TWiV 1352: 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 1352, recorded on August 26, 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. Your tie is like yellow. I can't see it from here. What is it? So this is all the like pathogens that you might get from food, all these fecal pathogens. So very appropriate for some of the stuff we'll be talking about. Right. All right, let's jump in because we actually have quite a bit to talk about. doubt is not a pleasant condition, but certainty is absurd.

0:59It's from Voltaire. We've got some pretty absurd characters floating about. No, we, you know, it's interesting. I was thinking about this today, Vincent, you know, you and I have some, I think, interesting banter before we start our shows. We probably just start the recording and let the banter go. Well, Well, we were talking about the Moderna mRNA cancer. Therapeutic, I guess I would call it. Vaccine therapeutic. Vaccine. They call it a vaccine because you have to be immunized multiple times to make a T-cell. It is making a T-cell response against the tumor antigens. Yeah. Yeah. Over 90 % five-year survival.

1:38I mean, in pancreatic cancer, which is just - Melanoma. Melanoma. Yeah. It's just amazing. Well, I mean, they had a very small number. They had 14 events. So the next phase three is going to be powered to look at survival. But this suggests that it could be good. I'm excited. Look at mRNA technology. That was originally a lot of people thought that was where we were going to see the impacts in cancer therapeutics. And we're seeing them in. Well, the thing is that it is personalizable. Personalizable. You can rapidly make, at scale, an mRNA vaccine for a patient, right? It's not that you have to do other things that would take forever.

2:22It is scalable and personalizable. That's the beauty of it. It's amazing. All right. Well, starting off in our news section on August 21st, HHS seeks public input on federal vaccine recommendation categories and shared clinical decision making. So the U.S. Department of Health and Human Services announced on August 21st a request for information seeking public input on the categories used in federal vaccine recommendations and the role of shared clinical decision-making. I'm going to leave a link into this. And I'm actually hoping some of our listeners can maybe weigh in on how helpful it's going to be if actually the public comments here.

3:11But they're asking the public to make comments about several categories, several recommendations, the availability, quality, strength of evidence, the appropriate approach when randomized clinical trial evidence is limited or absence, how to deal with individual autonomy, informed consent, religious freedom, legal and programmatic consequences of recommendation categories, how shared clinical decision-making is understood and applied in practice, and how the category could be improved, and communication practices necessary to earn a main public trust. So I'm going to leave in a link if people want to make comments.

3:51And maybe in our show notes, I sent in a comment, Vincent. Good. So we can leave in the show notes, you know, what I had to say. But I think, you know, it's sort of tough, right, when they get to frame the questions here. Yes. And I think, you know, a couple of things I commented on when I responded and maybe people respond. And I'm sort of more curious, like, is this helpful? the time I spent, the time people might spend. But I did talk first about, I think a lot of people are concerned that there's a, really there's a prejudice. There's a bias there at the HHS leadership at the moment. So, you know, that's going to be an issue.

4:32Like when they say, oh, we're looking at peer reviewed literature. Well, you know, cherry picked literature that serves their end, not actually, as we talk about in science, literature that we look at to try to inform ourselves as opposed to just support our prejudices and our biases. And then talked about like, what do we do when we don't have RCT evidence? And we talk about a lot of studies that are not prospective, randomized, placebo-controlled trials. There's still a lot of value and knowledge in the studies that we talk about. And then, you know, the balance, right, between autonomy, informed consent, religious freedom, and just the freedom to be safe in our society, to not have to worry about sending your child to school where they might die from a contagious disease.

5:21And, you know, we deal with this all the time. We have speed limits. We have restrictions on the use of firearms, illegal drugs, tobacco in neighborhoods and schools. And we do have this obligation to provide a safe community and safe schools for our children. And And then I sort of go on and talk a little bit more. So I don't know, Vincent. I find this kind of inappropriate from an administration where we're having that biggest measles outbreak in years. They're talking about task force on safer childhood vaccines. What's wrong with the safety of childhood vaccines? You need to use them. You need to use MMR to stop the measles outbreak.

6:01This is just nonsense. I don't understand if they're even going to pay attention to any of the comments that are made. But this whole idea, as you said, of making informed choices, no, the committee is supposed to tell you which vaccines you should get because it's based on evidence. It's not what you feel you should get or not. That's ridiculous. I think, yeah, I think that's so critical. I mean, the reason we have these advisory groups is we want experts to dig through and then say, We've looked at all the data, all the information available, and here's what the recommendation is, not what we have.

6:43And we said, I've been saying for a while, that when you mix politics and medicine, you end up with dead children. And we are seeing that. We're going to talk more, a couple more deaths. We've had five deaths from measles since this current health secretary has come into play, come into that role. Hundreds of children have died from flu, you know, more than we had historically. Vaccinations are dropping. Our children are less safe than they were before. Yeah, this should have a lot of people really upset. All right, but we're going to keep sharing the science. And we have an article on the HPV vaccine.

7:23And this is the article, HPV Vaccination and Risk of Head and Neck Cancers, a large real-world cohort study accepted for publication in the International Journal of Infectious Diseases. And I like this, say, sort of theme of research where we're seeing that these vaccines don't just protect us against infection. They protect us against, what, dementia. They protect us against cancer. And so the HP vaccination is really a cancer protection vaccine. They have some highlights. So in this study, they analyzed 1.4 million individuals in a US real world cohort. HPV vaccination was associated with about a 70 % reduction in head and neck cancer risk and oropharyngeal cancer.

8:13That was more than a 90 % reduction. And that's amazing, right? It's amazing because when these vaccines were made, we didn't even know HPV caused these oral cancers. Yeah. Right? And now we know, and it's incredibly, I mean, it's great at preventing cervical and anal genital cancers, but now this is amazing, right? Yeah. I mean, and this is a pretty robust, again, this was a retrospective cohort study, right? So it's not a prospective randomized placebo saline-controlled trial, but really robust, compelling data. So retrospective cohort study, 716 ,630 propensity score matched pairs, 40 head and neck cancers occurred in the HPV vaccinated individuals versus 130 in the unvaccinated controls.

9:04And they have a really nice figure where you can just see this really continue to separate, follow this even farther, and you're going to see even more of an impact of this HPV vaccination. The graph couldn't be clearer, could it? Yeah, no overlap. I mean, the p-value, how many zeros there, right? I had to put on my glasses. You know, p-value less than 0.0001. I mean, this is very clear data. All right. Well, another, right, we were talking about now measles is endemic, and we'll talk about measles again. But now, unfortunately, the MMWR monkeypox virus surveillance in the United States, 2024-2025, the number of reported cases of the MPXV, so that's the MPX virus infection, during September through October 2025 was double that during the same period in 2024.

9:59Four, unvaccinated patients accounted for 76.1 % of cases and had almost 10 times the odd of hospitalization as those who completed the two-dose Ginius vaccine. Unfortunately, as we're seeing here, persistent low-level transmission of the clade 2B MPXV in the United States suggests a likely transition toward endemic circulation. So measles is now endemic. The Mpox virus is now endemic in the U.S. And you can see, again, really nice figures where you can see this seasonality to it, and you can actually see the areas where we're seeing most of the cases. All right, now this next one is tough. This is the polio vaccine article.

10:49And as we've talked about, not only are the rates dropping for measles vaccination, But as we shared last week, the polio virus vaccination is dropping in the same level. So we still need to understand polio. So here we have the article, Effective Inactivated Polio Virus Vaccine on Nasal Mucosal Immunity and Pharyngeal Shedding Following Novel Oral Polio Virus Vaccine Type 2 Challenge, a Randomized Open Label Trial Published in JID. And I'm going to ask you to jump in at any point, as often as you want, Vincent, because there's a lot in this article, which I think a lot of people are going to be confused by.

11:32So this is a multi-center, randomized, open-label, parallel group trial conducted in Bangladesh in 500 polio vaccine-naive infants aged six to eight weeks. We've got two infant cohorts vaccinated with three doses of either IPV or bivalent oral poliovirus vaccine challenged at 18 to 20 weeks with novel OPV type 2. Pharyngeal and fecal viral shedding and nasal intestinal and serum immune responses were measured post novel OPV2 challenge. So first off, Vincent, why are we doing this? What's going on here? So they're trying to compare shedding in IPV versus OPV vaccinated infants. The problem is that IPV is a trivalent preparation, and bivalent OPV is just types 1 and 3.

12:32So there's no type 2. And so then you're going to challenge with type 2, bivalent OPV, and you're going to look at neutralization titers in the stool. in the serum. And so the IPV, first of all, the shedding, pharyngeal shedding, which we think happens in high-income countries, fewer of the IPV vaccinated shed than the OPV vaccinated infants. Because again, there's no type 2 in the BOPV to prevent that. Yeah. I mean, those are interesting things like off the bat. One is, right, you're really the bivalent OPV, right? Yeah. And I think the other interesting thing, and this is probably new to a lot of people, the idea of pharyngeal shedding, right?

13:25Yeah. So pharyngeal shedding is thought to happen in high-income countries due to vaccination coverage. So remember, there's no type 2 in bivalent OPV. So the NOPV2 challenge is really a prime. It's not a boost. So it's not surprising that those in the IPV group have higher serum neutralizing against type 2 because the IPV has type 2 in it, right? And so then this thing about pharyngeal shedding in high-income countries, IPV gives you a strong serum-based immunity. NOPV is more attenuated than Sabin strain. So it's not surprising that a small percentage of vaccinated children post-NOPV challenge shed infectious virus.

14:09Yeah. So sort of, yeah, I guess we'll sort of move on. What I thought was really, you know, so I'm reading this, and one of the things that I was concerned about was fecal excretion, right? So this falls into the exploratory objectives. So exploratory objectives included assessment of PV2, so polio virus type 2 fecal excretion at one, two, and four weeks post-challenge, as well as the PV2-specific neutralizing activity and total and PV2-specific IgA responses in stool at day zero, two weeks, and four weeks, right? So jumping to kind of the chase here. So in stool samples, the PV2-specific RNA was detected in 72.2 % in the IPV group, 72.5 % in the bivalent OPV2 group.

15:02At all time points, stool levels of infectious challenge virus were not different between the groups. So again, if levels of infectious virus are the same post-NOPV2 challenge, there's no relevance to the marginally higher type 2 IGA found in the stool of children who get BOPV than NOPV2. Yeah. So what do we do with this? What do we do with this article? What does it tell us? Is it reassuring? Does it tell us that, you know, well, I'll leave it there. Yeah. What do we do with this? Well, so the role of IgA in preventing shedding has always been questionable, right? Much of the previous data doesn't support the idea that you need IgA to reduce shedding.

15:48It's also known by some studies that multiple doses of IPV can stimulate immunity at mucosal surfaces. And so because type 2 polio is absent from BOPV, it's not surprising that IPV vaccinated children have higher type 2 antibodies following an OPV challenge. And so the relevance of this study is not clear because they're measuring antibody responses following the administration of a vaccine for something that's not in the vaccine. It's also known that IPV gives you a high serum neutralizing response, which is all you need to prevent neuroinvasion and paralytic disease, right, the serum antibody response.

16:26And so this work is to say cessation of BOPV will not cause a catastrophe as the switch in 2016 did. If IPV could not be used for an outbreak response, how does one explain that no paralytic disease has been observed in Europe, which is IPV only, when virus circulation has been detected intermittently? So IPV was used in vaccine clinics in Rockland County in 2022 following the case of paralytic disease. And so IPV can and should be used for outbreak responses, not OPV, not bivalent OPV. Yeah, I feel like we've been saying this for a while. We have, yes. Yeah. And just to be clear, I think for all our listeners, so the IPV, this is the only vaccine available in the US.

17:14I'll leave in a link to the IPV. This is the inactivated or injectable. I always forget which the I is for, but it's inactivated. I always feel like injectable would work better. It should be the IIPV, the injected inactivated vaccine, polio vaccine. But it has type 1, type 2, and type 3. It covers them all. And you need that because they're circulating type 2 in the world. And you need to have IPV, which has all three serotypes. You shouldn't be using a bivalent vaccine. So the idea would be to switch to IPV everywhere and just use that forever. Yeah. And that's what we keep suggesting. So, you know, just for those of you listening out there.

17:59All right. But while we're talking about, you know, more vaccination with IPV, yeah, I just was reading this right before we got on. Florida prepares to roll back school vaccine requirements. A proposed rule represents a step forward in the state surgeon general's plan to eliminate all vaccine mandates and a step backward for mankind. I think that was what they said when they got to the moon. Florida is set to roll back four vaccine requirements for children attending the state's public school. And basically, they're trying to get rid of chickenpox vaccination, hepatitis B vaccination, homophilus influenza type B and pneumococcal vaccination.

18:41So this is just so backwards. It's ridiculous. Yeah. Even the Catholic bishops in Florida are for making kids get vaccinated to go to school. You know, the Catholic schools in Florida do not accept religious exemptions for vaccines. How forward is that? Yeah. I mean, we'll leave a link. It's really interesting, right? I don't know. So the Catholics versus the Protestants. The interesting thing here, right? The Catholic system is kind of hierarchical, right? I mean, the book was originally written in Aramaic and other languages that most of us don't speak. And so I don't know, growing up Catholic and being married to a Protestant, we sometimes discuss about really, can really a person read that book translated by someone else without all the nuances of the original language?

19:33So, yeah, in Catholicism, the bishops, the priests, the cardinals, all the higher, you know, they basically say, yeah, I'm looking at this book and I'm not seeing any right to refuse vaccines here. So, all right. So he wanted to originally roll back all vaccines. So now he's going for four. Yeah. No, that's their goal. You know, big quotes around they. Yes, to get rid of the protection and make our schools unsafe for the children. I just don't understand. This guy's an MD. I don't know what he's thinking. Yes. Yeah. What do they – you know what the name is? I don't know. If you go to medical school, Vincent, we have a name for the person who graduates the bottom of their class and barely graduates from medical school.

20:14And we call that doctor. That's right. Yeah. All right. So we were talking – well, talking about Mai Tai. Apparently, we're not doing such a good job in the US of making sure that our food is safe. That's another thing. We have measles back. We have five people now dead. We have children dying of flu. You know, we'll talk about how many now that we have the total for this last season. But just compare. So, you know, in the past, you know, we would see about 1 ,000 cases of cyclospora each year. That was kind of, you know, our tolerance. Now, since May 2026, this is the explosion of the explosive diarrhea.

20:53So this is the parasitic cyclospora diarrhea. So far, the CDC has 17 ,180 lab confirmed cases, an additional 11 ,844. So we're looking at close to 30 ,000 cases of cyclospor, usually about 1 ,000. So a 30-fold increase. So why is that, Daniel? We're not even going to talk about importing bad beef from Argentina and putting all our good ranchers in poverty. So why is this happening, Daniel? Well, so unfortunately what we're hearing about is there really seems to be a reduction in basically the staffing, the focus, the funding of imported food safety. So you don't necessarily get the lettuce and some of the other things inspected.

21:44It comes in this country and then after people get super, super sick and thousands of people get sick, then you say, oh, I think we have a problem here and you stop doing that. so yeah no we're having a problem where you know it was going into this uh this administration i think it was only about 50 percent of food coming in the u.s would get inspected now it seems like that's really diminished further all right ebola this is a disaster right so ebola i mean it is so much going on i think you can kind of drown but this is an area that i think a lot of people need to appreciate. So in the AP, we have the article, here's data showing Congo's Ebola outbreak is on track to surpass history's largest.

22:27So the Ebola outbreak that's spreading is spreading at unprecedented speed in Congo has not peaked yet and could be three times the current known size, according to data from the authorities and Africa's top public health agency. It's history's fastest Ebola outbreak, and the WHO says it's on track to surpass the deadliest on record. That was the one with over 11 ,000 deaths across West Africa. The current outbreak has already recorded 2 ,516 deaths. You know, and this is an area with an intensely mobile population. A lot of folks are displaced by armed conflicts. There's a lot of distrust of medical authorities.

23:09And this is really critical. Less than 10 % of cases are currently coming from known contacts. So, yeah. So they're having trouble contact tracing basically. Yeah. Well, because only 10 % are actually from their contact tracing. And then this is – you just sort of take our number and multiply it by three. So the current estimate is that we've only detected about 30 % of the cases. So if you take that 5 ,000, you say 50 % mortality, 15 ,000, you know, we're already probably 7 ,000 deaths are just, you know, sort of waiting for the numbers to roll in. So yeah, and there's a couple graphs that I put in, a number of Ebola cases and deaths arising faster than the previous outbreaks.

23:59You know, even if you say, oh, it took a while, well, it's already the slope is already worse than it was in the West African. But I also put in some pictures and hopefully this will be up for the YouTube people to watch. So now this first photo and this stuff is all coming from the AP News article. So you've got these two, I guess, healthcare professionals. But basically there's two individuals that are in these plastic blue gowns. They've got masks. One has a head net on. There's another gentleman behind them. These tall rubber boots, right? Two of them are holding the casket. Another standing behind them.

24:36But then you've got all these just other people just right there. Yeah, with nothing. Nothing. This is very sad. It's a three-year-old. It's a tiny coffin they're putting in the ground. Yeah, tiny coffin and all these unprotected people right there. I mean, they feel bad enough that this child died, but then they may get sick themselves, right? And then you sort of have this cascade effect. And then there's a map where you can see it's multiple areas. It's not just one concentrated area. You think about these ring vaccinations and other strategies, which we'll talk about in a moment. But you've got multiple districts here where we're seeing cases.

25:16It's really unfortunate that we didn't have a vaccine because this Bundy Bugio virus was just under the radar. Yeah, yeah, yeah. And we're going to find out here in a moment. But yeah, so CDC, 5 ,584 cases, 2 ,680 confirmed deaths. We've got that really high increase going on. But I'm going to talk about a couple articles. These are actually about the monoclonal antibodies. So the first, it's really a case study. So the first is this article, a case of Bundabugio virus disease treated with monoclonal antibodies and remdesivir. It's published in Nature Medicine. Both of these are Nature Medicine.

25:56So here they describe the case of a previously healthy 39-year-old healthcare worker who gets the infection while working in the DRC. They get Medivac to Germany. They receive this MBP134, an investigational combination of two monoclonal antibodies. This is under an FDA IND. They get remdesivir. They get supportive care. And basically, they go on and they follow, you know, oropharyngeal swabs, plasma, show that the virus becomes undetectable as time goes on. They're able to monitor the induced antibody responses. Patient actually recovers. And so we've got this nice case description of the clinical course, virological dynamics, and the immune responses.

26:48Doesn't necessarily tell us, right? We don't know, like, what would have happened without the antibodies. But then we have this article, post-exposure prophylaxis with a monoclonal antibody cocktail following Banda Bougio Ebola virus exposure to adults and children, post-nature medicine. So here we've got five individuals from a single-family cluster. One, this was the ZBOF vaccinated adult, four unvaccinated children age one to seven. They end up getting this investigational MBP134, right? We're now familiar. That's that cocktail, right? And this is a broadly neutralizing monoclonal antibody cocktail.

27:32And given the absence of approved preventive interventions against this particular virus, it's administered as individual treatment. Administration is well-tolerated. no treatment adverse events. Throughout the 21-day monitoring period, all family members remain free of clinical or laboratory evidence of BVD as assessed by daily medical examination. So this is basically a post-exposure monoclonal antibody treatment. I wonder if this one person who was vaccinated against ZBOV, well, he got the monoclonal, so we can't tell. Yeah, like everyone – yeah, you don't really have a – because everyone does well.

28:15The thing that gets me is these two papers, right? Incredibly intensive treatment really, especially in the first one. Yep. And you have to hospitalize these patients. There are thousands of patients in DRC. How can you possibly treat everyone like this? Yeah, the amount of – yeah. You don't have hospital space for this. Yeah, you know, and that was an interesting thing in the last of those, the last Ebola outbreak in Uganda when I was there. And I was trying to avoid it. I did not end up in the middle of that on purpose. But I was talking to some of the doctors without borders who were there.

28:53And, you know, if you have proper, you know, critical care, supportive care, the outcomes are much better. The mortality really goes down. Like early on, we don't know what's going on. You're not sure what to do. Mortality is super high. But do you have access to this level of care in these parts of the DRC? The answer is no, you don't. But in West Africa, in the 2015 outbreak, we built – someone built Ebola treatment centers outdoors, right? It could have just tents and that was good enough. There actually were really – some of those centers were quite good, yeah. So you could implement that in DRC and just treat everybody.

29:31Yeah. You could give them the – you can give them an antibody and give them remdesivir. Yep. And to impact all these deaths, it's crazy. Yeah, yeah. All right, measles, right? We basically added another 200 cases this last week. So we're now up to 2 ,813 measles cases, adding 200 in a week. And I should point out that we're concerned because when historically do measles cases go up, it's when you send the kids back to those crowded classrooms. Yep. And so we're very concerned in the next couple of months what is going to happen here. And we did have a couple more deaths. We're up to five measles deaths during this administration under this HHS secretary.

30:22We did not have deaths from measles in the U.S. So Pennsylvania Department of Health confirms two measles-associated deaths. The deaths marked the first related to the highly contagious virus in Pennsylvania in 35 years. DOH confirmed both individuals were unvaccinated residents of Lancaster County. They're not going to tell us much about them to protect their privacy. But we don't know if their children are adults. True, true. All right. So quantifying the cost of measles outbreak in the U.S. and how costs scale with outbreak size. So this is actually an article published in Vaccine. And it really is looking at the cost.

31:06Like, is this a wise economic decision to basically allow vaccination rates to drop? Like, how many, like, hundreds of millions of dollars is this going to cost us? So the investigators conduct a literature review. They look at PubMed. They look at official CDC and state health department data. And they examined how cost scale with outbreak size, 120 articles screened, 33 underwent full text review. Now, the average outbreak cost per case was estimated at$43 ,203, while the average cost per contact was$443. and there was a variation. The average cost per case varied from about$33 ,000 up to about$60 ,000 and this included public health response costs.

31:59So basically when they run all the numbers, measles outbreaks in the U.S. continue to reemerge and impose significant financial and public health burden. There's a really nice CIDRAP article. I'll leave a link into that. But basically, each measles case in the US, when you add it all together, costing about 60 ,000 study estimates or$134 million. So this is amazing. Like they're supposedly cutting all this funding and you're costing us over$100 million a year. And then forget about the fact that we have five dead individuals. We know at least some of them were children. And then, you know, so my wife and I were talking about that Brady Bunch episode.

32:48Because apparently that's like, that's part of like the handbook of the anti-vax, you know, like, oh, look at the Brady Bunch. Measle has never, was never a thing. You know, my wife was commenting, there were six kids. We're seeing like for every five kids, one ends up in the hospital, like basically desperate to get enough oxygen, struggling to breathe. So if that was not a kid-friendly show but actually a realistic depiction of measles, one of the Brady Bunch kids would have been in the hospital struggling to breathe, requiring supplemental oxygen, maybe even ending up in the ICU. And then if you follow them out, like how do they do over time?

33:23I think it's a lot cheaper to get vaccinated, don't you think? It's cheaper and it sure is a kinder and the safer choice for our children. All right, and we've got a total for pediatric flu deaths, 2025, 2026. You know, oh, it's just the flu? Well, pediatric deaths, a total of 191 deaths for last year. And these are little kids, and half those kids, as we pointed out, were completely healthy before within 48 hours they got sick and died of the flu. And the majority, as we pointed out too, were not vaccinated. it. So we'll be encouraging everyone to get their vaccine starting next month. All right.

34:09COVID, it is on the way up. And I'm going to talk a little bit about blue washing, Vincent. I don't know if you're familiar with blue washing. I'm not. What's that? So there's a couple of things out there. Like there's, do you know sports washing, right? This is when you do really bad things to people, but then you like pay for really nice sports events. It's called sports washing. Well, this is like – this is about as horrible as that. So what you do, we talked about before, they have these categories, right? Like very low, low, moderate, and high. And like you have certain numbers like put you in each category.

34:44So what you just do is you just say, well, let's just change those categories. So let's like take what was moderate and we'll make that low. And what was low, we'll make that very low. So that's apparently what has gone on is the CDC has changed its threshold for the different categories. So right now you can see this is mid-August number 815, and you can see it's starting to enter the low. Well, historically, that would have already been up in the moderate. I see. But they're blue washing, which is basically, you know, instead of things being red and scary, they're basically blue washed down to like, don't you worry so much.

35:19But when you look at the map of the country, you can see that, yeah, Texas, Mississippi, they're already high. California's already moderate. Yeah, the numbers, it's really coming up and it's coming up fast. All right. So we're having a late summer outbreak. Yeah, I don't know how this works because we're already like late. You know, we're in August now. So it's sort of going to be right into the fall. It will be interesting to see how the dynamic works here. Yeah. Maybe it will just go until next year. Just keep going. It's very strange. So here is the thing I want to talk about. This is really I think an important one.

36:01So the next article that we're going to talk about, there's a nice little piece in SIDRAP. But it was this question that came up. And I remember having this conversation with a mother of a young child. Young child trying to go back in time here. So we're talking about teenager, right? 15-year-old boy. And the mother was concerned, family history of some heart issues. She's like, I don't know if I want to vaccinate them because there's this choice, right? Like if I vaccinate them, there's a certain risk of heart issues, right? The myocarditis, pericarditis. But there's also the issue that if you don't vaccinate them and let them get the COVID without being protected from the vaccine.

36:41And so the question is, what is the safer choice, right? So here's a study that we're going to talk about. It was published last week in Vaccine that looked at more than 4 million children. And we're going to see that basically getting the vaccine was associated with a significantly lower risk of your heart ending up developing issues. So here we are, pandemic, the safer choice, right? So here we have the article, Cardiac Outcomes Following SARS-CoV-2 Infection Versus BNT162B2 vaccination in adolescents and young adults, a cohort study of 4 million individuals. These are the results of a retrospective cohort study.

37:22They use this database for over 4 billion individuals aged 16 to 25. And so they put them into the different groups. But what we're significantly interested in is, so let's look at the folks that get SARS COVID-2 infection. So SARS-CoV-2 infection was associated with significantly higher risk of myocarditis. That's a relative risk of 5. Pericarditis, about 2. Mortality, 1.3 versus no infection. But now, in direct comparison, vaccination was associated with an 85 % lower myocarditis risk, a 79 % lower pericarditis risk, and 72 % lower mortality versus infection. And that's even with the vaccine causing some low rate of myocarditis, right?

38:16Yeah. So much safer. The safer choice if you try to protect your, well, young lad, right? Because this was more of an issue on the boys. All right. So I'm going to wrap us up there before we get to our emails. No one is safe until everyone is safe. We're in our American Society of Tropical Medicine and Hygiene fundraiser. Vincent, I just booked my hotel and my travel down to Washington for the conference. It'll be November. Our fundraiser runs August through October. And what we're trying to do, we're trying to raise$100 ,000 because we're trying to create this ongoing five-year Dixon-Depamier Memorial Lecture Series.

39:01We're going to support the president's reception where we're going to announce that. And so go to parasiteswithoutborders.com. Click on that Donate button. Thank you so much. It's time for your questions for Daniel. You can send yours to Daniel at microbe.tv. Bob writes, a friend mentioned that he had heard that long COVID is associated with small blood clots that could be associated with the symptoms of long COVID. He heard that treatment with anti-clotting medication is prescribed. And he sends an article and wants your opinion. Circulating microclots are structurally associated with neutrophil extracellular traps and their amounts are elevated in long COVID patients.

39:46Yeah. So Bob, this is definitely something that's been described. And the big challenge now is, so what do you do about this, right? And so there are these ongoing trials. People are jumping in, right? And maybe this is, I'm going to say, a lesson in humility, right? So the oath we always take is do no harm. And what happened a lot during the early days of COVID, a lot of people just couldn't keep their hands in their pockets. And the whole idea is, I've got to do something, right? So we had a couple of disasters, right? Hydroxychloroquine increased mortality by 20%, you know, and there've been a lot of other things that happened where actually, you know, if you have a good idea and you have a good theory, unfortunately what we've learned over decades and decades is most good ideas are not helpful.

40:32Like we are not as smart as mother nature. Like we're not as smart as what evolution has crafted. So, you know, a lot of people are already jumping. They're using these blood thinners, these direct oral anticoagulant therapies. We don't know. We don't know if they help. We don't know if the benefit outweighs the risk, the harm. Some people will have strokes. Some people will bleed out and die. So at this point, this is interesting. It's important. We need funding to do those studies so that we actually know what is the safe thing to do with these potential problems. Mark writes, check out this dashboard that a collaborator at Tulane University in Louisiana put together some time ago.

41:16And this is a very nice pandemic mitigation collaborative dashboard where you can see the map of the U.S. and the heat map of, you know, your very low, low, moderate, high, and very high wastewater. And then prevalence estimates. It's a very interesting table. Chances anyone is infectious in a room of 10 to 100 people. I think that's helpful. Give people some kind of a context. Every so often I see this. Like, oh, at this level, that means one in every 20. At this level means one in every 50. And I think that helps people when they're thinking about, oh, I'm going to a party. There's going to be 50 people there.

41:50But one in 20 people have COVID at this level. You're like, so someone at the party is going to have COVID and I'm going to get it. And then I'll have a heart attack or a stroke or something. This is put together by Michael Horger at Tulane. I've been following Mike on social media for a year, and now the project has really improved better than the CDC's infographic, in my humble opinion. Also, I thought a great topic for a TWIV clinical update would be information on nasal vaccines, including any interesting studies or preprint info or emerging studies or project funding you might be aware of.

42:29Appreciate you guys. Best wishes from the front lines of the ineptocracy here in Florida. Oh, my gosh. Yes. Good luck in the race to the bottom down there. But yeah, no, I, you know, definitely if we see some interesting nasal vaccine studies, this would be a great place to share them. So, Mark, just send me your address, Vincent at microbe.tv. You want some stickers, I'll send them out to you. Charmaine writes, Daniel, here's an article about the Trump administration letting cattle in from Mexico. How do you feel about this? I'm a bit worried. I'm not sure if I really trust these people to inspect every animal adequately.

43:06Yeah, you know, it's a challenge right now, right? Like, so, you know, historically, we've always prided ourselves, right? Texas and all the beef production. And now we've got a number of things going on, right? So we've been talking about the New World screw worm and concerns about cattle coming in, potentially bringing that in. And we just heard about, what was it, 30 ,000-something pounds or tons or just some huge amount of beef coming into Texas and Florida. And then it finds out after the fact that it's contaminated. So really a little bit concerned about cattle and other things coming in if we don't put the effort and the right people there to basically protect our food and our animals from all these problems.

43:50So you think it's okay to let these cattle in, Daniel? Should we let the cattle in? I mean, I think we're not going to expect them. We're just letting them in. That's not great. I would be a little bit worried. Bruce writes, in TWIV 1350, Daniel recited the first four couplets of the poem Worthwhile, written by Ella Wheeler Wilcox and first published in her 1892 collection, An Erring Woman's Love. And Bruce sends a link to her bio in Wikipedia. I have watched your TWIV podcasts every week since 2020. They have been tremendously helpful, even life-saving for family and friends. In the spring of 2020, I started publishing a weekly email newsletter, COVID Updates, to track the emerging SARS-2 epidemiology, immunology, public health best practices, and treatments.

44:40My aim was to summarize in simple lay terms many reputable technical preprints and journal articles, as well as commentary by experts to make their science useful for grandmas with iPads. These newsletters were sent to 1 ,000-plus regular readers and forwarded to many more. Aside from my own diligence reading preprints in referee journals, I relied on and cited your commentary and analysis, as well as that from Sid Rapp, Trevor Bedford, Shane Crotty, Christian Anderson, Caitlin Hettelina, and Nikiko Iwasaki, to name a few sources. My readers and I owe you and all the other experts a large debt of gratitude.

45:18That's really kind, Bruce. It's nice to be included in that list. Sheila writes, I am currently watching clinical update 1350 and saw the graphs on the increase in kindergarten students with non-medical vaccine exemptions. Well, I have no doubt that there are a lot fewer kids getting vaccinated. There is something strange related to exemptions that I have seen in my area. I've seen multiple Facebook posts in recent years from people that have recently moved to Alabama, and they all have their kids' vaccine records, but the schools here require the vaccine records on a specific card. Parents are posting because they haven't found local doctors yet and are having trouble getting a doctor's appointment to get the records transferred onto the correct card and signed by the doctor and are looking for doctors that might be able to help.

46:07Each of the last few years, I see multiple people recommending that they just fill out the exemption form because it's easier to get an exemption than to provide the correct paperwork to show your kids are vaccinated. Last year, someone even said someone at the school had recommended this. It probably isn't a large number, but it would be interesting to know how many kids with exemptions are really actually vaccinated but just don't have the records on the right form. Wow. Now, that's interesting. I appreciate you saying that. And I'm hoping this isn't a significant issue. But that's a problem, actually, to create so much bureaucracy that people are filling out an exemption for.

46:43And Anne writes, you're probably sick of questions about timing vaccinations by now, but here's mine. I'm 67, no additional risk factors. I was hoping to get my COVID booster before going on vacation September 10th. I spent the afternoon trying to find out when and where this year's updated vaccines would be available. and I couldn't find anyone to even give me a date. I got estimates of the beginning of September, end of September, and before the end of the year. I'm really eager to get vaccinated before a vacation because twice I caught COVID on vacation, fortunately not feeling sick till the day after I got home.

47:18The last time I was vaccinated was about a year ago. Given the timing, should I just give up on the new one and take the old one 14 days before I leave, or should I gamble that it'll come at the very beginning of September and wait until then? Thanks for being a voice of informed sanity. Yeah, yeah, this is a tough one. And no, I don't grow tired of giving people advice about their timing of their receipts. But yeah, so, you know, we are hoping, you know, here we are. By the time this drops, like August is almost over. and, you know, we're hoping the new, you know, the new updated vaccine is going to be there.

47:58You know, it is interesting, right? Like, you know, how much does it matter? How much is the new one going to be better than the old one? We never know until like a year from now when finally the data rolls in. And we never really do those like prospect. We say, okay, listen, a thousand people get the old one, a thousand people get the new one, and let's follow them over time. I would love that, right? That would be amazing. So wait, and if basically the clock runs out, then get whatever you can get. Yeah. I mean, last week I asked you about the mRNA flu vaccine, and you said, just wait, because I'm going away on the 15th to Europe.

48:34And you said, just wait till the last possible minute, which would be September 1st, which is just next week. It's going to be there before you know it. Yeah, right. That's TWIV Weekly Clinical Update with Dr. Daniel Griffin. Thank you, Daniel. Oh, thank you. And everyone be safe.