TWiV 1320: Clinical update with Dr. Daniel Griffin

This Week in Virology, the podcast about viruses, the kind that make you sick. From Microbe TV, this is TWIV, This Week in Virology, episode 1320, recorded on May 7th, 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. What do we have on the bow tie today, Daniel? That looks very nice, pink and black and little dots and swirly things. Sort of a shepherd's crook look to it. Is it like Ebola virus, right? You got it. You got it. I was looking at, yeah, I can see it. But what are the white dots? Is that just an artistic thing? Probably, yeah. Okay. Those artists. All right. Well, we got a lot. We got a lot of exciting stuff. So let me start off. This is going to be a longer one. I sort of let people know. You break it up. Let's do it all at once, you know. But anyway, I will start off with a longer than usual quotation. I really enjoyed this. So this is from John Marshall. Maybe people know who that is. But many opinions are taken up and supported at the moment, which at a distance of time, when the passions of the day have subsided, no longer meet our approbation. He who lives a life and never changes his opinions may value himself upon his consistency, but rarely can be complimented for his wisdom. Experience cures us of many of our theories and the results of measure often convince us against our will that we have yet seen them erroneously in the beginning. I mean, I like this quote. It's a bit windy, but I get the point that you need to be flexible and change your mind when the data are there. It really – I think it's appropriate. It's by John Marshall. And I actually came across this. I was reading the book The Last Branch Standing. And Sarah Ishgar is a very pithy sort of condensation of this where she says, hold strong convictions but hold them loosely. Yeah, that's good too. I like that. But yeah, no, I mean, it really is interesting. It's sort of too bad that as psychological beings, we value that decisiveness. But it sort of puts you in a position where, I don't know, whenever you make that, maybe you're 12 or 14 years old and you make your decision. And then what? Like 90 years later? You know, that's still your opinion. Yeah. All right. Hantavirus. What's that? Hantavirus. Well, I have this mug with me, and it's got a ship on it. If you're going to be on a ship, this is the kind of ship you want to be on. Yeah, a mug. But I'm going to put a link at the end. On my way home, I was listening to your YouTube, Vincent. It was excellent. It's already out of date to some extent. Things are happening very quickly. But, yes, it gives you a basic background for the whole thing, I think. Yeah, no, I think it was excellent. So we'll talk a little bit. I put some notes here, but the interesting thing about Hantum, I actually can give some background here, this is during our lifetime during my medical career. It was actually back when I was in medical school, right? So it was during spring of 1993, a mysterious respiratory disease struck the Four Corners region of the southwestern United States. And I, you know, not only was I around when this happened, but the next year I actually went to New Mexico, to the University of New Mexico, and I got a chance to talk with some of the ICU doctors that were involved when these cases came in. So it's really interesting. So we're going to talk about hantavirus, and people know why we're talking about hantavirus. So we'll get there. We'll get up to 2026. But yeah, so back here it was 30 plus years ago, this mysterious virus, and you have these previously young and healthy people get acutely ill. They end up with significant pulmonary issues. They end up in the ICU really quickly, 40% mortality, so almost half of them were dying. The CDC sends out the Epidemiology Intelligence Service folks back when we had a functioning CDC that was properly funded. And it's a fascinating story. I'll leave a link to an article about it. But what I really – about the story I found really interesting is they do a bunch of things, right? They got virologists. They've got epidemiologists. They got people like out talking to folks. And some of the older individuals – actually, the epicenter is on one of the reservations in the Four Corners region. And some of the older natives, the elders, oh, yeah, yeah. This happens. What do you mean this happens? And they actually describe what we're later going to see. They're like, you know, whenever we have these periods of heavy rain followed by a dry period, a bunch of people will get really sick and then they'll die. Like, well, what's this about? And there's a really nice article that I'll leave a link into because we're talking about the Sinombre virus, this particular type of hantavirus. And the article is Outbreak of Hantavirus Infection in the Four Corners Region in the United States in the week of the 1997-1998 El Nino Southern Oscillation. And so the story is this, is that you, and this is done very well in your YouTube, Vincent, and we're going to leave in a link. People should watch and listen to that. That's excellent. But what happens is during the heavy rains, you get a growth of the pinion pines. And a lot of these pinyon nuts. And pinyon nuts are like these sort of buttery, nutty nuts, right? You can either eat them raw, you can roast them. Should I give you the recipe, 350 degrees for about 10 to 15 minutes? They're really great. You go pick them up, roast them yourself. They're really good. Yeah, they're delicious. Yep. Not only do we find them delicious, but the mice find them delicious. And during these periods when there's a lot of pinyon nuts, you might gather a whole bunch, you might store them in your house, roast them up later. Well, then after you've had all this heavy rain and you have a dry period, then this exploded mouse population that has expanded because of this great food source, they're having trouble finding food. Where's the food? It's in our homes. They come in, you end up with mouse droppings, and then somebody sweeps up, you know, and you can aerosolize, you can breathe this stuff in. But this article is nice because it actually shows you get this increase after the rainfall during the dry. So that's kind of our background here in the US. But we're not the only place with hantavirus. There's hantavirus all over the world. And they're different. There's a particular hantavirus over in Asia, hemorrhagic fever, the sole hantavirus, right? Maybe some people are familiar with that. There's a European hemorrhagic fever hantavirus. And there is a South American hantavirus. And we're going to have to talk about that, the Andes virus. So we hear from the WHO, Disease Outbreak News, and all this, it's a rapidly moving story. But they get alerted on the 2nd of May that there's a cluster of passengers with a severe respiratory illness on board a cruise ship. This ship is carrying 147 passengers and crew. As of May 4th, there's seven cases, two lab-confirmed cases of hantavirus, five suspected cases. This keeps evolving over time. The WHO outbreak page gives us a little bit of information. They say human hantavirus infection is primarily acquired through contact with the urine, feces, or saliva of infected rodents. It is rare but severe disease that can be deadly. Then they throw in, although uncommon, limited human-to-human transmission has been reported in previous outbreaks of Andes virus, a specific species of hantavirus. So I'll leave it a link. There's actually a very nice New England Journal article that describes that outbreak. Oh, that's awesome. Published in 2024. We can put a link to that in. Yeah, we'll throw a whole bunch of links in. I'll leave in a link to the WHO. It's a very well-studied outbreak. It started with an index case who had rodent exposure. That person went to a party and spread it to a bunch of other people. And it lasted for a couple of months. And then they put quarantine and it stopped. As soon as they did that. As soon as you step in with appropriate quarantine. and no yelling about medical freedom, okay? The medical freedom to kill people. So we got that fact sheet. We've talked a little bit about what we want to know, but here are the big rubs in this case, right? You know, as we mentioned, you know, this is usually contact with infected rodents or urine. So what, were there like rodents on the ship and they're sweeping it up and it's getting sucked through those ventilation systems? Well, as we now know, as this has developed, we've got some sequencing data. There's an exception. This is this type of hantavirus, the Andes virus found in South America. And we're going to leave in a link to a bunch of these different articles. But yeah, this vessel departed from, you know, from down in that part of the world. um we now know it's this andes virus hantavirus that actually can transmit from person to person we'll talk about what what that is um but what about incubation period right we'll just let them sit on that ship until the incubation because what can that be like one or two days maybe a week oh my gosh um is it seven to 39 days is it all the way out to eight weeks amazing right Yeah. So that whole idea that we're going to wait until someone – and then I guess you got to be really careful because what if someone starts getting symptoms? If they're not all by themselves, then that next person probably has to wait eight weeks. Yep. So I think leaving on the ship is going to present a little bit of problems if you think about that. some people are going to be allowed to leave so this ship is now going to Spain because the Canary Islands wouldn't allow them to dock it's going to Spain and people will have to stay on the ship unless they can go right to the airport and get on a flight home I don't think that's a great idea I don't think that's a great idea what if you're on that plane and you start to get sick on the plane yeah so the thing that happened this elderly couple now we know they went hiking in Uruguay and Chile and Argentina for a while just before getting on the cruise He dies first She gets sick So they airlift her to Johannesburg She trying to fly to Amsterdam They don let her get on the flight but she had brief contact with the flight attendant who's now being tested in Amsterdam, and that's really the key. She then dies. I think in the airport, right? Yeah, she dies in the airport. I mean, they were right not to let her on the plane. I don't know what she was thinking, but she had some brief contact with the flight attendant at the airport. And so, you know, the flight attendant was exposed and they're doing tests today. And we should know by the end of today. And, you know, if they didn't have intimate contact, right, they're just standing at the gate and talking to the lady. So that would be a little bit different kind of transmission than, you know, if you have to be in the same cabin in the cruise ship. Yeah, that's maybe good. So we talked about the incubation period, maybe this one to eight weeks. Probably most of it is about three weeks, about 18 days is sort of the median as we think, but can be up to eight weeks. The other is a type of transmission. This is not measles, right? This is not like you enter a room theoretically. Theoretically, this is, at least in those studies, was close contact, right? So you're sharing a room, you're physically with the person. Apparently, there were super spreaders at one of those events, so people that like spraying you in the face with their pulmonary hantavirus. Yeah, they had high levels of viremia apparently. Yeah, so there's the same. There's probably that principle we've talked about where there are certain super spreaders and then maybe most people don't actually do any spreading. But that's a little bit of an issue here, you know, as far as that goes. Along those lines, well, fortunately, we know where everyone is and none of those folks are here in America, right? and the CDC would be keeping track if that was the case. But I don't know if you came across this article. So apparently on April 24th, nearly two weeks after the first person aboard a cruise ship died of Hantavirus, 30 passengers, including six Americans, disembarked. And those Americans are back here in the U.S. And is the CDC monitoring them, Vincent? No, no. Well, imagine how many people they've contacted on the way back. Not from the CDC or the State Department, but we apparently hear from MedPage today. This is ridiculous. This is totally ridiculous. Yeah. I mean, that's not where you should get your news from. It should come from CDC in the U.S. And so, folks, if you really approve of this administration destroying the CDC, this is what happens. Yeah. Yeah. Normally, we would say nothing to worry about here. This is like the CDC is on top of this. It's fairly close contact. Well, you remember when some Ebola patients came back from Africa, West Africa, they weren't sick yet, but they went to Dallas and then they got sick. And so the CDC was right on it and quarantined and isolating everyone. And it limited the spread. That situation. Yeah. So, I mean, I just – And of course, many people are already saying to take ivermectin for this, Daniel. Oh, oh. Well, you might as well. Just to be on the safe side, a little bit of chocolate-flavored horse paste. How can that be the wrong thing to do? Well, this morning I did a search for antivirus, ivermectin, and PubMed, and it said zero results. Yeah. I mean, the tough thing – and actually, so I told a little bit about my sort of personal, you know, sort of being when this started. And I actually have taken care of individuals with severe pulmonary hantavirus and was actually involved. We did trials looking at antivirals. So, you know, IV, ribavirin, nothing. We have no treatment. We have no treatment, no antiviral, no treatment that we know makes a difference. So these folks get super sick and it's supportive care. They end up on a ventilator. Maybe they end up on this extracorporeal membrane oxygenation. And you cross your fingers because it's a 30% to 40% mortality, even in these young, healthy folks. Yeah. Yeah. So, all right. And we'll leave a link into your YouTube. The YouTube, Vince, is really good. I mean, it's very – it's content-rich, so people should follow that. It's 30 minutes and someone already wrote that it's too long. Too long. They already said, you take too long to get to the Andes virus. And so I deleted the comment because this is typical of America today. You want everything fast. You need some background, folks, like Daniel just provided to you. You need to know what a hantaviruses are and what they can do. That's what life is all about, learning stuff. And I despise the fact that people don't want to learn anymore. Yeah. And then you can actually have your own opinion. You can weigh the facts. Like, are we okay that there's a few Americans who might have this hunt and might be incubating this hantavirus, like cruising around? Is that okay? Well, Daniel, let's talk about it. Is this going to cause a pandemic? So no, it's not. How do you know? Yeah, yeah, yeah. So the reason I'm going to say no, I'm going to go out on a limb there, Vincent, is as we've seen in the past, this is something that once you implement control strategies, the reproductive number drops less than one immediately. So this is something where really you can, but the problem is the challenge in this world of medical freedom is eight weeks of incubation. Well, what if it's getting into more people than it was previously and it mutates, which viruses do all the time, and the patient randomly arises that can now make it transmit better? That is not theoretically impossible. Yeah, that's true. And, you know, as we know, we have Hanna virus. We have it here on Long Island. We have Hanna virus in upstate New York, right? You actually have seen Nombre and Sol virus out on Long Island. Yeah. So the thing is, Daniel, we are worried about avian influenza H5N1 becoming more transmissible in people. It's the same issue. Yeah. Now there, lots more animals globally are infected. And so the worry is a little more realistic. Who knows how many rodents in South America are infected with Andes virus? We don't really have a good survey. And now we have maybe dozens of patients who are infected. Who knows what can happen? The best thing that anyone can do is to isolate everybody so they don't pass it on. Yeah. I mean, and were these the only two people that got whatever variant it is that they got, right? I mean, it's sort of like no one even knew for a while. Just think about that part of the world. Someone gets sick. They've got a pulmonary thing. They get sick. They die. What's the chance they're going to get good sequencing done by the South Africans? I think zero is the answer. So, yeah. That's why you have to pay attention. You have to pay attention. And when you know stuff, when you have expertise, you're ready to react and answer questions and think about it, right? Yeah. But the press doesn't know much. All they do is speak to experts, okay? Yeah. And you have to be careful. Who are these experts? Are these virologists? Are these people that have taken care of people with Hanta pulmonary virus? I mean, if you go on social media, everybody's talking about this now. They read something and they make a video. They're suddenly an expert, right? And so the real experts, I mean, I've been contacted by two media outlets, right? Just Newsweek wrote me an email and somebody else wrote me an email. But have you been contacted by anyone? to talk to you. I'm trying to lay low, Vincent, right? Well, you should talk about this. You're the expert and you're a doctor on top of being an expert. So, I mean, nobody's talking to, why isn't Apoor talking to you? No, they're probably talking to that cardiologist, right? He's an expert. Yeah. All right. Let's move on. Because this other one, I was listening to, I was a little late getting to the TWIV 1319, but I couldn't let this go because I was listening to the discussion between you and Alan Dove there. I had to jump in. And so the article you guys discussed, the article emergence of vaccine-derived poliovirus strains from the novel oral polio vaccine in the Central African Republic. And basically, as you guys discussed, this is really good. This really puts together the fact that when they tried to come up with this novel oral polio virus vaccine, you know, they were a little bold. Here, we've fixed it. This is not going to revert to a paralytic virus. They seem to not have got in their heads this combination, this recombination aspect. I mean, what was going on, Vincent? I mean, I understand the other part, but wasn't that right there? Like, hey, this is going to recombine with... Well, they introduced amino acid changes in the polymerase, which drive down recombination very low in cell cultures. Yeah. Okay. But when you give it to a billion kids, you know, all bets are off. There's a lot of substrate. So it turned out that it does recombine and now you have phenotypic reversion. Yeah. So this is an interesting discussion. So Alan is of the view that we can't do IPV because we can't inject people or everybody in the world. It's impossible. I don't agree. I don't think any paralyzed kid from a vaccine is any good. Yeah, that was what fired me up because, you know, it is interesting just because that tends to be the like, oh, my gosh, if you don't do OPV, IPV is just injectable vaccines are just a no-go in these tough areas. This is the best we have. But I think we need a reality check here. I mean, right now we are seeing, we are causing 100 to 200 cases of vaccine-drawn polio per year with our current strategy. We are paralyzing hundreds of children every year. That's not okay. That's not okay with that. I agree. I totally agree. But Alan's point is the Central African Republic can't do better than 50% immunization even with Sabin oral strains. And so he said, how can they inject them any better? Yeah, so let's talk about that. So what about, they do do injectable vaccines in the Central African Republic. They do Tdap, they do MMR. You know, the Tdap first shot is over 50%. That's a shot. That's an injectable vaccine. And you can combine that with polio, IPV, right? The Tdap. And they're rolling out injectable malaria vaccines. We're rolling out, okay, so how come suddenly we can do a four-shot injectable malaria vaccine, but we still have to give it oral? Yeah, I agree. I think the reality check is that we have to stop paralyzing kids with vaccines because that one it horrible Two it not a good look Three like we already having issues with vaccine uptake and hesitancy et cetera et cetera Yeah let yeah I think we really But you know Daniel we could step in give them a billion dollars in personnel and they could do it. Well, that's a crazy thing. Like how many billions are we dropping on Iran at the moment, right? I mean people say we don't have the money to do this stuff. Oh, we have the money. It's just what we're choosing to spend it on. Yeah. So, all right. I just wanted to make sure I brought that up. I couldn't. It's good. All right. And speaking of that, there was an article, MMR vaccine hesitancy in a polarized information ecosystem results from a cross-sectional survey of US adults published in the journal Vaccine. I like this for a couple reasons. One is it really seemed like something that a lot of people could do. I mean, these folks actually created a survey. They reached out to this company, Dynata, who distributed the survey for them, and then they basically got these responses. Overall, they report that 17% of adults believe the – you ready for this? The risks of MMR outweigh the benefits. And most adults engage with a wide range of digital media, but engagement with, quote-unquote, new right media outlets was associated with an increased odds of MMR hesitancy, adjusted odds ratio of two. Seeking health information from non-authoritative sources, both online or alternative health newsletters, also increased the odds ratio of this hesitancy. This is nonsense. These people are wrong. They're being misinformed by this digital media. Now, the policy article, CDC, communication undermines trust in vaccines, appeared in the journal Science. The CDC revised its public statement on vaccines and autism in November 2025, suggesting that a possible association between vaccination and autism had not been ruled out with sufficient scientific rigor. Yeah, a large-scale online experiment tested the efforts of this shift in communication, showing the new uncertainty-based statement amplifies public uncertainty, reduces vaccination intentions, and increases endorsement of science denial strategies. I mean, basically, RFK Jr. is lying, and he's making the CDC lie to it. He's lying, and it's having consequences. Yes. All right. And then I couldn't – you know, I wasn't sure I wanted to put this in. It just made me sick. But this article, FDA-blocked publication of research finding COVID and shingles vaccines were safe by Christina Jewett. It was published in the New York Times. The Times says that in October, scientists were directed to withdraw two COVID-19 vaccine studies that had been accepted for publication in medical journals. The studies, which cost millions of dollars in public funds, were conducted by scientists at the agency who worked with data firms to analyze millions of patient records. They found serious side effects to be very rare. Dr. Aaron S. Kesselheim, a Harvard University medical professor who studies FDA regulation, said he had worked with the agency on a number of research papers and found its work to meet the highest standards of scientific investigation. He suggested that the request to pull the papers was an act of censorship. He added, at any other time in history, this would be a major scandal that would lead to congressional hearings, resignations of leadership, and I hope that's what happens next. I love that quote. That's just perfect, right? It's really appropriate. This is wrong. Yeah, this is censorship. All right. So let's move on to what is going on. What are we seeing? Viruses are down. Ticks are up. I love that. That's great. This is really nice, these figures. So if people are watching on YouTube, you can see. We've got patterns, right? Like us ID docs are always busy with something. One thing starts to go down and the other thing comes up. So right now the ED visits for tick bites are shooting upwards. It starts in March and then it just rises all the way up. And at the same time, our viral infections are on the way down. I didn't realize people went to the ED for a tick bite. Oh, yeah. People get pretty worried about the tick bites. Really? They're worried about Lyme and Borrelia and what else? They're worried about everything. Lyme's the biggest concern. And then you start telling them, like, I understand you're here for Lyme, but let me frighten you more. You can get adiplasma. You can get Ehrlichia. You can get Babesia. Oh, wait. That's a dog tick. We can worry about Rocky Mountain Spotted Fever. And sometimes you get more than one. Just stay home. Don't go walking in the woods. You can see home, play video games and get diabetes. I mean the people who went on the hike into South America. Why did you do that? All right. Measles. So the numbers keep ticking up. This time I've actually got last week and this week for the measles tracker from Hopkins. So we went from 1877 up to 1923. So it's another 46 cases. So as of April 30th, 2026, a little behind from the CDC, 1,814 confirmed measles cases. Now, I want to point out that the majority of these, as you can see looking at the map here, these are local. These are not imported cases. And that's going to be an issue because the letter came out in the Lancet, will the USA lose its measles elimination status? And this group used the elimination indicators established by the CDC, National Immunization Program Expert Panel in 2000, and applied during the 2011 recertification review, introducing cutoffs based on the 2001 to the 2011 period. And we have this really nice figure. But what are kind of the different criteria? We've got seven of these. So you want to have a low measles incidence. So annual total reported measles cases of less than one reported cases per 10 million people. Yeah, we're, you know, 77.6 per 10 million people, you know, as of January 23rd, as of February 17th, 2026, we're up to 93.2 cases per 10 million people. So not even close. High proportion of imported cases, right? If you're going to have cases, they're imported, people coming here. And how are we doing with that? Nope. 7.2% of cases are imported. 6.3% of cases are imported. So mostly here. Low number and size of outbreaks. Yeah, anyone paying attention. 48 outbreaks in 2025. We already have five outbreaks, you know, in the beginning part of this year already. transmission levels. They talk about that. We're not doing great there. All we're really waiting for at this point is some sequencing data because we do not have the high population immunity that we need to get out of this. So I'll leave in a link to that. But they conclude, given the current epidemiological context, it appears highly likely that the USA will lose its elimination status in 2026. Strengthening vaccination efforts, reducing exemption rates, and interrupting ongoing local transmission will be essential to reverse this trajectory. Are you optimistic, Vincent? Oh, no. We are losing this unless censorship happens, right? Unless the RFK's people decide to censor the data and then, you know, because they don't like this. It's not a good vision, right? Yeah. The only way we don't lose status is by lying, basically. Yeah. Yeah. So, I mean, we basically, we're just waiting for the stamp. They've already kind of delayed this, so it wouldn't affect the midterms quite as much as they're worried. So, all right. As mentioned, we're getting out of the respiratory season. At least flu is well below the baseline. But another six influenza-associated pediatric deaths reported this week. We're up to 155 children died of flu this year. RSV, also we're coming, we're pretty much down out of the RSV season as well. But another article about another benefit, the article Impact of Respiratory Syncytial Virus Immunization on the Rate of Pediatric Acute Otitis Media, a time series analysis published in CID, the benefit of vaccination as opposed to infection, RSV. These investigators conducted an interrupted time series analysis based on a French network involving 110 ambulatory pediatricians trained in pediatric ID. All ambulatory visits for AOM, acute otitis media, June 2017 to February 2025, were included. Main outcome was the monthly rate of pediatric ambulatory visits for acute otitis media in infants under 12 per thousand pediatric ambulatory visits over time. Basically, what they're going to find is the rate of acute otitis media was decreased after RSV immunization implementation. So this included the passive, so nircebamab for the babies, and active, the abrisvo RSV vaccine for the moms. And we saw about a 24% reduction. Pretty impressive. So this is a disease that the pediatricians used to always give you antibiotics for. It's interesting. So here becomes the issue. Are you getting a bacterial otitis media or is this sort of related to the RSV? Because you could get the RSV, then get a secondary bacterial infection, or you could get an RSV otitis media and they just don't know. So you end up with antibiotics. What is the proportion? Do we know viral versus bacterial of otitis media? I don't think we really know. I have to say, in a lot of places in Europe, they tried not to treat otitis media with antibiotics. We have a little bit more of an issue in the US, just probably more of a legal issue, just sort of a one in a thousand cases will go on to become more serious, a mastoiditis or a meningitis. All right, COVID. Things look really good except for Nebraska and West Virginia. What is going on? But everywhere else, it's very, very low, except it's high in Nebraska, and it's moderate in West Virginia, so kind of crazy. But the wastewater, what is the graph here, the multicolored lines? Is that wastewater Yes this is our multicolored wastewater line No it way down right It in the very low area Yeah No overall this is as low as it been This is fantastic All right. And we're going to wrap us up with just a couple articles here in the long COVID section, the article, Multisystem Inflammatory Syndrome in Children, MIS-C, United States 2023, 2024, published in JID. It's a nice update. So this is that rare issue following SARS-CoV-2 infection, but we're still seeing sporadic cases. This analysis of cases during this time period showed little change in clinical presentation. Among vaccine-age-eligible children, 99% occurred in children who were not up to date with their vaccines. 99%. So just craziness. And we also have the article, Current Status and Future Perspectives on the Mechanistic and Pathophysiological Understanding of Long COVID, published in Communication Medicine. And this is really a review, and I'll leave in a link. But, yeah, it's kind of what I have to say. All right. And we'll conclude, as we have for a while, no one is safe until everyone is safe. We're in our FIMRIC, our Foundation International Medical Relief of Children fundraiser, May through June, where we're going to try to raise that $10,000. We're going to double your donations up to that maximum donation of $10,000. It's time for your questions for Daniel. You can send them to Daniel at microbe.tv. Now, we got many emails asking us to talk about the Paxlovid study. Well, we thank you very much, but we covered it already, didn't we, Daniel? We did. So maybe they just have to go back and listen to, what, 1318. And we covered it in depth. Yeah, and we're still getting lots of emails. So it just tells me that maybe you're not up to date on your listening. So check it out. It's all good. All right. Anonymous writes, I listen to your podcast and really appreciate your solid science-based views. I would love your recommendations on my questions. One, would you recommend my 14-year-old daughter with alpha-1 antitrypsin deficiency, clinically extremely well, take an antiviral if she gets flu this winter? We live in New Zealand, so we're going into winter now. She had flu vaccine. She's never taken antivirals before, but I hear we have super K influenza coming, which our vaccines aren't covering very well. TANV flu has been around longer, has a good safety profile compared to Zofluza, which has no carcinogenicity studies. However, Zofluza has a lower risk of liver tox compared with Tamiflu. My daughter has frequently had raised liver enzymes as part of alpha-1 antitrypsin deficiency. Our GP is reluctant to prescribe antivirals as they, quote, only shorten length of sickness for one day. As she is healthy and vaccinated and we want to avoid the possible liver issues or possible long-term issues. What are your thoughts on this? Yeah, so I would recommend it in this context. I mean, as we keep covering this whole idea that, oh, it's just the flu, we are seeing one to 200 children die. The majority of these are completely healthy. You're describing your daughter who is not completely healthy, who actually has this alpha antitrypsin deficiency. So yeah, I would actually, I mean, I see this as a risk benefit, you know, so I would talk to your doctor a little bit more about this. Number two, would you recommend that I ask for antivirals if I get influenza? I'm 54 and vaccinated against flu. My doctor advised me not to take antivirals as they are only for people at high risk. Oh, dude. So not only should you take it, but remember, we talked about the study how the Zofluza, the Biloxivir, you take it, you reduce your risk of spreading it to your daughter. So we discussed that a couple of episodes ago, probably, right? So letter writer, you should go find that study and show it to your GP. And then last question, would you recommend me taking Paxlovid if I test positive for COVID? I'm not in a high-risk group again, and my GP is not recommending it for me. I'm keen to know your thoughts. My first COVID infection knocked me out for 12 weeks. I did take Paxlovid and suffered a, quote, rebound, end quote. So I'm not sure what to do. I really want to avoid long COVID and other complications and get vaccinated every six months. My risk factors are anxiety and that I had a large number of symptoms last time. I am female and over 50. Yeah, so this is like perfect to the study we talked about last time where, you know, basically it was, as we discussed, healthy women in their 50s getting Paxlovid was associated with feeling better seven days sooner. You know, so I appreciate your comment about the rebound, but the rebound is an inflammatory rebound. Symptomatically, it's not different. This is not something that was triggered by the Paxilovid. And as we saw in the study, basically looking at folks like you, women in their early 50s, you could actually feel better a week sooner, which might be helpful if you've got a daughter and, well, a life to live. 14-year-old daughter, oh my gosh. that and feeling sick for an extra week. Aaron writes, first, thank you for all that you do. I never miss an update. And along with TWIV, I also really enjoy Puscast and all the other Microbe TV podcasts. I'm sure you want to hear that it's a spring-like rainy day and five degrees C here in southwestern Ontario, Canada. I am a professor of nursing, and my research focuses on effective vaccine communication techniques. I frequently give talks in collaboration with Merck on the HPV vaccine, and I truly appreciate the HPV papers and discussions you've shared over the past year. I recently received a question during one of these talks, and I wanted to pass it all along to you. How long does HPV survive on fomites and non-human surfaces? I realized I didn't have a clear evidence-based answer and was hoping you might have insight. Okay, so this is good. You know, my first thought, Vincent, before I sort of went into like thinking about like the time course was, you know, how is HPV transmitted, right? Like, even if it survives on these surfaces, is it really going to end up infecting someone from those surfaces? Because I think that's something to think about. So, you know, some of the stuff you can look at is PCR detection, but what you really want is you want to know, you know, are there still infectious, you know, HP viruses? So, you know, what we usually quote based upon some of these studies is hours to days, you know, maybe out to three days. But there is some evidence that maybe you get out to seven days or something like that. Vincent, you had... Yeah, I think that, you know, it's not easy to measure infectivity of HPV. so you can compare it to other papillomaviruses. And yeah, in one study, 50% infectivity retained after three days at room temperature. Half-life on dry materials, about three days. Infectivity of about 30% for seven days. So it doesn't last forever, but this is a sexually transmitted infection, right? So I don't know what surface contamination would play in that. Yeah, I mean, unless it was something that was being used sort of that would have contact with, you know, that part of the body. Yeah, but, you know, I mean, this is sexually transmitted, which means you have to get virus near the cervix, right? Yeah, so you would need something that would do that. I don't know that that's going to be – but anyway, it's a short-lasting on surfaces. Yeah. Anonymous writes, years of age and immunosuppressed. Yeah, no, I mean, I hate when they do this. I mean, a lot of times institutions will run the numbers and they're making decisions based upon the bottom line. And, you know, we've talked about the evidence that the Pemgarda infusions should continue to have efficacy. So, yeah, no, this could be awkward and somehow you got to navigate this because the evidence, forget about the beliefs, forget about the decisions some administrator made. The science would suggest that those PemGuard infusions would still be a reasonable option for you. Marie writes, you mentioned how Paxlovid shortens the COVID course and helps prevent hospitalization on May 2nd. Does Paxlovid help prevent long COVID also? Yeah, unfortunately, Marie, the data on that has been mixed. So I would say that, you know, we don't have compelling evidence that it's going to prevent long COVID. We really thought it would. There were studies that maybe it would even be a treatment, but sorry. Joey writes, you often advise pregnant people to get certain vaccines in the last trimester of their pregnancy to protect their babies until the babies can get vaccinated. Just curious, are there certain types of vaccine that this will not work for? Wouldn't it be great if women could get booster measles, pertussis, chickenpox, et cetera, vaccines to protect their babies? I'm assuming it doesn't work for all childhood illnesses or you would be recommending it. Yeah, so I think part of it is studies. You know, it would be reasonable to start looking at more vaccines, like because we do this with RSV, right? We do it with COVID. We do it with flu. You know, would it make sense to start doing some of these other vaccines during that last trimester and then helping to protect the babies during this window? Vincent, any thoughts? Yeah, I think it's a great idea, right? So why don't we do it? I think we need to study it, right? It's one of those things that, you know, just like that, you know, it's got to be humility. Like, we don't know. And so you've got to study and find out. And if we have evidence that it's safe and effective, then I think we can move forward. Yeah. And also, Joey writes, every time I hear RFK Jr. talk, I like to imagine that the ghost of his father has him by the throat trying to stifle. His foolishness. It gives me some comfort. That's TWIV Weekly Clinical Update with Dr. Daniel Griffin. Thank you, Daniel. Thank you. And everyone, be safe.