In the 50 years since it was identified, Lyme disease has become one of the most recognized and widespread vector-borne illnesses in the world. Transmitted by ticks, this elusive infection presents ongoing challenges in detection and treatment. In this episode of Tomorrow's Cure, we explore how researchers are advancing diagnostic tools to detect Lyme disease — and what these innovations mean for the future of global health.

The episode features two leading experts including Bobbi Pritt, M.D., microbiologist and pathologist at Mayo Clinic, and Allen Steere, M.D., a rheumatologist, director of Translational Research and Rheumatology at Massachusetts General Hospital and professor of medicine at Harvard Medical School. Together, they discuss the latest advancements and the ongoing efforts to better control Lyme disease.

Dr. Steere identified Lyme disease in 1976 while investigating a cluster of children in Lyme, Connecticut, who were experiencing unexplained arthritis. His research ultimately led to the discovery and naming of the disease. Since then, researchers have devoted their efforts to advancing diagnostic tools, treatments and vaccine development.

Lyme disease continues to grow in prevalence, driven by factors such as climate change, ticks' ability to thrive in diverse environments, urbanization and increased global travel. As ticks adapt and spread, the development of effective and innovative testing methods becomes increasingly vital to improve patient outcomes and enhance the ability to respond swiftly to outbreaks. 

Lyme disease is challenging to detect given its ability to mimic other illnesses or appear asymptomatic altogether. "There may not be specific symptoms when the patient comes in that would tell them this is a vector-borne disease," said Dr. Steere. "There may be symptoms that we commonly see with infection, or they may also be absent."

Given this challenge, the development of better diagnostic tools is critical. 

"My job as a pathologist and microbiologist specializing in laboratory diagnostics is to create tests that can accurately detect the disease at various stages," Dr. Pritt said. "And equally important is guiding my clinical colleagues on which tests to order."

One promising advancement is the use of metagenomics, a cutting-edge technique that enables the simultaneous detection of multiple genomes. This approach allows for the identification of bacteria, DNA and RNA viruses, fungi and parasites in a single assessment.

As researchers continue to advance the science, the outlook for more effective detection and treatment of Lyme disease grows increasingly promising. To learn more about these transformative advancements, listen to the latest episode of Tomorrow's Cure. The podcast is available on all audio platforms, including Apple Podcasts, Spotify and Amazon Music. Episodes are also available on Mayo Clinic's YouTube channel. 

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Dengue fever is a potentially life-threatening viral infection transmitted through the bite of infected mosquitoes.

"Four different subtypes of the virus can cause infections in humans," says Dr. Stacey Rizza, a Mayo Clinic infectious diseases specialist. "Wherever you have a significant number of mosquitoes and warm hot environments is where you see dengue transmission."

Watch: Dr. Stacey Rizza explains dengue fever

Journalists: Broadcast-quality sound bites with Dr. Rizza are available in the downloads at the end of the post. Please courtesy: "Mayo Clinic News Network." Name super/CG: Stacey Rizza, M.D./Infectious Diseases/Mayo Clinic.

Approximately half of the world's population lives in areas vulnerable to dengue fever, particularly in hot and humid tropical and subtropical climates.

"That's why you see it in parts of the world such as Southeast Asia, South America, the Caribbean, and even some parts of the southern U.S., around Florida and Louisiana.," says Dr. Rizza.

The primary transmitter of dengue fever is the Aedes aegypti mosquito, known to bite during both day and night. About 1 in 4 people infected with the virus will experience symptoms ranging from mild to severe.

Symptoms of dengue fever

"They usually notice fevers, body aches, bone aches, muscle aches; many times, they even describe an aching behind their eyes. They can get some nausea, vomiting and even diarrhea," Dr. Rizza says.

While most people recover within about a week, severe cases can lead to life-threatening emergencies.

Symptoms of severe dengue fever may include:

• Severe stomach pain.
• Persistent vomiting.
• Bleeding from your gums or nose.
• Blood in your urine, stool or vomit.
• Bleeding under the skin, which might look like bruising.
• Difficult or rapid breathing.
• Fatigue.
• Irritability or restlessness.

Treatment

Unfortunately, there is no medicine to treat dengue fever.

"There's no antiviral or no treatment for dengue fever," she says. "It's what we call supportive therapy. Maintaining good hydration, particularly as people are sick and having fevers, is important. They can use acetaminophen to take care of the fevers, bring down the temperature, and then ensure they take in fluids and still get some form of eating."

"If they become severely ill and aren't able to keep up with their fluid status, they should go to their hospital and may require hospitalization to help support them," says Dr. Rizza.

Though there is no direct treatment, a vaccine is approved in many countries for children ages 9-16 who have previously shown evidence of dengue infection. Dr. Rizza says the vaccine is not approved in the U.S.

"You give it to people who have already had immunologic evidence of a previous dengue infection, and then you give it to them to help prevent them from becoming reinfected," she says.

Prevention

Preventing mosquito bites is vital to avoiding dengue fever. Here are some strategies:

• Use bug spray with DEET, picaridin or oil of lemon eucalyptus to prevent mosquito bites.
• Remove any stagnant water where mosquitoes can lay eggs.
• Eliminate items that hold water, such as vases and flowerpot saucers.
• Ensure intact window screens and closed doors to keep mosquitoes outside.
• Wear protective clothing such as long sleeves and pants.

The Aedes aegypti mosquito is responsible for several viral infections, including dengue fever, yellow fever, chikungunya and Zika.

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According to the Centers for Disease Control and Prevention (CDC), more than 700 confirmed measles cases have been reported in at least 25 states as of mid-April — and that number continues to grow. Most cases are among people who are unvaccinated, have an unknown vaccination status or are children. The highly contagious disease can lead to serious complications and hospitalizations, and two deaths have already been confirmed.

As awareness of the measles outbreak spreads, many Americans are asking questions and reassessing their vaccination status. Now may be a good time to brush up on the basics.

Who's at risk?

Anyone can get measles, especially if they are unvaccinated. You don't even have to come face-to-face with someone who has it to be infected. Measles is one of the most contagious infectious diseases and is highly transmissible. It spreads through the air when an infected person coughs or sneezes, and it can infect others up to two hours after the sick person has left a room.

Measles symptoms and complications

Common symptoms of measles include:

• Fever
• Dry cough
• Runny nose
• Conjunctivitis (red, watery eyes)
• White spots inside the mouth
• A rash made up of large, flat spots and small raised bumps that start on the face or neck and spread down the body

Complications from measles can include pneumonia, encephalitis (brain infection), airway inflammation and diarrhea leading to dehydration. Some complications may be severe and result in death. Becoming infected during pregnancy can result in premature delivery, stillbirth, miscarriage or birth defects. Those who are at increased risk for developing complications are children under the age of 5, people over age 20, pregnant women and people with a weakened immune system.

Prevention and vaccines

Vaccination is the safest and most effective way to prevent measles. The measles, mumps, rubella (MMR) vaccine plays a vital role in safeguarding the health of patients, staff and communities.

The CDC recommends that children receive two doses of the MMR vaccine: the first dose at 12 to 15 months of age, and the second between 4 and 6 years old. In some cases, the second dose may be given earlier, based on guidance from the child's primary care clinician. Full vaccination with two doses is on average 97% effective at preventing measles illness. The combined measles, mumps, rubella, and varicella (MMRV) vaccine also provides excellent protection. Varicella is better known as chickenpox. Parents can consult with their child's physician about which vaccine is best for their child.

Measles was declared eradicated from the U.S. in 2000 through a successful vaccine program; however, according to the CDC, a decline in vaccination rates among the nation's kindergartners over the past several years has contributed to measles outbreaks.

Mayo Clinic stands behind the evidence supporting the efficacy and safety of vaccines approved by the Food and Drug Administration and the vaccination schedules outlined by the CDC.

Measles in adults  

According to the CDC, if you had the vaccine as a child or if you ever had the measles, you are protected for life and do not need a booster vaccine. If you don't have proof of immunity, you might need a vaccine. If you are unsure of your vaccination status, check with your healthcare team.

Treatment

There are no effective antiviral treatments for measles. Vitamin A can reduce the risk of complications from measles infection, especially among people who are vitamin A deficient. If you or your child are diagnosed with measles, your healthcare team may recommend you take vitamin A. Keep in mind that this vitamin does not prevent measles infection and taking high doses without the supervision of a healthcare professional is dangerous and can result in liver failure and death. Taking too much vitamin A during pregnancy can result in serious birth defects.

Read more about the diagnosis and treatment of measles.

What you can do now

Verify with your healthcare team that everyone in your family is up to date with their measles vaccines. This is especially important if you are planning to travel internationally or to an area in the U.S. that is affected by the outbreaks.

Be aware of the symptoms of measles, and notify your healthcare team if you suspect you may have it so that testing can be performed as soon as possible.

Related:

Researchers take rare peek into how a virus spreads in a human brain 

Resources:

Frequently Asked Questions About Measles

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If you or a family member has the flu or other respiratory infection, Dr. Tina Ardon, a Mayo Clinic family medicine physician, says there are ways to manage most respiratory infection symptoms at home.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:03) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"Most upper respiratory infections can be managed at home," says Dr. Ardon.

That can start by staying hydrated, which is important part of the body's recovery process.

"If we are feeling sick and we're not drinking enough — maybe we have a high fever or throwing up, we have diarrhea — we are at risk of dehydration. And that may need more urgent evaluation, perhaps in the ER settings," says Dr. Ardon. 

Cough is a very common symptom of upper respiratory infections and is usually the last symptom to leave. When it comes to cough, time is the best treatment.

"For the most part, cough will resolve on its own, but some patients may benefit from using things like honey at home as long as you're over the age of 1."

She says if a cough lasts more than two weeks, that's when you should contact your healthcare team.

The other thing you can do for your body when you're sick can sometimes be the hardest.

"Take the time to rest. That's one way to help your body recover faster," says Dr. Ardon. "I often find people have a hard time turning things off to be able to rest and recover. So that really is probably key for most patients to recover fastest."

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H5N1 bird flu, also known as avian influenza, continues to spread, with reports of a third human case from an unknown exposure source. To date, 67 cases have been confirmed, and one death has been reported in the U.S.

"Most of the people are interacting with infected birds and animals, and there have been several cases where we don't have a specific history of that individual interacting with an animal or a bird that might be infected," says  Dr. Matthew Binnicker, director of the Clinical Virology Laboratory at Mayo Clinic. "And that's why we're cautious and somewhat concerned because the question arises, how did those several individuals become infected?"

There are no reports of the virus spreading from person to person, and the public health risk remains low. 

Watch: Dr. Matthew Binnicker provides update on H5N1 bird flu outbreak

Journalists: Broadcast-quality sound bites are available in the downloads at the bottom of the posts. Name super/CG: Matthew Binnicker, Ph.D./Laboratory Medicine and Pathology/Mayo Clinic

Avian influenza spreads as migratory birds carrying the virus travel between hemispheres. Wild birds can transmit the virus to poultry, farm animals and backyard flocks through respiratory secretions, droppings or shared water. Dr. Binnicker says most cases of infection in humans are from animals to humans at dairy and poultry farms.

"Right now, the primary means of transmission is from individuals interacting with an infected bird or an animal like a dairy cow, handling a sick or dead bird, and then self-inoculating the virus into your eyes, nose or mouth, or working with a dairy cow and becoming infected during the process of collecting milk. We have not seen documented human-to-human transmission of H5N1 yet," he says.

Precautions

U.S. dairy and poultry workers are encouraged to take precautions to prevent infections.

"It's really important for those who work in bird facilities or on farms where there are dairy cattle when interacting with the animals or debris from the animals that those individuals wear a mask, eye protection and gloves. Many individuals who have been affected following exposure to dairy cattle are coming down with conjunctivitis because the virus is being introduced into the eyes. There are receptors that the virus binds to in the eyes, so wearing eye protection is also important," says Dr. Binnicker.

How to protect yourself from bird flu at home:

• Cook poultry, meat and eggs to their recommended internal temperatures.
• Use only pasteurized dairy products.
• Practice good hand hygiene, especially when handling food.
• Use separate utensils for raw and cooked meat to avoid cross-contamination.

Dr. Binnicker says the U.S. is seeing the most infections due to increased testing and screening, but the virus is likely prevalent in many countries. Health officials are concerned about the potential for a large outbreak in humans. 

"We've seen now for years this growing outbreak among birds and animals and in mammals, with millions of poultry being affected in the U.S. and worldwide. We're seeing a growing number of human cases. Fortunately, those cases have been mild so far, but what we know about influenza is that the more it infects animals and humans, the better the chance it has to change and mutate. And it's a numbers game. The more times that happens, the greater the probability that a virus will arise that can transmit effectively between one person and another and cause severe disease," says Dr. Binnicker.

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You may have heard recent news reports about a surge in cases of human metapneumovirus, or HMPV, in the Northern Hemisphere, especially in China. But Dr. Matthew Binnicker, director of the Clinical Virology Laboratory at Mayo Clinic, says people shouldn't be concerned.

"In the late winter, early spring, it can account for 5% to 10% of all the respiratory infections that we diagnose in the United States. So it's definitely out there," says Dr. Binnicker.

Watch: Dr. Matthew Binnicker discusses human metapneumovirus (HMPV)

Journalists: Broadcast-quality sound bites are available in the downloads at the bottom of the post. Name super/CG: Matthew Binnicker, Ph.D./Laboratory Medicine and Pathology/Mayo Clinic

HMPV is a respiratory illness that generally causes mild symptoms similar to the common cold that usually last just a few days.

"Typically, individuals will progressively feel worse with a runny nose, maybe a sore throat, some slight body aches, perhaps a cough. The symptoms are not typically as severe as other respiratory viruses like RSV or especially influenza," says Dr. Binnicker.

He says, like many other respiratory viruses, HMPV spreads from an infected person or through contact with a contaminated surface, and he emphasizes the importance of proper hand-washing and covering your cough.

"Human metapneumovirus is transmitted in a similar way to other respiratory viruses, like the flu and COVID and RSV, mainly through respiratory droplets that are produced while an individual coughs or sneezes. It can also be spread through what we call contaminated fomites. So if an infected individual coughs into their hand and then touches a door handle, another person could come along, touch that door handle, and then self-inoculate the virus into their eyes, nose or mouth. And that's a potential way of transmitting the virus as well," says Dr. Binnicker.

He adds that there is no approved antiviral medication to treat HMPV.

"If you would happen to go in and see your family physician with a few days history of a sore throat and a cough and a runny nose, and you were ultimately diagnosed with human metapneumovirus, they wouldn't be able to prescribe you a medication or an antiviral. They would typically just recommend supportive care. So if there's medication that you can take to reduce any body aches or reduce a fever, and staying well hydrated," says Dr. Binnicker. "Really, it all comes down to supportive care, rather than a specific drug to target the virus."

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It's a post-holiday surge. The Centers for Disease Control and Prevention (CDC) reports the number of people seeking care for acute respiratory illness is at a high level.

The latest nationwide numbers show that emergency department visits for flu, RSV and COVID-19 are all increasing. RSV, in particular, is very high in many areas, especially among young children.

Dr. Matthew Binnicker, director of the Clinical Virology Laboratory at Mayo Clinic, says the surge is not unexpected. "We are in what's called respiratory virus season right now, which basically runs between the beginning of November and the end of February. We typically see increasing rates of viral infections like influenza or respiratory syncytial virus (RSV), and, since 2020, COVID-19."

Dr. Binnicker says the symptoms of all three of those viruses can overlap, especially early on, so you probably wouldn't know which virus is causing your illness based on how you're feeling. That’s why he stresses the importance of testing. "My recommendation and guidance has been: If you start to feel ill, if you have a sore throat, cough, fever, maybe some body aches, and you have a COVID-19 antigen test at home, take that. If it's positive, you have COVID-19, and you could call your doctor if you have risk factors. And they may think about putting you on an antiviral," he says. 

Watch: Dr. Matthew Binnicker discusses acute respiratory illness

Journalists: Broadcast-quality sound bites are available in the downloads at the bottom of the posts. Name super/CG: Matthew Binnicker, Ph.D./Laboratory Medicine and Pathology/Mayo Clinic

If the COVID-19 antigen test is negative, Dr. Binnicker says you still might want to make an appointment with your healthcare team because "they can order up a test that looks for all three of those viruses. They'll get a swab, they'll send it to the lab, and they'll be able to do a molecular or PCR test that will test for COVID-19, RSV, influenza A and influenza B — all in the same test — and be able to tell you if you're infected with one of those viruses."

He says that's a good step because therapies can be considered now for COVID-19, influenza and even RSV in some populations.

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If you've been bit by a stomach bug lately, you're not alone.

Noroviruses are usually more widespread in the fall and winter, but you can get sick from the virus any time of the year. The Centers for Disease Control and Prevention (CDC) says norovirus is the leading cause of vomiting and diarrhea from acute gastroenteritis in the U.S.

Norovirus infection, sometimes referred to as stomach flu, is unrelated to the flu caused by the influenza virus. Dr. Nipunie Rajapakse, a pediatric infectious diseases physician with the Mayo Clinic Children's Center, says it's a virus that causes gastroenteritis.

"Norovirus is a type of virus that causes gastroenteritis or stomach flu. Usually, it presents with symptoms like vomiting and diarrhea. Most healthy people will have recovery over a few days. But for people with a weakened immune system, for example, their symptoms can last longer than that," she says.

Watch: Dr. Nipunie Rajapakse explains norovirus and how to avoid it

Journalists: Broadcast-quality sound bites are available in the downloads at the end of the post. Please courtesy: "Mayo Clinic News Network." Name super/CG: Nipunie Rajapakse, M.D./Pediatric Infectious Diseases/Mayo Clinic.

Dehydration is a concern, especially for young children, older adults, and those with other health issues or who are pregnant. Those symptoms can include decreased urination, dry throat and mouth, and feeling dizzy when standing up.  

Transmission

"Norovirus is spread through contact with the virus. People sick with norovirus shed the virus in high amounts in their vomit and stool, so coming into contact with the virus is how you get sick. This can be through direct contact or through contaminated food, or you can pick it up from a surface. That's why hand-washing is important and the best way to prevent getting sick with norovirus," says Dr. Rajapakse.

Risk factors

The CDC says that around half of food-related sickness outbreaks caused by norovirus are linked to restaurants or food-related environments. This happens when infected food workers and staff touch food or when it is contaminated.

Dr. Rajapakse says food that is contaminated with norovirus usually looks, smells and tastes normal so it can be difficult to tell it is contaminated.

Norovirus can quickly spread, especially in confined spaces, such as day care centers, nursing homes, schools and cruise ships. These viruses are tough to eliminate since they can endure high and low temperatures and most disinfectants.

"One of the common places that we see norovirus outbreaks occur is in close confined settings, like cruise ships, for example, where you have a lot of people eating from the same places and living in close proximity to each other," says Dr. Rajapakse. "Even one case of norovirus on a cruise ship can spread quickly to others there. That's why it's crucial to make sure that you're washing your hands well, especially before you eat."

Preventing norovirus infection

Antibiotics won't help because it's a viral infection, not bacterial. The best protection is prevention.

Tips to prevent the spread of norovirus:

• Wash hands with soap and water for at least 20 seconds.
• Avoid food and water that might be contaminated.
• Clean fruits and vegetables before eating.
• Cook seafood thoroughly.
• If you're sick, stay home and avoid others.
• Avoid preparing food for others if you are sick with vomiting/diarrhea.
• Disinfect surfaces and counters that may be contaminated.

And use caution when traveling. The CDC tracks outbreaks of norovirus and other diseases. You can learn more on their website. 

The CDC says outbreaks from norovirus are usually more common in the winter months. In countries above the equator, outbreaks are most common from November to April, while they are most common from May to September in countries below the equator. 

Related post:

• Mayo Clinic Minute: What to do when sick with norovirus or ‘stomach flu’

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According to the Centers for Disease Control and Prevention, respiratory infections like colds, flu and RSV are rising across the U.S. 

When you get sick, it’s helpful to understand how to manage your symptoms effectively, especially if you’re at higher risk for complications. Dr. Tina Ardon, a family medicine physician at Mayo Clinic, offers tips for managing common viral illnesses and when to seek medical care.

Recognizing symptoms

Flu symptoms include sore throat, runny or stuffy nose, fever, body aches and fatigue. These symptoms may overlap with other illnesses, like the common cold, but key differences exist. Colds generally develop gradually, while flu symptoms typically appear suddenly within two or three days of exposure to the virus.

Managing your symptoms

Start using over-the-counter medications such as pain relievers or cough suppressants to alleviate your symptoms. Staying hydrated is essential; drink plenty of water, broth or warm tea to nourish your body. Using a humidifier or taking a steamy shower can help ease congestion and make breathing easier.

Your body needs time to heal, so rest is crucial. "If you can, I highly recommend you stay home from school and work so your immune system can recover," says Dr. Ardon.

Try the following to help manage symptoms:

• Stay hydrated: Drink water, juice, or warm lemon water with honey to ease congestion and prevent dehydration. Avoid alcohol, coffee, and caffeinated drinks.
• Use warm liquids: Sip chicken soup, tea or warm apple juice to help with congestion.
• Try honey: Honey can soothe coughs in adults and children over 1 year old. Add it to warm tea or lemon water.
• Rest: Let your body recover with plenty of rest.
• Add moisture: Use a cool-mist humidifier or vaporizer to relieve stuffiness. Clean and refill daily.

Planning ahead 

For people at higher risk of flu complications—such as older adults or those who are pregnant or have chronic conditions or weakened immune systems—consider discussing a care plan with your doctor before getting sick. “If you’re at higher risk, we may recommend closer monitoring or additional care,” says Dr. Ardon.

High-risk patients diagnosed with the flu might be prescribed antiviral medications. These prescription drugs, available as pills, liquids, inhaled powders, or intravenous solutions, target the flu virus directly and require a medical prescription.

It’s important to note that flu antivirals differ from antibiotics, which treat bacterial infections, and antiviral treatments for other illnesses like COVID-19. Flu-specific antivirals won’t work for COVID-19 and vice versa.

When to seek medical attention

While most respiratory illnesses resolve on their own, you should seek medical care if your symptoms worsen or if you experience any of the following:

• Trouble breathing
• Chest pain
• Dizziness or confusion
• Severe dehydration or weakness

For children, also watch for:

• Fast breathing or blue lips
• No tears when crying or no urination
• Symptoms that improve but then return or worsen

Dr. Ardon says recovering from a respiratory virus can be managed at home for most people. "Knowing when to get help can make all the difference," she says.

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Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:05) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Whether it's the annual flu shot, latest COVID-19 booster, or milestone shots that cover pneumonia, shingles or tetanus, staying up to date on immunizations is just one way to protect your health.

"It's worthwhile having that conversation with your primary care team because we might change depending on conditions that you have and potentially even the age at which you would receive that vaccine," says Dr. Presutti.

Adult vaccinations to update

Pneumonia can be life-threatening when fluid fills the lungs' air sacs. In general, a vaccination is recommended for all adults 65 and older.

Shingles, a reactivation of the virus that causes chickenpox, can cause a painful, blistering rash. Vaccination is recommended in adults over 50.

Tetanus is caused by a bacterial infection, often from a cut or wound. The Tdap vaccine is recommended every 10 years and also protects against diphtheria and pertussis – the latter known as whooping cough.

"If you're a new parent or a new grandparent, then you should be getting the pertussis update vaccine to decrease the risk of you actually communicating, or giving, pertussis to the newborn baby," says Dr. Presutti.

Related posts:

• Mayo Clinic Minute: Strategies to stay healthy during respiratory virus season
• Can you get COVID-19 and the flu at the same time? A Mayo Clinic expert weighs in
• Mayo Clinic Minute: Why vaccines are especially important for older people

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