This episode of "This Week in Virology" (TwIV) emphasizes the critical role of truth in science and public health, opening with a compelling quote from Star Wars' "Andor" to underscore the dangers of misinformation, particularly regarding vaccines. Hosts Vincent Racaniello and Daniel Griffin discuss the ongoing "attack on science" in vaccine programs, proposing solutions like independent guidance from medical societies and highlighting initiatives such as SIDRAP's Vaccine Integrity Project. The episode previews an upcoming ACIP meeting, detailing its agenda for COVID-19, RSV, influenza (including a focus on thimerosal), and MMRV vaccines, while expressing concerns about transparency. Updates on arbovirus, mpox, avian flu, and persistent measles outbreaks are provided, alongside a discussion on the overuse of antibiotics for pediatric viral infections. New research on RSV vaccines, including the high effectiveness of Nurse Mab and the FDA approval of Moderna's mRNA-1345 vaccine for at-risk adults, is presented. The hosts also explore the correlation between wildfire smoke and COVID-19 outcomes, the evolving SARS-CoV-2 variants, and the utility of drug-drug interaction tools for COVID-19 antivirals, concluding with listener questions on diverse public health topics.
Exploring Current Virology and Public Health Challenges
0:00 Introduction & The Death of Truth: Hosts Vincent Racaniello and Daniel Griffin begin the podcast, with Daniel highlighting his Prion Jakob disease bow tie. They introduce a powerful quote from the Star Wars series "Andor" ("The death of truth is the ultimate victory of evil"), linking it to the ongoing importance of truth in science and public health.
2:30 Safeguarding Vaccine Programs: The discussion moves to an opinion piece in The Washington Post on RFK Jr.'s alleged efforts to undermine vaccine programs. Daniel suggests that medical societies should establish independent expert panels to issue guidance, acknowledging the challenge posed by a lack of reliable CDC data. He spotlights SIDRAP's Vaccine Integrity Project, generously supported by philanthropist Christy Walton, as a crucial effort to ground vaccine use in scientific evidence.
7:12 Preview of ACIP Meeting: A detailed overview of the upcoming Advisory Committee on Immunization Practices (ACIP) meeting (June 25-26) is provided. Key agenda items include discussions and potential votes on:
COVID-19 Vaccines (8:08): Epidemiology, vaccine effectiveness, safety, coverage, and implementation.
RSV Vaccines (8:31): Both active and passive vaccination strategies, including new monoclonal antibodies like klesro vmab, with a public comment session and votes.
Influenza Vaccines (9:07): A specific focus on thimerosal-containing vaccines, with a proposed recommendation for their removal, raising concerns about "to be determined" presenters.
MMRV Vaccines (10:23): Discussion on the combined measles, mumps, rubella, and varicella vaccine.
Arboviruses (12:07): A report summarizing 2023 data reveals a significant doubling of arboviral disease cases in the US, with West Nile virus being the most common and cases clustering geographically in the western US.
Mpox on Cruise Ships (13:03): Eight mpox cases were reported on four cruise ships in 2024, prompting CDC recommendations for educating crew and passengers on symptoms, risks, prevention, and vaccination.
Avian Flu (H5N1) (13:50): Bird flu continues to have a "tremendous impact" globally, with over 174 million poultry affected in the US and outbreaks in dairy cows across 17 states, indicating its persistent spread.
Measles Outbreaks (14:56): As of June 12, 2025, the US reports 1,197 confirmed measles cases in 35 jurisdictions, and Canada reports 3,170 cases, highlighting continued outbreaks despite the approaching summer.
15:57 Unnecessary Antibiotic Use in Children: A study on pediatric antibiotic prescriptions reveals high rates of unnecessary use for viral infections like RSV and influenza. This overuse, particularly of macrolides like Z-pack, contributes to antibiotic resistance and disrupts children's microbiomes.
Nurse Mab Effectiveness (18:18): A retrospective study from Chile demonstrates high effectiveness of Nurse Mab (a passive monoclonal antibody) in infants, reducing RSV-related lower respiratory tract infection hospitalizations by 76% and ICU admissions by 85%, with a low "number needed to immunize" (35).
Moderna's mRNA-1345 Vaccine (20:16): Phase 3 trial results indicate that Moderna's mRNA-1345 vaccine is well-tolerated and elicits robust, non-inferior antibody responses in adults aged 18-59 at increased risk for RSV, supporting its efficacy.
FDA Approval for Resvia (23:30): Moderna's RSV vaccine, Resvia (mRNA-1345), receives FDA approval for adults aged 18-59 at increased risk, marking the first vaccine approved for this specific age group based on immunogenicity data.
24:30 COVID-19 Dynamics and Environmental Factors:
Current Trends (24:37): While national wastewater data suggests stability, local hospitalizations are noted to be increasing, indicating a potential local surge.
Bimodal Waves (25:12): The hosts discuss why COVID-19 exhibits bimodal waves (unlike flu or measles), speculating on factors like rapid antibody contraction and increased summer gatherings.
Wildfire Smoke Correlation (26:10): A 2020 California study shows a clear association between wildfire smoke exposure and an increase in COVID-19 cases and subsequent deaths, underscoring smoke's detrimental impact on respiratory health.
Variant Evolution (28:40): The rising prevalence of the NB.1.8.1 variant in the US is noted, which previously correlated with pediatric hospitalizations in Southeast Asia. The hosts reiterate that anecdotal symptom reports (e.g., "razor blade throat") for specific variants are not scientifically supported.
30:19 COVID-19 Treatment & Management: The discussion covers Encatrell (Zokova), an antiviral approved in Japan that is similar to Paxlovid, and the utility of online drug-drug interaction checkers for managing antiviral treatments. Current US treatment options for the early viral phase (Paxlovid, Remdesivir, Molnupiravir, convalescent plasma) and early inflammatory phase (steroids, anticoagulation, immune modulation like Tozilmab) are reviewed.
33:52 ME/CFS and Long COVID Overlap: A recent "David Tuller" episode is highlighted, exploring the commonalities and potential shared learning opportunities between Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Long COVID.
Trust in MMWR (34:55): Daniel pledges to continue evaluating and commenting on the trustworthiness and educational value of MMWR reports for the public.
IgA Deficiency and Vaccination (35:50): A listener asks about vaccination for IgA-deficient individuals. Daniel notes this as a neglected area, confirming an increased risk for mucosal infections, and proposes it as a topic for a future "immune deep dive."
Measles Transmission & Masks (37:40): In response to a query about measles transmission from an infected airport traveler, Daniel confirms that proper N95 mask use by an infected person can reduce transmission, emphasizing its importance for vulnerable, unvaccinated individuals.
Avian Flu Risk at Summer Camp (39:19): A listener raises concerns about H5N1 exposure at a summer camp with significant water fowl droppings. Daniel acknowledges the unsanitary conditions but states the current risk of direct bird-to-human transmission is low, while suggesting strategies to deter the geese.
COVID-19 Risk Reduction for Elderly (42:58): Practical advice is given for reducing COVID-19 risk when visiting elderly family members, including sequential testing, improving ventilation (open windows, CR boxes), using air filtration, and considering alternative accommodations.