Okay, here is the abstract and summary for the TWiV 1210 transcript, following the requested format.
Abstract:
This episode of TWiV features Dr. Daniel Griffin providing a clinical update amidst significant concerns over deep funding cuts impacting US public health agencies like the CDC, NIH, and FDA. Dr. Griffin details the detrimental effects of these cuts on disease surveillance, research (including STI, hepatitis, and chronic disease programs), and the loss of institutional knowledge, sharing a firsthand account from a dismissed CDC employee. The discussion covers ongoing outbreaks, including rising measles cases (exacerbated by funding issues), an unreported deadly E.coli outbreak linked to lettuce, and meningococcal disease cases tied to travel. Updates on respiratory viruses show declining influenza and RSV activity, though pediatric flu deaths remain high. Significant ACIP recommendations include expanding RSV vaccine eligibility to high-risk adults aged 50-59. COVID-19 wastewater levels are low, but concerns remain, particularly regarding severe outcomes and long COVID, with new studies highlighted showing increased risks of kidney and cardiovascular problems in children post-infection. The update also touches on COVID vaccine reactogenicity differences (Novavax vs. mRNA) and potential shifts in booster strategies. The episode concludes with listener questions on pertussis/kennel cough vaccines, H5N1 risk from backyard chickens, Hantavirus precautions, the shingles vaccine's link to dementia prevention, and Gerald Ford's vision issues.
TWiV 1210: Clinical Update - Public Health Under Threat & Disease Overview
2:04 Public Health Funding Crisis: Dr. Griffin expresses grave concern over a "purge" of federal workers and massive budget cuts targeting HHS, particularly the CDC, NIH, and FDA. Confirmed cuts exceed 56,000 personnel, with over 20,000 from HHS. Proposed further cuts could slash NIH funding by $20 billion (40%) and CDC funding by 44%, eliminating chronic disease programs and domestic HIV work.
5:01 Impact on CDC Operations: A firsthand email from a dismissed CDC employee highlights the severe consequences: the potential closure of the Emerging Infectious Diseases (EID) journal, elimination of the Center for Global Health, disruption of state health departments, and abrupt shutdowns of critical labs (STI surveillance, hepatitis investigation), halting ongoing outbreak investigations and losing institutional knowledge. Staff were locked out with little notice.
10:11 Trust in Science & Politics: Discussion revolves around a Nature Human Behavior study showing lower trust in scientists among conservatives compared to liberals in the US, with virologists among the least trusted. Interventions to improve trust were unsuccessful. The hosts link the public health cuts to political ideology (Project 2025) and distrust of scientific institutions.
15:03 Unreported E. coli Outbreak: The FDA reportedly chose not to publicize a deadly E. coli outbreak linked to romaine lettuce that affected 15 states, sickening dozens and causing one death. The agency closed the investigation without detailing the source companies, raising concerns about transparency.
16:20 Meningococcal Disease Update: Reports of invasive meningococcal disease cases in Saudi Arabia and among recent travelers returning from Umrah pilgrimage highlight the importance of vaccination, as compliance among international pilgrims is only around 50%.
18:41 Measles Outbreak Worsens: US measles cases exceed 700 in 25 jurisdictions, the worst outbreak since 1998, with Texas heavily affected (561 cases). Response efforts are hampered by the aforementioned funding cuts. A significant portion of cases involve children under five (32%) and ages 5-19 (38%), with 11% overall requiring hospitalization. Mexico and Canada also report high case numbers.
21:15 Influenza Update: Flu activity is decreasing nationally, dropping below baseline, though pediatric deaths associated with the season approach 200.
22:01 RSV Update & Vaccine Recommendation Change: RSV activity is also declining. ACIP voted to expand the recommendation for Pfizer's RSV vaccine (Abrysvo) to include adults aged 50-59 at increased risk (due to conditions like obesity, cardiovascular disease, diabetes, COPD, asthma), broadening previous recommendations for older adults.
23:38 RSV & Cardiovascular Risk: A Danish study published in JACC shows a 4-8 times higher incidence of heart failure hospitalization and ischemic stroke within 14 days of testing positive for RSV in adults 65+.
25:51 COVID-19 Update: National wastewater levels for SARS-CoV-2 are low, and deaths are down. However, Dr. Griffin notes recent cases in older individuals following holiday gatherings and describes a severe ongoing patient case highlighting the continued risk.
27:15 COVID-19 Severity in Children: A study in PIDJ on hospitalized children in Spain and Colombia found that while comorbidities increase risk, 64% of hospitalized children had no underlying health conditions, challenging the narrative that COVID was benign for all children.
29:02 COVID-19 Vaccine Updates: A Utah study indicates Novavax's COVID-19 vaccine causes fewer reactogenicity symptoms (systemic and local) compared to Pfizer's mRNA vaccine. ACIP is discussing potentially narrowing recommendations for boosters in the future, with a formal decision expected in June. Current guidance (annual shot for most, optional 6-month for high-risk/elderly) remains for now.
31:54 Long COVID/PASC in Children - Kidney Risks: A large RECOVER initiative study (JAMA Network Open) found SARS-CoV-2 infection in children/adolescents is associated with a higher risk of new-onset chronic kidney disease (17% increase for stage 2+, 35% increase for stage 3+) and worsening pre-existing kidney disease.
34:07 Long COVID/PASC in Children - Cardiovascular Risks: Another RECOVER study (Nature Communications) found children/adolescents post-COVID infection had significantly increased risks (28-179 days post-infection) for various cardiovascular issues, including hypertension (+47%), ventricular arrhythmias (+49%), pericarditis (+85%), myocarditis (+266%), heart failure (+76%), cardiomyopathy (+50%), cardiac arrest (+56%), and thromboembolism (+30-60%), even in those without prior heart disease.
37:13 Long COVID Treatment Research: An IDSA update summarizes ongoing research into long COVID treatments, including pharmacological trials and non-pharmacological interventions like nerve stimulation and acupuncture.
37:43 Call to Action: Listeners are encouraged to contact their political representatives to voice support for science funding, regardless of political affiliation.
Pertussis vs. Kennel Cough: Discusses differences between human pertussis vaccines (acellular) and dog kennel cough vaccines (mucosal, against a different Bordetella), explaining the shorter duration of protection in dogs.
H5N1 & Backyard Chickens: Currently considered a low risk, though vigilance is advised, especially given egg shortages and price increases.
Hantavirus Prevention: Recommends using an N95 respirator when cleaning potentially rodent-infested areas (crawl spaces, basements, cabins) to prevent inhaling aerosolized virus from droppings.
Shingles Vaccine & Dementia: While the linked study showed shingles vaccination reduced dementia risk, it didn't specifically stratify based on prior shingles history. However, preventing shingles (a potential trigger) likely contributes to the benefit.
Gerald Ford's Falls: A listener clarifies Ford's reported clumsiness might have been due to mono-vision contact lenses affecting his depth perception.