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Featured topic and speakers
What are the symptoms of Mpox? Who is high risk for monkeypox? Is raw milk illegal? When is Hajj 2024? Are there long term effects of meningococcal disease?
Our guest is AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.
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- CDC current avian flu map.
- For bird flu news, visit Centers for Disease Control and Prevention CDC H5N1 Bird Flu Current Situation Summary.
- Updated CDC Mpox vaccine recommendations.
- CDC monkeypox guidelines, symptoms, Mpox vaccine schedule and more.
- Googling "mpox vaccine near me"? Use the CDC Mpox Vaccine Locator.
- If the CDC issues new health warning, get the latest CDC health alert 2024 via the Health Alert Network (HAN CDC website).
Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia. I'm Todd Unger, AMA's chief experience officer. Andrea, welcome back.
Garcia: Thanks, Todd. It's great to be here.
Unger: We're going to start out with headlines about Mpox. When we talked about this a couple of weeks ago. We were seeing an outbreak in the Democratic Republic of Congo, driven by a deadlier version of the virus. Andrea, what's the latest news there?
Garcia: Well, that outbreak in the DRC continues to get worse. And in response on Thursday, the CDC urged people at risk in the U.S. to be vaccinated as soon as possible. Although no cases of this particular subtype have been identified outside of Africa so far, experts have said that the escalating epidemic in the DRC does pose a global threat, just as infections in Nigeria set off that 2022 outbreak that struck tens of thousands of people here in the U.S. and abroad. According to a New York Times article, as the outbreak in the DRC worsens, that less deadly type of the virus that caused that 2022 outbreak is also regaining strength.
Just as a quick reminder, there are two main types of Mpox. Clade 1—that's the type that is dominant in the DRC right now, which is more deadly—and then clade 2, which is the type that caused the 2022 global outbreak. With Pride events scheduled all over the world in the coming weeks, U.S. officials expect that it's only a matter of time before we see a resurgence here.
Unger: Andrea, were many of those who are at high risk now already vaccinated in 2022?
Garcia: Well, Todd, we did contain that outbreak through behavioral change and vaccination, but there are still many people who are at high risk who have not been immunized or who haven't received two doses, because as you remember, there were supply shortages during that 2022 outbreak. We know that two doses of the vaccine are better than one with an effectiveness of up to 90%.
And even when the vaccine didn't prevent infection, it lessened the severity and duration of the illness. Fewer than one in four Americans who are at risk have received two doses. This is a problem because vaccination is really the key to controlling this long-term. Given this, CDC is now working with advocacy groups and social media influencers to help get the message out to those in the U.S. who are at the highest risk in hopes that they'll get vaccinated before the virus resurges. In December, the agency also urged physicians to remain alert for possible cases and travelers from the DRC, and that is going to be especially important now.
Unger: Well, speaking of getting prepared, Andrea, what symptoms do physicians and patients need to watch for?
Garcia: Well, people with Mpox may have fever, intense headache and back pain, followed by a rash. Many patients also develop painful sores, often at the site of infection. We know that people who have weakened immune system, including those living with HIV, are at highest risk of becoming severely ill and dying. Compounding the issue is many countries have limited access to tests, vaccines and treatment, which means a vast majority of cases are being diagnosed solely based on symptoms.
Here in the U.S., there is an FDA-approved test that detects all versions of Mpox. The challenge is it can't distinguish between them, so a positive result on that test would need to be followed by a more specific test that can identify the clade. The good news so far is that the available vaccines and antiviral drugs are expected to be effective against all forms of the virus.
Unger: All right. Thank you, Andrea. And we're going to certainly continue to watch and track the issues around Mpox. Andrea, something else that we've been tracking—bird flu. That continues to make headlines. What's the latest news this week?
Garcia: Well, according to the latest data, USDA is now reporting that 51 dairy cattle herds in nine states. Nine states have confirmed cases of H5N1. There have still been no additional human cases detected since that one case from Texas was reported on April 1, and recent wastewater surveillance data, which the CDC posted for the first time last week, shows no indicators of unusual flu activity in people, including avian influenza viruses, which is good news.
While influenza testing typically declines over the summer, the CDC is working on a plan for enhanced nationwide summer monitoring to help ensure that even rare cases of H5N1 in the community are detected. This plan includes increasing the number of influenza virus specimens that are tested and then subtyped in public health laboratories that can detect H5N1, and we should be hearing more about that plan in the coming weeks.
Unger: All right. Thank you. Andrea, I know a big concern of people out there is about the milk supply. Has there been any additional news about that?
Garcia: Well, we did see the CDC issue recommendations for physicians to support consumption of only pasteurized milk and dairy products made from pasteurized milk. And most of the nutritional benefits of drinking milk are available from pasteurized milk. Physicians are being asked to educate patients on the risks of consuming unpasteurized milk or products made from unpasteurized milk, particularly emphasizing that unpasteurized milk can contain bacteria or viruses, including the H5N1 virus.
I think physicians should also remind patients that unpasteurized or raw milk and any products made from raw milk, which can include cheese and ice cream or yogurt, can be contaminated with germs that can cause serious illness, hospitalization or death. Anyone, even healthy adults, can get sick from drinking raw milk. And it's important that anyone who consumes raw milk and gets sick seek medical attention immediately.
Unger: Andrea, it just makes you wonder. Is selling raw milk even legal?
Garcia: Well, federal law prevents the sale of raw milk for human consumption in its final packaged form across state lines. But each state makes its own laws about selling raw milk within its borders. Just because raw milk may be legal to obtain in a particular state obviously does not mean that it is safe to drink.
Unger: That's a very good reminder. Andrea, earlier this week, the CDC also issued a new health alert. Tell us more about that.
Garcia: Well, on Monday, the CDC issued a health alert, or HAN, to alert physicians to cases of meningococcal disease linked to Umrah travel to the Kingdom of Saudi Arabia, or KSA. Umrah is an Islamic pilgrimage to Mecca in the Kingdom of Saudi Arabia that can be performed any time of the year, and the Hajj is an annual Islamic pilgrimage. This year, that's taking place June 14 through 19. Since April of 2024, there have been 12 cases of meningococcal disease linked to KSA travel for Umrah, and they've been reported to national public health agencies. Five of those were here in the U.S., four in France and three were in the UK.
Unger: And Andrea, I think that can be potentially very devastating. Tell us more about that.
Garcia: Well, meningococcal disease is a rare but severe illness with a case fatality rate of 10% to 15%, even with appropriate antibiotic treatment. Initial symptoms may be nonspecific, but they can worsen rapidly and can become life-threatening within hours. Survivors may experience long-term effects, such as deafness or amputation of extremities. Immediate antibiotic treatment for meningococcal disease is critical.
Unger: So what do physicians need to know, in this case?
Garcia: Here in the United States, quadrivalent meningococcal conjugate vaccination is routinely recommended for adolescents, and it's also recommended for travelers to countries where meningococcal disease is hyperendemic or epidemic. In addition, all Hajj or Umrah pilgrims age one year or older are required by KSA to receive quadrivalent meningococcal vaccine.
Physicians should be working with their patients who are considering travel to perform Hajj or Umrah to ensure that those aged one year or older have received a meningococcal conjugate vaccine within the last five years and administered at least 10 days prior to arrival in KSA. Physicians should also maintain increased suspicion for meningococcal disease in anyone presenting with symptoms after recent travel to KSA for Hajj or pilgrimage. U.S. health departments and physicians should also preferentially consider treating close contacts as well.
Unger: Andrea, that's great to know, and something we're going to continue to keep an eye on. That's it for today's episode. Thanks so much for being here and keeping us informed.
Folks out there, if you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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