In this weekly clinical update, Dr. Daniel Griffin and Vincent Racaniello discuss the current state of several viral outbreaks and related research. They begin with the measles epidemic, noting that 2025 has seen more cases in the U.S. than any year since the disease was declared eliminated, and question the data from states reporting zero cases. A significant update on H5N1 in dairy cows reveals the infection is more severe than previously understood, causing notable mortality and major financial losses. The hosts review the past influenza season's record number of pediatric deaths and discuss new RSV prevention guidelines recommending monoclonal antibodies for infants. A major portion is dedicated to SARS-CoV-2, covering early signs of a summer wave, a debate on whether seasonality is driven by viral evolution or human behavior, a large meta-analysis confirming the efficacy of Paxlovid and Remdesivir for early treatment, and a trial showing no benefit to extending Paxlovid duration for immunocompromised patients. The episode also introduces a new study (SPEAR) investigating monoclonal antibodies for Long COVID. The discussion concludes with listener correspondence addressing vaccine timing in pregnancy and the deliberate misrepresentation of scientific literature by anti-vaccine advocates.
A Clinical Update on Measles, H5N1, COVID-19, and More
2:24 Measles Epidemic Update: As of July 2025, the U.S. has seen more measles cases than in any year since its elimination in 2000, with over 1,300 confirmed cases across 40 jurisdictions. Dr. Griffin notes that the absence of reported cases in some states surrounded by outbreaks is suspicious and likely due to a lack of testing and reporting.
7:05 H5N1 in Dairy Cows is More Severe Than Thought: Contrary to initial beliefs that H5N1 was mild in cattle, a new study in Nature Communications reveals significant impacts. In an affected Ohio herd, clinically sick cows had a six-fold increased risk of death, with about 7% of sick cows dying or being euthanized. The financial cost was estimated at nearly $1,000 per affected cow.
14:08 Influenza Season Review: A total of 260 influenza-associated pediatric deaths were reported in the last flu season, the highest number for any non-pandemic season. The majority of these children were previously healthy, and over 90% were not vaccinated.
15:13 RSV Prevention Update: The ARMADA task force published consensus recommendations for using long-acting monoclonal antibodies (like Nirsevimab) to prevent RSV in all infants under 8 months of age, particularly if the mother did not receive an RSV vaccine during pregnancy.
17:13 COVID-19 Summer Wave: Wastewater data and emergency department visits across the U.S. are beginning to show an increase in COVID-19 activity, suggesting the start of a summer wave.
23:25 Mild COVID-19 Treatment Review: A comprehensive BMJ meta-analysis of treatments for mild-to-moderate COVID-19 found that Paxlovid and Remdesivir are the most effective drugs for reducing the risk of hospital admission.
26:23 Extended Paxlovid Duration Trial: A randomized trial published in The Lancet investigated whether extending Paxlovid treatment from 5 days to 10 or 15 days benefited immunocompromised patients. The study found no significant difference in outcomes, supporting the standard 5-day course.
31:33 New Long COVID Trial (SPEAR): Researchers have formed the SPEAR study group to formally investigate whether monoclonal antibody therapy can help patients with Long COVID. The trial is based on anecdotal reports and the hypothesis that the antibodies may help clear persistent SARS-CoV-2 spike protein from the body.
35:41 Vaccine Timing in Pregnancy: In response to a listener question, Dr. Griffin discusses the ideal timing for Tdap, RSV, COVID-19, and flu vaccines during the third trimester to maximize protection for both the mother and the newborn.
46:12 The Assault on Science: The hosts discuss a listener's email that debunks a claim made by an anti-vaccine advocate. The advocate misinterpreted a study on thimerosal to suggest it caused harm, when the study's abstract explicitly states its results "provide little if any support" for that hypothesis.