This episode of TWIV (This Week in Virology) delves into a wide array of public health and infectious disease topics. The hosts discuss the history and impact of Helicobacter pylori on ulcers and cancer prevention. A significant portion addresses the dangerous consequences of anti-science rhetoric, exemplified by a violent attack on the CDC stemming from COVID vaccine misinformation, and the controversial changes within the CDC's immunization advisory committee (ACIP) leading the American Academy of Pediatrics to issue its own vaccine schedule.
The episode also covers updates on various infectious threats: a warning about Vibrio vulnificus in warming coastal waters, a trial investigating Ivermectin for malaria control, and the historical context of Legionnaires' disease amidst a current outbreak. Detailed recommendations are provided for RSV, influenza, and COVID-19 vaccines, highlighting pediatric deaths from flu and the benefits of high-dose flu vaccines for seniors. Finally, a study on accelerated vascular aging after COVID-19 infection, notably affecting women more significantly, is discussed, underscoring the long-term health implications of the virus. Throughout, the hosts emphasize the critical role of accurate scientific information in public health.
This Week in Virology: A Clinical Update on Public Health Challenges
0:00 - Introduction & H. pylori: The episode opens with hosts Vincent Racaniello and Daniel Griffin. Daniel wears a tie with H. pylori markings, prompting a discussion about the bacterium's discovery, its role in ulcers, and how antibiotics revolutionized treatment, eliminating the need for extensive surgeries. The importance of this basic medical science for public health is highlighted.
2:44 - The Dangers of Anti-Science Rhetoric: Daniel introduces a quote from Mary Shelley's Frankenstein about choosing evil, transitioning into a discussion on the real-world, often violent, consequences of anti-science rhetoric. He cites personal experiences of colleagues like Peter Hotez requiring armed security due to threats, and a recent attack on the CDC.
6:10 - CDC Attack Details from Employee Email: An email from an anonymous CDC employee details a violent attack on August 8th where a gunman fired 500 rounds, striking six buildings and killing a police officer. The motive was a belief of harm from the COVID vaccine, fueled by misinformation. The email suggests the trauma from this event may have delayed CDC public health updates.
7:59 - Vibrio Vulnificus Alert: The Massachusetts Department of Public Health issued an alert about Vibrio vulnificus bacteria in coastal waters. Cases are increasing, especially in the Gulf Coast, due to warmer water temperatures. Infections occur through open wounds or contaminated shellfish and can cause severe, life-threatening illness, including fulminant sepsis, particularly in individuals with liver compromise.
10:20 - Ivermectin for Malaria Control: A study published in the New England Journal of Medicine on Ivermectin for malaria control in Kenya is discussed. The trial showed a 26% lower incidence of malaria infection in groups receiving Ivermectin compared to Albendazole. Ivermectin is believed to work both as an antiparasitic (targeting malaria parasite life cycle stages) and as an insecticide, offering community-wide benefits by affecting mosquitoes. Concerns about potential drug resistance are noted.
14:33 - Legionella Outbreak & History: Daniel provides a real-time update on a Legionella outbreak (111 confirmed cases, 6 deaths as of August 21st, 2025), with contaminated cooling towers identified and cleaned. He then delves into the history of Legionella, distinguishing between Pontiac fever (1968, mild flu-like illness without pneumonia) and Legionnaires' disease (1976, severe pneumonia, often fatal). Both are acquired by inhaling bacteria from contaminated water sources. Diagnostic challenges (limited urine antigen sensitivity) and treatment options are discussed.
20:25 - AAP vs. ACIP Immunization Schedules: The American Academy of Pediatrics (AAP) released its own evidence-based immunization schedule, diverging from the CDC's Advisory Committee on Immunization Practices (ACIP). This divergence is attributed to the ACIP's recent overhaul and inclusion of individuals with a history of spreading vaccine misinformation.
21:49 - RSV Vaccine Recommendations: The AAP recommends RSV immunization for infants under 8 months (if the pregnant parent was not vaccinated or infant born soon after maternal vaccine) and for high-risk infants/children aged 8-19 months entering their second RSV season. Two monoclonal antibodies (nirsevimab and clrovmab) are recommended.
23:05 - Influenza Vaccine Recommendations: The AAP recommends annual flu vaccines for all children 6 months and older. This contrasts with ACIP, particularly given that 270 children died from flu last season, with a majority being healthy and unvaccinated.
24:18 - COVID-19 Vaccine Recommendations: The AAP recommends the COVID-19 vaccine for all children aged 6-23 months (due to similar risk profile as over 65s) and a single annual dose for children/adolescents aged 2-18 years in high-risk groups or whose parents/guardians desire protection.
25:58 - Global Measles Update: Updates on measles cases indicate a concerning rise: 1,375 confirmed cases in 42 U.S. jurisdictions, 4,638 in Canada, and over 10,000 cases with 18 deaths across 10 Pan-American countries (a 34-fold increase year-over-year). Israel also reported two recent measles-related deaths in unvaccinated toddlers and ongoing outbreaks.
28:32 - Rising Pediatric Flu Deaths: The number of pediatric flu deaths reached a record high of 270 in the last non-pandemic flu season, continuing an alarming upward trend over recent years. Nearly all affected children were unvaccinated, and about half had no underlying medical conditions.
29:35 - High-Dose Flu Vaccine for Seniors: For individuals 65 and older, the CDC preferentially recommends high-dose inactivated, recombinant, or adjuvanted flu vaccines. A study (DANFLU-1) showed these high-dose vaccines significantly reduce the risk of hospitalization for pneumonia/influenza (63-67%) and all-cause mortality (74%) in seniors, regardless of frailty.
32:55 - RSV Vaccine and GBS Risk: The CDC recommends the RSV vaccine for those 75 and older, or 50-74 if at increased risk of severe RSV. It's currently a one-time dose. A small risk of Guillain-Barré Syndrome (GBS) (7-9 excess cases per 1 million vaccinated adults >60) was noted in clinical trials for some RSV vaccines (GSK's Arexvy, Pfizer's Abrysvo), but not Moderna's mResvia.
34:36 - COVID-19: Rising Levels & Vascular Aging: Wastewater data indicates increasing COVID-19 levels nationally. Standard antiviral treatments and inflammatory phase management are reiterated. A study (Cartesian study, European Heart Journal) reveals "accelerated vascular aging" (artery stiffening, measured by pulse wave velocity) after COVID-19 infection, even in non-hospitalized individuals. This effect was predominantly observed in women, regardless of disease severity, and correlated with persistent symptoms. The long-term cardiovascular implications are discussed, along with the potential for vaccination to mitigate these effects.
40:56 - ASTMH Fundraiser: A fundraiser for the American Society of Tropical Medicine and Hygiene is announced, with donations being doubled up to $20,000.
41:31 - Measles Data & Misinformation: An email from Richard validates concerns about CDC's measles data reporting practices and attributes discrepancies with Canadian figures to anti-vax disinformation from high-level officials.
45:04 - Paxlovid Accessibility & Cost: Ellen's email describes difficulty and high cost ($279 with insurance, $1200 without) in obtaining Paxlovid, highlighting financial barriers to effective COVID-19 treatments.
46:31 - Antarctic Bird Flu: Bill clarifies that the research vessel mentioned in a previous episode is a cruise ship with lab space and confirms bird flu likely reached Antarctica via migrating birds.
48:24 - Senior Vaccine Confusion: Chris's email seeks clarification on fall 2025 vaccine recommendations for seniors, covering updated COVID vaccines (expected soon despite ACIP issues), high-dose flu vaccines, and the one-time nature of the RSV vaccine.
50:39 - Alternative Measles Trackers: Mark and Abby provide links to Johns Hopkins and Brown University's measles trackers, which aggregate data from state and county health departments, as alternative sources for reliable measles data.
52:05 - Measles Testing Barriers: Javad, a primary care doctor, raises concerns about Minnesota's Department of Health requiring measles tests to be sent directly to them, creating an unnecessary burden and potentially hindering rapid diagnosis and containment. Daniel agrees that testing should be made as easy as possible.