Infectious Disease Puscast #95 reviews recent literature, highlighting critical policy decisions and novel clinical trial data. A major positive finding is the confirmation of non-inferiority for a single dose of HPV vaccine (bivalent or nonavalent) compared to two doses, which significantly streamlines global immunization efforts. Conversely, the recent ACIP vote against universal Hepatitis B birth dose is strongly critiqued as an irresponsible policy decision expected to increase perinatal infections due to systemic failures. The podcast also covers a successful human challenge trial showing high-dose Mosnodenvir prophylaxis is effective against Dengue and a promising combination immunotherapy regimen resulting in HIV control in 70% of participants after ART cessation. Furthermore, new data challenge the safety of using benzimidazoles (like albendazole) for high Loa loa loads due to risks of associated encephalopathy, requiring urgent re-evaluation of treatment protocols.
Summary of Infectious Disease Puscast #95
1:52 Chikungunya Treatment (Viral): A retrospective cohort study suggests that early, low-dose Dexamethasone (4mg/day for 3 days) significantly shortens acute febrile illness (3 vs 5 days) and rheumatic manifestations (7 vs 10 days) in confirmed Chikungunya patients with severe arthralgia. As far as I can tell, randomized trials are required to confirm this benefit.
3:32 Single-Dose HPV Vaccine Efficacy (Viral): The ESCUDDO trial published in NEJM demonstrated that one dose of either bivalent or nonavalent HPV vaccine is non-inferior to two doses over five years, maintaining $\ge 97%$ effectiveness against HPV 16/18. This is an efficient outcome that directly supports expanded global single-dose regimens.
7:42 Dengue Prophylaxis with Mosnodenvir (Viral): A controlled human infection model (CHIM) trial in NEJM showed the oral antiviral Mosnodenvir (JNJ-64281802) provides dose-dependent prophylactic activity against DENV-3. The high dose prevented signs of infection in 60% of participants versus 0% for placebo and led to a significantly lower RNA load ($P<0.001$). However, resistance-associated amino acid variations were detected in all drug recipients, which needs monitoring.
12:07 Critique of ACIP Hep B Birth Dose Reversal (Policy): The hosts vehemently criticize the ACIP decision to end the universal Hepatitis B birth dose recommendation for infants of HBsAg-negative mothers. They cite a JAMA viewpoint projecting an 8% increase in perinatal HBV infections due to reliance on imperfect screening and follow-up. This is characterized as a dangerous, politics-driven policy that eliminates a crucial public health safety net.
14:50 HIV Cure Strategy (Viral): A proof-of-concept study in Nature using combination immunotherapy (vaccination, bNAbs, and a TLR9 agonist) in 10 patients on ART achieved post-intervention control after stopping ART in 7 of 10 participants (70%). The control was linked to robust CD8+ T cell expansion, showing a path toward sustained ART-free remission.
18:17 Rabies Transmission via Transplant (Viral): An MMWR report details the fourth US transplant-transmitted rabies event (2024-2025). A kidney recipient died after receiving an organ from a donor with undiagnosed rabies (likely from a skunk scratch 6 weeks prior). This reinforces that clinicians must consider rabies exposure in potential donors presenting with acute encephalopathy.
20:05 CMV CMI Utility (Viral): Two studies in $CID$ analyzed the utility of CMV-specific cell-mediated immunity (QuantiFERON-CMV) testing at the end of prophylaxis in kidney and stem cell transplant recipients (SCRs). For both populations, CMV-CMI increased over time, but the assay results did not reliably predict the risk of post-prophylaxis CMV disease, suggesting limited current clinical utility for guiding prophylaxis duration.
29:20 IDSA Rejects CAP Guidelines (Bacterial/Policy): IDSA refused to endorse the ATS Community-Acquired Pneumonia (CAP) 2025 guidelines because they recommended empirical antibiotic use for non-severe patients with positive viral tests. IDSA argues that this indiscriminate use promotes antibiotic overuse and complications (C. diff, resistance) without clear evidence of benefit, preferring individualized decision-making to minimize unnecessary harm.
32:25 Misleading Lyme Incidence Trends (Bacterial): Analysis of Massachusetts EHR data showed an apparent decline in Lyme disease was a localized artifact, driven by a Quality Improvement (QI) initiative in one large practice group aimed at reducing treatment based solely on screening tests. This confirms that relying on surveillance data without understanding local clinical practice changes is unsound.
35:10 Itraconazole vs. Voriconazole for CPA (Fungal): The VICTOR-CPA trial compared Voriconazole to Itraconazole for chronic pulmonary aspergillosis. Both achieved similar favorable response rates (69% vs 67%), but Voriconazole caused significantly more adverse events (55% vs 34%). The conclusion is clear: Itraconazole is the preferred, cost-effective first-line agent.
38:11 Benzimidazoles and Loiasis Encephalopathy (Parasitic): A systematic review challenges the long-held assumption that benzimidazoles (e.g., albendazole) are safe alternatives for hypermicrofilaremic Loa loa patients. Six potential cases of encephalopathy, including two fatalities, were reported, suggesting the risk may be substantial ($\sim 1:200 - 1:2000$). This necessitates a critical re-evaluation of current loiasis treatment protocols.