TWiV 1358: 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 1358, recorded on September 17th, 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. I'm wearing my Spike t-shirt today. I don't know if anyone can see that, but no bow tie, the Spike t-shirt, which I think was a gift from you. I feel like you got me this as a gift, Vincent. Yeah, that's right. I got everyone a Spike t-shirt at one point during COVID, right? All right, well, let's jump in. we've got a lot to cover. And I've got these two, they're very similar Mark Twain quotes.

1:06But it was really, you know, it's the second one that kind of got me, but then I found the first one. So you get double Mark Twain. Mark Twain, I guess. So no one is willing to acknowledge a fault in himself when a more agreeable motive can be found for the estrangement of his acquaintances. And then the next, which gave me pause, always acknowledge a fault frankly. This will throw those in authority off their guard and give you opportunity to commit more. He was really something, wasn't he? I like that last one. That's good. So, all right, maybe people will figure out why I picked those. So, all right, unfortunately, we have some pretty sad stuff.

1:51We're up to four deaths in Pennsylvania from measles. The first is, I guess, so the first two, right? So we had a young child and then we had the child at birth, the splenic rupture. And then unvaccinated woman likely died of measles complications. This is the county coroner says a 40-year-old unvaccinated woman in Pennsylvania died Saturday. That was 9-12, so a week prior from when this will drop. Most likely because of measles complications, the Jefferson County Coroner Greg Furlong said on Sunday. The news comes as Pennsylvania faces a rapidly expanding outbreak that has already sickened more than 670 people and hospitalized 124.

2:37I just wanted to point that out. We have over 100 people that have ended up in the hospital. And as they point out, roughly one in five unvaccinated people in the United States who contract the virus lands in the hospital. often for complications such as pneumonia, severe dehydration, and brain swelling. So this is not the Brady Bunch. This is not RFK Jr. joking about stuff. These are people who get really sick. And I think Paul Offit and I have both said that you can always tell who has measles because they're the most miserable person in the room, usually the most miserable child. And fourth death from measles in Pennsylvania, an 18-year-old has died of acute disseminated encephalomyelitis, a rare severe neurological complication of measles.

3:22This is according to the coroner in Mifflin County, Pennsylvania. Now, prior to 2025, when three measles-related deaths were linked to an outbreak in Texas, the last reported measles death in the U.S. was in 2015. Measles was declared eliminated in the United States in 2000, but the country is likely to officially lose that status later this year. All right, Pennsylvania Department of Health is leading a robust, proactive, and transparent response to PA's largest measles outbreak in more than 30 years. So we read here, this is inside medicine sub-stack, the Pennsylvania Department of Health is leading a robust, proactive response, administering nearly 4 ,300 MMR vaccinations at 130 pop-up vaccination clinics in the affected communities since the outbreak began in late April.

4:14In homes, churches, community centers, anywhere they are invited, healthcare providers are seeing a surge in interest from residents seeking MMR vaccination. In a typical month, all PA healthcare providers administrate approximately 75 ,000 doses. In August, more than 46 ,000 MMR vaccines were administered across the Commonwealth. So really, really stepping This is just great. This is perfect. This is just what the state should be doing. And you'll see this will curtail the outbreak. I really hope so. Now, the CDC doesn't seem to be helping. CDC's new tracking method for measles, deaths, puzzles, experts.

4:56We've talked a little bit about how they didn't want to count the recent deaths. The U.S. Centers for Disease Control and Prevention, CDC, has pivoted to using data from the National Center for Health Statistics for measles death counts and not state data collected via the National Notifiable Diseases Surveillance System. Despite Pennsylvania reporting four recent measles-associated deaths, two in babies, two in adults, the CDC website states the NCHS does not currently have any death records from 2026 that indicate measles is the underlying cost. I'm just sort of paused there. I mean, what's going on, Vincent?

5:39This is just craziness. This is RFK Jr. telling them not to report the measles death. And what's her name? Erica Schwartz is listening to him so she can keep her job. And this is very disgusting. Does that job pay really well or something? I mean, what is the price of a human soul these days? Can we say conflict of interest? Kennedy delivered a keynote for anti-vaccine group he once led. And so, yeah, I just want to point this out. This has been his history. Health Secretary RFK Jr. will give a keynote address at a children's health defense conference in the nation's capital, embracing the anti-vaccine organization he once led.

6:27This is totally inappropriate, isn't it? Well, he has, you know, this is, you know, he lies, right? Because he has actually said that he distanced himself. He's not really involved in this anymore. And now he's going to go do this keynote. So clearly not a lot of distance there. Now, next, I feel like we have a lot of like news section here. Exclusive NIH Research Center on Vaccine Harms Takes Shape. The NIH is launching, is preparing to launch a clinical research program to study people who believe they were harmed by vaccines, including COVID-19 vaccines. In an internal meeting last week, officials of the NIAID, so that's the National Institute of Allergy and Infectious Diseases, discussed plans for a new research center on the NIH campus in Bethesda, Maryland that could start up in mid-October.

7:20The agency plans to fund outside researchers to study adverse effects of vaccines, piggybacking off existing studies of people with vaccine-related illnesses. The amount of funding for the efforts has not been determined. You know, if this was done under anyone else, Vincent, I would praise this. I mean, we clearly, we talk about the fact that there are risks with vaccines. They're greatly overshadowed by the risks of the diseases they target. I just I worry about people with an agenda not actually doing science, but really drumming up propaganda. And, you know, and we've talked and I've cared for folks that have had issues post vaccinations.

8:03This is a real issue, but it needs to be addressed with science, with rigor, not with propaganda. Yep, I agree. All right. ICE. Next section is on ICE. U.S. pediatricians reported seeing fewer patients because of immigration enforcement worries. Immunization clinics in San Diego, California are usually packed in August as parents prepare their kids for the new school year. Not this year with agents from ICE often waiting outside medical clinics. Many immigrants and their families are now afraid to seek health care. We hear this from a professor of pediatrics, Gia Panaraj. She's the vice chair of the American Academy of Pediatrics Committee on Infectious Diseases.

8:52And here's a quotation. We saw a huge drop off in people getting vaccinated. She told CIDRAP News, many immigrant families' parents are afraid of being detained or arrested by ICE. And it's a valid fear. 31 % say fewer families applying for the government programs. Almost half of all pediatricians in the United States believe they're seeing fewer families because of concerns about ICE. This is really, you know, really terrible. It's horrible. So that means these outbreaks are going to get worse and worse. Yes, yes. And it's also going to fuel this whole, you know, concern about immigrants. And, you know, so it's just backfires.

9:34now tell me a little bit about this vincent so surgeon general nominee pledges support for vaccines in senate hearing i i read this and i'm like oh my gosh somebody somebody's gonna be upset with this uh this pick dr nicole sapphire mr trump's pick president trump's pick for surgeon general expressed unequivocal support for childhood vaccines during a hearing on wednesday held by the Senate Health Committee. Her comments didn't start contrast to those made by other Trump administration nominees, some of whom have cast doubt on vaccinations. Dr. Safir said she did not believe vaccines caused autism and that she believed immunizations saved lives.

10:15She also supported universal vaccination against hepatitis B. Now, previous on her podcast, Dr. Safir had questioned the recommendation that all newborns received the hepatitis B vaccine. So a little bit interesting. Here she is contradicting a false claim that Mr. Trump made in an August event at the Oval Office. Dr. Safir said at the hearing, she did not believe the combinations that measles, mumps, rubella, MMR vaccine was lethal. Do we trust her? I don't know, Daniel. I'm just a little suspicious. Why would she be against the birth dose of hep? Every doctor knows that it's needed in the U.S.

11:00So, you know, we thought that Erica Schwartz would be good and look what happened. So let's see with her. Yeah, it's really tough. I mean, we you know, she promised she said, I will not do something that is not, you know, in the interest of the health of people in America. And here she is. All right. This is kind of a long one. So SIDRAP op-ed, HHS is asking what to call vaccine recommendations. You have four days to weigh in, four more days to weigh in, and we're going to leave some links. Federal vaccine recommendations come in three kinds. Routine means the default is to vaccinate everyone in an age group.

11:38Risk-based means the recommendation applies to people with a particular condition or exposure. Here's the meat of it. shared clinical decision-making, which the HHS now also calls individual-based decision-making, means there is no default. The decision is made one person at a time between a clinician and a patient or parent. So this third category is what the notice is built around, and it helps to know what no default does in a clinic because it does more than the phrase suggests. A routine recommendation works while nobody is looking. It shows up in the chart on its own because the clinical decision support logic used by the CDC encodes routine recommendations and the forecasting software in electronic records acts on them.

12:25So a nurse, a pharmacist just gives the vaccine understanding order. The visit begins from the assumption that the child is due and the clinician can say so, which is the approach the communication research most consistently ties to vaccine acceptance. Now, shared clinical decision-making takes the default away. Nothing about the category forbids reminders or standing orders, and the conversation does not need a physician. And the CDC's page lists nurses and pharmacists among the people who can have it. But the prompts and the orders would default for a schedule with, and now you've got this issue.

13:05I'm going to leave in links to this. But yeah, I know. Did you want to jump in on this? Because there was really a lot in here. We probably need to have a lot of this in the show notes. Well, the problem is that they want to change this to the default where the charts say you're due for a vaccine to nothing. And, you know, it has to be built in. It's not part of it right now. and then it's going to cause a lot of friction in terms of getting vaccination. And, you know, they go on to say that there's one recommendation that exists for the first days of life. That's the hep B vaccine, right? That is important to get.

13:47We know that you need to get it in the U.S. And if you don't do that, then you're immediately susceptible to infection. And so the change, there is for infants whose mothers say they're Hep B negative. And there's a story here about a woman who tested positive, but it was erroneously transmitted as negative and she didn't get the birth dose in the end. So that's the thing. It should be a default and not depend on any screening of the mother. Yeah, it's tough. Well, we'll leave in a link. You can go to regulations.gov. There's a docket number you search for. We'll leave that in as well. And then basically people need to write in.

14:39This is one of those things where, you know, don't just, you know, complain. We need to step up. We need to protect our children and our communities. Now, a little bit here. This is from polioeradication.org. Vaccines at work. In Germany, approximately 21 ,000 children have not received their first vaccination against diphtheria, tetanus, and pertussis. Compare it to the country's overall high vaccination coverage. This may seem like a small number. Nevertheless, it is one that should concern us. Germany does not have a fundamental vaccination problem, but this is precisely where the challenge lies.

15:16Vaccination programs have been so successful that many people have never experienced the disease they protect against. Illnesses that were once part of everyday life are now known to many only through stories or textbooks. Most young parents have never seen a child develop polio. They've never witnessed how quickly diphtheria can become life-threatening or the serious complications that measles can cause. The fact that they have been spared these experiences is one of the great achievements of modern medicine, but that success has a downside. The rarer these diseases become, the easier it is to forget why vaccination is so important in the first place.

15:52That's precisely why ongoing public education remains essential. In Germany, all childhood vaccine recommendations come from the Standing Committee on Vaccination, the STIKO, S-T-I-K-O, free of charge. The key, therefore is ensuring that parents have access to reliable information. They get their questions addressed early. And since this is from polio.org, they mentioned polio is perhaps the best example. Germany has been free of endemic transmission of the virus for decades, but that does not mean polio virus has disappeared. It continues to circulate in parts of the world and has been detected repeatedly in wastewater in several European countries in recent years, including Germany.

16:35The fact that these detections have not led to outbreaks is no coincidence. It demonstrates how well vaccines work. High levels of immunity in the population combined with robust surveillance prevent the virus from regaining a foothold. That's exactly why we must not allow high vaccination rates to create a false sense of security. They are not guaranteed to continue on their own. Every generation must be reminded why vaccines matter. Every immunity gap increases the risk that diseases we believed have been consigned to history will return. All right, scientific funding. Researchers file First Amendment Challenge to NIH grant screening.

17:15This is an interesting one. So researchers asked a federal court to find that the NIH is acting illegally in barring grants on topics disliked by President Donald Trump's administration. NIH, which streamed grants for sensitive terms and requires changes in how projects are described, is violating the Constitution's First Amendment protections of free speech and rules requiring that grants be awarded based on scientific merit. The NIH is systematically trying to silence research-related speech, including biomedical results, that it suspects will express views the administration does not like on everything from DEI to gender identity to climate change.

17:58The plaintiffs are asking the court to order NIH to drop its screening policy, restore terminate grants, and re-review those not funded. The complaint was filed in a San Francisco federal district court. really interesting that's and I don't know where this comes from but you know every so often I stick my nose in social media and I see people making comments about oh yes the NIH they were they were funding all this woke research what is woke research Vincent what are they talking about you don't know what woke research is what is woke research well it mean it's basically a word that means being alert and aware of racial prejudice and social injustice.

18:43And over time, it's become a highly debated political term. So basically, today the word is used as a shorthand for progressive or left learning political ideas involving identity politics, and social justice. It's basically used now as an insult. And so this lawsuit is great because, you know, them taking away grants for things they don't like, I'm sorry, it doesn't matter what you don't like. These grants were reviewed by a study section of scientists. They were approved by a council. They were funded. And the money comes from congressionally appropriated funds. The president has no right to say, I don't like this gender research and you're not having your grant.

19:31So this is a great suit. They have great points. I hope they get it. All right. So Legionella, any Yankees fans? Vincent, are you a Yankees fan? No, I'm not an anything fan anymore. All right. I guess not after this, right? In NBC News, We have the headline, Cooling Towers at Yankee Stadium Test Positive for Legionnaires in New Cluster. So we've got another cluster. The New York City Health Department has ordered 10 cooling towers in the South Bronx to be cleaned and disinfected after preliminary testing found the presence of Legionella bacteria as officials investigate a cluster in zip codes, 10451 and 10456.

20:16two of the locations are tied to high profile sites i'm just going to say they're tied to high i don't know which which are the two so one high profile is the cooling tower at yankee stadium where the yankees played the mets in the subway series oh my gosh do we have mets fans another is at the address of lincoln hospital the other is the the borakua college bronx campus Yeah, so we've got, unfortunately, we have 13 people that have tested positive. A couple are in the hospital. Nine have been discharged. One is not hospitalized. One actually died. Now, as we read, in addition, so this PCR testing, they're also going to be doing cultures.

21:04But the culture tests take up to two weeks. So they're going ahead. They're cleaning. Yeah. So another cluster. This is a big problem because a hospital cooling tower, that could be tragic, right? It really, really could be. Screwworms. So this is interesting. We had another case of screwworm, right? But for the first time, so we're up to 49 animal cases. For the first time in more than 60 years, new world screwworm has been detected in a ranch horse in Texas. And this is just an update. So I don't know if this has even made it into the numbers there. But the case was detected in Presidio County.

21:41The parasite was found on the hind limb of the animal. So, you know, as mentioned, so up to 49 animals in all Texas and New Mexico. So I'm glad they found it. Now we know we have some treatments. But yeah, what is happening to our country? Well, Ebola, the MMWR notes from the field, the first 100 days of five Ebola outbreaks, Democratic Republic of the Congo, Uganda, and West Africa, 2007 to 2026. So reread. The first 100 days after identification of an outbreak, and I think that's really critical. It's after identification of the outbreak. Because as we know, we're past 100 days because we've gone back and realized there probably were cases before we identified the outbreak.

22:26So as I mentioned, the 100 days after identification of an outbreak are important to understanding transmission dynamics, impact of early public health interventions, and trajectory of potential future cases and deaths. Now, a large Ebola disease outbreak is underway in the DRC, which has become that country's largest and deadliest. To better understand the current outbreak, this report compared metrics from the first 100 days of this outbreak with those of four past Ebola outbreaks. Well, which four? So the historic outbreaks of Ebola disease selected for this comparison include the two largest, so that's the 2014 outbreak in West Africa, a 2018 outbreak in DRC, and the only two previous outbreaks caused by Bundabugio virus.

23:17We had a talk on Bundabugio virus at Columbia just on Tuesday, and they did not get the Buzio. They pronounced it the way I pronounce it, which is wrong. The 2007 outbreak in Uganda and the 2012 outbreak in the DRC. So we've got these basically five in context. So 2007, the Bundabugio virus disease outbreak, Uganda. This was first identified in 2007 when it caused an outbreak of Ebola disease in Uganda. Fewer than 50 cases identified during the first 100 days of the year. That was limited, ended within six months, total of 131 confirmed probable suspected cases. 32 % of those folks died. 2012, five years later, we had Bundabujo virus disease outbreak in DRC.

24:15This is the second one. Fewer than 50 cases in the first 100 days, limited to a single health zone, ended within six months. 62 confirmed, 55 % was the case fatality rate. Now, 2014, this was the big one. 2014 Ebola virus disease outbreak, West Africa. In 2014, large outbreak of Ebola virus disease caused by, this was the Zaire. So it was the ortho Ebola virus Zairenze. The initial outbreak report included 49 confirmed cases, 59 % deaths. During the first 100 days, 759 suspected, probable or confirmed cases, 62 % deaths in these cases. The outbreak lasted three years, went on for three years with 28 ,610 cases and 11 ,308 deaths across 10 countries.

25:182018 this is the large outbreak of ebola virus in in the drc and this was this was again the ebola zaire this occurred in the drc during the first 103 days 295 cases 51 percent was the fatality there the outbreak resulted in 3 470 cases 2 287 deaths that was 66 percent Now, here's where we are now. 2026, Bundabugio virus disease outbreak. On May 14th, an outbreak of Ebola disease caused by Bundabugio virus was detected in DRC. The outbreak was declared on May 15th, at which time DRC's Ministry of Health confirmed 246 suspected cases, 76 suspected deaths. During the outbreak's first 100 days, 5 ,458 confirmed cases, 2 ,606 deaths.

26:18Across 57 of DRC's 519 health zones, 21 probably confirmed cases related to this outbreak were identified in Uganda, but that was limited. um now during the first 100 days after detection the current outbreak resulted in more cases than the other two largest Ebola disease outbreaks um and they're actually in this MMWR they have um they have the first 100 days but I also like the fact that they they do a first 365 where we put this in a broader context. So hopefully those will be up for our YouTube listeners to watch. But what's nice too is actually they've expanded, if you go to the CDC updates, they've expanded out so you can start to get a better sense of where the DRC-2026, the current outbreak, is relative to the trajectory of some of the others.

27:13But yeah, we're up to 7 ,200 confirmed cases, 3 ,475 confirmed deaths.

27:24All right, well, measles, bounce back to measles. We talked earlier about the four deaths in Pennsylvania. In the AP, we have the article suspected measles causes cases kill nearly 1 ,000 as Bangladesh struggles to contain outbreak. You know, it's interesting because historically the argument was, oh, measles is a problem in these other areas where they don't have good nutrition and all the rest. We're seeing like 10 to 20 % of the people with measles end up in the hospital in the US. We saw four deaths already in Pennsylvania. So yeah, measles is not just a problem in other parts of the world, but it is a problem in other parts of the world.

28:02So a few years ago, Bangladesh had measles largely under control with a vaccination program that was credited for decades for protecting children and mothers from the deadly diseases of TB, diphtheria, whooping cough, tetanus, polio, and measles. Between 2021 and 2025, the country recorded just 100 to 300 cases per year, down from 2004-10 in 2020. But in the last few years, disruptions to the vaccine program have left a growing number of children unvaccinated. First, the COVID-19 pandemic interrupted routine vaccinations. Then in 2024, the government largely missed a vaccination campaign, previously carried out every four years.

28:42We first discussed this on TWIV 1328 as the consequence of political upheaval, and I'll leave a link into the TWIV 1328 as well as the AP News. All right, and numbers, we are up to 3 ,387 U.S. measles cases. I mean, this is just, you know, we blew by last year's total of 2 ,242. And we now have gotten to a point where we have a New York State measles dashboard. And I'll leave a link into that. Yeah, this is just, so 51 cases in the state. And this is New York State excluding New York City, because then New York City has its own count, and we're up to half a dozen, six confirmed to measles cases in New York City.

29:31And we'll keep that stuff updated. All right. Well, it is time to get your vaccines. So time to get your yearly flu jab. If you haven't gotten your RSV and qualify, look at that. And let's talk a little bit about RSV, right? So we've got the active and then we've got the passive, the monoclonal antibodies. So we have the article RSV, immunization, Effectiveness and Safety for the 2026-2027 Respiratory Season, published in JAMA. So here, Medline, PubMed, Embase, Cochrane, Central, and Scopus were searched from August 1st, 2025 through June 29th, 2026 for studies evaluating the safety and effectiveness of U.S.

30:20licensed RSV vaccines or RSV monoclonal antibody products. A total of 75 eligible studies were identified, including 12 randomized controlled trials, 33 observational studies with a comparator group, 16 observational studies without a comparator, and 14 descriptive studies on RSV epidemiology. I wanted to sort of comment there, right? I saw this meme on the social media. And there's like a play on the Atlantic. I think it's called the Vertlantic or something like that, where it's like, no, no, no, not that study. Look at this study. And, you know, you look at a paper like this and you just, I mean, this is, they're looking at, you know, how many different studies and then they're, you know, narrowing it down to 75 eligible and all the rest.

31:07So this is really the way. You can't just cherry pick, you know, look at this one cherry pick study. I want you to look at this one cherry pick study. No, you really have to go into science with the null hypothesis and you have to say, what do we actually know? What's true? And here, what is true? In older adults, RSV vaccinations was associated with a reduction in RSV-related hospitalization, vaccine effectiveness, 83.3%. That's huge. Point estimates for RSV vaccine effectiveness against hospitalization and lab-confirmed RSV illness among older adults were significantly higher during the first season after vaccination compared with 12 to 8 months of follow-up.

31:50The vaccine effectiveness for maternal vaccination ranged from 51 % to 70 % against RSV-related infant hospitalization. Estimates for effectiveness are Sevimab, right? That's getting the monoclonal. That's the babies getting that. For the infants, 63.6 to 93 % for RSV-related hospitalization within 6 to 12 months. And from a safety issue, right? I mean, NIH is now going to study vaccine safety. We always do that. No cases of Guillain-Barre GBS were identified across three RCTs among older adults. One self-controlled case series reported a possible increased risk of GBS during the 42 days following vaccination.

32:37None of the comparative studies included in this review found in association of RSV vaccination during pregnancy with pre-term birth or other adverse pregnancy outcomes. All right, well, time to get your COVID jab, right? Your yearly COVID jab. And we have some updates here. I really like the map because you can really see that this is regional, right? Even with the blue walking, even with changing the level, Texas is high. California is high. Nevada, Mississippi, very high. And if you follow along, we really got a nice, well, nice, pretty significant spike in the wastewater levels. You know, it's a little too early to tell.

33:23Have we peaked? Is this kind of an up and down? But pretty high activity in a lot of these areas. You know, modern Alabama and Florida. that moderate would have been high with previous. So it's going to be a challenge, right? Because when we see, oh, the peak isn't as high, we have to realize that that peak has been kind of adjusted. Because it's very scary for people, Vincent, to know that there's COVID around. So we've tried to like, you know, move those levels down. Okay. So yeah, time for the jabs. Maybe we'll talk about this in the question answer. But you've got a lot of choices, right? You can get your Comirnaty jab.

34:02You can get your Moderna spike vax. You can get your M, Moderna M next spike, which might be a little bit more efficacious. You've got the new Vaxavid, which is confusing, but this is the Sanofi Novavax product, which maybe has the advantage of a little less reactogenicity. But also, as we pointed out, it's not mRNA. So if you have an issue with mRNA, This is a traditional protein-based vaccine, so we've got a lot of choices out there. But again, somebody is throwing a wrench in the gears. COVID vaccines delayed for half of U.S. children. The health department has not decided whether to provide shots to states through the Vaccines for Children program, which serves uninsured and low-income families.

34:52nearly three years after the FDA approved. Three weeks. Three weeks. Sorry, three weeks. Three weeks. Three weeks after the FDA. You got to imagine this is getting me quite upset, right? This is, you know, we were told, don't worry, everyone who wants vaccines are going to be able to get them. Well, this is not that. The FDA approved updated COVID vaccines and now about half of American children still cannot receive them because the federal government has not made the doses available through the Vaccines for Children program. And we hear from Emily Hilliard, a spokesman for the Department of Health and Human Services.

35:28She confirmed on Wednesday, the department has not yet made a decision about whether to provide shots through that program. Vaccines for Children provides free shots to children who are uninsured, underinsured, eligible for Medicaid, as well as American Indian or Alaska Native children. Pediatric doses are available for children who have insurance or whose parents can afford to pay for vaccines out of pocket. What pocket do we, what country do we live in? This is this administration. They have tons of money and they're cheaping out to protect children. We have not yet decided whether to protect children who can't afford it.

36:09This is so obnoxious, it's unbelievable. I don't know this. Emily Hilliard should be ashamed of herself for saying that. Yeah. I mean, it's just, you know, we haven't decided whether or not to make vaccines eligible for children who can't afford them. But if you got insurance and money, you're all good, right? I mean, that is not the country we live in. All right. So we've been trying to repeat this for a while. And I really feel like maybe it's good to just the mantra, like vaccines prevent disease. That's what it's about. You know, whether or not you get a little extra benefit, but really vaccines prevent disease.

36:46So people want to know, like, ah, should I even bother? Should I go ahead? Should I get that COVID-19 shot? You know, I was at Stop and Shot the other day and I got my COVID shot and my flu shot, right? So I got my, I did the new Vaxivid. Of course it was a problem. And the only reason I got it was because my wife helped me navigate, you know, which shouldn't be that way. She's like, you know, we go there. Oh, we don't have that. My wife, fortunately, writing to me, said, no, no, I called. I spoke to Jason, the pharmacist. He said you got your shipment this morning. Back and forth half an hour later.

37:16But so I get my flu. I get my COVID shot. But there was an older couple next to me. And older is anyone over 59. They were over 59. And they were just getting their flu shot. No COVID shot. So what's up with that? So maybe we need a little more education. So COVID-19 vaccine effectiveness and safety for the 2026-2027 respiratory season was published in JAMA. This is a systematic evidence review. This is not some cherry-picked study that you found in your social media. Cochrane, Central Registry, Register of Control Trials, PubMed, Medline, Embase, and Scopus were searched from August 1st, 2025 through June 29, 2026.

37:59Studies were eligible if they reported on the effectiveness, efficacy, or safety of a U.S.-licensed COVID-19 vaccine or SARS-CoV-2 epidemiology in the U.S. So they look at 11 ,829 identified references, right? So when people tell me, oh, I did my own research, really? If you look through those 11 ,829 references, you then tailored them down to, as they did, 155 publications that were eligible, including 15 randomized clinical trials, 84 observational studies with a comparative group, 38 product safety studies, 18 descriptive studies, consistent with prior evidence studies reported that updated COVID-19 vaccinations were associated with a reduction in the risk of hospitalized among both older adults.

38:49So these are folks 65 and older, 53 % vaccine effectiveness at reducing your risk of ending up in the hospital. For adults 18 to 64, a 54 % reduction in ending up in the hospital. Maternal vaccination was associated with reduced risk of COVID-19 associated emergency department or urgent care encounters among individuals vaccinated, 58 % with fewer COVID-19 related hospital contacts in the first two months of life among the infants. That was 50 to 54 % regardless of what trimester you got your vaccine. Vaccination was also associated with a significant reduction in COVID-19 related a pediatric emergency department visit, nine months to four years.

39:35That was 76%. Vaccination was associated with a reduced risk of critical COVID-19 illness. So that's ending up in the ICU or dying. That was a vaccine effectiveness of 32 to 53%. Healthcare personnel, oh my gosh, they were protected too. Post-acute COVID-19 symptoms were reduced 57%. No identified studies conducted under the updated guidance on extended dosing intervals for the primary series reported an increased risk of myocarditis or pericarditis. I want to point that out. No new safety signals, no increased risk of myocarditis or pericarditis. We are seeing increased myocarditis and pericarditis if you get COVID without the protection of the vaccination.

40:21So, all right. We're going to come to an end here. No one is safe until everyone is safe. So this is where I ask everyone to pause the recording right here. Go to parasiteswithoutborders.com and click on Donate. Even, you know, a small amount helps. I want to thank you to everyone who's actually stepped up so far because we're going to be using this fundraiser. We're going to be matching these. We're doubling your donations. We're trying to do this five-year lecture series on One Health in memory of Dixon DesPommiers. So we're going to fund that. We're going to support ASTMNH and even their president's reception.

40:59And we're going to, as we've been doing for quite a while, we're going to help support early career people from around the world coming to the annual meeting. It's time for your questions for Daniel. You can send yours to danielatmicrobe.tv. Brian writes, I know COVID vaccines have been discussed a lot on Twitter, but since we are entering booster season, could you briefly list and summarize the current COVID boosters available and the differences between them? My understanding is that there are three mRNAs, one traditional available. Are there differences between them in terms of indication and efficacy?

41:37And can you explain the rationale behind M-nex spike? Is the higher precision of this formulation intended to reduce inflammation and other unintended immune activation sequelae of vaccination? All right. So, so Brian, thanks for this. And, and I'll just run through this. And so we we've moved early on, like, so early on we did this prime and boost and we still, for little kids, there still is a scheduled series of vaccines, right? So you never saw COVID, never got a shot before, you know, you would get a prime, you get a boost and actually the kids and some of the, some of the sequence or scheduled series would be like three shots.

42:15We've now moved to kind of the same way we approach influenza. It's fall, you know, maybe at some point SARS-CoV-2 will cooperate and will respect the 12-month time it takes for us to get around the sun, and we'll just have a nice, clean winter peak like flu has done for us, maybe like RSV has been doing for a number of years. So we don't care what you did in the past. You know, we don't care if you didn't get a shot last year. We don't care if you didn't get a shot before. We're expecting to see SARS-CoV-2. We're expected to see cases of COVID-19 this winter. So you got four choices, and you go in, you get your one shot, and you're good for the winter season.

42:56You can get Comirnaty, that's Pfizer's product. That's an mRNA product. There are two choices available from Moderna. We have the SpikeVax and the MNEX Spike. We discussed a while back a head-to-head trial where it looked like the M-next spike might actually be a little more efficacious. I think it's about a 25 % increase in reducing symptomatic COVID-19. And then number four, you've got the Novavaxavid. What a horrible name. They should have just called it Novavax, but it's the Sanofi Novavax. It's the protein-based. If people are concerned about the mRNA, it also has a slightly lower reactogenicity.

43:39So those are your four choices out there. Christine writes, I find the increase in rate of vitamin K refusal for newborns to be alarming and symptomatic of a rise in pseudoscience and misinformation fueled by RFK Jr. and his acolytes. As healthcare providers and public health professionals, we are obligated to advocate for our patients, particularly the most vulnerable, like newborns. What short-term and long-term strategies do you recommend encountering dangerously false messaging and improving vaccine uptake and life-saving interventions like vitamin K? I appreciate your measured approach at a time when the loudest and most outlandish voices seem to consume public attention.

44:26Yeah, Christine, you know, this is tough. You know, and we've been doing what we've been doing. It's just constant education. I mean, you know, the other side for whatever their agenda is, they're willing to misinform. They're willing to be dishonest. We need to just keep countering that dangerous misinformation with the truth. And, you know, they say that, you know, people who you trust, people who seem to care about you. And I think that's important. I think whether it's a doctor, whether it's a nurse, whether it's just you're, you know, talking to your neighbor as just a person out there. We just need to, when there's this misinformation, when there's this dangerously false messaging going on, we just have to stand up and say, no, that's not the case.

45:14And what we're seeing now, unfortunately, as we're having refusals, vitamin K refusals for newborns, we're actually seeing negative outcomes for these little kids. So I'm at a meeting at the European Society for Clinical Virology meeting, and there was a session today on vaccine resistance. And one of the points they made was sometimes it doesn't help to give numbers. There was a campaign in Japan for encouraging the use of Gardasil, the HPV vaccine. And they said, all the mother has to do or all that someone has to do is tell the mother, do you want to see grandchildren? Then your daughter should get this vaccine.

46:05And that was incredibly powerful at raising Gardasil uptake in Japan. Wow. I mean, I think it's important to realize we're psychological beings. We're not all scientists that numbers, you know, but you, you see, you see like, oh my gosh, this, this, this woman now has cervical cancer and you could have, you could have prevented that and they're going to die and they're not going to be able to have children. And yeah, we need to hear stories and, you know, and that, that's, I think also, like, I hate to share the stories of the people that died of measles, but you need to hear, you need to hear this little baby died because it's spleen ruptured because it was, you know, riddled with measles virus.

46:45And the mother was really upset. she'd been lied to, or the other child that died. And what was RFK's? I was going to die anyway. Like, oh my gosh, we're all going to die anyway, but it's horrible. Or the other two deaths that we talk about. So you need to hear that 10, 20 % of people with measles end up in the hospital. You need to hear about people that die because the other side is, oh, it's no big deal. Watch the Brady Bunch and, oh, we don't have to do HPV. It's going to get people to be more permissuous. We have some really incredible, powerful tools, but there's a lot of money in this misinformation.

47:27So now it's important for us to use the language that really allows people to understand why we're encouraging vaccination. Brandy writes,

48:05take proper documentation to our local health department, or the family can bring the same documentation to a new patient clinic appointment. Staff in either setting can upload the vaccinations into our state registry and then allow for state-specific proof of immunization form to be generated. Schools and daycare centers require this form for registration. Unfortunately, the states all have individual vaccine registries that don't link to each other, at least not in my experience. Thanks for all you do and the TWIV team do to educate longtime listener from the primary care trenches. All right.

48:43Thank you, Dr. Coleman. This is super helpful. Pamela writes, greetings from a loyal TWIV follower. Today, I went for my appointment at a local CVS after booking a new Vaxovid vaccine online. Despite clear indication in writing that this was my request, the pharmacist messed up and gave me spike vax. Though he was profusely apologetic and admitted his error, it's not like he was going to suck it back out of my arm. My question now is whether it would be worth a follow-up vaccine at some point this winter, and if so, when. Though it is unscientific and N equals one, last year I did not get COVID with new vaxovid despite two bouts in previous years after the Moderna mRNA vaccine.

49:32Yeah, Pamela. So, you know, we've looked at, you know, we've looked at the Moderna vaccine, we looked at the Pfizer vaccine, we've looked at the new Vaxavid, which I know you were hoping to get. And it all looks like very similar efficacy. So, you know, I don't think there's a huge, you know, you've got to rush back in and get that new Vaxavid. This sounds like a little frustrating. You know, I described to Maya, like, how hard it seemed to actually be able to get this, even when I was specifically asking for it. There can be a safety issue. I guess I'll bring that up. And if you look at the licensing and the product inserts, you do not want to get a second COVID-19 vaccination if you've had a prior one within the last two months.

50:15And so this is similar like if someone shows up in the ER and maybe they have like a bad dirty wound and they got a tetanus shot a couple weeks before and the ER doc is thinking about giving them a tetanus shot and they say, oh no, I just got one two weeks ago, then we don't in general because we want to avoid potential reactogenicity and a bad reaction. So I think the two things is one is, fingers crossed, unfortunately, vaccines, they're not 100%, they're not a bulletproof shield. You still may end up with COVID this winter, but hopefully we're going to reduce your risk of severe disease, either severe disease at all or the severity of that disease.

50:56But if you do end up getting another one, you want to just from a safety point of view, make sure you let the provider know so that you don't end up with getting a second shot that would cause problems. And Janet writes, on today's show, you spoke to taking Tamiflu when diagnosed with flu. My 42-year-old son tested positive for flu B last Monday. He was able to get a script for and find a pharmacy which stocked Tamiflu the next day. He did this because he has MS and is on a drug that dampens his immune system. He thinks he got flu from his two kids, ages four and seven, who had runny, stuffy noses in the previous days.

51:35No one else but him did a rapid test. In today's show, I think you said everyone with flu should get an antiviral, not just those who are immune compromised or elderly. How would this work with kids? Would you be swabbing them every time they had a runny nose? Here in Canada, each test costs$15, and it's challenging to swab kids' noses and throats. Do GPs even prescribe Tamiflu for otherwise healthy kids? Well, so Janet from Halifax, Nova Scotia. I'm hopefully going to head up to Halifax next July. So Janet, keep writing in, and I'll let you know if I'm going to be up there. There's a sailboat race, Vincent, where you sail from Massachusetts across.

52:18But, you know, a lot of times when I was in primary care in rural northern Colorado, a lot of times you wouldn't necessarily have to do a flu test on everyone. A lot of times you'll basically have, you know, it's the flu's running rampant and, you know, you have a whole bunch of people with positive flu tests. And then the next group of folks come in and you just presumptively, you know, get them going on the Tamiflu. It is a little challenging, you know, because if every test costs$15, I get it. You know, kids knows they're always running. And so there is a challenge, right? They're always, you know, I think it was funny, like early in the pandemic, oh, kids can't transmit COVID.

52:56I'm like, oh my gosh, really? Children can't transmit respiratory viruses? In what world, right? They're always a running nose. My daughter always, right? She's teaching fourth grade. She's like, daddy, I'm sick all the time. I'm like, yes, welcome to children. Yeah, so it is challenging. But as we talked about a study last time, little kids can end up in the hospital. You know, we've actually lost a few hundred kids, you know, half of them completely healthy otherwise before they died from the flu. So it does make sense to pay attention. And it is kind of tough to make that distinction. I certainly recognize it.

53:31Right now we have a lot of enterorhinovirus going around. But it's a challenge because, you know, in a lot of different groups, we've clearly shown this benefit of getting Tamiflu, particularly in the first 48 hours. That's TWIV weekly clinical update with Dr. Daniel Griffin. Thank you, Daniel. Oh, thank you. And everyone, be safe. Thank you.