilities. Medicaid covers 4 in 10 children in the United States.

“It really became an issue when RFK Jr. stepped into the role of HHS secretary,” said Deborah Greenhouse, a pediatrician in South Carolina.

The concern accelerated after the shake-up of a key Centers for Disease Control and Prevention vaccine advisory body in June, raising fears that millions of American families could soon have to pay out of pocket for shots now covered by their health insurance.

Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist, removed all 17 members of the CDC’s Advisory Committee on Immunization Practices (ACIP), the panel responsible for recommending which shots are included in the nation’s adult and childhood immunization schedules.

Kennedy replaced the panelists with new members aligned with his views, prompting alarm among medical professionals and public health experts.

Insurance uncertainty worries parents

“People should be worried about what’s going to happen to the availability of vaccines for children,” said Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured at KFF, a national health information nonprofit that includes KFF Health News.

Under the Affordable Care Act, health insurers are required to cover all ACIP-recommended vaccines.

States and other jurisdictions use the childhood vaccine schedule to set immunization requirements for schoolchildren.

ACIP’s recommendations also determine which vaccines get covered by the Vaccines for Children Program, a CDC-funded initiative that provides free immunizations to low-income and uninsured children. Half of children in the U.S. are eligible for the VFC Program.

If the new ACIP members withdraw support for a particular vaccine and the CDC director agrees, Tolbert said, the consequences would be immediate.

“It would automatically affect what is covered and therefore which vaccines are available to children on Medicaid,” she said.

Health insurance companies have not yet said how they would alter coverage, but Tolbert said such a move would open the door for private insurers to refuse to cover the vaccine.

Pediatricians worry about a future where parents might have to choose: pay hundreds of dollars out of pocket for shots or leave their kids unprotected.

The health insurance industry group AHIP said that health plans “continue to follow federal requirements related to coverage of ACIP-recommended vaccines and will continue to support broad access to critical preventive services, including immunizations.”

Pediatricians say news about President Trump’s new budget law, which is expected to reduce Medicaid spending by about $1 trillion over the next decade, has also prompted questions from parents.

While parents may be worried about losing their Medicaid, the law doesn’t mention vaccines or change eligibility or benefits for children’s Medicaid, Tolbert said.

But less federal funding means states will have to make decisions about who is covered and which services are offered.

To raise the revenue needed to pay for Medicaid, states could raise taxes; move money earmarked for other spending, such as education or corrections; or, more likely, reduce Medicaid spending.

“And they may do that by cutting eligibility for optional populations or by cutting services that are optional, or by reducing payments to providers in the form of provider rates,” Tolbert said. “It’s unclear how this will play out, and it will likely look different across all states.”

In May, Kennedy announced in a post on X that the CDC is no longer recommending the COVID-19 vaccine for healthy children and pregnant women. The move prompted a lawsuit by the American Academy of Pediatrics and other physician groups that seeks to freeze Kennedy’s directive.

And in June, the new ACIP members appointed by Kennedy voted to recommend that adults and children no longer receive flu vaccines with thimerosal, a preservative rarely used in some flu vaccines. Anti-vaccine activists, including Kennedy, have rallied against thimerosal for decades, alleging links to autism despite no evidence of any association.

“There is no cause for concern,” Department of Health and Human Services spokesperson Emily Hilliard said in a statement. “As Secretary Kennedy has stated, no one will be denied access to a licensed vaccine if they choose to receive one.”

“When the ACIP committee met last month, they reaffirmed that flu vaccines will remain accessible and covered, and they emphasized safety by ensuring these vaccines are mercury-free,” Hilliard wrote.

“The Vaccines for Children (VFC) program continues to provide COVID-19 vaccines at no cost for eligible children when the parent, provider, and patient decide vaccination is appropriate. Medicaid will continue to reimburse the administration fee.”

But the possibility that a vaccine could be restricted or no longer covered by insurance is already changing how parents approach immunization.

In Falusi’s practice, parents are scheduling appointments to coincide precisely with their child’s eligibility, sometimes making appointments the same week as their birthdays.

Doctors warn that fewer kids may get shots if cost shifts to families

Melissa Mason, a pediatrician in Albuquerque, N.M., has treated some patients who got measles during the multistate outbreak that started in neighboring Texas.

She’s concerned that any new limitations on access or reimbursement for childhood vaccines could lead to even more preventable illnesses and deaths.

Nationally, there have been more than 1,300 measles cases since January, including three deaths, according to the CDC. “We’re seeing this outbreak because vaccination rates are too low and it allows measles to spread in the community,” Mason said.

Children and teens account for 66% of national measles cases. Mason has begun offering the measles vaccine to infants as young as 6 months old, a full six months earlier than standard practice, though still within federal guidelines.

Last year, overall kindergarten vaccination rates fell in the United States. At the same time, the number of children with a school vaccination exemption continued to rise.

Pertussis, or whooping cough — another disease that can be deadly to young children — is spreading. As of July 5, more than 15,100 cases had been identified in U.S. residents this year, according to the CDC.

Mason said pertussis is especially dangerous to babies too young to receive the vaccine.

For now, pediatricians are trying to maintain a sense of urgency without inciting panic.

In Columbia, S.C., Greenhouse used to offer families a flexible age range for routine vaccinations.

“I’m not saying that anymore,” the pediatrician said.

She now urges parents to get their children vaccinated as soon as they are eligible.

She described anxious parents asking whether the HPV vaccine, which helps prevent cervical cancer, can be administered to children younger than the recommended age of 9.

“I actually had two parents today ask if their 7- or 8-year-olds could get the HPV shot,” Greenhouse said. “I had to tell them it’s not allowed.”

With the vaccine requiring multiple doses months apart, Greenhouse fears time may run out for families to get the series covered by insurance. If they have to pay out of pocket, she’s afraid some families may choose not to get the second dose. A second dose could cost about $300 if no longer covered by insurance.

“I cannot be 100% sure what the future looks like for some of these vaccines,” Greenhouse said. “I can tell you it’s a very scary place to be.”

Kennedy’s newly appointed vaccine advisory committee is expected to hold its next public meeting as soon as August.

This story comes from NPR’s health reporting partnership KFF Health News, a national newsroom that produces in-depth journalism about health issues. It’s one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

Copyright 2025 KFF Health News

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