This TWiV episode features Dr. Daniel Griffin's weekly clinical update, discussing several critical public health topics. The segment begins with news of Vinay Prasad's controversial return to the FDA and the potential non-renewal of Pfizer's COVID-19 vaccine authorization for young children, sparking debate on vaccine access for vulnerable populations, supported by data on pediatric COVID-19 mortality. Dr. Griffin also provides updates on a Legionnaires' outbreak in Harlem, the re-labeling of the Chikungunya vaccine amid global outbreaks, and the broader benefits of the zoster vaccine. A significant part of the update covers the concerning arrival of H5 avian influenza in Antarctica, detailed reports on measles, influenza, and RSV activity, and the latest COVID-19 treatment guidelines. A key highlight is the discussion of groundbreaking research suggesting that respiratory viral infections like influenza and SARS-CoV-2 can reactivate dormant cancer cells, significantly increasing the risk of cancer-related mortality in survivors. The episode concludes with listener questions on HIV treatment delays, vaccine recommendations, ivermectin for malaria, and the experimental stellate ganglion block for Long COVID.
TWiV 1244: Clinical Update with Dr. Daniel Griffin
1:26 Ignoring vs. Ignorance: Dr. Griffin opens with a quote emphasizing that ignorance often requires active effort, setting a tone for critical evaluation of information.
2:00 Vinay Prasad's Return to FDA: Discusses reports of Dr. Vinay Prasad's reinstallation at the FDA's Center for Biologics Evaluation and Research, raising questions about transparency and leadership.
2:54 Pediatric COVID-19 Vaccine Concerns: The FDA may not reauthorize Pfizer's COVID-19 vaccine for children aged 6 months to 4 years, potentially limiting access for the youngest population. Dr. Griffin argues against this, citing thousands of pediatric COVID deaths and hospitalizations, many in previously healthy children, emphasizing that vaccine recommendations should apply universally.
5:48 Pediatric COVID-19 Mortality Study: A Canadian and Caribbean study (PICNIC) on pediatric COVID-19 mortality shows a 0.7% fatality rate among hospitalized children, with most deaths occurring in children under five. 75% of deaths after vaccine approval were in unvaccinated children, reinforcing the need for vaccination in this age group.
9:48 Harlem Legionnaires' Outbreak: An update on the ongoing Legionnaires' disease outbreak in Harlem, with 99 confirmed cases, 4 deaths, and 17 hospitalizations (as of Aug 14th). The infection is inhaled, often linked to cooling towers, and requires specific treatment.
11:00 Chikungunya Vaccine Update: The FDA initially paused, then removed the pause, and approved updated labeling for the attenuated Chikungunya vaccine (Ixchiq) for individuals 60 years and older, following investigations into adverse events. Global outbreaks are noted in China, Bolivia, Kenya, and other regions, with vaccination recommended for travelers.
13:40 Zoster Vaccine Benefits: The recombinant zoster vaccine (Shingrix) is effective against herpes zoster ophthalmicus (shingles in the eye) and is associated with a lower risk of acute myocardial infarction (28% reduction) and stroke (42% reduction) in adults aged 50 and older.
15:32 Bird Flu Reaches Antarctica: Highly pathogenic avian influenza (H5) has been detected for the first time in Antarctic seabird populations (Adeline penguins and Antarctic shags) through asymptomatic sampling, adding two new species to the infected list and indicating further global spread.
19:16 Measles Data Blackout & Cases: The CDC has paused updates to its measles case tracker, raising concerns about information flow, especially with school resuming. A new case in Idaho following positive wastewater signals is noted, and Canada continues to report thousands of cases.
22:09 Respiratory Virus Activity: Influenza saw 267 pediatric deaths last winter (highest non-pandemic season). RSV cases are increasing, especially in the Western US, with reports of testing refusals.
23:59 COVID-19 Treatment Guidelines Update: The IDSA 2025 guidelines highlight Pemivibart for pre-exposure prophylaxis in immunocompromised individuals, and Vilobelimab, Abatacept, or Infliximab for severe or critical illness. Standard early treatments (Paxlovid, Remdesivir) remain, with steroids and anticoagulation for inflammatory progression.
26:20 Viral Infections & Cancer Reactivation: Groundbreaking research in Nature demonstrates that respiratory viral infections (flu, SARS-CoV-2) can awaken dormant metastatic breast cancer cells in the lungs of mice, leading to rapid proliferation. Human observational data supports this, showing a significantly increased risk of cancer-related mortality and lung metastasis in cancer survivors post-SARS-CoV-2 infection. This is discussed as a "post-COVID condition."
29:48 Support MicrobeTV: A call for donations to "Parasites Without Borders" for an ASMH fundraiser, with donations being doubled to support tropical medicine.
32:04 Delaying HIV Treatment: Discussion on how delaying the initiation of long-acting antiretroviral therapy for HIV patients, despite its proven efficacy, is detrimental due to restrictive US guidelines and high drug costs, particularly for Gilead's lenacapavir.
35:00 Chickenpox & Shingles Vaccines: Clarification on vaccine recommendations: chickenpox vaccine for young children/those who haven't had it; shingles vaccine for those who had chickenpox (starting age 50). No universal shingles vaccine recommendation for those who received the chickenpox vaccine due to low risk of reactivation.
37:57 Ivermectin & Malaria: Confirms that ivermectin does have an anti-malarial/anti-plasmodium effect and is being explored in anti-malaria campaigns, while reiterating its ineffectiveness against viruses.
39:19 Stellate Ganglion Block for Long COVID: Dr. Griffin discusses the Stellate Ganglion Block (SGB) as a potential treatment for Long COVID-related dysautonomia (e.g., brain fog). Columbia's clinic is pursuing a randomized controlled trial (RCT) to evaluate its effectiveness, following intriguing small cohort studies.