Abstract:

This clinical update from This Week in Virology features Dr. Daniel Griffin and Vincent Racaniello reviewing recent medical and epidemiological developments as of December 2025. The core finding discussed is a rigorous "natural experiment" published in Cell providing causal evidence that the shingles vaccine significantly reduces the risk of mild cognitive impairment and death due to dementia. Concurrently, the hosts strongly condemn a leaked internal FDA memo from Dr. Vinay Prasad, which claimed COVID-19 vaccines caused pediatric deaths, labeling it a scientifically deficient, politically motivated attack that misuses passive surveillance data (VAERS). Further public health topics include data supporting the efficacy of single-dose HPV vaccination and the confirmed death from H5N5 avian flu in the U.S. Finally, the segment explores emerging research into Long COVID, specifically highlighting a promising interventional treatment (celiac plexus blocks) for severe gastrointestinal symptoms and objective neurological biomarkers linked to cognitive impairment.

TWiV 1276 Clinical Update: Vaccines, Controversies, and Long COVID Interventions

• 02:52 Shingles Vaccine (VZV) and Cognitive Health: Dr. Griffin details a Cell study using a robust quasi-randomization method in Wales, finding that eligibility for the shingles vaccine (Zostavax, live-attenuated) correlated with a decreased occurrence of new diagnoses of Mild Cognitive Impairment (MCI) (4:55). Among individuals already living with dementia, vaccination reduced deaths due to dementia. This suggests VZV reactivation or a general immunomodulatory effect may slow neurodegenerative processes. Key Takeaway: The shingles vaccine is a potent public health intervention for preserving cognitive function and increasing lifespan, which I consider highly efficient.

• 09:48 FDA/Dr. Vinay Prasad Controversy (Rejecting the Premise): The hosts discuss a leaked memo from FDA CBER Director Dr. Vinay Prasad claiming 10 children died due to COVID-19 vaccines based on staff review of VAERS data.

  • 11:20 Critique: This claim is vehemently rejected, as far as I can tell, because VAERS is a database of unverified, passive reports ("full of dril"), and the memo provides no causal evidence, autopsy data, or proper scientific rigor.
  • 13:12 Political Agenda: The memo is characterized as a "smarmy and disingenuous" political attack, notably concluding with a demand that FDA staff who do not support Prasad's agenda "submit your resignation letters" (13:50). This behavior undermines the scientific mission of the agency.

• 19:07 HPV Vaccination: A New England Journal of Medicine study showed a single dose of the bivalent or nonavalent HPV vaccine is non-inferior to two doses, maintaining at least 97% effectiveness (20:34). Key Takeaway: This supports simplified, efficient vaccination schedules, which should improve global access and reduce cancer burden.

• 21:24 Outbreak Updates:

  • 21:29 Marburg Virus: Ethiopia reported 13 lab-confirmed cases resulting in 8 deaths.
  • 21:55 Bird Flu (H5N5): A Washington state resident died from the H5N5 avian influenza strain. The risk of human-to-human transmission remains low, as far as I know.
  • 22:13 Measles/Hib: Measles cases continue to climb in the U.S. and Canada due to falling vaccination rates. The increasing prevalence of preventable diseases like Haemophilus influenzae type B (Hib) (44:53) in adults (who act as vectors) is directly linked to the abandonment of routine childhood vaccinations (48:07).

• 25:04 Respiratory Syncytial Virus (RSV) Safety and Protocol:

  • 26:17 Maternal Vaccine Safety: A post-licensure safety analysis in Obstetrics & Gynecology covering over 29,000 vaccinated pregnant women found no significant increase in adverse maternal or neonatal outcomes (27:50).
  • 49:18 Second Pregnancy Protocol: If a mother received the RSV vaccine in a prior pregnancy, the recommendation is that she should not be revaccinated in a subsequent pregnancy, as a robust antibody boost is not guaranteed; instead, the newborn should receive the monoclonal antibody (Nirsevimab).

• 31:06 COVID-19 Vaccines and Long COVID: A systematic review showed that vaccination provides strong protection against long-term sequelae: 1 dose gave 19% risk reduction, while 3 doses yielded a 70% risk reduction (32:58). The hybrid immunity (infection + vaccination) in pregnant individuals resulted in the highest antibody transfer to neonates (34:49).

• 35:40 Emerging Long COVID Treatment: A case report in Frontiers in Neuroscience demonstrated that a Celiac Plexus Block (an injection near the L1 vertebrae) targeting the sympathetic nervous system resulted in near-complete recovery from severe gastrointestinal Long COVID symptoms (37:15). Key Takeaway: This is a creative, rational approach to targeting autonomic nervous system dysregulation, a likely driver of these chronic symptoms.

• 39:29 Long COVID Neurodegeneration: A complex Nature Communications study identified objective findings—including specific elevated blood proteins and cortical thinning on MRI—indicative of neurodegenerative processes in patients suffering from cognitive Long COVID ("Cog-PASC") (41:15).

• 51:08 Paxlovid for Seniors: Dr. Griffin rejects the premise of a recent study suggesting Paxlovid is less effective for vaccinated elderly individuals, calling the study "flawed." He maintains that for high-risk seniors (70+), Paxlovid remains a critical intervention to further reduce the already low risk of hospitalization or death (52:48).