This clinical update covers a range of infectious disease topics, interspersed with sharp criticism of US health policy appointments. Dr. Daniel Griffin and Vincent Racaniello review the current pertussis outbreak driving infant deaths in the US, linked directly to declining vaccination rates. The hosts analyze a massive Cochrane review confirming HPV vaccine efficacy and safety, investigate a Phase 1 trial of novel oral polio vaccines they deem unethical, and discuss the Marburg virus outbreak in Ethiopia. Considerable time is spent on respiratory viruses: the superiority of cell-based influenza vaccines over egg-based ones, the efficacy of mRNA COVID-19 boosters against current variants (KP.3.1.1, XEC), and the lack of myositis risk post-vaccination. The episode concludes with listener questions addressing HPV latency in older adults and the continued reliability of rapid antigen tests.
TWiV 1274: Clinical Update – Key Takeaways
3:33 | CDC Appointment Criticism: Ralph Abraham, former Louisiana Surgeon General, was appointed as CDC deputy director. The hosts identify this as a disaster for public health; Abraham is a critic of COVID vaccines, pushed Ivermectin, and advocated stopping Hepatitis B birth doses. As far as I can tell, this signals a shift toward "medical freedom" over evidence-based medicine, which will likely result in increased preventable mortality.
Infant deaths reported in Kentucky and Texas (first in years).
National cases exceed 25,000; Texas has 3,500+.
The cause is explicitly linked to drops in vaccination coverage. The hosts express frustration that political "freedom" arguments are resulting in dead children.
9:42 | HPV Vaccine Efficacy: A Cochrane review (225 studies, 132M subjects) confirms the vaccine is incredibly safe and effective.
80% reduced risk of cervical cancer if vaccinated by age 16.
No increased risk of Guillain-Barré syndrome (GBS) or Postural Orthostatic Tachycardia Syndrome (POTS).
13:01 | Marburg Virus: An outbreak is occurring in Ethiopia with five confirmed deaths. No spread outside the region has been reported yet.
Discussion of a Phase 1 trial for novel oral polio vaccines (nOPV1 and nOPV3).
Critical Takeaway: The hosts tear into the ethics of this. Using a live attenuated vaccine that can cause paralysis (even if at a lower rate than Sabin strains) in humans is indefensible when a completely safe Inactivated Polio Vaccine (IPV) exists. This seems to be driven by Gates Foundation funding strategies rather than patient safety.
19:54 | Measles: US cases are approaching 1,800. The elimination status from the year 2000 is effectively gone due to poor outbreak response and falling vaccination rates.
Cell-based vaccines show ~20% better relative efficacy than egg-based ones, which translates to preventing an estimated ~2.4 million symptomatic illnesses.
mRNA Flu Vaccine: Phase 3 data for an mRNA flu shot shows it works, but reactogenicity is higher. It seems doubtful this administration will approve it given its anti-mRNA stance.
Griffin discusses the math of GBS risk (vaccine vs. natural infection).
Side Note: Dr. Oz is mocked for being unable to calculate a percentage drop from $242 to $10. It’s a 96% reduction; basic arithmetic seems beyond the federal government’s top healthcare officials.
A Danish register-based study (N > 890k) shows JN.1 vaccines remain highly effective against hospitalization (70-85%) and death (76-95%).
Crucially, this protection holds up against newer variants like KP.3.1.1 and XEC. Chasing every single variant match may not be necessary for severe disease protection.
39:44 | Myositis Safety Signal: A large Nordic study (13M people) found no increased risk of myositis following mRNA or Adenovirus vector COVID-19 vaccination.
A 64-year-old listener tested positive for HPV for the first time.
Mechanism: This is likely reactivation of a decades-old latent infection triggered by stress, not a new infection. The vaccine is recommended as it may have therapeutic value in clearing the virus.
A General Practitioner claimed rapid tests don't work on current variants. This is false. The nucleocapsid protein targets remain stable; tests are effective if used correctly (serial testing).