In this clinical update, Dr. Daniel Griffin and Vincent Racaniello discuss several recent developments in virology and public health. They begin with positive findings on the shingles vaccine, which appears to reduce the incidence of mild cognitive impairment and dementia-related mortality, suggesting a protective effect across the entire course of the disease. They also cover a study indicating that a single dose of the HPV vaccine is non-inferior to the standard two-dose regimen for preventing HPV 16/18 infection, a finding with significant implications for global public health.
The core of the discussion is a sharp critique of a leaked FDA memo from Dr. Vinay Prasad that claims COVID-19 vaccines are linked to 10 child deaths. The hosts condemn the memo for its lack of scientific evidence, its improper use of the unverified VAERS database to infer causality, and its politically charged, unprofessional tone. They frame it as a dangerous attack on evidence-based medicine.
The episode also provides routine updates on rising cases of measles, influenza, and RSV. Finally, it explores new research on Long COVID, including a case report on celiac plexus blocks for gastrointestinal symptoms and a study identifying objective brain alterations in patients with cognitive impairment.
TWiV 1276 Clinical Update: Vaccine Efficacy, FDA Controversy, and Long COVID Research
2:06 Shingles Vaccine and Dementia: A study using a natural experiment in Wales found that the herpes zoster (shingles) vaccine was associated with a reduced incidence of new mild cognitive impairment (MCI) and a lower rate of death from dementia among patients already diagnosed. This suggests the vaccine may provide a protective effect throughout the entire disease course.
9:48 Critique of FDA Memo on Child Vaccine Deaths: The hosts express dismay over a leaked FDA memo by Dr. Vinay Prasad claiming COVID-19 vaccines caused at least 10 child deaths. They criticize the assertion as unscientific, noting it improperly infers causation from the VAERS database—an open, unverified reporting system. The memo is condemned for lacking any actual evidence and for its threatening, anti-scientific demand that dissenting staff should resign. As far as I can tell, the hosts' critique is valid; making such a strong causal claim from VAERS data without rigorous follow-up is a fundamental misuse of the system.
19:15 Single-Dose HPV Vaccine Efficacy: A study published in the New England Journal of Medicine demonstrated that one dose of either the bivalent or nonavalent HPV vaccine was non-inferior to two doses in preventing persistent HPV 16 and 18 infections. This could simplify vaccination schedules and increase uptake globally.
Measles: Cases continue to rise across North America, a direct result of declining vaccination rates.
Influenza: Flu season is beginning, with H3N2 being prominent. Hospital admissions, particularly among the elderly, are increasing.
RSV: Activity is increasing, with severe cases requiring ventilation reported in both adults and children.
26:12 Maternal RSV Vaccine Safety: A large study from France provides further evidence for the safety of the RSV vaccine (Brisvo) during pregnancy, showing no increased risk of adverse outcomes for the mother or newborn.
31:06 COVID Vaccination Reduces Long COVID Risk: A systematic review and meta-analysis found that receiving one or more doses of a COVID-19 vaccine was associated with a 41% reduction in the risk of developing Long COVID. The protective effect increased with more doses, reaching a 70% reduction for those with three doses.
36:03 Novel Long COVID Research and Treatment: Two new studies are discussed:
A case report shows that a celiac plexus nerve block successfully improved severe gastrointestinal symptoms in three Long COVID patients.
Another study found distinct, objective brain alterations and evidence of neurodegenerative processes in patients with cognitive impairment after mild COVID-19, providing a potential biological basis for "brain fog."
51:08 Paxlovid for Vaccinated Individuals: In response to a listener question, Dr. Griffin dismisses a Canadian study suggesting Paxlovid is not helpful for vaccinated individuals as flawed. He maintains that for high-risk patients (e.g., age 70+), the medication still provides a valuable reduction in the risk of hospitalization and death.