This episode of "This Week in Virology" provides a clinical update with Dr. Daniel Griffin, covering a range of pressing infectious disease topics. Key discussions include the first locally acquired case of Chikungunya in New York, the scientific refutation of concerns about aluminum in vaccines based on a large Danish study, and new detections of H5N1 avian influenza in US commercial turkey farms. The hosts express deep concern over the US government shutdown's impact on the CDC, the ongoing measles outbreak (now over 1,600 cases), and a recent study from Tanzania showing that a significant percentage of measles cases can present without a rash, complicating diagnosis. The episode also covers updates on influenza and RSV, including increased access to the antiviral Zofluza and high post-licensure efficacy for the RSV vaccine. Finally, Dr. Griffin discusses a clinical trial that found colchicine ineffective for treating long COVID and answers listener questions on topics such as the safety of Paxlovid, the efficacy of the monoclonal antibody Pemgarda, and vaccine recommendations for international travel.
TWiV 1264 Clinical Update: Measles, Vaccines, and Antiviral Access
2:48 First Local Chikungunya Case in New York: New York State has confirmed its first locally acquired case of Chikungunya virus in Nassau County. The transmission is believed to have occurred when a local mosquito bit an infected international traveler and subsequently bit the resident.
4:40 Aluminum in Vaccines is Safe: A nationwide Danish cohort study involving over 1.2 million children found no association between aluminum in vaccines and the risk of autoimmune, allergic, or neurodevelopmental disorders. The hosts note that this scientific evidence directly contradicts claims from vaccine skeptics.
9:58 H5N1 Bird Flu Detected in US Turkey Farms: Highly pathogenic avian influenza (H5N1) has been detected in multiple commercial poultry flocks, including a large turkey farm in Minnesota with 34,000 birds. This raises concerns about potential impacts on the poultry supply ahead of Thanksgiving.
12:20 Concerns Over CDC Shutdown: The hosts discuss the ongoing government shutdown and its detrimental effect on the CDC's ability to collect and disseminate public health data. An initiative by other organizations to create an alternative to the CDC's MMWR report is mentioned, though they acknowledge the immense challenge of replacing the CDC's surveillance infrastructure.
14:11 Measles Can Present Without a Rash: A study in Tanzania found that 30% of hospitalized children with confirmed measles infections did not present with the characteristic rash. This is highly concerning as the rash is a key diagnostic criterion, and its absence could lead to missed diagnoses and increased community transmission.
19:59 US Measles Outbreak Worsens: As of October 21st, there are 1,618 confirmed measles cases in the US. The country is on track to lose its measles elimination status, with major outbreaks continuing in states like Utah, Arizona, and Texas, primarily among unvaccinated populations.
23:47 Increased Access to Influenza Antiviral: The influenza antiviral pill Zofluza is now available direct-to-consumer in the US at a discounted cash price of $50, following pressure from the government on pharmaceutical companies to lower drug prices.
27:09 RSV Vaccine Shows High Efficacy in Older Adults: A post-licensure study found that the RSV vaccine demonstrated 92% effectiveness in preventing RSV-related emergency department visits and hospitalizations among adults aged 60 and over.
30:19 Colchicine Ineffective for Long COVID: A randomized, double-blind clinical trial published in JAMA Internal Medicine concluded that the anti-inflammatory drug colchicine was not effective for treating long COVID symptoms.
33:41 Paxlovid is Safe and Does Not Drive Resistance: Dr. Griffin confirms that studies on over a million users show Paxlovid does not cause viral resistance. It remains a safe and effective treatment for individuals over 50, with the primary concern being potential drug-drug interactions.
36:55 Pemgarda Monoclonal Antibody Remains Effective: While its efficacy against current COVID-19 variants is likely reduced, the monoclonal antibody Pemgarda still provides a significant 74-84% relative risk reduction for preventing symptomatic infection in vulnerable populations.