Okay, here is the abstract and summary for the provided TWiV transcript.
Abstract:
This TWiV clinical update features Dr. Daniel Griffin discussing pressing infectious disease topics. He expresses concern over the ongoing US measles outbreak, highlighting rising case numbers, hospitalizations (particularly in children), the concentration in Texas, and the spread in Canada (Ontario). He laments reported CDC muzzling regarding measles risk forecasts and stresses the importance of vaccination facts. Updates include H5N1 detection in recalled raw cat food, declining but still present seasonal influenza and RSV activity, and promising early data on RSV vaccine effectiveness reducing hospitalizations in older adults in England. A significant portion covers COVID-19: decreasing national trends but substantial burden compared to flu, a preprint showing Moderna's updated vaccine efficacy (~53% vs. hospitalization, ~40% vs. medically attended illness), the FDA missing the Novavax vaccine approval deadline potentially impacting access, and a critical discussion of a retrospective metformin study suggesting potential benefits only for older diabetics already taking it, cautioning against extrapolating to general treatment. Long COVID is addressed with a preprint indicating increased PASC risk after reinfection in youth and the release of comprehensive Canadian management guidelines. The episode concludes with listener questions on measles vaccination nuances for specific individuals and Zika travel risk.
TWiV 1206 Clinical Update Summary:
0:39 Fungal Disease Awareness: Discussion opens highlighting the WHO's call for more attention to fungal diseases, noting their prevalence (e.g., Coccidioidomycosis) can be underestimated.
2:05 Tuberculosis & Stigma: Dr. Griffin relates to John Green's book "Everything is Tuberculosis," using a quote to discuss how stigma wrongly attributes blame to victims of disease, rather than recognizing infectious agents.
4:24 Measles Outbreak & Victim Blaming: Concerns raised about blaming measles victims (like the child who died) instead of addressing the failure of public health measures and vaccine hesitancy.
5:16 CDC Measles Forecast Reportedly Buried: Discussion of a ProPublica report alleging CDC leadership suppressed an expert assessment highlighting high measles risk in undervaccinated areas near outbreaks, undermining transparency.
7:11 Rising US Measles Cases: As of late March, 483 confirmed US cases across 20 jurisdictions (likely over 500 now), with 70 hospitalizations, many among children under five.
8:14 Geographic Spread & Vaccination Rates: Texas remains a major hotspot, but cases are widespread. A map shows many states below the crucial 95% vaccination rate needed for herd immunity.
10:28 Texas & New Mexico Case Counts: Specific mention of 422 cases in Texas and 48 cases in New Mexico related to the outbreak.
11:01 Canadian Measles Outbreak: Ontario reported 572 measles cases between Oct 2024 and Mar 2025, indicating a significant problem in Canada as well.
11:46 Measles Vaccine Recommendations: A link to NYP's vaccine recommendation table is provided for guidance.
12:24 H5N1 in Raw Cat Food: Highly pathogenic avian influenza (H5N1) confirmed in samples of recalled "Savage Cat" raw chicken cat food linked to feline infections.
13:20 Influenza Update: Wastewater levels remain high, but ER visits are declining nationally. Activity is minimal in most areas, though still high in New York.
14:00 Upcoming Flu Vaccine Composition: Link provided for the 2025-2046 influenza vaccine strain recommendations.
14:10 RSV Update: Similar to flu, RSV wastewater levels are high, but ER visits and activity are dropping significantly.
14:25 RSV Vaccine Effectiveness (England): A Lancet study shows early, impressive impact of RSV vaccination (Pfizer's Abrysvo) in England, with ~30% reduction in RSV-related hospitalizations among eligible older adults (75-79).
16:28 COVID-19 Trends: Wastewater levels nationally are low-to-medium, and ER visits/deaths continue to decrease. A recent temporary blip resolved.
18:48 Moderna COVID Vaccine Efficacy (Preprint): A study evaluating the 2024-2025 seasonal Moderna (mRNA-1273, KP.2 updated) vaccine found it was ~52.8% effective against COVID-related hospitalization and ~40% effective against medically attended COVID compared to no fall booster, primarily in adults 65+ or with comorbidities, over ~2 months follow-up.
24:01 COVID vs. Flu Burden: Comparison highlights the immense burden of flu this season (e.g., 20-34M medical visits, 560k-1.2M hospitalizations) often dwarfing COVID numbers, reinforcing the need for vaccination against both.
25:40 FDA Misses Novavax Deadline: The FDA failed to decide on full approval for Novavax's protein-based COVID vaccine. With current EUA stocks expiring end of April, access to this non-mRNA option is threatened.
27:05 Current COVID Vaccine Recommendations: Reminder: Annual dose for ages 5-64; twice-yearly doses (fall + 6 months later) recommended for those 65+ or immunocompromised.
27:59 Metformin & COVID (Retrospective Study): A study from Shanghai found elderly diabetic patients already on metformin before COVID infection had statistically lower inflammatory markers and slightly shorter hospital stays compared to diabetics not on metformin. Crucially, this doesn't support starting metformin to treat acute COVID and has many limitations (observational, potential confounders).
35:55 Paxlovid Cost-Effectiveness: A modeling study suggests the high cost of Paxlovid may no longer be cost-effective given current lower baseline hospitalization rates, implying a need for price reduction.
37:24 Long COVID Risk with Reinfection (Preprint): A Recover consortium pediatric study (under 21s) found SARS-CoV-2 reinfection during the Omicron era was associated with a >2-fold increased risk of an overall PASC diagnosis and higher risks for specific conditions (myocarditis, etc.) compared to a first infection.
41:25 Canadian Long COVID Guidelines: McMaster University researchers released comprehensive guidelines for diagnosing, managing, and treating Long COVID (PCC), including conditional recommendations for Paxlovid for prevention and specific diagnostic tests (NASA lean test).
43:58 Q&A - Measles Vaccine Transmission: Receiving the MMR vaccine poses no meaningful risk of transmitting the attenuated virus to an immunocompromised household contact.
45:24 Q&A - Measles Vaccine & CLL: For individuals with early-stage, stable Chronic Lymphocytic Leukemia (CLL) not requiring treatment, the contraindication against live vaccines isn't absolute. Consultation with an ID specialist is recommended to assess individual risk/benefit for MMR booster.
48:20 Q&A - Zika Risk in Bermuda: Currently, no significant Zika transmission is reported in Bermuda, but advises checking travel health advisories closer to the May travel date due to concerns about CDC's current operational status.