transcript

Speaker 1:
[00:08] Hello, and welcome to the Osterholm Update, a podcast about infectious diseases and public health featuring Dr. Michael Osterholm. Dr. Osterholm is an internationally recognized medical detective and director of the Center for Infectious Disease Research and Policy, or CIDRAP, at the University of Minnesota. In this podcast, Dr. Osterholm draws on over 50 years of experience in infectious disease epidemiology to provide straight talk on the latest infectious disease outbreaks, counter misinformation and disinformation about vaccines, and distill the complex and ever-evolving public health threats facing our world. I'm Chris Dall, reporter for CIDRAP News, and I'm your host for these conversations. Welcome back, everyone, to another episode of the Osterholm Update podcast. It's been 239 days since the Centers for Disease Control and Prevention had a Senate-confirmed director. But in reality, the CDC has been rudderless for longer than that. It was August 27th when Susan Menorrez was fired by the Trump administration. But remember, she had only been in the job for a month before being ousted by Health and Human Services Secretary Robert F. Kennedy, Jr. Since early January of last year, the CDC has mostly been led by a rotating cast of acting directors. But last week, after missing a congressionally mandated deadline, the Trump administration finally nominated Dr. Erica Schwartz, a physician, Coast Guard officer, and supporter of vaccines to lead the CDC. Public health experts appear to be encouraged by the selection of a highly qualified, more traditional choice to be the agency's director. If confirmed by the Senate, can Dr. Schwartz bring some much-needed stability to the agency? That will be one of the topics we'll be addressing on this April 23rd episode of the Osterholm Update, episode number 207. We'll also discuss changes to the charter of the Advisory Committee on Immunization Practices, examine a somewhat misleading poll on public support for vaccines, provide an update on US respiratory virus activity, explain a concerning rise in cases of extensively drug-resistant Shigella, and answer an ID query on lung COVID in women. Of course, we'll have the latest installment of this week in public health history. But before we get started, as always, we will begin with Dr. Osterholm's opening comments and dedication.

Speaker 2:
[02:40] Thank you, Chris, and welcome back to the podcast family. It's wonderful to be with you again. I can't say it enough times how much we appreciate your feedback, your support, your ideas. It really means a lot to us, and I really do believe it feels like a family. Also, I want to say to those who might be joining for the first time or only have joined with us on an irregular basis, I hope today we're able to provide you with the kind of information you're looking for. We've promised you for years with this podcast that we would try to give you a variety of experiences, both the hardcore science in some cases, but also a little touch of life. Today, as I start out dedicating this particular episode to, I think, a very magical moment that occurred in an otherwise tormented world in the last two weeks. This week, I want to take a moment to reflect on the Artemis II mission, the first mission to the vicinity of the moon in over 50 years. And over 10 days, the crew of four astronauts circled around the moon and broke the record traveling for the furthest human spaceflight, traveling just over 250,000 miles from Earth. I must say that looking up at the sky and seeing that bright moon as the spacecraft hurled towards it was a quite remarkable experience. Also, I just want to make a note because I think many people do not fully appreciate who Artemis is or how did it come about with this title. Well, for those who are familiar with ancient Greek religion and mythology, you know that Artemis is the goddess of hunting, of the wilderness, of wild animals, transitions, nature, vegetation, childbirth, and even the care of children. But in this case, all about the wilderness, exploring that beyond which we had ever had a chance to see before. It is an amazing experience to think that dating back to the beginning of this entire world as we know it, all that exists, no one is a human had ever gone to the backside of the moon and we did it. Last week, those four incredible astronauts, Christina Cook, Jeremy Hansen, Reid Weisman, and Victor Glover splashed down safely in the Pacific after their groundbreaking 10-day mission. Today's episode is dedicated to everyone involved with the Artemis II mission. Not only those inspiring astronauts, but to the countless scientists, researchers, engineers, and other workers who helped turn this dream into a reality. This mission showed us just how far humans can come in the world, especially when we work together. I think astronaut Reid Weisman summed it up best when he said, There is nothing normal about this. Sending four humans 250,000 miles away is a Herculean effort, and we are now just realizing the gravity of that. When you take a moment to sit with what this crew has accomplished, it's such an extraordinary achievement, don't you think? And what a team it took to make that happen. Ironically, space exploration can actually really ground us. There's even a scientific term for it called the overview effect, which is the profound experience you get from seeing Earth from a great distance. And you don't have to be an astronaut to experience this. Even seeing a photo of Earth from the space above can do it. The sheer awe of seeing our planet from afar can help people realize just how precious life on Earth actually is. It's a chance to zoom out and take in how little we are in the grand scheme of things. So thank you to the Artemis II mission. What an incredible feat for humanity and a rare moment for all of us to celebrate together. And now moving on to one of my favorite parts of the podcast. But for some of you, you can take your 32nd break right now if you'd like to. Today, on April 23rd, here in Minneapolis, St. Paul, sun rises at 614, sunset is at 808 p.m. By the way, that's Central Daylight Time. I'll come back to that in a moment. That's 13 hours, 54 minutes, and one second of sunlight. Wow! It is getting bright out there. By the way, we're gaining sunlight right now this week at about 2 minutes and 53 seconds a day. Now, I will have to admit, living in Minnesota over the past few weeks has been a challenge. As I would like to think, we are experiencing the 90 days of weather in the month of April. One day it can be 80 degrees and the next day it can be snowing. We're at that transition time right now where I can't wait till we just have some wonderful, beautiful 75 degree days with a little bit of rainfall to make those flowers grow. Now, to our dear, dear friends and colleagues at the Occidental Belgian Beer House in Alcon Lane in Auckland, today your sunrise is at 6:53 a.m. sunset at 5.45. That's 10 hours 52 minutes and 11 seconds of sunlight. Unfortunately, you're losing about 2 minutes and 6 seconds of sunlight a day. Of course, we here in Minneapolis, St. Paul, live in the Central Daylight Time Zone. The question came up, what is the zone for New Zealand? What do they call it? I bet most of you don't know. So, here you get a little piece of information that otherwise you would not have ever had. In fact, it's called the New Zealand Standard Time. They just went on Standard Time last week after having been on their daylight savings time. But it's the New Zealand Standard Time. So, now you're really up to speed on light, both here in Minnesota and of course in New Zealand.

Speaker 1:
[08:19] Mike, as I noted in the introduction, Dr. Erica Schwartz appears to be a more traditional choice to lead the CDC than we might have expected from this administration. But she still needs to be confirmed, and even if she is, she will be working under a health secretary who to date has shown nothing but disdain for people with traditional medical and public health expertise. Can she succeed under these circumstances?

Speaker 2:
[08:43] Well, Chris, let me first say I don't know her personally. Dr. Schwartz is definitely a departure from the type of nominees we've seen from the Trump administration in the past year. She is a highly qualified, respected, and experienced physician, former Deputy Surgeon General, former Chief Medical Officer of the US. Coast Guard, a retired rural admiral in the Commissioned Corps of the US. Public Health Service, and notably she has a history as a vaccine supporter. She also holds a law degree and led the federal government's drive-through COVID-19 testing program during the peak of the pandemic. After her nomination last week, respected organizations such as the American Public Health Association endorsed her as someone who would understand that the CDC must be guided by evidence-based science. But other experts have cautioned despite her best intentions, she would likely have to face off with HHS Secretary Robert F. Kennedy Jr. on vaccines during the Senate confirmation process and if appointed would be under considerable pressure to kowtow to the ideology of the superiors. My comments should not be the ones that would convince you that there will be a challenge for her to be a successful CDC director. Look no further than what happened this past Tuesday, when in fact Secretary Kennedy was testifying before the House Energy and Commerce Health Subcommittee and was asked point blank about his relationship with the new CDC director. He actually refused to commit not to interfere with recommendations from CDC under the leadership of the new director. So in fact, I don't know how anyone could be an outstanding CDC director when in fact you may end up becoming nothing more than a puppet for what is Mr. Kennedy's decisions around so many critical public health issues, most notably vaccines. So all I can say is stay tuned, hold on, and know that this is going to be a challenge. One other point that I want to make, and this is one that we have struggled with repeatedly over the course of the last 16 months, and that is, can you trust what CDC is telling you now? The question is, well, wait, wait, why would that be the case? Well, let me point out that during the Biden administration, and again, I'm not here to endorse his administration or their actions, but in fact, at any one time, there was one and maybe two political appointees and leadership positions at the CDC. Otherwise, it was all really time-tested public health experts who were there. Now, the current CDC has more than 15 politically appointed individuals and leadership positions at CDC. The kind of oversight that is happening now is such much more about ideology than it is about science. And so we really do have a challenge today of discerning which information from CDC can you trust, that which has not gone through the review and editing of the political appointees versus that which has. And so when I talk about the you can't trust CDC today, that is only applying to certain information that has been altered. And we don't always know immediately that that's what's happened. There is also still very important work being done by many, many competent, capable and dedicated public health experts at CDC. You can trust their work. It is very important work. But again, it will always be interpreted through the lens of what did the political oversight end up having to do with that particular piece of information. So let me just conclude by saying Chris, I actually believe that this is going to be a struggle. I think just as Susan Monoraz ended up having to quit or fired, depending on whose story you believe, I think this new CDC director is going to have a very difficult time maintaining public health credibility and the editorial oversight that is likely to come directly from the Secretary of HHS himself.

Speaker 1:
[12:52] While the Trump administration recently has appeared to want to downplay Secretary Kennedy's actions on vaccines, Kennedy recently made some changes to the charter of the Advisory Committee on Immunization Practices that would allow him to nominate more vaccine skeptical voices to the committee. Mike, what does this mean for the future of the ACIP?

Speaker 2:
[13:12] Well, let me first start out by saying that what is likely to take place over the next four to six months, as it relates to the midterm elections and how positions will be staked out, about do I want to take on difficult issues and alienate certain populations out there, and it's clear that the data supports that the vast majority of Americans still support vaccines. So don't be surprised if you see a pullback on some of the criticisms and some of the actions that have been taken by this administration around vaccines. This is not polling as a popular issue right now for the administration. So I interpret everything both in the immediate lens and the lens of the midterms. Well, Chris, first of all, let's understand what's happened with ACIP. Every two years, the ACIP renews its charter under the Federal Advisory Committee Act. This is a standard practice across agencies and typically involves routine paperwork. It will likely come as no surprise when I tell you that this renewal is not typical and this new ACIP charter contains some real red flags. The previous charter expired on April 1st, which I'll remind you was just two weeks after a federal judge ruled that Kennedy's restructure of the ACIP and changes to the childhood immunization schedule were actually unlawful. The ruling placed all vaccine policy changes that occurred since June 2025 on hold. While the administration still had not appealed this decision, it has made changes to the newly updated charter that seems to address some of the judge's rulings. For example, the previous charter required members to have expertise in vaccine use. The new charter does not. Instead, it expands the eligibility to include those with expertise in pediatric neurodevelopment, toxicity, data, statistical analyses, health economics, and notably expertise in recovery from serious vaccine injuries. That last clause in of itself is very concerning. It's unclear who will determine whether an injury has been proven to be the result of a vaccine, which is a discussion for another podcast. But I will add that people who are known to oppose vaccines have advocated for this membership change for a very long time. Next, this updated charter also made changes in the non-voting liaison organizations, removing the American College of Obstetricians Gynecologist or ACOG, which had withdrawn itself in February. It added three new groups, all of which are generally considered to be vaccine skeptical. The Association of American Physicians and Surgeons, Physicians for Informed Consent, and the Independent Medical Alliance. Finally, the language used in this revised charter suggests an emphasis on vaccine risks, as opposed to their health and economic benefits, opening the door for the committee to revisit existing evidence-based recommendations. So what does this mean for the future of ACIP? Frankly, it's really hard to know for sure. There could be legal challenges, especially in the context of the March ruling by Judge Murphy, and many states are taking action to move away from the new HHS guidance. What we do know is that these changes will undermine the integrity of the ACIP. That is not new. These actions are yet another way for this administration to plant doubt and skepticism, which has been their goal all along. A lot of damage has already been done, and it's going to take years to rebuild the trust and integrity that has been destroyed. But what I can promise is, we here at CIDRAP and the Vaccine Integrity Project, we will continue to focus on facts, science, and evidence to provide you with the best information available.

Speaker 1:
[17:00] While we're on the topic of vaccines, there was a poll published last week in Politico, in which 46% of respondents agreed that facts on vaccines are still up for debate, and that it is damaging to enforce their uptake. But Mike, as you just noted, that contradicts some other polling that shows the US public widely supports vaccines. And as you pointed out, there is some concerns about the wording of the questions in this particular poll. Explain.

Speaker 2:
[17:27] Well, let me first start out by saying that I'm very disappointed to see a poll like this being supported by and reported out by Politico. Politico has had a reputation for being an organization that is careful to present the data as factually as possible. Well, they blew it on this one. First, a bit of context. Politico surveyed approximately 3,900 adults in the United States in March about vaccine safety, the recommended schedule, and personal choice. As you mentioned, Chris, nearly half of the respondents claimed the science was unclear and it was, quote, damaging to enforce their uptake, quote. The article goes on to share quotes from prominent vaccine skeptics regarding the rise of MAHA and the medical freedom movement influencing the current health landscape. Taking this on its face, it's incredibly alarming, leading us to believe the cause is lost and Americans have given up on vaccines and public health altogether. But there are actually a number of issues with how this poll was conducted, which leaves its conclusions truly very shaky. David Higgins, a pediatrician and researcher on vaccine policy and communication in Colorado, published an opinion piece in STAT with the same article posted on his substack, which we will link to in our podcast show notes. He points to a broader issue, which he has been publishing on for more than two years. There is a growing problem of overstating how widespread vaccine skepticism really is, which itself is undermining confidence in public health and vaccines. Now, let me be clear, there surely is a problem with under-vaccination and the challenges we see today from those who oppose it. But the whole entire sky is not falling either, and we need to keep emphasizing that. While anti-vaccine and vaccine skeptical individuals are certainly present, their beliefs are not in fact the norm. Not only does Higgins' own work support this claim, but a closer reading of the political poll discounts this narrative as well. Here is the question the respondents were given. Try to answer it yourself. The question, which of the following comes closest to your view? The science on vaccines is clear and is damaging to question it, or the facts on vaccines are still up for debate and it is damaging to enforce their uptake. So you had a choice, either one. It's forced to choice between two statements that actually have multiple components all bundled together. It mixes clarity of vaccine science, whether debate is appropriate, whether questions cause harm, and whether policies to increase uptake backfire. These are all separate issues. People may reasonably hold different views on it. It's like asking, are dogs great companions and easy to train, or do they take hard work and make life far too hard? Well, many people would say dogs are great companions, they do take work. But that's not an option. Forcing a single choice muddies the water of what people actually believe. That's what happened with this survey. When you look at the broader evidence base of high quality survey data, a more consistent picture emerges. A strong majority of Americans across political parties, typically ranging between 75 and 90 percent, support routine childhood vaccinations like MMR, polio and Tdap. While movements like the Children's Health Defense and figures like Robert F. Kennedy Jr. continue to erode trust in vaccines, it is irresponsible to claim that vaccine skepticism is widespread. Headlines should actually reflect reality, which is that vaccines are generally a well-regarded, bipartisan public health tool. If we want to come up with better solutions to improving vaccine coverage, we need to be asking the right questions and then hoping to find the right answers.

Speaker 1:
[21:31] So this would be a good time to get an update on CIDRAP's Vaccine Integrity Project. Mike, what can you tell us?

Speaker 2:
[21:38] Well, I have to start out by just saying, I am so proud of the team at CIDRAP and the work of the Vaccine Integrity Project that is part of CIDRAP. This is truly an amazing effort. That's just 12 months ago, this month, when we first really stood up the Vaccine Integrity Project, there were many doubters that we could actually be helpful in dealing with the shortcomings of vaccine policies and recommendations because of what had happened to ACIP. Currently, we have several ongoing systematic evidence reviews, including safety and effectiveness of HPV, as well as a review of Tdap in pregnancy. However, today, I want to highlight the three reviews making up the respiratory immunization season, COVID, RSV, and flu. We're working with a stellar team of researchers for this work, and every step we take is in collaboration with the medical societies that are drafting their annual recommendations for these immunizations and coordinating closely with our partner, the American Medical Association. One of the first major steps we always take when conducting these reviews is to draft the protocols with subject matter expert input, and then post them to a platform called Prospero. Once posted, our methodology is public and relatively set in stone. This ensures we're transparent with our plans from the beginning, reducing the risk of reporting bias and allows other research teams the opportunity to duplicate our search and find the same set of publications. Last week, we published all three respiratory immunization protocols on Prospero, and we will link them in the show notes for interested listeners. Throughout this work, the research team has been meeting monthly with a range of representatives from medical specialty societies and state health officials, where they present their progress and gather feedback on how we can better fit the gaps left by the crumbling HHS vaccine structure. Discussions with colleagues at all levels of these organizations help us continue our work while keeping everyone on the same page. This is yet another example of our commitment to transparency in this process. You can look for more updates on our evidence reviews in the coming weeks and months. Our project staff and advisors will also continue to publish viewpoints intended to address timely issues regarding vaccines with straight talk and clarity by presenting facts to counter falsehoods. In case it wasn't clear, the Vaccine Integrity Project aims to earn and sustain trust in these times of uncertainty. We will continue to conduct our research in the open and partner with medical and state public health leaders to support evidence-based vaccine decisions. And as we hand off this very important evidence research to the medical societies, they now have the basis upon which to make recommendation that very well will be different than what ACIP comes up with. But the standing from a scientific perspective is undeniable. And therefore, we believe continues to support how and why our vaccines should be used as they had been before with the previous ACIP.

Speaker 1:
[24:53] Turning now to the US respiratory virus update. What does flu, COVID-19, and respiratory syncytial virus activity look like as we near the end of April?

Speaker 2:
[25:04] Well, it looks like we're going to have a relatively quiet end of April. I am relieved to report that it seems RSV has continued to decline, which reinforces the activity has most likely peaked for the season. Since RSV has been holding our attention recently by remaining elevated longer than usual, let's start there. Signs are pointing that activity has peaked across much of the country. The national wastewater concentrations is considered low. Concentrations low in the west and the northeast and very low in the south and midwest, though concentrations have slightly increased in the midwest over the past week. In addition, over the past week, RSV hospitalizations have continued to decrease in every age group, notably in the less than one-year-old age group, which experienced a nearly 50% decrease in weekly hospitalization rates from the first week of April to the second. Emergency room visits for RSV have also continued to decrease across every age group. While activity is still elevated, these declining metrics are assigned that things are moving in the right direction. Before I move on though, I want to highlight the results of a very large study conducted in the United Kingdom that was presented last week. The retrospective cohort study performed by the UK Health Security Agency looked at maternity records, immunization data, and hospital laboratory data for infants born in England from September 2nd, 2024, and March 24th, 2025, which was the period immediately following England's implementation of the National Maternal RSV Vaccination Program beginning September 1st of 2024. Let me remind you that the approach taken here is to vaccinate pregnant people prior to the birth of the child so that the maternal antibody will be transferred to the child and protect them in those first months after birth in an otherwise what would be a high risk period for them to develop RSV. Back to the UK study, researchers used the data that I just referred to to evaluate the impact that the RSV vaccine had on infant hospitalizations due to RSV infections. The analysis included 90% of the births in England from September 2024 to March 2025, nearly 290,000 births. Approximately 55% of these infants were born to unvaccinated mothers. Overall, the analysis found that when given at least two weeks before birth, maternal vaccination against RSV reduced the infant's risk of hospitalization by more than 80%. These are really impressive findings, and I want to highlight a few additional findings of the analysis as well. The analysis showed that of the nearly 4600 RSV-associated hospitalizations that occurred during the study period, 87% of those were in infants born to women who were not vaccinated against RSV. In addition, researchers found that when women were vaccinated at least two weeks prior to birth, the vaccine was 81% effective against hospitalization compared to the unvaccinated group. When the vaccination occurred at least four weeks before the delivery, the vaccine effectiveness was closer to 85% effective, again giving the mother more time to make that antibody and share it with her unborn child. The researchers did report that vaccination that occurred less than 14 days prior to the birth provided less protection, and those that occurred less than 10 days prior to the birth did not provide a reduction in hospitalizations at all. And of course, this makes biologic sense. The mother's immune system had just not had time to mount the kind of response that could then be passively transferred to her unborn child. Now moving to flu, activity continues to decrease across every metric and across the country. As of last week, 42 states and the CDC were considered to have minimal flu activity and the other eight were considered low. 2.1% of the outpatient visits were for influenza-like illness that last week, which is the lowest it's been since the beginning of November or what we call Week 45. Test positivity continues to decrease and both Influenza A and Influenza B activity are decreasing. Influenza B continues to account for the majority of Influenza activity recently, accounting for 59% of the samples at Public Health Laboratories and 85% at the clinical labs. There have sadly been 16 additional pediatric deaths reported since our last episode, bringing us to 143 so far this season. So tragic. Last, I want to mention that throughout the flu season, the CDC performs weekly in-season severity assessments based on three severity indicators. Percentage of Influenza-like illness visits to outpatient health clinics, the rate of flu-related hospitalizations, and the percentage of deaths resulting from flu across each age group. They also assess the severity of the entire season by using the highest weekly values for each of these three indicators observed from October 1st through the most recent week of available data. Based on this method, the CDC has preliminary classified this season as a moderate flu season across all age groups. And finally, COVID. It remains relatively quiet. COVID wastewater concentrations are considered very low, both nationally and in every region, and emergency department visits and hospitalizations for COVID-19 also continue to decline. But let me just quickly summarize what we're seeing in variant data, and that is really very little change. I don't see any evidence right now that what is circulated in our communities are going to cause a major increase in COVID cases, or a increased occurrence of serious illness in the months ahead. So I think that by itself is good news.

Speaker 1:
[31:21] Now it's time for our ID query. This week we have a follow-up to our focus on long COVID in the last episode. Rochelle wrote, for the April 9th long COVID summary, I wanted to see the prevalence of long COVID by gender, since wide differences have been noted in multiple studies across the United States. Have recent studies found that the prevalence is much lower in women than previously thought?

Speaker 2:
[31:44] Chris, from a historic perspective, remember that if we look at other what I call post-infection syndromes or conditions, for example, if you look at the syndromes that we have lived with for decades, such as chronic fatigue syndrome, other illnesses like that, surely have evidence of an infection leading to this post-infection status. We've seen an over-representation of women among those cases. So it's not a surprise that we might see a similar situation with long COVID. But as the data I'll share with you today also shows us, it's not a straightforward situation. So as I begin, let me thank Rochelle for her excellent question, what gets at an important issue in terms of understanding long COVID risk. If you look, there have been a number of different studies published throughout the past five to six years focusing on this very issue. And what's been demonstrated quite consistently is that women appear to be at a higher risk of developing long COVID compared to men. But it's a complicated story. When it comes to actually calculating what the risk difference is specifically, there's been some variation between some of the studies, which is not unexpected given differences in study designs of the populations being looked at. I'm not sure we're at a point where we can say with certainty that the prevalence of long COVID in women is much lower than previously thought. When you look at some of the most recent high quality studies that involve large and diverse populations and carefully adjust for confounding factors, the overall signal for long COVID in women is still there. For example, a study published in January 2025, featuring data from the NIH Recover Initiative, which is an effort that I detailed last episode involving a cohort of more than 12,000 participants across the US, found that 20.6 percent of female participants developed long COVID compared with only 16 percent of male. Even after accounting for things like disease severity and vaccination status, women still had a 31 percent higher risk of developing the condition compared to men. A separate 2025 analysis of national surveillance data found women about 40 percent more likely to develop long COVID. And a review paper published in November 2025, looking at 14 prospective cohort studies comprised of about 169,000 participants across multiple countries, had an odds ratio of 1.53 for females when it comes to developing long COVID, so more than a 50 percent increased risk. However, what's really interesting is that when you take a closer look, some of these same studies demonstrate that the elevated risk among women is not the same across all ages and hormonal states. In fact, the recovery study found that women 18 to 39 years of age showed no statistically significant difference in long COVID risk compared to men in that same age group. Post-menopausal women also had risk levels much closer to men. Otherwise, the highest risk group that was the perimenopausal women between 40 and 54 years of age, who had a roughly 42% higher risk of developing long COVID than men their age. So that finding suggests that sex hormones, particularly fluctuating estrogen levels that characterize perimenopausal transition could be a biological risk factor. In addition, there's some emerging immunologic research looking at immune cell profiles by age that offers possible explanations for risk differences and long COVID as well. All that said, untangling the full picture is very hard since we're dealing with complex and overlapping biologic and social factors. So clearly, much more research is needed. So Chris, I want to turn the tables on you for a minute and ask you about a recent report from the CDC and state public health departments on extensively drug resistant Shigella in the US. You wrote an outstanding piece about this report for CIDRAP News. What did you learn?

Speaker 1:
[36:02] Thanks, Mike. This was an eye-opening report from the CDC. But let's back up a second and start with a brief explanation of what Shigella is. It's a bacterium that lives in the intestines of people and animals and is spread, to be blunt, by ingesting food and water that's been contaminated by poop. When people are infected with Shigella, it typically causes diarrhea and vomiting. Now, historically in the US, Shigellosis has been largely seen in young children in daycare and early school settings and in people who have traveled to countries where there is poor sanitation. It's also been fairly easy to treat. In fact, most Shigellosis cases resolved themselves with fluids and rest, with antibiotics needed only in more severe cases. Like a lot of foodborne illnesses, people just ride it out at home. But the CDC report, which looked at more than 16,000 US Shigella samples, found that the proportion considered extensively drug resistant, which in this case means they were resistant to five different oral antibiotics, rose from 0% in 2011 to 8.5% in 2023. While Shigellosis cases are primarily self-limiting, one of the clinicians I spoke with said 15-20% of the cases seen at his hospital are more severe. People are coming in with dysentery and are severely dehydrated. In other words, they're sick enough to have to go to the hospital. When their infections are caused by these extensively drug resistant strains, the treatment options are limited. Clinicians are trying a lot of different antibiotics without much data on what's effective. Another noteworthy aspect of the CDC study is the changing profile of who's getting Shigella infections and how it's getting transmitted. The CDC found that most of the infections were in adult men, and very few had a recent history of travel abroad. Now, as I just said, Shigella is mostly transmitted by ingesting contaminated food and water, but it can also be transmitted through sexual activity. As one of the experts I spoke with told me, Shigella falls through the cracks between fluid-borne disease and sexually transmitted infection. Many of the cases of extensively drug-resistant Shigella are being seen in men who have sex with men, in the United States and in other countries. You're seeing it largely transmitted through sexual networks. Another population where these extensively drug-resistant strains appear to be spreading is the unhoused. So you have these two populations that have increased risk of a potentially serious infection and it doesn't appear that this risk is well known in these communities. Furthermore, there is concern that these extensively drug-resistant strains could spread beyond these populations. Now, Shigella is very easily transmittable. It takes very little bacteria to cause an infection. So for example, if you have a food worker who's been exposed and maybe hasn't washed his hands thoroughly, they could infect someone's food. And there's some evidence that this may be happening. I spoke with a clinician researcher at UCLA who identified two cases of a new strain of extensively drug-resistant Shigella, and these cases had no epidemiologic links. The patients had not been at the hospital at the same time. They lived 80 miles apart. One of the patients was a cancer patient who had none of the risk factors for Shigella infection. She was severely immunocompromised, and she turned out okay, but this was a very serious infection for her to have. As the researcher at UCLA told me, when you have this very resistant bacteria floating around the community, that's never a good thing. So the bottom line is, Mike, if we start to see wider spread of these Shigella strains, it could become a significant public health issue.

Speaker 2:
[39:36] Well, Chris, first of all, let me congratulate you on really a wonderful analysis of what's happening there, both in terms of your news story and what you presented here. I unfortunately believe we will have increasingly dark days out there occurring with this particular Shigella, and the implications of it are really far-reaching. So all I can say is thank you for alerting us to those, and we in public health with what tools we have can begin to address it so that the problem doesn't continue to grow and become what, in fact, you just described as a real possibility.

Speaker 1:
[40:14] So now on a brighter note, it's time for a space themed this week in public health history. Mike, who are we celebrating this week?

Speaker 2:
[40:21] Well, this is a fun one for me. It's really all about science of it, I think at its very best in terms of capturing unique experiences to learn from them. Yes, we are sticking with the science theme this week. I want to talk about the Goliad 11. Back in the late 1950s, before we had even sent anyone to the moon, NASA and the US. Navy recruited 11 deaf men from Goliad University in Washington, DC to help understand the effects of prolonged weightlessness on the human body. All but one of these men had become deaf early in their lives due to spinal meningitis, a disease that damages the vestibular system. This meant these men did not get motion sickness, which put them at a unique advantage. Over a decade, researchers measured these 11 volunteers' reactions both psychological and physiological to various motion experiments. The volunteers reported any sensations they experienced or changes in perception. One test had four subjects spend 12 consecutive days inside a room that slowly rotated about 10 times per minute. In another test, subjects flew on zero-gravity flights, also known as vomit comet. There was even one experiment where the subjects were tested on a ferry ride along the choppy seas in Nova Scotia. The test subjects played cards the entire time, unbothered. Meanwhile, the scientists aboard became so horribly seasick, they had to cancel the experiment. The Galdia test subjects reported no adverse physical effects from the various experiments, even noting that they enjoyed the experience overall. One of the participants, Baron Gulag, went on to say, In retrospect, yes, it was scary, but at the same time, we were young and adventuresome. Thanks to the Goliadet 11, NASA researchers found a better understanding of how the body's sensory systems respond to foreign gravitational environments, making significant contributions to the science of motion sickness and the body's adaptation to spaceflight. We continue to thank and honor these 11 men today, especially following the Artemis II mission. It wouldn't have been possible without their participation and endurance decades ago.

Speaker 1:
[42:42] Mike, what are your take home messages today?

Speaker 2:
[42:46] Well, first, let me comment on what I think is happening at HHS and what is likely to occur with their oversight of the new ACIP. As I shared with you in the summary, I am very skeptical that we're going to see anything good come out of what's happening with the newly constituted ACIP. The fact that Mr. Kennedy on Tuesday also announced that he would not commit to accepting the recommendations from the CDC and very well might make up his own recommendations and force them to enforce those. So this is a huge challenge and we're not out of the woods yet at all on what mischief this particular administration can cause with vaccines. The second thing is good news. I'm really happy to report that the seasonal viral infection profile of RSV, COVID and influenza is going down, down and down. And hopefully over the next few months, we can see a respite in what we went through this past winter. We'll keep a close eye on what's happening and already we're beginning to think about what it will be like to be prepared for the next fall and winter season. And finally, let me just say that your work, Chris, on the Shigella was really a wonderful gift in terms of helping everyone understand the great significance of what drug-resistant bacterial infections can do and what they mean. And as you very nicely painted the picture of the implications of this infection today with this type of resistance, it should be a reminder to all of us, we are in a losing battle with antimicrobial resistance. We have only limited drugs available for these very resistant pathogens. And I worry desperately that one day we're going to wake up and realize that in fact we are not necessarily in a much better shape than in fact were our ancestors decades ago before antibiotics were actually available.

Speaker 1:
[44:49] Well, Mike, my initial thought was that maybe you'd pick Elton John's Rocket Man as a closing song for this episode, but I believe you've gone with a quote.

Speaker 2:
[44:57] Well, thank you, Chris. Actually, I did think about Rocket Man, believe it or not, and only as Elton John could sing. But I thought given the condition of the world's in today and the challenges that we're seeing and how serious those challenges are, I would try to use something that was a bit more philosophical. So I really wanted to take this moment to reflect on in a serious way what space travel reminds us of and what it's all about. We all, I think, long admired our true Renaissance scientists and astronomer Carl Sagan. And here I want to share with you briefly a piece that Carl Sagan wrote about our Earth. The Earth is the only world known so far to harbor life. There is no where else, at least in the near future, to which our species could migrate. Visit, yes, settle, not yet. Like it or not, for the moment the Earth is where we must make our stand. It has been said that astronomy is a humbling and character building experience. There is perhaps no better demonstration of the folly of human conceits than this distant image of our tiny world. To me, it underscores our responsibility to deal more kindly with one another and to preserve and cherish the pale blue dot, the only home we've ever known. Carl Sagan. Thank you all very much for joining us again. We very much appreciate the opportunity to be with you. Again, I ask on behalf of the family, please send us your comments, your questions, your ideas, and we'll do what we can to try to address them. In the meantime, as things are so very difficult in this world right now, I can't emphasize it enough. The juice that should keep us moving, the grease that should keep our wheels running, all of all kindness. I know this is something that scientists aren't necessarily proficient at as a result of their training, but we all are people and that means we can be kind. And so I hope that you can find it in your heart in the next two weeks to do that. So thank you again for joining us. Thanks to the podcast team. Appreciate all your efforts. Chris, thank you. And just remember, be kind, be thoughtful. Thank you very much.

Speaker 1:
[47:35] Thanks for listening to the latest episode of the Osterholm Update. If you enjoy the podcast, please subscribe, rate and review wherever you get your podcasts. And be sure to keep up with the latest infectious disease news by visiting our website, sidrap.umn.edu. This podcast is supported in part by you, our listeners. The Osterholm Update is produced by Sydney Redepending, Elise Holmes and Ruby Guthrie. Our researchers are Corey Anderson, Meredith Arpey, Liam Oat, Emily Smith, Claire Stoddard, Angela Ulrich and Mary Van Buzicom.