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New data published by the UK Health Security Agency (UKHSA) has found that travel-related chikungunya cases are up 170%, as one of the country’s two approved vaccines remains controversial due to safety concerns.

Reported infections from the tropical virus have risen from 27 this time in 2024 to 73 in 2025, primarily stemming from travel to the Indian Ocean region – with the agency’s report specifically naming India, Mauritius and Sri Lanka.

This follows a stream of outbreaks across the globe, with the European Centre for Disease Prevention and Control (ECDC) estimating that there have been 240,000 chikungunya cases worldwide between January and July 2025.

The mosquito-borne disease, spread by Aedes aegypti and Aedes albopictus, is associated with a sudden-onset fever and persistent joint pain that can last between one week and years after infection.

Though rarely fatal, there have been several outbreaks of the virus in the Americas, as well as South and East Asia, with infections primarily being problematic for individuals with pre-existing comorbidities or those who are immunocompromised.

The disease has also been shown to have a significant impact on neonatal health, raising the risk of death in infants born to mothers infected with the virus by 50%, says a report from Pharmaceutical Technology‘s parent company GlobalData.

There are two vaccines currently approved by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) to protect against infection by chikungunya: Bavarian Nordics’ Vimkunya and Valneva’s Ixchiq. These are available to purchase through private travel clinics, which are not part of the national immunisation schedule.

However, Ixchiq’s future has been hanging in the balance following its UK approval in February 2025. This is due to two deaths in the French territory of La Reunion linked to a mass vaccination programme involving Ixchiq, which was initiated after a significant chikungunya outbreak in March.

This has caused the UK’s Joint Committee on Vaccination and Immunisation (JCVI) to recommend the restriction of Ixchiq’s usage in elderly patients due to safety concerns. In the wake of this, the MHRA suspended the vaccine’s use in individuals aged 65 years and over, pending further review.

An investigation by US regulators, however, deemed the La Reunion deaths unlinked – resulting in the US pause being revoked. Despite this, the US Food and Drug Administration (FDA) has tightened restrictions around its use, advising that only individuals at high risk of contracting the disease receive Ixchiq.

This differs from the previous allocation, which recommended the vaccine’s use for those at intermediate risk.

A total of 17 adverse events (AEs) in patients over 62 years have been linked to the jab.

Despite the controversy faced by Ixchiq, analysts at GlobalData have predicted that the drug will generate higher sales than Vimkunya. By 2031, it is forecasted to bring in $237m compared with Bavarian Nordics’ vaccine, which is estimated to make $170m for the company.

This trend could be due to Ixchiq’s first-in-disease status, as the vaccine was given FDA clearance in November 2023.

Over the past 20 years, a class of cancer drugs called CD40 agonist antibodies have shown great promise-and induced great disappointment. While effective at activating the immune system to kill cancer cells in animal models, the drugs had limited impact on patients in clinical trials and caused dangerously systemic inflammatory responses, low platelet counts, and liver toxicity, among other adverse reactions-even at a low dose.

But in 2018, the lab of Rockefeller University’s Jeffrey V. Ravetch demonstrated it could engineer an enhanced CD40 agonist antibody so that it improved its efficacy and could be administered in a manner to limit serious side effects. The findings came from research on mice, genetically engineered to mimic the pathways relevant in humans. The next step was to have a clinical trial to see the drug’s impact on cancer patients. 

Now the results from the phase 1 clinical trial of the drug, dubbed 2141-V11, have been published in Cancer Cell. Of 12 patients, six patients saw their tumors shrink, including two that saw them disappear completely.

“Seeing these significant shrinkages and even complete remission in such a small subset of patients is quite remarkable,” says first author Juan Osorio, a visiting assistant professor in Ravetch’s Leonard Wagner Laboratory of Molecular Genetics and Immunology and a medical oncologist at Memorial Sloan Kettering Cancer Center.

Notably, the effect wasn’t limited to tumors that were injected with the drug; tumors elsewhere in the body either got smaller or were destroyed by immune cells.

This effect-where you inject locally but see a systemic response-that’s not something seen very often in any clinical treatment. It’s another very dramatic and unexpected result from our trial.”

Jeffrey V. Ravetch, Rockefeller University

Engineering enhancements

CD40 is a cell surface receptor and member of the tumor necrosis factor (TNF) receptor superfamily, proteins that are largely expressed by immune cells. When triggered, CD40 prompts the rest of immune system to spring into action, promoting antitumor immunity and developing tumor-specific T cell responses.

In 2018, Ravetch’s lab-which has been supported in this line of research by Rockefeller’s Therapeutic Development Fund, founded by trustee Julian Robertson and continued by the Black Family Foundation-engineered 2141-V11, a CD40 antibody that binds tightly to human CD40 receptors and is modified to enhance its crosslinking by also engaging a specific Fc receptor. It proved to be 10 times more powerful in its capacity to elicit an antitumor immune response.

They then changed how they administered the drug. The long-time approach had been to give it intravenously. But CD40 receptors are widespread, so too many non-cancerous cells pick it up, leading to the well-known toxic side effects. Instead, they injected the drug directly into tumors.

“When we did that, we saw only mild toxicity,” Ravetch says.

Those findings became the basis of the phase 1 clinical trial described in the current study, which aimed to determine a starting clinical dose of the drug and better understand the mechanisms underlying its effectiveness.

Inducing remission

The trial included 12 patients representing myriad metastatic cancer types: melanoma, renal cell carcinoma, and different types of breast cancer. Of those 12, none suffered the serious side effects seen with other CD40 drugs. Six experienced systemic tumor reduction, of which two had a complete response-meaning their cancer disappeared entirely.

The two patients who experienced complete remission had melanoma and breast cancer, respectively-both notoriously aggressive and recurring.

“The melanoma patient had dozens of metastatic tumors on her leg and foot, and we injected just one tumor up on her thigh,” Ravetch says. “After multiple injections of that one tumor, all the other tumors disappeared. The same thing happened in the patient with metastatic breast cancer, who also had tumors in her skin, liver, and lung. And even though we only injected the skin tumor, we saw all the tumors disappear.”

Tissue samples from the tumor sites revealed the immune activity that the drug stimulated. “We were quite surprised to see that the tumors became full of immune cells-including different types of dendritic cells, T cells, and mature B cells-that formed aggregates resembling something like a lymph node,” Osorio says. “The drug creates an immune microenvironment within the tumor, and essentially replaces the tumor with these tertiary lymphoid structures.”

The presence of tertiary lymphoid structures (TLS) is associated with improved prognosis and response to immunotherapy, Osorio notes.

They also found TLS in the tumors they didn’t inject. “Once the immune system identifies the cancer cells, immune cells migrate to the non-injected tumor sites,” he says.

Improving immunotherapy

The findings have sparked a number of other clinical trials that the Ravetch lab is currently collaborating on with researchers at Memorial Sloan Kettering and Duke University. Now in either phase 1 or phase 2 study, the trials are investigating 2141-V11’s effect on specific cancers, including bladder cancer, prostate cancer, and glioblastoma-all aggressive and hard to treat. Collectively, nearly 200 people are enrolled in the studies. 

These studies will help to illuminate why some patients respond to 2141-V11 and others do not-and how to potentially change that.

For example, the two patients in the clinical trial whose cancer disappeared both had a high clonality of T cells-key cancer-cell killers-when they began the study. “This suggests there are some requirements from the immune system in order for this drug to work, and we’re in the process of dissecting these characteristics in more granular detail in these larger studies.” 

“As a general rule, only 25 to 30% of patients will respond to immunotherapy, so the biggest challenge in the field is to try to determine which patients will benefit from it. What are the indicators or predictors of response? And how can we convert non-responders into responders?”

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Researchers at the Icahn School of Medicine at Mount Sinai have found that prenatal exposure to acetaminophen may increase the risk of neurodevelopmental disorders, including autism spectrum disorder and attention-deficit/hyperactivity disorder (ADHD), in children. The study, published today in BMC Environmental Health, is the first to apply the rigorous Navigation Guide methodology to systematically evaluate the rigor and quality of the scientific literature.

Acetaminophen (often sold under the brand name Tylenol®, and known as paracetamol outside the United States and Canada) is the most commonly used over-the-counter pain and fever medication during pregnancy and is used by more than half of pregnant women worldwide. Until now, acetaminophen has been considered the safest option for managing headache, fever, and other pain. Analysis by the Mount Sinai-led team of 46 studies incorporating data from more than 100,000 participants across multiple countries challenges this perception and underscores the need for both caution and further study.

The Navigation Guide Systematic Review methodology is a gold-standard framework for synthesizing and evaluating environmental health data. This approach allows researchers to assess and rate each study’s risk of bias, such as selective reporting of the outcomes or incomplete data, as well as the strength of the evidence and the quality of the studies individually and collectively.

“Our findings show that higher-quality studies are more likely to show a link between prenatal acetaminophen exposure and increased risks of autism and ADHD,” said Diddier Prada, MD, PhD, Assistant Professor of Population Health Science and Policy, and Environmental Medicine and Climate Science, at the Icahn School of Medicine at Mount Sinai. “Given the widespread use of this medication, even a small increase in risk could have major public health implications.”

The paper also explores biological mechanisms that could explain the association between acetaminophen use and these disorders. Acetaminophen is known to cross the placental barrier and may trigger oxidative stress, disrupt hormones, and cause epigenetic changes that interfere with fetal brain development.

While the study does not show that acetaminophen directly causes neurodevelopmental disorders, the research team’s findings strengthen the evidence for a connection and raise concerns about current clinical practices.

The researchers call for cautious, time-limited use of acetaminophen during pregnancy under medical supervision; updated clinical guidelines to better balance the benefits and risks; and further research to confirm these findings and identify safer alternatives for managing pain and fever in expectant mothers.

“Pregnant women should not stop taking medication without consulting their doctors,” Dr. Prada emphasized. “Untreated pain or fever can also harm the baby. Our study highlights the importance of discussing the safest approach with health care providers and considering non-drug options whenever possible.”

With diagnoses of autism and ADHD increasing worldwide, these findings have significant implications for public health policy, clinical guidelines, and patient education. The study also highlights the urgent need for pharmaceutical innovation to provide safer alternatives for pregnant women.

Reference: Prada D, Ritz B, Bauer AZ, Baccarelli AA. Evaluation of the evidence on acetaminophen use and neurodevelopmental disorders using the Navigation Guide methodology. Environ Health. 2025;24(1):56. doi: 10.1186/s12940-025-01208-0

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source. Our press release publishing policy can be accessed here.

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The patient, female, Ms. Yang, 39 years old, had a history of good health. She had two full-term vaginal deliveries and two induced abortions. Her menstruation was regular, and her last menstrual period was on April 16, 2024. Her antenatal examinations were irregular. The blood glucose level was 12.0 mmol/L one hour after the oral glucose tolerance test. At 34⁺³ weeks of pregnancy, her blood pressure (BP) was 136/81 mmHg, and the urine protein was ±. On December 27, 2024, at 36⁺³ weeks of pregnancy, she occasionally had lower abdominal pain in the morning. At 17:26, the abdominal pain worsened. She took a private car to the hospital and gave birth to a baby boy in the private car at about 18:00. The placenta had been delivered. She arrived at the emergency department of Affiliated Hospital of Jining Medical University at 19:06, and her blood pressure was 134/75 mmHg. After admission, the uterine contractions were poor, and oxytocin was given to enhance the uterine contractions. At 19:44, the blood pressure was measured at 165/99 mmHg, and 10 mg of nifedipine was given orally. At 20:14, the blood pressure was 155/100 mmHg, and at 20:30, the blood pressure was 185/108 mmHg. 20 mg of nifedipine was given orally, and magnesium sulfate was infused by pump. At 21:00, eclampsia suddenly occurred. Rescue measures were taken (opening the airway, using a tongue depressor to prevent tongue bite, turning the head to one side, oxygen inhalation, intravenous injection + pump infusion of magnesium sulfate, and intravenous infusion of mannitol). After that, the eclampsia was controlled. At 21:30, the blood pressure was 123/78 mmHg, and the patient could be awakened and did not complain of any discomfort. An urgent examination showed that the hemoglobin was 116 g/L, the platelet was 82 × 10⁹/L, and the urine protein was 3+. At 22:00, the patient developed nausea, vomiting, and right upper abdominal pain. At 22:30, the blood pressure suddenly dropped to 82/51 mmHg, the pulse rate (P) was 82 beats per minute, the respiratory rate (R) was 20 breaths per minute, and the oxygen saturation was 99%. The blood pressure decreased progressively, reaching a minimum of 66/37 mmHg, and the pulse rate was 83 beats per minute. After the anesthesiologist arrived, norepinephrine and adrenaline injection were given to raise the blood pressure. An urgent blood gas analysis showed that the hemoglobin was 66 g/L. Considering the patient’s postpartum eclampsia, the possibility of the HELLP syndrome and subcapsular hepatic hematoma could not be excluded. Rapid fluid replacement was given, and 10% calcium gluconate was added to the infusion for intravenous drip. A bedside color Doppler ultrasound examination was arranged. The B-ultrasound showed a large amount of abdominal effusion. Under the guidance of the ultrasound, abdominal paracentesis was performed, and non-clotting blood was drawn out. There was a high suspicion of the HELLP syndrome and rupture and bleeding of the subcapsular hepatic hematoma, and exploratory laparotomy was carried out. During the operation, a large amount of bright red non-clotting blood, about 3000 ml, was found in the abdominal cavity. The hepatic capsule on the diaphragmatic surface of the right lobe of the liver was widely peeled off, with obvious oozing of blood. The hepatoduodenal ligament was edematous, and the liver showed severe fatty liver changes. An attempt was made to compress the bleeding site with a gauze pad, but the effect was not good. Ligation of the right hepatic artery and the middle hepatic artery + cholecystectomy were performed. After applying hemostatic fibrils on the diaphragmatic surface of the right liver, two and a half pieces of uterine gauze strips were packed in, and a 3-cm incision was made on the right abdominal wall to lead out and fix them. One abdominal drainage tube was placed under the right liver, above the left liver, and in the pelvic cavity respectively and fixed. The estimated blood loss during the operation was about 8000 ml. During the operation, 22 units of leukocyte-reduced suspended red blood cells, 2200 ml of plasma, 10 units of cryoprecipitate, 2 therapeutic doses of platelets, and 7000 ml of infusion were given, and the urine output was about 50 ml. After the operation, the patient was transferred to the intensive care unit.

After the operation, a large amount of vasopressor drugs were needed to maintain the blood pressure. The drainage volume of the three drainage bags was 1000 ml within less than 1 h. There was extensive bleeding from the surgical wound, severe shock, (disseminated intravascular coagulation) DIC, and abnormal coagulation. The drawn blood did not coagulate. The blood gas analysis showed that the lactate was greater than 10 mmol/L several times, and the highest was greater than 20 mmol/L. A multidisciplinary discussion involving departments such as Hepatobiliary Surgery, Gastrointestinal Surgery, Intensive Care Unit, Cardiology, Blood Transfusion Department, and Hematology Department was conducted across the hospital. To maintain blood pressure, a large dose of norepinephrine (186 mg in total within 24 h after surgery) was infused via pump, combined with 24 units of pituitrin and 0.5 mg of epinephrine. The ventilator was used to assist breathing, and organ function support treatment and blood transfusion were given. On the second day after the operation, the vasopressor drugs were stopped, and blood transfusion was continued. The patient was in anuria, with renal failure and obvious general edema, and plasma exchange was given. Fragmented red blood cells were found in the peripheral blood smear, suggesting hemolysis, which further confirmed the HELLP syndrome. The biochemical indexes deteriorated rapidly after the operation. On December 29, the alanine aminotransferase (ALT) was 3629.3 U/L, and the aspartate aminotransferase (AST) was 5034.5 U/L. On December 30, the lactate dehydrogenase (LDH) was 3993.7 U/L. The patient’s coagulation function improved, but there was persistent thrombocytopenia. A large amount of accumulated blood around the liver was found on the CT scan (Fig. 1).From January 1 to January 6, 2025, the platelet count fluctuated between (3–9)×10⁹/L. The provincial medical team was reported. The treatment mainly includes hormones, plasma exchange, and immunoglobulin, etc. Platelet transfusion must be extremely cautious and should be avoided in cases of non-fatal active bleeding to prevent the condition from deteriorating further. Imipenem and cilastatin combined with vancomycin were continued for anti-infection treatment, liver protection, maintaining renal perfusion, continuous renal replacement therapy treatment, continuous plasma exchange, application of intravenous immunoglobulin, and 60–80 mg of methylprednisolone was given once a day. On January 10, 2025, the blood urea nitrogen was 34.86 mmol/L, and the creatinine was 552.8 µmol/L. The CT scan showed a small amount of subarachnoid hemorrhage in the right parietal lobe, and antiepileptic treatment was given. On January 11th, the CT scan showed that the accumulated blood around the liver had decreased (Fig. 2).There was a large amount of pleural effusion accompanied by atelectasis, and thoracentesis and drainage were performed for 24 days. Imipenem + vancomycin was used for treatment for 10 days after the operation, and then it was downgraded to omadacycline + piperacillin/tazobactam for 12 days, and then it was changed to moxifloxacin for 6 days. The patient’s liver and kidney functions and platelet count gradually returned to normal, and the hormones were stopped. A total of 4 multidisciplinary case discussions were organized in the whole hospital, and the provincial treatment expert group and the remote consultation of Ruijin Hospital in Shanghai were invited many times. A total of 52 units of leukocyte-reduced suspended red blood cells, 8250 ml of plasma, 90 units of cryoprecipitate, 11 therapeutic doses of platelets, and 6 plasma exchanges (2500 ml of plasma was used each time) were given. The patient was cured and discharged 40 days after the operation. No abnormalities were found during the one-month follow-up after discharge.(Table 1).

Reference values: White blood cells 3.5–9.5 × 10⁹/L, hemoglobin 115–150 g/L, platelets 125–350 × 10⁹/L, fibrinogen 2–4 g/L, prothrombin time 10–14 S, alanine aminotransferase (ALT) 0–35U/L, aspartate aminotransferase (AST) 14–36U/L, lactic acid 0.5–1.8mmol/l, lactate dehydrogenase 120–250U/L, creatinine 41–73umol/l, urea 2.6–7.5mmol/l, blood pH 7.35–7.45.