This episode of "This Week in Violegy," recorded on September 11, 2025, covers a range of critical public health topics. Discussions include updates on Legionella outbreaks in New York, the spread of the invasive Asian Longhorned tick, and a new Ebola outbreak in the Democratic Republic of Congo. A significant portion is dedicated to the contentious issue of vaccine mandates, particularly Florida's move to eliminate school-entry requirements, and its implications for rising measles and influenza cases. The hosts also present positive data on COVID-19 vaccine efficacy and the therapeutic benefits of Paxlovid, alongside an update on NIH trials for long COVID treatments. The episode concludes by addressing listener questions on vaccine access, types, and immunization schedules, reinforcing the importance of science-based public health education and community support.
Summarizing "This Week in Violegy" - Episode 1252
0:00 Introduction and Somber Reflections: Hosts Vincent Racaniello and Daniel Griffin, recording from the Harvard Violegy Retreat, introduce episode 1252 on September 11, 2025. Daniel's tie features the influenza virus. They reflect on the somber anniversary of 9/11 and the current political climate, noting the intertwining of democracy, science, and medicine.
3:11 Legionella Updates: As of August 29th, New York reported 114 confirmed Legionella cases, 90 hospitalizations, and 7 deaths. A new outbreak in Westchester County resulted in 2 deaths and over three dozen illnesses. A reminder is given to clean air conditioning units as the season ends.
4:25 Asian Longhorned Tick Spreads: The invasive Asian Longhorned tick, native to Asia and capable of spreading spotted fevers, has been confirmed in Maine for the first time, marking its farthest northeast presence in the US. First identified in New Jersey in 2017, it has now spread to 20 states, affecting pets and livestock, with unknown human impact.
5:13 Ebola Outbreak in DRC: A new Ebola outbreak has emerged in the Balape and MCA health districts of the Casai province in the Democratic Republic of Congo, prompting a Level 1 travel notice. Advice includes avoiding contact with sick people, bats, and other potential animal carriers. Discussion arises regarding the potential for ring vaccination and the challenges of implementation in the DRC.
6:27 Vaccine Mandates and Measles Resurgence: Florida is moving to completely end vaccine requirements for schoolchildren. Only four states (Maine, New York, Connecticut, California) maintain medical-only exemptions, with most states offering religious or personal exemptions, which are seen as undermining public health requirements. Senator Cassidy warns of inevitable outbreaks of vaccine-preventable diseases like measles, risking vulnerable populations. The US has seen 1,454 confirmed measles cases as of September 9th, and Canada is approaching 5,000 for the year, marking a significant resurgence.
10:55 Early Influenza Season Predicted: Daniel predicts an early flu season for 2025, possibly by Thanksgiving, driven by holiday travel. Vincent adds that an early cold winter, as predicted by the Farmers' Almanac, could also contribute. Last season (2024-2025) saw hospitalization rates 1.8 to 2.8 times higher than historical medians, with only 32.4% of hospitalized patients vaccinated.
13:32 Flu Vaccine Effectiveness and Pediatric Deaths: While a flu shot doesn't guarantee against getting the flu, it significantly reduces the risk of hospitalization and death. Last season, 279 pediatric deaths from influenza were recorded, the highest in a non-pandemic season, with most children having no comorbidities and being unvaccinated—a preventable tragedy.
14:40 RSV Risk Factors in Children: A robust Swedish cohort study (2.3 million children) found that 60% of severe RSV cases in children under three months of age had no identifiable underlying comorbidities, highlighting the extreme vulnerability of infants. Protection is available through maternal vaccination and monoclonal antibodies.
17:06 COVID-19 Status and Canine Spillover: Nationally, COVID-19 cases continue to rise, particularly in the Southern US. A study confirmed SARS-CoV-2 spillover to domestic dogs in COVID-19 positive households (68% seroprevalence in exposed dogs vs. 12.24% in unexposed), though dogs do not appear to get sick or transmit to humans.
21:10 COVID-19 Vaccine and Paxlovid Efficacy: Pfizer and BioNTech announced robust immune responses for their 2025-2026 adapted COVID-19 vaccine. Over 5 billion doses of Pfizer-BioNTech vaccine have been distributed globally. Paxlovid demonstrated significant benefits in high-risk non-hospitalized adults, reducing time to health by 3 days and return to usual activities by 1 day. A large Taiwanese study (2.3 million patients) showed Paxlovid reduced hospitalization by 68% and death by 60%, with benefits seen across all age and vaccination statuses, especially in the unvaccinated and those over 65.
24:42 Expanding Vaccine Access in New York: Governor Kathy Hochul issued an executive order allowing pharmacists to administer COVID-19 vaccines to anyone three years or older without a prescription, including pregnant women and children, in response to federal actions seen as "contrary to public health."
30:37 Paxlovid for Renal Impairment: The Paxlovid package insert has been updated to include dosing adjustments for patients with severe renal impairment (GFR <30), including those on dialysis, making it more widely accessible.
31:45 Long COVID Research and Patient Dissatisfaction: The NIH RECOVER initiative announced new trials for long COVID treatments, including low-dose Naltrexone, Baricitinib, GLP-1 drugs, and stellate ganglion blocks. However, a recent poll revealed significant dissatisfaction among long COVID patients with current research efforts (38.4% strongly dissatisfied, 30% somewhat dissatisfied).
34:12 Listener Question: Vaccine Mandates for Immigrants: Daniel discusses applying vaccine requirements to immigrants, emphasizing public health protection while opposing automatic deportation for non-compliance. The conversation highlights issues like the reintroduction of vaccine-preventable diseases (e.g., oral polio, measles) by tourists or unvaccinated individuals.
36:06 Listener Question: COVID Vaccine Access Challenges: A 75-year-old emergency physician from Oregon described needing to write his own prescription for a COVID vaccine due to system hurdles, advising patients to "self-rescue" by persistently seeking prescriptions from their providers or urgent care.
38:48 Listener Question: Moderna Vaccine Types: Daniel clarifies that Moderna's M-next spike vaccine is not self-replicating mRNA. While it showed reduced reactogenicity and a slight benefit for symptomatic COVID, its impact on severe disease is less clear due to fewer T-cell epitopes, focusing primarily on neutralizing antibodies.
41:17 Listener Question: Best COVID Vaccine Brand: Daniel states there is no scientific evidence to suggest one COVID vaccine brand (Moderna, Pfizer, Novavax) is superior for people over 65; all are effective and safe.
42:38 Listener Question: Early Shingles Vaccine: For a healthy 40-year-old, Daniel acknowledges the desire to get the shingles vaccine (Shingrix) before the recommended age of 50 due to the painful nature of the disease, suggesting a discussion with their doctor given that early vaccination might prevent it.
43:43 Listener Question: MMR Booster: For an individual born in the early 1970s with prior positive measles antibody titers, Daniel confirms that if they received only one MMR dose between 1968 and 1989, a single second MMR dose is recommended due to observed secondary transmission and resurgence of measles. It is acceptable to delay the booster to coincide with a flu shot appointment.