In TWiV 1252, Dr. Daniel Griffin provides a comprehensive clinical update, discussing ongoing public health concerns and recent developments in infectious diseases. The episode covers current outbreaks, including Legionnaires' disease in Westchester County and a potential Ebola outbreak in the DRC, alongside the confirmed spread of the invasive Asian Longhorned tick in Maine. A significant portion addresses vaccine policy, particularly Florida's controversial move to eliminate childhood vaccine mandates, sparking concerns about vaccine-preventable disease resurgences, which are already evident with rising measles cases in the US and Canada.
Dr. Griffin then delves into the 2024-2025 influenza season, characterized as high-severity with alarmingly low vaccination rates among hospitalized patients and a record number of pediatric deaths. He also highlights new research on RSV, emphasizing that severe outcomes disproportionately affect young infants, often without underlying conditions, underscoring the importance of maternal vaccination and monoclonal antibodies. The discussion on SARS-CoV-2 includes its spillover into domestic dogs, new data reaffirming the benefits of COVID-19 vaccines (including in vaccinated individuals), and the effectiveness of Paxlovid in reducing severe outcomes and accelerating recovery. The segment concludes with updates on long COVID research, the "Recover" initiative's new trials, and a call for continued support for science-based education amidst challenges to public health.
Clinical Update with Dr. Daniel Griffin: Key Takeaways
0:00 Introduction & 9/11 Reflection: The podcast opens with Vincent Racaniello and Dr. Daniel Griffin discussing current locations and Dr. Griffin's influenza virus tie. They then reflect on the somber anniversary of 9/11, highlighting its impact and recent national tragedies.
3:09 Legionnaires' Disease Outbreaks: Dr. Griffin updates on Legionnaires' disease, noting a previous Harlem outbreak (114 cases, 90 hospitalizations, 7 deaths as of August 29th) and a new cluster in Westchester County, New York, with two deaths and over three dozen sickened.
Key Takeaway: Peaks often occur at the beginning and end of air conditioner usage; ensure proper cleaning and maintenance.
4:16 Invasive Asian Longhorned Tick: Researchers confirmed the presence of the Asian Longhorned tick in Maine, marking its farthest northeast discovery in the US. Native to Asia, it can spread spotted fevers and has now spread to 20 states since its 2017 detection in New Jersey.
Key Takeaway: This invasive tick can spread diseases to pets and livestock, with potential future implications for humans.
5:13 Potential Ebola Outbreak in DRC: A Level 1 travel notice has been issued for an Ebola outbreak in the Casai province of the Democratic Republic of Congo (DRC).
Key Takeaway: Avoid contact with sick people and animals; ring vaccination is an ideal strategy if implemented early.
6:29 Florida Ends Childhood Vaccine Mandates: Florida is moving to eliminate all vaccine requirements for school children, including those for polio and measles, in the name of "medical freedom."
Important Details: Only four states (Maine, New York, Connecticut, California) require medical exemptions only. Most states allow religious and/or personal exemptions. Senator Cassidy (physician) warns of inevitable outbreaks.
Key Takeaway: This political move undermines public health and risks outbreaks of vaccine-preventable diseases, endangering vulnerable children.
10:16 Resurgence of Measles: The US has seen 1,454 confirmed measles cases as of September 9th, the highest since its elimination was declared. Canada is approaching 5,000 cases for the year.
Key Takeaway: Measles is actively making a resurgence, underscoring the dangers of declining vaccination rates.
10:52 Early and Severe Flu Season Predicted: Dr. Griffin predicts an early flu season this year, starting around November/Thanksgiving, potentially exacerbated by an early winter.
Important Details: The 2024-2025 flu season was high-severity, with hospitalization rates 1.8 to 2.8 times higher than historical medians. Only 32.4% of hospitalized patients were vaccinated.
Key Takeaway: The flu vaccine, while not preventing infection entirely, significantly reduces hospitalization and death; 279 pediatric deaths from flu last season were preventable tragedies.
14:42 RSV Risk Factors and Protection: A Swedish study of over 2.3 million children found that the majority of severe RSV cases in infants under three months of age occurred in those with no underlying co-morbidities.
Important Details: Strongest risk factors include small for gestational age, multiple births, and young siblings.
Key Takeaway: Maternal vaccination and monoclonal antibodies (Nirsevimab, Kles Romab) are crucial for protecting young, vulnerable infants.
17:06 SARS-CoV-2 Activity & Spillover: COVID-19 activity varies by region, with the South driving national rises. There's a hopeful "shoulder" effect before winter.
Important Details: A study found 68% seroprevalence among dogs in COVID-19 positive households, compared to 12.24% in unexposed dogs, confirming spillover to domestic dogs. Dogs do not appear to get sick or transmit onward.
21:10 COVID-19 Vaccines (Active Vaccination): Pfizer and BioNTech announced robust immune responses from their updated LP.8.1 adapted COVID-19 vaccine for 2025-2026, even in those vaccinated 6+ months prior.
Important Details: 5 billion doses of Pfizer-BioNTech vaccine distributed globally, with no safety issues noted in the new trial. 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 due to federal actions limiting access.
Key Takeaway: Vaccines are incredibly safe and effective, reducing severe outcomes. State-level actions are crucial to maintain access amidst federal changes.
26:41 Paxlovid Effectiveness: Patient-reported outcomes show Paxlovid significantly reduces time to return to health (3 days), usual activities (1 day), and symptom resolution.
Important Details: A Taiwanese study of over 2.3 million patients showed Paxlovid reduced hospitalization by 68%, ICU admission by 59%, ventilator use by 62%, and death by almost 60% (even in vaccinated individuals). Greatest benefit seen in unvaccinated and those 65+.
Key Takeaway: Paxlovid is highly effective in preventing severe COVID-19 outcomes and speeding recovery, even for vaccinated individuals and those with severe renal impairment (with adjusted dosing).
31:21 Post-Acute Sequelae / Long COVID: The NIH "Recover" initiative announced new trials testing low-dose naltrexone, baricitinib, GLP-1 drugs, and stellate ganglion blocks.
Important Details: Long COVID patients expressed high dissatisfaction (38.4% strongly dissatisfied, 30% somewhat dissatisfied) with the current research efforts, feeling a wider net needs to be cast.
Key Takeaway: More diverse and coordinated research is needed to effectively address Long COVID, as current approaches are not fully satisfying the patient community.
Vaccine Mandates for Immigration: Dr. Griffin supports vaccine requirements for immigrants who wish to live in the US for public health protection but is against automatic deportation. He notes issues with oral polio vaccine reintroduction from tourists.
COVID-19 Vaccine Access: An emergency physician highlighted barriers to vaccine access, even for a 75-year-old doctor, emphasizing the need for patients to "self-rescue" by persistently seeking prescriptions from providers.
Moderna's Next Spike Vaccine: Discussed less reactogenicity and a potential statistically significant benefit for symptomatic COVID compared to the original, but uncertainty remains about its impact on severe disease due to fewer T-cell epitopes. It is not a self-replicating mRNA vaccine.
Best Vaccine for Over 65: No scientific head-to-head data suggests one COVID-19 vaccine brand (Pfizer, Moderna, Novavax) is superior for those over 65; all are effective and safe.
Shingles Vaccine for 40-year-olds: The vaccine was studied for ages 50+, but earlier vaccination might be beneficial given the pain of shingles, although it's an off-label discussion with a doctor.
MMR Booster for Waning Immunity: For those born 1957-1988 who received one MMR dose, a single booster is recommended if there is concern for waning immunity, even with prior high antibody titers. Waiting a few weeks for other vaccines (flu) is acceptable.
33:28 Call to Action: Dr. Griffin reiterates MicrobeTV's commitment to providing unbiased, science-based education and urges listener support.
Summary of References:
The provided references offer a multi-faceted view of public health challenges and policy decisions, primarily in the US.
1. Disease Outbreaks & Surveillance:
Legionnaires' Disease: Two outbreaks are noted in New York in 2025: one in Harlem with 114 cases, 90 hospitalizations, and 7 deaths, and a more recent one in Westchester County with 2 deaths and 37 sickened. High summer temperatures are implicated in increased bacterial spread.
Measles: As of September 9, 2025, the U.S. has reported 1,454 confirmed measles cases across 42 jurisdictions, with 37 outbreaks and 3 confirmed deaths. 92% of cases are in unvaccinated or unknown vaccination status individuals. New York alone has 20 confirmed cases. Canada is also experiencing a significant surge, approaching 5,000 cases for the year.
Influenza: The 2024–25 U.S. influenza season was categorized as high-severity, with hospitalization rates the highest since 2010–11. Alarmingly, only 32.4% of hospitalized patients had received an influenza vaccine. The 2025-2026 flu vaccine strains have already been recommended by the FDA.
RSV: While current U.S. activity is low, a Swedish study highlights that the majority of severe RSV cases in children occur in healthy, full-term infants under 3 months. Risk factors include prematurity, small gestational age, multiple births, and young siblings. The CDC recommends RSV vaccination for all adults 75+ and those 50-74 with chronic conditions, given as a single, non-annual dose. An economic analysis found RSV vaccination cost-effective for adults aged 50-59 with chronic conditions.
Overall Respiratory Illness: As of September 12, 2025, acute respiratory illness in the U.S. is low, with seasonal flu and RSV also low. However, COVID-19 activity is high or very high in wastewater across many states, and positive test percentages/ED visits are peaking nationally, though declining in some southern states.
2. Vaccine Policy & Access:
Florida's Vaccine Mandate Rollback: Florida's surgeon general, Dr. Joseph Ladapo, plans to eliminate all vaccine mandates for schoolchildren, framing it as "medical freedom." Public health organizations strongly criticize this, warning of preventable disease outbreaks, and note that the Florida Department of Health did not conduct a data analysis on its potential impact.
Vaccine Exemptions: A map indicates that only four U.S. states (Maine, New York, Connecticut, California) limit school vaccine exemptions to medical reasons. Most other states allow religious and/or personal belief exemptions.
CDC Vaccine Recommendations:
Measles (MMR): Routine 2-dose series for children (12-15 months, 4-6 years), 97% effective. Adults without immunity need at least one dose. Post-exposure prophylaxis (vaccine within 72 hrs or immunoglobulin within 6 days) is available. Presumptive immunity includes written vaccination records, lab evidence, or birth before 1957.
RSV: Recommendations vary by age and risk, with a single dose for older adults and those with chronic conditions.
Adverse Events: Most deaths reported to VAERS (Vaccine Adverse Event Reporting System) are temporally, not causally, associated with vaccination. Serious adverse events are rare (e.g., Td vaccine and Guillain-Barré syndrome, tetanus toxoid and anaphylaxis). Vaccines are among the safest medical products, and deaths directly caused by them are very rare.
3. Disease Management & Long COVID Research:
Influenza Antiviral Treatment: Underutilized, especially in children and adolescents.
Long COVID: The NIH "Recover" initiative is launching new trials for Long COVID treatments, including low-dose naltrexone, baricitinib, GLP-1 receptor agonists, and stellate ganglion blocks. However, a patient poll indicates significant dissatisfaction with these efforts, with many feeling promising targets are unexplored and efforts are duplicated.
Glossary of Medical Terms:
ACIP (Advisory Committee on Immunization Practices): A group of medical and public health experts that develops recommendations for vaccine use in the United States.
Anaphylaxis: A severe, potentially life-threatening allergic reaction.
Antibody Titers: A laboratory test that measures the amount of specific antibodies in the blood, indicating the level of immunity to a particular pathogen.
Anticoagulation: The use of medications to prevent blood clot formation.
Baricitinib: An immune system modulator, used in some autoimmune conditions and being tested for Long COVID.
Binning (in cameras): Combining the charge from multiple pixels on a CCD sensor to increase sensitivity (gain) at the expense of resolution.
Co-morbidities: The presence of two or more diseases or medical conditions in a patient simultaneously.
Convalescent Plasma: Plasma taken from individuals who have recovered from an infection, containing antibodies that can be used to treat others.
Dichroic Mirrors: Optical filters that selectively transmit light within a small range of wavelengths, while reflecting all others.
Dosing Directions: Instructions for how much of a medication to take and how often.
DRC (Democratic Republic of Congo): A country in Central Africa, often affected by Ebola outbreaks.
EEPROM (Electrically Erasable Programmable Read-Only Memory): A type of non-volatile memory that can be erased and reprogrammed electrically, often used to store device settings or runtime data.
Epitopes: Specific parts of an antigen (like a virus) that are recognized by the immune system, particularly by antibodies and T-cells.
FPGA (Field-Programmable Gate Array): An integrated circuit designed to be configured by a customer or a designer after manufacturing, often used for high-speed signal processing in cameras.
GFR (Glomerular Filtration Rate): A measure of how well the kidneys are filtering blood, used to assess kidney function and stage kidney disease.
GLP-1 Receptor Agonists (Glucagon-Like Peptide 1 Receptor Agonists): A class of drugs often used for type 2 diabetes and weight loss, now being explored for Long COVID.
Guillain-Barré Syndrome (GBS): A rare disorder in which the body's immune system attacks its nerves, potentially leading to muscle weakness and paralysis.
Hemodialysis: A medical procedure to remove waste products and excess fluid from the blood when the kidneys are unable to do so.
ICD-10 Code (International Classification of Diseases, 10th Revision): A medical classification list by the World Health Organization (WHO) for diagnostic, symptom, and procedure codes.
Immune Modulation: The process of adjusting or altering the immune response.
Immunoglobulin (IG): A type of antibody, often administered for passive immunity.
Influenza: The flu, a contagious respiratory illness caused by influenza viruses.
Legionnaires' Disease: A severe form of pneumonia caused by Legionella bacteria, often spread through contaminated water droplets from cooling towers, hot tubs, or large plumbing systems.
Long COVID (Post-acute sequelae of COVID-19 - PASC): A range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19.
Low-dose Naltrexone: An opioid antagonist sometimes used off-label for various conditions including chronic pain and autoimmune diseases, now being studied for Long COVID.
Micro-lenses: Tiny lenses placed over individual pixels on a camera sensor to concentrate light onto the light-sensitive area, increasing efficiency.
MMR Vaccine: A vaccine that protects against measles, mumps, and rubella.
MMWR (Morbidity and Mortality Weekly Report): A weekly report published by the CDC on public health issues.
Monoclonal Antibodies: Laboratory-made proteins that mimic the immune system's ability to fight off harmful pathogens like viruses.
Nirmatrelvir/Ritonavir (Paxlovid): An oral antiviral medication used to treat mild-to-moderate COVID-19 in individuals at high risk for progression to severe disease.
Nirsevimab: A long-acting monoclonal antibody approved for the prevention of RSV in infants and young children.
Non-human Primate (NHP) Data: Research data obtained from studies conducted on monkeys or apes.
Pel Cool Camera (Peltier Cooling): A camera that uses a Peltier element (thermoelectric cooler) to cool its sensor, reducing thermal noise and improving image quality, especially for long exposures.
PFG (Pulse Flush Gate): A setting or feature on some CCD cameras, possibly related to clearing charge from pixels rapidly or managing blooming.
Phosphor Conversion: A process where a phosphor material absorbs light of one wavelength (e.g., blue) and re-emits it at a longer wavelength (e.g., yellow or green), commonly used in white LEDs.
Post-exposure Prophylaxis (PEP): Treatment given after potential exposure to a disease to prevent infection or reduce its severity.
Prevnar 20: A pneumococcal conjugate vaccine that helps protect against 20 types of Streptococcus pneumoniae bacteria.
Reactogenicity: The property of a vaccine to cause common, expected adverse reactions such as pain, fever, or swelling at the injection site.
Remdesivir: An antiviral medication used to treat COVID-19, particularly in hospitalized patients.
Ring Vaccination: A strategy to control an outbreak where all individuals in a "ring" around an infected person (or geographically defined area) are vaccinated.
RSV (Respiratory Syncytial Virus): A common respiratory virus that usually causes mild, cold-like symptoms but can be serious, especially for infants and older adults.
SARS-CoV-2: The virus that causes COVID-19.
Seroprevalence: The percentage of individuals in a population who have antibodies to a specific infectious agent, indicating prior infection or vaccination.
Shingles (Herpes Zoster): A viral infection that causes a painful rash, caused by the varicella-zoster virus (the same virus that causes chickenpox).
Silica Gel Desiccant: A drying agent used to absorb moisture, often found in electronic devices to prevent condensation.
Stellate Ganglion Block: An injection of numbing medicine into a group of nerves in the neck (the stellate ganglion), sometimes used to treat pain or certain sympathetic nervous system disorders, and being explored for Long COVID.
Sympathetic Ganglion: Part of the sympathetic nervous system, which controls the body's "fight or flight" responses.
T-cell Breath: A measure of the diversity of T-cell responses, indicating how many different parts of a pathogen the T-cells can recognize.
TTL (Transistor-Transistor Logic) Interface: A type of digital electrical signal used for communication between electronic devices, often for simple on/off control.
USB Isolator: A device that provides electrical isolation between the USB host and device, preventing ground loops and protecting equipment from voltage spikes.
VAERS (Vaccine Adverse Event Reporting System): A national passive reporting system that collects information about adverse events (possible side effects) that occur after vaccination.
Vagal Tone: A measure of the activity of the vagus nerve, which is part of the parasympathetic nervous system and influences heart rate, digestion, and other functions; often associated with relaxation.
Waning Immunity: The decrease in the level of protection provided by a vaccine or natural infection over time.