This TWiV (This Week in Virology) episode, featuring Dr. Daniel Griffin, provides a comprehensive clinical update on various infectious diseases. The discussion covers a Campylobacter and E. coli outbreak linked to raw milk in Florida, a Legionnaires' disease outbreak in Harlem, and a concerning resurgence of measles cases globally. Dr. Griffin delves into recent research on influenza, highlighting severe acute necrotizing encephalopathy in unvaccinated children and clarifying that neuropsychiatric events are flu-induced, not a side effect of oseltamivir. The episode also reviews RSV vaccination strategies for pregnant individuals and infants. For SARS-CoV-2, Dr. Griffin addresses rising trends, the continued effectiveness of updated vaccines against severe outcomes, the ineffectiveness of metformin for acute COVID, and the association between viral rebound and increased post-acute mortality. Crucially, the segment on long COVID presents compelling evidence that COVID-19 vaccines significantly reduce the risk of post-COVID conditions, underscored by identified symptom phenotypes and objective immune disturbances in affected patients. The episode concludes with a fundraiser announcement and a Q&A segment addressing listener concerns on shingles vaccination, increasing HIV cases in cisgender heterosexual women, RSV vaccine risks, and the chikungunya vaccine.
A Detailed Clinical Update on Infectious Diseases and Public Health
0:00 - 1:09: Podcast Introduction and Philosophical Quotes: Vincent Racaniello and Dr. Daniel Griffin open the episode with reflections on George Orwell's quotes about truth and empathy, particularly relevant to discussions surrounding public health and controversial figures like RFK Jr.
1:09 - 5:19: Raw Milk Outbreak in Florida: Dr. Griffin details an outbreak of 21 E. coli and Campylobacter infections in Florida, including hospitalizations and cases in children, linked to the consumption of raw milk illegally sold as "pet food," emphasizing the severe health risks.
5:19 - 7:53: Legionnaires' Disease Outbreak in Harlem: A significant outbreak of Legionnaires' disease in Harlem, New York City, is reported with 73 confirmed cases and 3 deaths. Dr. Griffin explains the bacterial nature of the disease, its transmission via water vapor (often from cooling towers), and the importance of sputum cultures for diagnosis, as urine tests may miss half of cases.
7:53 - 10:22: Emergency Department Vaccination Opportunities: A CDC MMWR survey reveals that a substantial portion of underserved adult patients in emergency departments (EDs) are undervaccinated but express high willingness to receive vaccines if offered during their ED visit, presenting a key opportunity for public health intervention.
10:22 - 11:53: Global Measles Resurgence: The alarming trend of measles continues, with 2025 seeing more US cases (1,356 confirmed across 41 jurisdictions) than any year since its declared elimination in 2000. Canada also reports a high number of cases (4,394), raising concerns for the upcoming fall school season.
11:53 - 19:27: Influenza's Neurological Complications in Children: Dr. Griffin discusses two JAMA articles:
Acute Necrotizing Encephalopathy (ANE): An increase in severe, often fatal, influenza-associated ANE cases in US children during the 2024-2025 flu season, predominantly affecting unvaccinated, previously healthy children.
Neuropsychiatric Events: Research clarifies that neuropsychiatric events in children are caused by influenza infection itself, not by oseltamivir (Tamiflu), which actually reduces these complications by 50-60%.
19:27 - 21:35: RSV Vaccination for Pregnant Individuals and Infants: Dr. Griffin reiterates recommendations for RSV vaccination for pregnant individuals (32-36 weeks gestation) to provide passive immunity to newborns, and highlights the availability of passive protection options (Nirsevimab, Klesrovi Mab) for infants.
21:35 - 29:08: COVID-19 Trends, Vaccine Effectiveness, and Pediatric Risk:
Rising Cases: Current data from July 2025 indicates an upward trend in COVID-19 cases.
Vaccine Effectiveness: A Danish study published in The Lancet shows that JN.1-adapted vaccines are 70% effective against hospitalization and 76% against death in individuals over 65, reinforcing the broad benefit of vaccination regardless of specific variants.
Pediatric Hospitalizations: Thousands of children, many previously healthy, continue to be hospitalized for severe COVID-19, with only a small percentage (3.8%) up-to-date on vaccination.
29:08 - 31:16: Metformin's Ineffectiveness for Acute COVID-19: The ACTIVE-6 clinical trial found that metformin did not significantly shorten symptom duration or improve recovery time for adults with mild-to-moderate COVID-19, reaffirming Paxlovid, Remdesivir, and Molnupiravir as primary treatments.
31:16 - 35:28: Viral Rebound and Post-Acute Mortality: A Nature Communications study suggests that SARS-CoV-2 viral rebound (indicated by changes in CT values) is associated with a significantly higher risk of post-acute mortality and hospitalization in previously hospitalized COVID-19 patients, potentially pointing to underlying immune dysregulation.
35:28 - 41:09: COVID-19 Vaccines' Role in Preventing Long COVID: Multiple studies provide strong evidence that COVID-19 vaccines are effective against post-COVID conditions and long COVID (41% overall reduction, increasing to 70% with three doses). Objective findings reveal distinct symptom phenotypes and persistent immune disturbances in long COVID patients, refuting claims that symptoms are "all in your head."
41:09 - 41:53: American Society of Tropical Medicine and Hygiene Fundraiser: Announcement of a fundraiser to double donations (up to $20,000) to support early career investigators in tropical medicine globally.
41:53 - 47:03: Listener Questions and Updates: Dr. Griffin answers questions on:
Shingles Vaccine for Younger Individuals: Advising a 39-year-old with a history of shingles to seek off-label vaccination, despite typical age restrictions.
Rising HIV Cases in Cisgender Women: Highlighting a concerning increase in HIV diagnoses among heterosexual cisgender women in the Pacific Northwest, including perinatal cases, underscoring the need for broader education and awareness.
RSV Vaccine and Guillain-Barré Syndrome: Clarifying the link between RSV vaccines and GBS and promising a future reference.
Chikungunya Vaccine Availability: Confirming the lifting of age restrictions on the chikungunya vaccine, making it accessible for travelers to risk areas like France, which is currently experiencing an outbreak.
Error: value error Invalid operation: The response.text quick accessor requires the response to contain a valid Part, but none were returned. Please check the candidate.safety_ratings to determine if the response was blocked.