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Abstract:
This episode of "This Week in Virology" (TWIV 1208) features Dr. Daniel Griffin providing clinical updates. Key topics include a study suggesting the herpes zoster (shingles) vaccine may reduce dementia risk, leveraging a natural experiment in Wales. The escalating measles outbreak is discussed, highlighting recent child deaths in Texas, the controversy surrounding HHS Secretary RFK Jr.'s messaging, rising case counts across the US (including Texas and New Mexico), and the importance of MMR vaccination. An update on pertussis (whooping cough) covers infant deaths in Louisiana, the political decision to halt vaccine promotion there, details on the disease's stages and severity (especially in infants), and vaccination recommendations. Other updates include a human H5N1 case in Mexico, the seasonality of Human Metapneumovirus, a poignant patient story illustrating the lifelong impact of polio, and declining trends for flu, RSV, and COVID, though pediatric flu deaths remain a concern. COVID-related research presented includes confirmation of infectious aerosol transmission via ventilation systems in a specialized facility, negative results from trials using Paxlovid (PaxLC study) and Donepezil for Long COVID symptoms, and a review of brain volume changes post-COVID. The Q&A addresses penicillin allergy death statistics, Novavax availability, measles booster needs for certain age groups, adding H5N1 to flu vaccines, and understanding measles vaccine non-responders. The episode concludes with a call to support the Floating Doctors fundraiser.
TWIV 1208 Clinical Update: Measles, Pertussis, Long COVID Trials, and More
0:01:10 Importance of Stories: Dr. Griffin begins with a Paul Farmer quote emphasizing that statistics aren't optimal for understanding suffering, highlighting the need to connect data with human stories.
0:02:37 Shingles Vaccine & Dementia: A study published in Nature analyzing data from Wales (where vaccine eligibility was based on exact birth date) found a 20% relative reduction in new dementia diagnoses over 7 years in those who received the Zostavax (live attenuated) shingles vaccine compared to a closely matched ineligible group. This builds on theories linking herpesviruses to dementia.
A second child (an 8-year-old girl named Daisy) died from measles complications in Texas.
HHS Secretary RFK Jr. made public statements endorsing the MMR vaccine but reportedly undermined vaccine confidence in private conversations with the grieving family.
0:10:27 A case was confirmed at Fort Bliss Army base.
0:10:40 US confirmed cases exceed 600 across 22 jurisdictions.
0:11:32 Texas reports over 500 confirmed cases, with 57 hospitalizations; over 100 cases are in adults >18 years old.
0:12:30 Reminder of MMR vaccine recommendations, especially the need for a second dose for those vaccinated between 1971-1989 when only one dose was standard. Emphasizes vaccine safety and efficacy.
This follows Louisiana's decision to end vaccine promotion, a move criticized as political interference in medicine.
0:15:20 Explanation of pertussis: Caused by Bordetella pertussis, spread via respiratory particles, classic "whoop" cough, stages (catarrhal, paroxysmal, convalescent/100-day cough).
0:18:05 High severity in infants <1 year (especially <6 months), with high hospitalization rates, risk of apnea/pneumonia, and a 1% case fatality rate in infants <6 months.
0:19:45 Vaccination is key (DTaP for infants/children, Tdap boosters for adolescents/adults, crucial Tdap dose during each pregnancy).
0:20:52 Bird Flu (H5N1): Mexico reported its first human case of H5N1 in a 3-year-old girl, hospitalized in serious condition.
0:21:15 Human Metapneumovirus (HMPV): An MMWR report confirms HMPV seasonality, typically peaking in the spring as RSV and flu decline. It's highlighted as one of the "big four" respiratory viruses, often underdiagnosed if not tested for.
0:23:08 Polio's Lasting Impact: Dr. Griffin shares the story of a 74-year-old polio survivor he treated, infected at 18 months in 1953, detailing his paralysis, his sister's death from polio complications, overcoming challenges, and recent struggles after being hit by a car β illustrating the lifelong consequences of the disease.
0:26:52 Flu Season Waning: Flu activity is decreasing nationally, but 168 pediatric flu deaths have been reported this season, emphasizing the importance of vaccination.
0:28:13 RSV Season Update: RSV season is also declining and was less severe this year compared to previous ones.
0:28:28 COVID Update: National levels are low/medium, though hotspots persist (e.g., Tennessee, Alabama). Wastewater surveillance shows a downward trend.
0:29:16 COVID Aerosol Transmission Confirmed: A study using a specialized air research facility (built for TB) demonstrated that SARS-CoV-2 from infected patients could travel through the ventilation system and infect hamsters remotely (58% seroconversion), confirming infectious bioaerosols remain viable over distance within ventilation systems.
0:32:40 COVID Vaccination Reminder: Per CDC, a second dose of the current vaccine is recommended for those 65+ (six months after the first).
0:34:06 Long COVID Research Updates (Negative Trials):
PaxLC Trial: The Yale study published in Lancet ID found that 15 days of Paxlovid did not significantly improve outcomes in Long COVID patients compared to placebo, challenging the persistent replicating virus hypothesis.
Brain Volume: A systematic review in NeuroImage found inconsistent results regarding brain volume changes post-COVID, though smaller gray matter volumes were more often reported in severe cases requiring hospitalization.
Donepezil Trial: A JAMA Network Open trial found Donepezil (Aricept) provided no significant benefit for fatigue or psychological symptoms in Long COVID.
0:39:07 Floating Doctors Fundraiser: Reminder of the ongoing fundraiser to support medical care in Panama, with donations doubled through April.
Penicillin Deaths: The often-cited 500-1000 annual US deaths from penicillin anaphylaxis is likely inaccurate/inflated based on old modeling; real-world data suggests it's much rarer.
Novavax Availability: Concerns about Novavax vaccine availability due to production issues, lack of full FDA approval, and potentially low booster uptake affecting future supply.
Measles Booster (Born 1984): Yes, someone born in 1984 likely only received one MMR dose and should get a second.
H5N1 in Flu Vaccine: Not currently included as the risk to human health isn't deemed high enough; premature mass vaccination carries risks (recalling the 1976 swine flu vaccine issues).
Measles Non-Responders: Lack of antibody response doesn't necessarily mean no protection (T-cells matter); true non-response is complex and likely rare.
0:47:37 Communication Failure: An anecdote about a pharmacist dismissing the measles outbreak highlights ongoing issues with misinformation and the need for effective science communication using relatable stories.