This episode of "This Week in Virology" is a clinical update with Dr. Daniel Griffin. The hosts are intensely critical of a recent change to the CDC's vaccine safety webpage, which they argue uses disingenuous semantic arguments to cater to anti-vaccine sentiments by stating that a causal link between vaccines and autism has not been definitively ruled out. They discuss several global infectious disease events: the detection of wild-type poliovirus in German sewage, a Marburg virus outbreak in Ethiopia, the decimation of an elephant seal colony by H5N1, and the first human case of H5N5 influenza, traced back to transatlantic bird migrations.
The clinical update covers rising measles cases in North America, a predicted severe H3N2 influenza season due to a vaccine mismatch, and new data on RSV, including the high efficacy of monoclonal antibodies for infants and the higher risk of Guillain-Barré syndrome from RSV infection compared to the vaccine. For COVID-19, they cover rising wastewater signals, the risk of transmission in shared hospital rooms, and a study on resistance exercise for long COVID, the results of which they view with skepticism due to large error bars. As far as I can tell, the central theme is the degradation of public health institutions and the real-world consequences of misinformation.
TWiV 1272 Clinical Update: Key Points and Discussion
2:38 CDC Website Controversy: The CDC updated its "Autism and Vaccines" page to state that science has not ruled out the possibility of a link. The hosts condemn this as a scientifically disingenuous and politically motivated change that exploits the impossibility of proving a negative. They argue it dangerously fuels vaccine hesitancy and is a capitulation to figures like Robert F. Kennedy Jr.
9:22 Polio Surveillance: Wild-type poliovirus 1 (WPV1), originating from Afghanistan/Pakistan, was detected in German sewage. This is an importation event. The risk of an outbreak is considered low due to high vaccination rates, but it highlights the need for continued surveillance.
11:25 First Marburg Outbreak in Ethiopia: Ethiopia confirmed its first outbreak of Marburg virus, a filovirus related to Ebola. As of the recording, there were nine cases and six deaths. The virus is transmitted from Egyptian fruit bats.
13:37 H5N1 in Wildlife: Highly pathogenic avian influenza (H5N1) has caused mass mortality in the world's largest southern elephant seal breeding colony in South Georgia, killing nearly half the breeding females.
16:48 First Human H5N5 Influenza Case: A patient in Washington was diagnosed with H5N5 avian flu, a different strain than the more common H5N1. The hosts discuss a paper suggesting this H5N5 strain crossed the Atlantic via seabirds and shows signs of adaptation to mammals.
27:37 Alarming Rise in Measles: Measles cases are rising to levels not seen since 2000 in the US. Both the US and Canada are at risk of losing their measles elimination status, a direct consequence of reduced vaccination rates.
29:27 Influenza Season Warning: Flu activity is increasing, particularly H3N2. Experts predict the dominant strain will be subclade K, a mismatch for the current vaccine based on subclade J. This will likely reduce vaccine effectiveness, but vaccination is still strongly recommended as the best available protection against a potentially severe season.
36:37 RSV Protection and Risk: A study confirmed that the monoclonal antibody Nirsevimab is about 80% effective at preventing RSV-associated ICU admission in infants. Another study found that natural RSV infection increases the risk of Guillain-Barré Syndrome (GBS) by more than two-fold, putting the small risk from vaccination into perspective.
Transmission in hospitals is a significant risk; the secondary attack rate in a shared room is around 26%. Improved ventilation offers only a modest risk reduction. Wearing an N95 mask remains the most effective personal protection.
A randomized trial on resistance exercise for long COVID showed a statistically significant improvement in walking distance. However, the hosts are dismissive of the clinical importance of the finding due to the extremely large error bars, suggesting the actual effect is probably small or non-existent.
59:04 Vaccine and Cortisone Shot Timing: A listener asked about getting a COVID vaccine and a cortisone injection in the same week. Dr. Griffin advises getting the vaccine first and waiting at least three weeks before the cortisone shot to ensure an effective immune response.
1:00:55 Shoulder Injury After Vaccination (SIRVA): A listener described rotator cuff surgery after a COVID booster, where the surgeon found "sharp-edged crystals." Dr. Griffin suggests this was likely a case of Shoulder Injury Related to Vaccine Administration (SIRVA), caused by improper injection technique (injecting into the bursa or tendon instead of the deltoid muscle), rather than a reaction to the vaccine's contents.