As the calendar turned to 2025, a comprehensive clinical update was presented by Dr. Daniel Griffin and Vincent Racaniello on the podcast This Week in Virology (TWiV). The discussion, recorded shortly after the New Year, delved into critical public health issues, including a concerning whooping cough outbreak, declining tetanus vaccination rates, and the persistent challenges posed by endemic viral infections. Dr. Griffin also provided an in-depth analysis of current epidemiological data for measles, RSV, influenza, and SARS-CoV-2, highlighting the utility of new public health surveillance tools and offering practical guidance on accessing treatments and managing long COVID. The episode underscored the vital importance of evidence-based medical practice and the ongoing need to defend scientific integrity.
Resurgence of Pertussis and Declining Tetanus Immunity
A significant portion of the update focused on the alarming resurgence of pertussis, commonly known as whooping cough, across the United States in 2025. Pertussis, a highly contagious bacterial respiratory infection, is particularly dangerous for infants, often leading to severe complications and fatalities. While the United States has historically maintained low rates of pertussis due to widespread vaccination, recent data indicates a troubling upward trend.
Background and Timeline:
Pertussis was once a leading cause of childhood mortality in the US, with hundreds of thousands of cases and thousands of deaths annually before the introduction of the DTaP (diphtheria, tetanus, and acellular pertussis) vaccine in the 1940s. Widespread vaccination efforts led to a dramatic decline in incidence. However, immunity from the DTaP vaccine wanes over time, necessitating booster doses. Recommendations include boosters at ages 15-18 months, 4-6 years, and a Tdap (tetanus, diphtheria, and acellular pertussis) booster for adolescents and adults, with subsequent Td boosters every 10 years.
Current Data and Implications:
The 2025 outbreak has been characterized by an increasing number of reported cases, exceeding pre-vaccine era figures in some regions. While specific national cumulative data for the entirety of 2025 was still being compiled during the recording, preliminary reports suggested a significant rise in pediatric and adolescent cases. This resurgence is strongly linked to a concurrent decline in tetanus vaccination rates. Tetanus, a severe neurological disease caused by Clostridium tetani bacteria, is also preventable through vaccination. The DTaP and Tdap vaccines provide protection against both pertussis and tetanus.
Dr. Griffin highlighted that the declining tetanus vaccination levels are a critical indicator of potential vulnerabilities in broader immunization coverage. A lapse in one vaccine-preventable disease often signals a broader erosion of public trust or access issues affecting multiple vaccines. This decline means that not only is pertussis re-emerging, but the population is also becoming increasingly susceptible to tetanus, a disease that, while rare, remains potentially lethal and requires prompt medical attention.
Inferred Reactions:
Public health agencies, including the Centers for Disease Control and Prevention (CDC), have expressed deep concern regarding these trends. While official statements often emphasize continued vaccination efforts, the scale of the outbreak suggests a need for intensified public awareness campaigns and potentially revised strategies to address vaccine hesitancy and improve access, particularly in underserved communities. Pediatricians and infectious disease specialists have reiterated the importance of adhering to the recommended vaccination schedule for all age groups.
Deep Dive into Viral Infections: Measles, RSV, Influenza, and SARS-CoV-2
The clinical update provided a granular look at the current landscape of several significant viral respiratory illnesses. Dr. Griffin presented recent statistics and trends, emphasizing the interconnectedness of public health surveillance and individual risk.
Measles Epidemic: A Global and Domestic Concern
Measles, a highly contagious viral illness, continues to be a significant global public health challenge. Despite the existence of a safe and effective vaccine (MMR – measles, mumps, and rubella), outbreaks persist worldwide and have impacted the US.
Background and Data:
Measles was declared eliminated in the US in 2000, but this status is contingent on high vaccination coverage. Declining vaccination rates have led to recurrent outbreaks. In 2023, the US experienced a notable increase in measles cases, and early 2025 data indicated this trend was continuing, with several states reporting clusters of infections. Dr. Griffin referenced data from the Johns Hopkins Measles Tracker, a publicly accessible resource, which illustrated the geographical distribution and temporal progression of these cases. The tracker highlighted that outbreaks often originate from international travelers who are unvaccinated or under-vaccinated, subsequently spreading within communities with low MMR coverage.
Implications:
The resurgence of measles poses a direct threat to unvaccinated individuals, particularly infants too young to be vaccinated and those with compromised immune systems. Measles can lead to severe complications, including pneumonia, encephalitis (brain swelling), and death. The economic burden of managing outbreaks, including contact tracing, quarantine, and hospitalizations, is also substantial.
Respiratory Syncytial Virus (RSV)
RSV is a common respiratory virus that typically causes mild, cold-like symptoms but can be severe, especially for infants and older adults.
Current Trends:
While RSV seasons can vary, Dr. Griffin noted that patterns in 2024-2025 indicated continued circulation of the virus. The availability of new vaccines for older adults and pregnant individuals (to protect newborns) has been a significant development. However, the effectiveness and uptake of these new preventative measures are still being evaluated. Surveillance data, including information from the Wastewater Scan dashboard, which monitors viral shedding in wastewater, offers early indicators of community-level transmission.
Analysis:
The ongoing circulation of RSV underscores the need for continued vigilance and awareness, especially among vulnerable populations. Public health messaging around hygiene and symptom recognition remains crucial.
Influenza (Flu)
The 2024-2025 influenza season presented a particularly challenging period.
Data Highlight: New York’s Record Week
Dr. Griffin pointed to a stark statistic: New York State reported the greatest number of confirmed influenza infections in a single week during the week ending December 20, 2024. This record-breaking figure signals a potentially severe influenza season with high transmissibility and impact.
Broader Context:
Influenza activity is monitored globally and nationally through various surveillance systems. The intensity of the flu season is influenced by several factors, including the predominant strains circulating, the effectiveness of the annual vaccine, and population immunity. High case counts in one state often foreshadow wider national trends.
Implications:
Severe influenza seasons place a significant strain on healthcare systems, leading to increased hospitalizations, emergency room visits, and deaths. The availability and uptake of the influenza vaccine remain critical public health tools for mitigating the severity of these seasons.
SARS-CoV-2 (COVID-19)
Despite the global pandemic phase having passed, SARS-CoV-2 continues to circulate and evolve.
Ongoing Surveillance:
The Wastewater Scan dashboard has become an indispensable tool for monitoring community-level SARS-CoV-2 prevalence, providing a leading indicator of infection trends that can precede reported case numbers. This technology allows public health officials to detect surges in viral shedding, enabling timely public health responses.
Impact and Management:
While severe illness and mortality have decreased due to vaccination and prior infection, SARS-CoV-2 continues to pose risks, particularly for immunocompromised individuals and those with underlying health conditions. The focus has shifted towards managing ongoing transmission, preventing severe outcomes, and addressing the long-term consequences of infection.
Accessing Treatments and Addressing Long COVID
Beyond infectious disease outbreaks, Dr. Griffin provided essential information regarding treatment accessibility and the complex challenges of long COVID.
Antiviral Treatments for COVID-19
Paxlovid Access and Cost:
For individuals diagnosed with COVID-19, timely access to antiviral medications like Paxlovid is crucial for reducing the risk of severe illness. Dr. Griffin clarified the pathways for obtaining Paxlovid, emphasizing that it is a prescription-only medication. Patients should consult their healthcare provider. Information regarding cost and insurance coverage is often available through pharmacies and public health resources. Programs may exist to subsidize costs for eligible individuals.
PEMGARDA:
The discussion also touched upon PEMGARDA, a long-acting antibody treatment for COVID-19 prophylaxis. Dr. Griffin provided guidance on where to find information and how to access this preventative option, noting its importance for immunocompromised individuals or those unable to receive vaccines.
Long COVID: Treatment and Support
The persistent and often debilitating symptoms of long COVID remain a significant public health concern.
Treatment Centers and Resources:
Dr. Griffin highlighted the growing need for specialized care for long COVID. He directed listeners to dedicated long COVID treatment centers and emphasized the importance of seeking out healthcare providers knowledgeable about the condition. For those seeking answers to their long COVID questions, he recommended consulting reputable medical institutions, patient advocacy groups, and official public health websites that compile evidence-based information.
The "Assault on Science" and Advocacy:
In a passionate appeal, Dr. Griffin urged listeners to contact their federal government representatives to advocate for the protection and support of science and biomedical research. He characterized current challenges as an "assault on science," suggesting that efforts to undermine scientific inquiry and evidence-based policy could have detrimental long-term consequences for public health and societal progress. This call to action underscored the critical role of scientific integrity in addressing current and future health crises.
Conclusion: Evidence-Based Practice and Future Preparedness
The TWiV 1284 episode served as a potent reminder of the dynamic nature of infectious diseases and the ongoing need for robust public health infrastructure, accessible healthcare, and informed citizens. The discussion, anchored in evidence-based approaches to medicine and public health, provided critical updates on outbreaks, surveillance, treatment, and the imperative to defend scientific principles. As Dr. Griffin and Vincent Racaniello concluded their update, the message was clear: vigilance, education, and collective action are essential in navigating the ever-evolving landscape of virology and public health.
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