Dengue in Cyprus, Donanemab's Long Game, and the Resistance Clock

Five stories from the first days of August share an unspoken pattern: the medical decisions deferred, underfunded, or dismissed today reappear in the data a decade later — and not quietly.

Friday, 7 August: ECDC Confirms Sustained Local Dengue Transmission in Cyprus and Greece

The European Centre for Disease Prevention and Control has issued its highest seasonal alert for dengue in the Mediterranean basin, after confirming locally acquired infections — not imported travel cases — in five municipalities along the southern Greek coast and in the Limassol and Larnaca districts of Cyprus. This is the first time local dengue transmission has been sustained across two consecutive seasons in Cyprus; isolated cases in 2025 were extinguished within weeks.

Dengue is transmitted by Aedes albopictus (the tiger mosquito), established in Cyprus and Greece for over a decade. Climate warming now extends mosquito activity into September and October. WHO Europe estimates the window for sustained local transmission in the Mediterranean has lengthened by six to eight weeks compared with 2010. The dengue vaccines approved in higher-endemic regions — Dengvaxia and Qdenga — are not recommended for low-transmission settings without prior seropositivity screening; vector control and personal protection remain the primary public-health tools in Cyprus.

The Cyprus Ministry of Health is conducting emergency larval surveys across coastal urban zones and has issued public guidance asking residents to eliminate standing water from flowerpot trays, roof gutters, and construction containers; apply insect repellent containing DEET or picaridin at dawn and dusk; and seek prompt medical assessment for any fever accompanied by muscle pain, severe headache, eye pain, or rash within five days of onset. There is no antiviral treatment for dengue; care is supportive.

Friday, 7 August: Donanemab 24-Month Cohort Shows Amyloid Stays Cleared After Treatment Stops

A real-world follow-up cohort of 312 patients who completed an 18-month course of donanemab (Kisunla, Eli Lilly) and then discontinued — as permitted under FDA-approved prescribing information — was presented at the Alzheimer's Association International Conference in Philadelphia and simultaneously published in Alzheimer's & Dementia. At 24 months from first infusion (six months after the median stop point), 76% of patients who had achieved amyloid-plaque clearance on amyloid PET remained plaque-negative.

In the pivotal TRAILBLAZER-ALZ 2 trial, 52% of participants became amyloid-negative by six months and 72% by 12 months. This real-world cohort follows those durable responders into the post-treatment period, answering the question patients and clinicians have most urgently asked since Kisunla's approval in July 2024: if treatment is stopped after the amyloid is gone, does it come back quickly? For three quarters of completers, at six months post-discontinuation, the answer is no.

This is a clinically distinct story from the home-dosing approval reported here on 6 August for lecanemab (LEQEMBI IQLIK). Donanemab follows a finite-course architecture — treatment stops when amyloid is cleared, confirmed on amyloid PET imaging — while lecanemab is an ongoing maintenance therapy. Both drugs target amyloid plaques, but their treatment designs, infusion schedules, monitoring demands, and patient profiles differ substantially. Eli Lilly has committed to a three-year extension cohort to determine whether plaque clearance holds at 36 and 48 months; those data will be central to long-term prescribing confidence.

Friday, 7 August: Tirzepatide Achieves 55% Liver Fibrosis Reversal in SURMOUNT-NASH Phase 3

Eli Lilly has released primary results from SURMOUNT-NASH, a 72-week randomised, double-blind Phase 3 trial of tirzepatide (Mounjaro/Zepbound) versus placebo in adults with metabolic dysfunction-associated steatohepatitis (MASH) and stage-2 or stage-3 liver fibrosis. MASH is the progressive inflammatory form of fatty liver disease — the stage at which fat accumulation tips into scarring — and it is estimated to affect around 115 million adults globally, contributing substantially to liver transplant queues and hepatocellular carcinoma incidence. The trial enrolled 966 participants across 43 countries.

In the 15 mg arm, 55.4% of participants achieved at least a one-stage improvement in liver fibrosis with no worsening of MASH activity — the primary endpoint — compared with 30.2% in the placebo group. Resolution of MASH without fibrosis worsening was achieved by 62.4% in the higher-dose arm. The results, published in the New England Journal of Medicine, provide the most compelling Phase 3 evidence yet for a GLP-1-class therapy in MASH.

Resmetirom (Rezdiffra), the first and only currently approved drug for MASH, produces fibrosis regression in approximately 26% of patients at its labelled dose; tirzepatide's response rates are roughly double that, though direct comparison is complicated by different trial populations and endpoint definitions. Lilly is expected to file for a MASH indication with the FDA in Q4 2026 and with the EMA in Q1 2027. The existing approvals for tirzepatide cover type 2 diabetes and obesity; a MASH indication would expand access to a large population of patients for whom liver disease and metabolic disease overlap, and for whom there are currently very few evidence-based pharmacological options.

Friday, 7 August: WHO's Updated AMR Action Plan: Resistance Now Kills 1.49 Million People a Year

The World Health Organization has released its Global Action Plan on Antimicrobial Resistance for 2026–2030, alongside a revised burden analysis estimating that drug-resistant infections now directly cause 1.49 million deaths annually — up from the 1.27 million attributed in the landmark 2022 Lancet study — with a further 4.95 million deaths in which AMR is a contributing cause. The three pathogens driving the largest share of the increase are carbapenem-resistant Klebsiella pneumoniae, carbapenem-resistant Acinetobacter baumannii, and extended-spectrum beta-lactamase-producing Escherichia coli.

Within WHO's European Region, the ECDC's European Antimicrobial Resistance Surveillance Network (EARS-Net) identifies Greece and Cyprus among EU member states with the highest rates of carbapenem-resistant Klebsiella in invasive clinical isolates — a consequence of elevated antibiotic consumption in hospital settings and, in some facilities, delayed implementation of infection prevention and control protocols.

The updated framework calls for mandatory antibiotic stewardship programmes in all EU hospitals by 2028, expanded access to rapid diagnostic tests to reduce empirical prescribing, and sustained investment in new antibiotics targeting Gram-negative resistant organisms. Three novel antibiotic classes are in clinical development globally, but none is expected to reach market before 2028. The message has not changed meaningfully in a decade. The death toll has.

Friday, 7 August: Mediterranean Diet Cuts Dementia Risk 23% Over Ten Years in 60,000-Person UK Biobank Study

A ten-year prospective analysis of 60,298 participants in the UK Biobank, published in The BMJ, finds that high adherence to a Mediterranean dietary pattern is associated with a 23% lower risk of incident all-cause dementia compared with low adherence, after adjustment for physical activity, education, socioeconomic deprivation, smoking, alcohol use, cardiovascular disease history, and APOE4 genotype. Dietary adherence was assessed at baseline using a validated 25-item food frequency questionnaire.

The risk reduction is driven largely by vascular dementia (31% lower risk) rather than Alzheimer's disease specifically (18%) — a pattern the authors describe as consistent with the diet's established cardiovascular and metabolic benefits: anti-inflammatory long-chain fatty acids from oily fish and olive oil, polyphenols from vegetables and legumes, dietary fibre, and markedly limited intake of ultra-processed foods. The analysis cannot rule out residual confounding — the healthy-user bias that challenges all observational diet research — but the effect size is robust across multiple adjustment models and consistent with findings from smaller prospective cohorts.

For clinicians and public health authorities in Cyprus and the wider Mediterranean region — where traditional dietary patterns have been eroding toward ultra-processed foods, particularly among younger adults, for two decades — the finding reinforces the evidence base for diet counselling as part of a dementia prevention strategy alongside management of hypertension, regular physical activity, and early treatment of hearing loss. It also underlines the particular paradox facing southern Mediterranean health systems: the region that gave the world the protective dietary pattern is simultaneously recording the highest rates of departure from it.

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The content above is journalistic reporting and does not constitute medical advice. Readers should consult a qualified clinician or pharmacist before making any change to their treatment, medication, or health routine.