In this episode of This Week in Virology (TWiV 1212), Dr. Daniel Griffin joins Vincent Racaniello for his weekly clinical update. They begin by expressing significant concern over the US withdrawal from global health initiatives, particularly pandemic preparedness efforts like the universal avian flu vaccine, and the defunding of critical resources such as the EID journal, potentially hindering early outbreak detection. The discussion covers the negative impact of undermining routine childhood vaccinations, leading to surges in pertussis and measles, alongside critiques of RFK Jr.'s proposed autism registry and CDC staff cuts hampering public health responses. Updates are provided on the identification of squirrels as an mpox reservoir and a yellow fever outbreak in Colombia. Dr. Griffin reviews current statistics for RSV, influenza, and SARS-CoV-2, referencing the WastewaterScan dashboard, noting waning RSV vaccine efficacy over three seasons. He discusses research suggesting Paxlovid may reduce post-COVID stroke risk, the availability of PEMGARDA, and provides extensive information on Long COVID resources, the protective effect of vaccination against Long COVID, and concerns about its potential to become epidemic. Listener questions address vaccine recommendations during pregnancy, yellow fever vaccination timing, post-COVID symptoms, and shingles risk after breakthrough chickenpox.
TWiV 1212 Clinical Update Summary:
0:00 Introduction & Context: Dr. Daniel Griffin joins from Paris, sharing quotes about ignorance and division before diving into the clinical update.
2:31 Correction & US Public Health Concerns: A correction clarifies that the peer-reviewed EID journal (defunded) differs from the CDC mouthpiece MMWR (continuing with approvals). Defunding EID and other expert resources is criticized as cutting off early warning systems for global health threats, termed "malignantly incompetent."
5:00 Avian Flu Awareness & Preparedness: Public awareness of H5N1 risks (human transmission, raw milk danger) is low. A significant portion of the US public is unwilling to change behavior or vaccinate even if recommended. Efforts towards a universal avian flu vaccine (mRNA, potentially mucosal) are underway (DioSynVax/ACM Biolabs).
8:27 HPAI in NYC Live Poultry Markets: Despite a temporary shutdown order two months prior, highly pathogenic avian influenza continues to be detected in numerous live poultry markets across NYC boroughs and nearby counties.
9:46 Mpox Reservoir Identified: A preprint study identifies fire-footed rope squirrels as a likely reservoir host for the mpox virus outbreak observed in wild mangabeys in Côte d'Ivoire, based on genomic and observational evidence.
12:21 Pertussis (Whooping Cough) Surge: US cases have surged dramatically in early 2025 (4x 2024, 25x 2023 levels), primarily affecting the unvaccinated. The severe coughing fits cause significant suffering.
14:59 Measles Outbreaks & Response Issues: US measles cases reach 800, with 96% unvaccinated or unknown status and 11% requiring hospitalization. Texas remains the epicenter (624 cases). CDC assistance to Texas schools was canceled due to staff layoffs, hindering response efforts like ventilation checks and vaccination drives.
17:59 Influenza Update: Flu activity is low across most of the US, with New York State as a high-activity outlier. Nearly 200 pediatric flu deaths have occurred this season. FDA/CDC/DOD met regarding the 2025-2026 vaccine composition.
19:48 RSV Update & Vaccine Waning: RSV levels are seasonally low. A phase 3 trial (GSK vaccine) shows RSV vaccine efficacy in older adults wanes over three seasons (Season 1: 82.6%, Season 2: 56%, Season 3: 48%). The benefit of a booster dose after one year is currently unclear due to wide confidence intervals.
24:35 COVID-19 Wastewater & Trends: Wastewater surveillance shows COVID-19 levels are low and decreasing, nearing levels seen a year ago, though seasonal patterns remain uncertain.
25:52 Paxlovid & Post-COVID Stroke/Mortality Risk: Discussing Pope Francis's recent death potentially linked to post-pneumonia cardiovascular complications, a large retrospective study suggests acute-phase Paxlovid use is associated with reduced risk of stroke (~15%) and all-cause mortality (~32%) in the 90 days following mild-to-moderate COVID-19.
30:32 Long COVID Updates & Resources: Vaccination significantly reduces the risk of developing Long COVID (2 doses: 58% reduction, 3 doses: 63% reduction), even in those with prior infection. Resources mentioned include the ORCHESTRA consensus on diagnosis/management, Columbia's Long COVID hotline, the website longcovidtheanswers.com, and the Mount Sinai Center for Post-COVID Care (now expanded to other complex chronic illnesses). Concerns are raised about Long COVID potentially becoming a national epidemic.
37:10 Listener Q&A - Last of Us: A humorous question about using antifungals like posaconazole for prophylaxis against the fictional Cordyceps infection.
39:36 Listener Q&A - Pregnancy Vaccines: Recommended vaccines during the third trimester include COVID-19, Influenza, RSV, and Tdap (tetanus, diphtheria, pertussis) for maternal and infant protection. Newborns should receive HepB and potentially Nirsevimab (passive RSV antibody).
41:10 Listener Q&A - Yellow Fever Vaccine: One dose is now generally considered lifelong protection. Risk of adverse events with the first dose is higher in those over 65 (approx. 1 in 100,000). Chikungunya vaccine is recommended for travelers to areas with active outbreaks.
43:22 Listener Q&A - Post-COVID Cough: Worsening cough three weeks after acute COVID (without Paxlovid) is unlikely rebound; could be a secondary bacterial infection or another virus. Consulting a doctor is advised.
45:15 Listener Q&A - Chickenpox & Shingles: Having lab-confirmed breakthrough chickenpox as an adult after prior infection and vaccination suggests an unusual immune susceptibility and likely increases the risk for shingles. Discussing early Shingrix vaccination (before age 50) with a physician is reasonable.