TWiV 1342: Clinical update with Dr. Daniel Griffin

0:00This Week in Virology, the podcast about viruses, the kind that make you sick.

0:10From Microbe TV, this is TWIV, This Week in Virology, episode 1342, recorded on July 22, 2026. I'm Vincent Racaniello, and you're listening to the podcast all about viruses. Joining me today from New York, Daniel Griffin. Hello, everyone. And I can't see you, Ty, because I'm home and the monitor is really small. All I see is like red. Is this like one of those little 12-inch black and white TV monitors? Yes. It's not black and white, but it's 12 inches. Yes. Okay. All right. So it's – let's see here. I believe it's influenza. Yeah. Oh, very good. Little particles of influence. We have a few flu things to discuss.

1:00I know it's not that time of year, but that's okay. And so I have a George Eliot quote. You know, I just go actually go through it. Every so often I find something and say, you know what? I don't know how much that connects with the stuff we're talking about, but this made me think of a lot of those emails we get, right? People who say, oh, you know, I should have done X. I should have done Y. So the quotation from George Eliot, it is never too late to be what you might have been. I like that very much. Right? I mean, just as an example, right? I was in private practice out in rural Colorado. And then I became a graduate student, got a PhD.

1:42And yeah. So I mean, you could reinvent yourself. Your wife may want to kill you. But yeah, if they love you at the end of the day, they'll still tolerate you. I think it doesn't matter how old you are either. Yeah. You can do it at any age. So I'm still – When I was in medical school, Caleb, one of my fellow medical students, are you ready for this? He was a professor at Cooper Union and then he went back to medical school and became a surgeon. It's great. No, I think you should not be discouraged. You should pursue it. I mean it may not work but you can't give up. You always have to dream. Yeah.

2:20So all those people that say, oh, I should have become a virologist or yeah, become a virologist, become a parasitologist. All right. So we got a lot to talk about now. We can start with cyclospora, the explosion of the explosive diarrhea. And so it's really funny. I don't know. I find this entertaining. I mean, if you don't laugh, you cry, right? And so big news here is this potential putative connection to Taylor Farms shredded lettuce imported from Mexico, primarily served at Taco Bell restaurants. Now, according to Bloomberg News, and don't worry, this is going to be a follow-up, and well, just about everyone else, Taylor Farms said its Mexican subsidiary is voluntarily removing the product based on information provided by the U.S.

3:16FDA. Yes, but then the FDA retracts its PCR result, but then the FDA says that's okay. FDA retracts test result, but still links Taylor Farms' lettuce to cyclosporiasis. The FDA said there was overwhelming epidemiological data to support the voluntary recall. And I'm going to leave a link. This is an hour Washington Post article. The FDA said Sunday that a lab finding showing cyclospore contamination in a sample of shredded iceberg lettuce supplied by Taylor Farms Day Mako was a false positive, but the agency did not back away from its conclusion that the company remains linked to a multi-state outbreak of cyclosporiasis through its traceback investigation.

3:59FDA's traceback investigation and outbreak data continue to converge on shredded iceberg lettuce from Taylor Farms located in central Mexico, the agency said on social media. Monday afternoon, it said there was overwhelming epidemiological data to support the voluntary recall. This is an indictment of our food supply chain, right? Because we have big farms supplying a lot of individuals, and this is going to happen from time to time? It's a challenge too, because as we know, like maybe on a, I'm going to say, maybe on a good day, 50 % of the food coming into the country actually gets like tested, right?

4:35So it's really, it's a monumental task. And, you know, there may imagine there might even be some corruption on who gets tested and who doesn't, right? But it's not just things like lettuce, it could be beef, it could be many different things, right? Well, I think that's the challenge is that when you live in this interconnected web, there's all kinds of things like coming from other places, whether it's raspberries or lettuce or basil or cilantro or grapes or avocado, right? No, that's the way the world is now. They're not going to change. We're not going to go back to little farms supplying locally, right?

5:09Yeah, yeah. Yeah, I don't know. Did you watch the final of the FIFA final, Vincent? No, I did not. They tried to sort of make it into the Super Bowl, right? We now have quarters instead of two halves. There's a halftime show. The only difference was people weren't eating like the guacamole avocado dip. So that's why you could tell that it was – anyway. OK. Sorry about that. All right. Michigan, cyclospora, we are up to over 7 ,000 cases. And unfortunately, 102 reported cases indicated they've been hospitalized. So people can get pretty sick with this explosive diarrhea. It's really horrible. Right.

5:49I mean, and then we now have New York City up to 374. And you can actually see, we're still seeing cases. So not so great. But, and people keep asking me. I mean, we got a text today from this woman. Speaking of FIFA, she works on the Bend It Like Beckham account, right? So David Beckham is sort of a person who does a lot of ads. And she wanted to know if she could start eating lettuce again. And, you know, my advice to people is, you know, and I've done some interviews on this, is you can. But if it says it's pre-washed, you just wash it again, you know. It's the reason you sing, what is it? Twinkle, twinkle, a little star that second time when you're washing your hands, you know, just because you thought you got to wash the first time.

6:36So, all right. Legionella. Unfortunately, a fifth person has now died in connection with this disease cluster on the Upper East Side. So 82 cases, eight people remain hospitalized, 56 have gotten out of the hospital, but no new cases in the last six days as of this recording. You know, this is the summer of infectious diseases, isn't it? We have cyclospora, we have Legionella, we have Ebola, we have Marburg, we have LASA. Yeah, we'll talk about – I mean, there's a lot. I mean, there's so much, and I just sort of say it's so much I don't cover at all. So I do apologize for not covering everything, but I'm trying to cover kind of the top ones.

7:26And with Legionella, I noticed a bunch of comments. We were talking about the cooling towers. And so I'm going to leave a link into actually what is going on. People mentioned cooling towers. What are these things? So there actually is a link that I'm going to leave in. And it's a newyorkcity.gov cooling towers, information for owners and operators. But I think we're all interested. We talked about this concept of using UV or a biocide. So here you have it. From a physician standpoint, this is an area that can involve infectious disease physicians, occupational health physicians, but also other specialists.

8:02And here we read, cooling tower management requires a team of trained professionals and staff, each with specific roles and qualifications to ensure safe and compliant system operation. Qualified person and MPP preparer. So here, a qualified person is someone with expertise in water quality management, planning, and operations. They may be a New York State licensed professional engineer, a certified industrial hygienicist, a certified water technology, or a certified environmental consultant with two years of experience in water quality management. Apparently, I was hearing that we have a shortage of these trained individuals.

8:42Building owners must comply with a New York City Health Department regulations for operating a cooling tower. And there's a PDF. I'll leave a link into that. It's detailed in Chapter 8 of Title 24 of the Rules of the City of New York. But each cooling tower system must have a maintenance program and plan. Asside treatment of the cooling tower water loop. We talked about that. Water quality monitoring and testing, records of all actions taking. So chemicals and biocides. Chemicals and biocides must be used in quantities and combinations sufficient to control the presence of Legionella, minimize biofilms, and prevent scaling and corrosion that may facilitate microbial growth.

9:25Yeah, that's really, it's a really well-developed system, isn't it? It is. And what we hear in some of the discussions is that maybe there's a failing on some individuals to follow the rules. And that's when you have an outbreak, yeah. Yeah. Yeah. All right, screw worm. I'm going to say still a trickle. I keep seeing new cases. Last week, 37. Now we're up to 41. So we keep seeing cases. So I'm going to be a little optimistic, right? So hopefully we really, it's sort of a wake up, a little bit of wait, a little bit of a late wake up, you know, sort of already woke up an hour after our job started, but we're awake.

10:07All right. And we mentioned Ebola. And I just want to point this out. And really, I thought this was a great figure on the CDC update on Ebola. So Ebola cases in the first 100 days of five Ebola outbreaks and look at the current DRC 2026. And hopefully this will be up for people watching on YouTube or follow the link and you can look at this yourself. But just compare that slope. Just to give people who are listening. So you've got Guinea 2014, Liberia 2014, Sierra Leone 2014. You've got DRC in 2018. And basically you see a relatively flat line with a little bit of a slope. And then basically you see right angle, 45 degrees, shooting up DRC 2026.

10:56I mean this is a little bit misleading because the West African outbreak really shot up after three months, right? Yeah. This is first 100 days, right? So I mean this one clearly is different, right? That's fine. But the other one may have – if we look three months down, it may be just as steep a slope. I don't know. I think that will be interesting. I mean, unfortunately, we're going to – two months from now, right? We're going to start having that data where we see when this goes out far enough. Unfortunately, and that's – we're already confirmed cases, 2004-23. Confirmed deaths, we're approaching 1 ,000.

11:34We're already at 967 in the DRC. Yeah, so – That's bad. 1 ,000 deaths is really bad. Yeah. And they're horrible deaths, right? One is bad. But this is now substantial and it looks like it's out of control, right? Yeah, it really looks like it's out of control. All right. Measles, another speaking about out of control up to the Johns Hopkins measles tracker. Up to 2 ,295 if we look at the areas. We've got an outbreak in Pennsylvania, 114 cases this year already, 10 cases over the last week. We now have a state dashboard. I like the dashboard. I'm going to leave a link into it, measles cases by county.

12:22The interesting thing is you can see, you kind of guess, where do you think you're going to see the measles cases by county? It's going to be in a population that's under-vaccinated. Lancaster County. Yeah, yeah. And there's a certain group that lives there which has a low vaccination rate, so Lancaster, Lebanon. But this whole outbreak is entirely ascribable to RFK Jr., not emphasizing vaccination. It really is amazing. Like we really, we were struggling with the challenges here. Every time, you know, this is like whack-a-mole. Every time there start to be issues, clear messaging, hey, you know, here's what's going on.

13:02Let's get some vaccinations in here. But, you know, two years ago, that messaging changed. It became, oh, you did the right thing by not vaccinating your child. They may have died, but hey, that's okay. You know, last year, full year, total 2 ,242 confirmed cases. If you look at the CDC data, 2 ,260, we're past that. And it's July. Yeah. Incredible. I didn't think that you had – I thought Mises was seasonal and that the season is over. You know, Paul Offit says that. And this will be one of those things where, you know, as time goes by, will it become seasonal? Will we have like thousands and thousands of cases peaking at certain times of the year?

13:53Influenza, a couple of things I promised I would talk about influenza with my bow tie on. And we're actually going to be talking about influenza vaccine effectiveness and a couple of things. First is just in general, the article, Influenza Vaccine Effectiveness Against Outpatient Acute Respiratory Illness with Lab-Confirmed Influenza, United States 2024-2025 Season, published in CID. So as far as influenza A H1N1, PDM09, and influenza A H3N2, these viruses predominated during the last season. These investigators estimated the influenza vaccine effectiveness in the United States against mild to moderate outpatient influenza illness by influenza type and subtype during that season.

14:41They looked at outpatients aged eight months or older with acute respiratory illness. They looked at seven states. Upper respiratory specimens were tested for influenza type subtype by RT-PCR. They use a test negative design. Among 6 ,793 enrolled patients, 30 % tested positive for flu, including 961 for H3N2, 770 for H1N1, 183 for flu B. Overall, vaccine effectiveness against any influenza illness was 33%. And then they kind of break it down. Interesting. They did not detect statistically significant interaction between current and prior season vaccination. This is very low. It's crummy, right?

15:29Horrible. 33 % is like placebo effect. It's pretty crummy. So I don't know why it's so low. But people, you should not get it. You should get it because it will stop you from dying. We're going to talk about that in a second. So interesting. Yeah, it's going to keep you out of the hospital. It should keep you from dying. There are ways to use more effective rates. This is 33, but then we have that new approved licensed mRNA, which is 25 % better, right? So we do need better flu vaccines. One of the approaches we've done is to try to use high dose versus standard dose in the higher risk seniors, right?

16:11So we looked at that. But before we go, I want to talk about this last line, which I think is really important. So they're looking at, you know, oh, I got a flu shot last year. Do I really need to get it every year? And even though this is crummy, you did not see protection from the year before. Unfortunately, these flu shots, they only last a year. Yep. No, just to point that out. The reason I bring that up is I was involved in the discussion today where we talked about the COVID vaccines. And unfortunately, you know, my wife is annoyed by this because, you know, we would like to just get our COVID shot once a year, particularly everybody, all the high risk, everyone, just keep it simple.

16:52But unfortunately, we'll get into this in a little bit. when we see these double seasons, the data on the COVID shots is that protection tends to go away at six months. So sort of a problem. I mean, you got to follow the science, not the calendar. All right. The effect of high dose versus standard dose flu vaccines on hospitalization outcomes and mortality in older adults, a systematic review and meta-analysis published in, this is a journal, The Lancet Healthy Longevity. Not just longevity, but healthy longevity. Healthy longevity. So they do a systematic review and meta-analysis. They look at the usual suspects, right?

17:32Medline, Embase, Cochrane Central Registry of Controlled Trials, Global Health, ClinicalTrials.gov, all the way. They say from Inception, which reminds me of that really cool movie, to September 3rd, 2025. And basically, they're looking at randomized trials, comparing the high dose with 60 micrograms of the hemagglutinin and the standard dose with 15 micrograms. So it's a high dose. It's four times as much hemagglutinin in there. And they're looking at that targeted population, so adults age 65 and over, total of 1 ,422 records identified after screening 830 titles and abstracts, which 84 full texts were assessed for eligibility.

18:13They end up with 14 unique RCTs with 581 ,845 participants. Of the 49 outcome results assessed, 32 are rated as lower sub bias, 17 is having some concerns. And here is cut to the chase. Compared with standard dose, the high dose reduced hospitalization for influenza by about 39%. But the absolute risk difference for events per 10 ,000 vaccinated individuals, not really a huge return on your investment, is it? No, but we have done other studies that paint a better picture than this, I think. Yeah. And I think that's one of the problems, right? And so they also talk about they're not able to show here in this, remember, systematic review and meta-analysis, a mortality impact, looking at high dose versus standard dose.

19:07But this is, what was Mark Chrislip say about the cow pies when you pile them high? The problem with a meta-analysis like this is, you know, do you really take the time to look at each individual study? And as they're pointing out here, right? There were a lot of issues with, you know, how much you could rely on these, right? So, you know, risk of bias, concerns. So 32 were low risk of bias. 17 is having some concerns. So, you know, which ones do you look at, et cetera? So we still recommend it. This is not as rosy a picture as we would have liked. So we need better flu shots. Yeah. But you can find, I mean, see, this is a meta-analysis.

19:51That's the problem. You can find studies that show a better effect and a worse effect. This is just lumping them all together and you get this average of not great. But we need a better - Yeah, it didn't turn into gold. It turned into like - Yes. No, no gold. We need better flu vaccines. There's no question about it. Yeah. All right. And COVID, you ready for COVID? I am. Well, it's not here yet. Pretty flat. July 11th. Yeah, we're up to July 11th, week ending July 11th. Still flat, but I did take a little deeper dive. Are we seeing any activity anywhere, right? Because now's the time, right? Texas.

20:34It's a season. And we are seeing some activity in Texas. Yeah. But really kind of an outlier. Very low just about everywhere else. Low in California, Nevada, and Florida. But really very low pretty much everywhere else. Very interesting. It's very flat on the wastewater. Yeah. Not even a hint of uptick yet. Yeah, kind of interesting. All right. So I threw this in probably, I think, right after we recorded last week. And this is an article published at JID. And it is randomized, double-blind, placebo-controlled, first-in-human trial of a first-in-class AI, artificial intelligence design, monoclonal antibody, GB0669, against a conserved SARS -CoV-2 spike S2 stem helix.

21:25Quite a title. We got first in human, first in class, AI designed. I mean, okay. So this is fun. Now, here we read that antibodies against the SARS-CoV-2 spike receptor binding domain provided effective COVID-19 treatment until resistant variants emerged. And I think we all remember the days of bamlanivimab and the Regeneron. And GB0669 is a half-life extended monoclonal antibody optimized using artificial intelligence. It targets the conserved spike S2 stem helix, a region subject to limited selective pressure from antibody responses induced by infection or vaccination. Like the way I leave natural out.

22:12Preclinical safety studies were conducted in cinemalgous monkeys. Did I get that right? You got it. Very good. All right. In the first inhuman trial, healthy adults aged 18 to 55 received single intravenous doses of GB0669 or placebo in five ascending cohorts. We've got different doses. Participants were monitored for 43 weeks. They're going to look at safety, yes, pharmacokinetics, pharmacodynamics, serum live virus neutralization. In vitro studies assessed neutralization combined with antiviral drugs. We're going to do remdesivir, nermitrelivir, maldupirivir. So here's what we got. Preclinical studies revealed no safety concerns.

23:01In the clinical trial, this was well-tolerated without dose-limiting toxicities. All adverse reactions were mild. Um, PK showed dose proportionality up to 2 ,400 milligrams with a half-life of 54 days. Dose dependent increases in serum live virus neutralization occurred at 600 and 1200 milligrams with separation from placebo. Um, basically really good stuff. Finally, in vitro experiments proved improved neutralization profiles in combination with antivirals. So you could use this with the antivirals. It can be kind of an add-on. Of course, we don't know anything about efficacy yet because it's just safety.

23:46But what I wonder is there are people who just don't like GMO, right? There are people who may not like AI-designed therapeutics either. I have to admit I was thinking about that. Like, right, will there be labels in the future? AI-designed. Yeah. I'll have to put a label on there. Like this therapeutic is AI-designed. I don't know I don't think it's a problem as long as you test it properly in the end right all right well I'm going to wrap us up here we're actually recording on a Wednesday night right because I'm going to be in another sailing race tomorrow this is the around Long Island race so we start at the Statue of Liberty under the Verrazano Bridge all the way out around Montauk and all the way back.

24:38But you can't go actually all the way around because it's connected, right? So you can actually go all the way around Long Island. You go under the bridges. Oh, so there's a waterway that goes all the way around Long Island? Yeah, it is actually an island. I didn't know that. I thought, so it's like, what is it, the Whitestone or something bridge that you go on? So there's a bunch of bridges you're going to go under. So the Throgs the White Stone. There's a bridge at Hell's Gate. You've got the Manhattan Bridge, the Williamsburg Bridge, the Brooklyn Bridge, all under these bridges. Actually, the trip down to the start of the race is pretty cool.

25:13But then, yeah, the start of the race, Statue of Liberty, out through the Verrazano Narrows. And it's you and one other person or just you? No, it's 11 of us this time. I think that that two-person, 700-mile race from Bermuda, yeah, that was a lot. How many miles is around Long Island? 200. This will be a day trip. All right. Good luck. All right. So no one is safe until everyone is safe. I'm leaving in links to the House folks, the senators. You know, if something is important to you, reach out. Let them know. I do want everyone to pause the recording right here and go to parasiteswithoutborders.com.

25:51Click the donate button. Even a small amount helps. Every bit helps for all the people that have donated so far. Thank you so much. We are nearing the end of our Foundation International Medical Relief of Children fundraiser. We're doubling those donations. Going to send that donation, hopefully up to$10 ,000, which really will go a ways there in Uganda. It's time for your questions for Daniel. You can send yours to Daniel at microbe.tv. Delia writes, I'm a recent graduate from Binghamton University with a BS in class. Global Public Health. I'm a big fan of your work and love listening to your clinical update every other week on TWIV.

26:32What do you mean every other week? It's every week. My friend Tia introduced me to it. I was wondering if you had any advice to give on how to break into the public health world as a post-grad student. There are so many different sides to public health that it can sometimes feel a little daunting while I am still figuring out what I want to do. I really respect and appreciate your work. Thank you for spreading legitimate public health information in a time where it's hard to find and doing so in a digestible way. I look forward to hearing your response and listening to your next clinical update, which is every week, Delia, every week.

27:11Yeah, so yeah, I guess I'm trying to figure out, maybe there's an issue with your subscription thing because, Delia, every week we got two. We got my clinical update. We got the deep dive. But so it's great that you know T, Sweeney. And so this might be a plug for one of the ways to figure out what part of public health are you excited about. Is it global public health? Maybe you want to take a trip down to floating doctors down there in Panama and see what that's like. Maybe you want to reach out to FIMRIC and volunteer with them. Sometimes the first things are these kind of these internships, these volunteer opportunities, and then you start meeting people and that opens the doors.

27:59So yeah, but the big thing is get in there, start getting some experience. Yeah, it can be daunting, but just keep putting one foot in front of the other. Lana writes, hello and happy belated birthday, Dr. Griffin. First, thank you for your contributions to science education, keeping us all informed. I hope you enjoyed your birthday and wish you many more fulfilling years. In terms of the recent outbreak of cyclospora, I can't be the only person wondering why the parasitic infection is treated with an antibiotic. What is the underlying mechanism or logic that underpins this particular treatment?

28:38Also, what is the life cycle of the parasite like? Are there any effective controls that an individual can apply in terms of washing produce in such a way to limit exposure? Or is this really something that has to be tackled at the source? All right. Why don't we take those first? Yes. So there's a few. So first, thank you for the birthday wishes. Yes, I'm getting older. So as far as the outbreak, it's a really interesting history. And there was an outbreak in Nepal and Kathmandu is my understanding. And so you grab sort of off-the-shelf Bactrim inexpensive sulfur antibiotic that messes with the metabolism of this animal, this parasite.

29:21And that's actually the underlying mechanism. And so it turned out that that worked. And that still is kind of our first-line treatment to this day. As far as the life cycle, the really important thing is that the cyclospora kaiatinensis, named after Heredia kaiatinensis, that Peruvian hospital where I got some time to work at one point, is person to person. So the cyclospora kaiatinensis, somebody has it, somebody is having diarrhea, that diarrhea gets on stuff that's going to ultimately end up in someone else's mouth with fecal contamination. Maybe that's raspberries, maybe that's lettuce, maybe that's basil, Maybe that's cilantro, et cetera.

30:04And it's not washed off. And that really is the big thing to break this cycle. Next person gets it. Next person has diarrhea, goes on. It really is pretty chlorine bleach resistant. So that's kind of hard to do that. So really the best way, and it doesn't have to be tackled at the source, right? We get this bagged lettuce. Hey, this is great. It's pre-washed, as we've sort of said, as I've suggested. Wash it again. Rinse it off. Even those raspberries with all the nooks and crannies, You can rinse the fecal contamination off and then you can enjoy those raspberries. So Lana also wants to know why the CDC page refers to food potentially contaminated with feces when many sources point to contaminated water.

30:48Yeah, so it's the feces in the water, right? It's that thing when you go swimming and they say, oh, the coliform count. Yeah, basically they're talking about fecal bacteria count. So yeah, it's feces, contaminated feces, feces with microbes getting in your water, you drinking or swimming in it. Yeah. And she also wants to know about this connection between iceberg lettuce from Mexico and Taco Bell. She wants to know, is there only one source or could there be others? So there probably is more than one, right? So the big over 7 ,000, hundreds of quadruply, what we're seeing here in New York. And there's always a certain number of cases we see, right?

31:30Because people in the US, people in Mexico, people in other parts of the world. I mentioned Kathmandu in Nepal. People have cyclospora. They get diarrhea. There's a transmission cycle. But when you get a big outbreak, there's usually some source like this in the past. There was the raspberry. I think we mentioned basil at one point. And now the smoking gun, all the epidemiology seems to be suggesting it's this big increase is the iceberg lettuce and Taco Bell. Nicholas writes, I am on safari in Tanzania with my two children at the moment. We are quite well prepared with vaccinations in advance, repellents and malaria prophylaxis.

32:09Today in Serengeti National Park, my children 12 and 17 were bitten by sitsi flies. My son threw his sock. As a medical microbiologist and specialist in laboratory medicine, I know they can transmit trypanosoma brucei rodensiense here in Tanzania. but I have no idea how frequent transmission is in real life. Can you help? Do we have to worry? My daughter is crying now because she fears African sleeping sickness. Do you have any hints for the next days or weeks? All right, Nicholas. So your daughter can listen to this. Your other child can listen to this. I'm not that worried. Very low risk. I mean, you know, there's two sides to this.

32:52As someone who likes to see really interesting diseases, is we just really don't see a lot of sleeping sickness anymore. But that's the good thing, right? Because it's a horrible disease. It is treatable. The treatments have gotten better. But I have to say, it is really rare. So, you know, your daughter, it hurts, right? I mean, you really say getting, you know, getting bit. You really do get bitten by these. I mean, they're amazing animals, these tsetse flies. But it hurts. But I will reassure you, very low risk. Tell your daughter she can go ahead, not worry, and get a good night's sleep. And that could be your dad joke.

33:28P.S. I'm – oh, yes, right. I'm a constant TWIV listener for years and don't miss any clinical update. Keep up the good work. Okay, Anonymous writes, based on the brief pneumonia discussion with Senator McConnell's hospitalization on episode 1340, I thought I would try my luck with this question regarding the pneumonia vaccine. I'm in my mid-40s, had a recent mild to moderate pneumonia diagnosis. In my mid-20s, I was diagnosed with Mycobacterium abscessus, treated with 10 months on IV antibiotics and a lingulectomy. I also have asthma. I had a pneumococcal vaccine in 2007, and my PCP recommended I get the newer Prevnar 20 vaccine.

34:13How often should I be getting a pneumococcal vaccine? Do I get another one when I'm over 50? Do I get one whenever there's a new one developed? I had been getting a COVID vaccine annually, but should I be getting it every six months given my history? I definitely do not want to go through feeling as terrible as I did three weeks ago anytime soon, and I want to be sure I'm protected as much as possible. Thank you for all your dedication to science and education and truth. Sincerely, no longer as short of breath in California, 31C and sunny. Yeah, so the conjugate, the Prevnar, and there's also a 21 conjugate vaccine, these are at this point we're recommending you get it once.

34:58We're not recommending boosters. Now, the polysaccharide, the Pneumovax that we used before, those actually were associated with boosting going on. So this is at this point the one recommendation, and then we'll go ahead and see what that does. Now, you brought up the COVID vaccination as well. I talked about the challenge here, right? Is when we look at the data, the protection we see, you know, you could talk about T cell, you could talk about antibodies. We can make believe we understand the mechanism. But when we look at the studies, it kind of is six months in the high-risk folks, and then it goes away.

35:34So that's still the science there. Rona writes, happy birthday. I know you've been talking about shingles lately. I have a question about immunity for someone who has gotten shingles before. My 52-year-old friend had chickenpox as a youngster. She got shingles in her late 40s and shingles for a second time while fighting cancer in 2023. Do people get shingles multiple times until they get the shingrix? In other words, does prior infection not provide immunity? Yeah, so this is a challenge. So we'll walk through this because I think this is important. So an individual gets chickenpox, right? They get the virus, the chickenpox virus, the varicella zoster virus.

36:18We should make this all complicated like we did with SARS-CoV-2 and COVID-19, like which is the virus and which is the disease. So chickenpox is disease, varicella zoster virus is the virus. And the challenge here is that chickenpox virus stays dormant. And then in this case, you get a reactivation, right, in their late 40s. And some individuals, not just once, but as we see here, some individuals will get another reactivation. Sometimes there's something like cancer or stress, immunosuppression. Sometimes there's just something about that person's genetics. So people can get it multiple times.

36:55We do recommend that someone who gets shingles or also anyone 50 and over go ahead and get the Shingrix vaccine. But unfortunately, people who get shingles can get it again. So that's why we're making this recommendation to get that reduction, you know, even if you've already had the shingles. And Charles writes, the FDA recently reversed a PCR test result for cyclospora on Taylor Farms lettuce. The skeptic in me wonders whether the reversal was influenced by political pressure, given that Taylor Farms donated$1 million to a pro-Trump super PAC, and their executives met with White House and FDA officials the day before the initial recall.

37:40My guess as a computer programmer, however, is that the CT value was close to the cutoff of 38, that Taylor Farms challenged the result, and that the FDA reconsidered caved into political pressure. Cyclospora is notoriously difficult to detect and confirm by PCR, which may make the false positive more technically plausible. I've not been able to find any reporting that addresses the specific laboratory methodology behind the reversal. I'm hoping you or one of your colleagues might have insight. P.S. If you're a Pink Floyd fan, may I suggest an obscure one, Obscured by Clouds from 1972. two. Their soundtrack to the film La Valet.

38:24Free Four is my favorite track, though I should warn you, it is not a cheerful listen. All right. So I am a Pink Floyd fan. I'll have to put this on my list. Thank you. Yeah, I don't know the details. I'd love to know the details. Was it an issue? Was there a borderline CT value? Yeah, there's a lot going on on social media about the timing of that million dollar donation. Not that that would influence the president of the United States, by the way, because he's just, isn't he so rich, this wouldn't really be a big deal. Yeah. Yeah. But it's really - I wish I knew a little bit more. But nonetheless, it's been epidemiologically linked to the farm, so - Yeah, it's linked.

39:08And I think it's great that you bring up the fact that this can be difficult to detect, having the PCR, that's great, but without the PCR, the epidemiology is usually how we sort these things out. That's TWIV weekly clinical update with Dr. Daniel Griffin. Thank you, Daniel. Oh, thank you. And everyone be safe.