Dr. Dalilah Restrepo

Infectious Diseases Doctor. Trained in Colombia🇨🇴, practiced in NYC🗽, New Zealand🇳🇿 and currently in California.

[Dr. Dalilah Restrepo @drdalidali]

Who knew? 🤔

[Eric Feigl-Ding @DrEricDing]

NIH director admits after being grilled by @SenSanders: 1) The best way to stop the measles epidemic is to vaccinate your kids against measles. 2) no single vaccine causes autism. RFK Jr is wrong.

[Dr. Dalilah Restrepo @drdalidali]

I guess we are at that point where we need to explain the 5day symptom tracker does not constitute the entirety of follow up.

[Jake Scott, MD @jakescottMD]

I'll admit the package insert language isn't crystal clear if you don't know clinical trial conventions. "Monitored for 5 days after each dose" sounds like that's the whole picture.

But here's what that section is actually describing: the frequency of injection site reactions and common systemic symptoms like fever, irritability, fatigue. That's the 5-day diary card window.

A diary card is exactly what it sounds like: a paper form (or now often an app) where participants record specific symptoms each day after vaccination. Researchers ask about predictable, short-term reactions: soreness at the injection site, redness, swelling, fever, fatigue. These are called "solicited" adverse events because you're actively asking about them. The 4-5 day window exists because these acute inflammatory responses either happen quickly or they don't. There's no biological mechanism for a sore arm to appear three weeks later. This is standard methodology across all vaccine trials, not something unique to hepatitis B.

What the package insert doesn't spell out in that section (because it's covered elsewhere in the regulatory record) is that serious adverse events (hospitalizations, deaths, any significant medical event) were tracked for the entire study duration. That's a separate reporting system that runs for months to years.

The actual monitoring periods:
- Recombivax HB efficacy trials followed infants for 9 months to confirm chronic infection hadn't occurred
- Engerix-B trials followed participants for 6 to 18 months to measure antibody persistence and infection rates

The foundational Szmuness trial, a double-blind RCT with an alum adjuvant placebo, monitored over 1,000 participants for 24-30 months, recording hepatitis events, hospitalizations, and deaths

You cannot verify that someone remains free of chronic hepatitis B for 9 months or 2 years if you stopped monitoring after 5 days. Attrition was tracked. Causes of dropout were recorded. Deaths were investigated.

For context: we've catalogued 43 hepatitis B vaccine RCTs spanning 1980-2021, enrolling nearly 19,000 participants. Eleven were placebo-controlled (most with alum adjuvant placebos), with close to 7,000 participants across populations including neonates, children, adults, hemodialysis patients, and healthcare workers.

The 5-day diary card and the full study duration measure different things. Both are in the record.

A note on the Szmuness trial: Wolf Szmuness was a Polish-born epidemiologist who survived a Soviet labor camp in Siberia before immigrating to New York. He became interested in hepatitis B after his wife nearly died from the disease following a blood transfusion. He designed the first efficacy trial for the hepatitis B vaccine, and died of lung cancer the year after publishing the final report.

Szmuness et al. (1981): https://t.co/cuy7dAdm8u

[Dr. Dalilah Restrepo @drdalidali]

@angie_rasmussen Who listens to this guy??! He's soooo phony. Geez

[Jill Filipovic @JillFilipovic]

Reminder that your social media algorithm is selecting for the most extreme and reaction-fueling posts right now, and what you're seeing get tons of retweets and outrage-quotes is probably not representative of anything except the worst of humanity.

[Dr. Dalilah Restrepo @drdalidali]

@futtywap Phenomenal! GoBills

[Dr. Dalilah Restrepo @drdalidali]

Disorienting and sad to say the least.
https://t.co/gk1uJIgf1x

[DrDemetre @dr_demetre]

My resignation letter from CDC.

Dear Dr. Houry,

I am writing to formally resign from my position as Director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), effective August 28, 2025, close of business.   I am happy to stay on for two weeks to provide transition, if requested.

This decision has not come easily, as I deeply value the work that the CDC does in safeguarding public health and am proud of my contributions to that critical mission. However, after much contemplation and reflection on recent developments and perspectives brought to light by Secretary Robert F. Kennedy Jr., I find that the views he and his staff have shared challenge my ability to continue in my current role at the agency and in the service of the health of the American people. Enough is enough.

While I hold immense respect for the institution and my colleagues, I believe that it is imperative to align my professional responsibilities to my system of ethics and my understanding of the science of infectious disease, immunology, and my promise to serve the American people.  This step is necessary to ensure that I can contribute effectively in a capacity that allows me to remain true to my principles.

I am unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health.  The recent change in the adult and children’s immunization schedule threaten the lives of the youngest Americans and pregnant people.   The data analyses that supported this decision have never been shared with CDC despite my respectful requests to HHS and other leadership.  This lack of meaningful engagement was further compounded by a “frequently asked questions” document written to support the Secretary’s directive that was circulated by HHS without input from CDC subject matter experts and that cited studies that did not support the conclusions that were attributed to these authors.  Having worked in local and national public health for years, I have never experienced such radical non-transparency, nor have I seen such unskilled manipulation of data to achieve a political end rather than the good of the American people.

It is untenable to serve in an organization that is not afforded the opportunity to discuss decisions of scientific and public health importance released under the moniker of CDC.  The lack of communication by HHS and other CDC political leadership that culminates in social media posts announcing major policy changes without prior notice demonstrate a disregard of normal communication channels and common sense.  Having to retrofit analyses and policy actions to match inadequately thought-out announcements in poorly scripted videos or page long X posts should not be how organizations responsible for the health of people should function.  Some examples include the announcement of the change in the COVID-19 recommendations for children and pregnant people, the firing of scientists from ACIP by X post and an op-ed rather than direct communication with these valuable experts, the announcement of new ACIP members by X before onboarding and vetting have completed, and the release of term of reference for an ACIP workgroup that ignored all feedback from career staff at CDC.

The recent term of reference for the COVID vaccine work group created by this ACIP puts people of dubious intent and more dubious scientific rigor in charge of recommending vaccine policy to a director hamstrung and sidelined by an authoritarian leader.   Their desire to please a political base will result in death and disability of vulnerable children and adults.  Their base should be the people they serve not a political voting bloc.

I have always been first to challenge scientific and public health dogma in my career and was excited by the opportunity to do so again.  I was optimistic that there would be an opportunity to brief the Secretary about key topics such as measles, avian influenza, and the highly coordinated approach to the respiratory virus season.  Such briefings would allow exchange of ideas and a shared path to support the vision of “Making America Healthy Again.”  We are seven months into the new administration, and no CDC subject matter expert from my Center has ever briefed the Secretary.  I am not sure who the Secretary is listening to, but it is quite certainly not to us.  Unvetted and conflicted outside organizations seem to be the sources HHS use over the gold standard science of CDC and other reputable sources.  At a hearing, Secretary Kennedy said that Americans should not take medical advice from him.  To the contrary, an appropriately briefed and inquisitive Secretary should be a source of health information for the people he serves. As it stands now, I must agree with him, that he should not be considered a source of accurate information.

The intentional eroding of trust in low-risk vaccines favoring natural infection and unproven remedies will bring us to a pre-vaccine era where only the strong will survive and many if not all will suffer.  I believe in nutrition and exercise.  I believe in making our food supply healthier, and I also believe in using vaccines to prevent death and disability.  Eugenics plays prominently in the rhetoric being generated and is derivative of a legacy that good medicine and science should continue to shun.

The recent shooting at CDC is not why I am resigning.  My grandfather, who I am named after, stood up to fascist forces in Greece and lost his life doing so.  I am resigning to make him and his legacy proud.   I am resigning because of the cowardice of a leader that cannot admit that HIS and his minions’ words over decades created an environment where violence like this can occur.  I reject his and his colleagues’ thoughts and prayers, and advise they direct those to people that they have not actively harmed.

For decades, I have been a trusted voice for the LGBTQ community when it comes to critical health topics.  I must also cite the recklessness of the administration in their efforts to erase transgender populations, cease critical domestic and international HIV programming, and terminate key research to support equity as part of my decision.

Public health is not merely about the health of the individual, but it is about the health of the community, the nation, the world. The nation’s health security is at risk and is in the hands of people focusing on ideological self-interest.

I want to express my heartfelt gratitude for the opportunities for growth, learning, and collaboration that I have been afforded during my time at the CDC. It has been a privilege to work alongside such dedicated professionals who are committed to improving the health and well-being of communities across the nation even when under attack from within both physically and psychologically.

Thank you once again for the support and guidance I have received from you and previous CDC leadership throughout my tenure. I wish the CDC continued success in its vital mission and that HHS reverse its dangerous course to dismantle public health as a practice and as an institution.  If they continue the current path, they risk our personal well-being and the security of the United States.

Sincerely,

Demetre C. Daskalakis MD MPH (he/his/him)

[Dr. Dalilah Restrepo @drdalidali]

@dr_demetre Thank you for all your expertise, guidance and support over the years. I agree and support your decision because as you say, 'enough is enough'. Extremely sad day for American Health, It will become obvious-that this is not the path to MAHA- too late. 😞

[Jake Scott, MD @jakescottMD]

RFK Jr. went on national TV and spouted egregious, dangerous falsehoods about vaccines. As a parent and infectious diseases doctor, I couldn't stay silent. @FoxNews might not fact-check him, but I will. I've reviewed the trials. I've catalogued them. I have receipts. 🧵

[Dr. Dalilah Restrepo @drdalidali]

@realdocspeaks 💯

[Real Doc Speaks @realdocspeaks]

Thank you for asking this important question.

CPT code 99213 has a time component of 20-29 minutes for an existing patient.

Florida Medicaid would pay $32.56 for this visit.

This amount needs to cover the following:
• Office rent or mortgage
• Staff salaries
• Computer system
• Staff benefits
• Equipment
• Utilities
• Taxes
• Malpractice insurance
• Supplies (office and medical)

This doesn't include that the physician gave up their twenties and has large student debt from undergraduate and Medical school studies.

This is not a sustainable pay rate, and because of this, most physicians are now employed.

Why should you care if this doctor is employed?

Now that the doctors are employed, they have to do the following:

• See as many patients as possible per hour.
• Bill as much as possible.
• Order as many expensive tests and consults as
possible.
• Spend the visit carefully entering data into the EHR
in order to optimize billing.

You have now lost a caring and empathetic physician, and your care has been monetized.

Patients must demand that physicians be reimbursed enough to maintain their independence.

This is the only way patients will get the excellent care they deserve.

[Dr. Dalilah Restrepo @drdalidali]

@arghavan_salles You're not alone

[Brian Tyler Cohen @briantylercohen]

The last time the Dodgers won the World Series, Trump was defeated in the general election. Just saying.

[Dr. Dalilah Restrepo @drdalidali]

@Schwarzenegger Incredible. Agree on all counts. Thank you!

[Dr. Dalilah Restrepo @drdalidali]

Again I'm part of the 'sandwich generation ' who tried to hold on but now PJP is as natural as it comes....

Great article

[Paul Sax @PaulSaxMD]

I know you’ve all been on tenterhooks, awaiting the dramatic conclusion to “How PCP Became PJP”.
Well here it is.
You’ll laugh! You’ll cry! And you’ll finish reading it so much better informed about this critical debate. @JWatch @NEJM https://t.co/wDolWBB4NW

[Dr. Dalilah Restrepo @drdalidali]

@IDWeekmtg "no idea is new". Thank you Dr. Bonomo. Learning Beta-lactamases from a true GIANT !

[Dr. Dalilah Restrepo @drdalidali]

Nutshell

[Dr. Dalilah Restrepo @drdalidali]

@DrNeilStone 😁 bingo!

[Dr. Dalilah Restrepo @drdalidali]

@EvanKellz @gtconway3d @realDonaldTrump Exactly

[Dr. Dalilah Restrepo @drdalidali]

@thejackhopkins If they allow her name on the ballot.. shame on Montana SOS. How could this tampering of ballots go unpunished? What a disgraceful cult they are.