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What is travel illness? Can I test for HPV at home? How many cases of measles are there? What are vector-borne diseases? How dangerous is bird flu to humans?
Discussing over 1000 confirmed measles cases, H5N1 bird flu, healthy travel health tips for summer, a new at-home pap smear FDA approved test, and a JAMA study on prenatal cannabis use with 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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Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Transcript
Garcia: Last Friday, the CDC reported that we surpassed the 1,000 case mark for confirmed measles cases so far this year. This is the second highest case count we've seen in 25 years, with the highest being in 2019. That year, more than 1,200 measles cases were detected.
Unger: Hello and welcome to the AMA Update video and podcast. Today is our weekly look at the public health issues facing physicians and patients across the country with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia. I'm Todd Unger, AMA's chief experience officer. Welcome back, Andrea.
Garcia: Thanks, Todd. Good to see you, and great to be here.
Unger: We have a lot to talk about today. We're going to start with bird flu. Last week, we talked about new cases of bird flu in dairy cattle and poultry. And since then, there have been some new comments from the CDC about the state of bird flu outbreaks. Andrea, what did the agency have to say?
Garcia: Well, Todd, these comments came from CDC staff during a clinician outreach and communication activity, or COCA, call last Tuesday. They indicated that detections of H5N1 avian flu have slowed in both animals and humans. However, cautioned that continued surveillance is still warranted. As you know, we've been closely following these outbreaks over the last six months. Towards the end of last year, we saw cases in dairy cattle surge, but by January, they indeed had started to decline. Cases in poultry flocks began to fall after February and were down last month in backyard flocks as well.
Unger: Well, this sounds like good news. Obviously, a little cautious optimism, I guess I'd classify it as. Andrea, what does this mean for us going forward?
Garcia: Well, these are encouraging trends. But even on the call, the CDC stressed that continued surveillance is still necessary. If the situation changes, we really need to be able to identify that quickly. The team lead of the National Surveillance and Outbreak Response team at the National Center for Immunization and Respiratory Diseases was also on that call.
She said that this decline in animal cases will likely lead to fewer infections in humans as well, and that's because most of the human cases are known to be associated with animal exposures. Overall, this is good news for a situation that's been full of uncertainty for a while now. Although, as you noted, this is something we'll continue to monitor closely.
Unger: All right. Well, thank you very much. Unfortunately, we don't have good news to share on the other outbreak that we've been following. And of course, that's measles. Andrea, can you bring us up to speed on what's going on there.
Garcia: Yes. Last Friday, the CDC reported that we surpassed the 1,000 case mark for confirmed measles cases so far this year. This is the second highest case count we've seen in 25 years, with the highest being in 2019. That year, more than 1,200 measles cases were detected. According to the CDC, measles cases have now been reported in 31 jurisdictions. There have been 14 outbreaks, which again, is defined as three or more related cases. By far, the biggest outbreak is the one that's happening in the Southwest, where cases are still on the rise.
Unger: Andrea, what are the latest case counts there?
Garcia: Well, there have now been 709 cases in Texas, which is up from 683 the last time we talked. In Texas, El Paso County saw the biggest increase in cases, adding 12 in the past week. In New Mexico, there were four new cases over the last week for a total of 71. And in Oklahoma, there was one new case, which brings the total there up to 17. As of last Wednesday, there have also been 48 cases detected in Kansas, which is up to since the last time we talked.
Unger: Well, thank you for that update, Andrea. And these measle cases are especially concerning, since we're heading into a very busy summer travel season. Do you have any advice to help people stay healthy while they're on the go?
Garcia: Well, it is indeed that time of year again. Here are a few things that people can do before and during their trip to stay healthy. A month or two before you leave, you'll want to think about what vaccinations and medications you might need based on your destination. The CDC website does make it easy to learn about the potential health risks of where you are traveling to.
This step is important even if you're traveling within the U.S. And as we just discussed, measles outbreaks are happening across the country. In a number of previous cases, we've seen infected individuals pass through airports. So making sure you're up to date on all routine vaccines, including measles, before traveling is critical.
Unger: Obviously, really, really important foundational step. Any other additional steps that people should be taking in the midst of their trips?
Garcia: Well, many of the things we do to stay healthy when we're at home, we'll also want to do when we're away as well. So that includes drinking plenty of water, protecting yourself from the sun, eating balanced meals, and making sure to get enough rest. You'll also want to take steps to avoid bug bites, especially if you're traveling to areas where diseases such as yellow fever, malaria, dengue or chikungunya are more common.
I think it's important to keep in mind that we are seeing shifts and expansions in the geographic ranges of some of those vector-borne diseases. And then finally, if your travel plans include visiting those crowded tourist attractions, remembering that wearing a high-quality mask will go a long way in protecting you from respiratory infections.
Unger: All right. Well, I hope everyone has a fun and safe time traveling this summer. Some of those things you suggested not really the hallmarks of my particular vacations, Andrea, but good advice. Another story making headlines recently was an announcement from the FDA that could have a big impact on cervical cancer screenings. Andrea, tell us more about that.
Garcia: Well, last Friday, the FDA approved the first at-home cervical cancer screening tool. This test is made by Teal Health, and it offers an accessible alternative to pap smears. So we know that in conducting pap smears, clinicians insert a speculum into the vagina and scrape cells from the cervix, which can be uncomfortable.
This new test involves swabbing the vagina with a sponge-like tool. Similar tests were approved last year for the use in doctor's offices, and that allowed patients to collect their own sample using a narrow swab. This at-home version could make screening for cervical cancer even more accessible, especially for people who can't easily get to an in-person appointment.
Unger: This is a really big development. It seems like we've got a lot of more at-home tests, period. Will this be available to patients?
Garcia: Well, Teal Health plans to mail an initial round of tests to customers in California next month. And then from there, it'll expand to other states. Patients will be able to order the test online and speak with a physician via telehealth. After that, they'll collect their sample and send it back to be tested for HPV.
If the test is positive, Teal Health will refer them for a pap smear or colposcopy. If the test is negative, then no further screening will be needed for three to five years. Studies show that this test is about as accurate as pap smear. So with the added benefit of it being more accessible, hopefully, that translates to a lot more patients getting screened for cervical cancer.
Unger: Absolutely. It's interesting. We just had a physician on a few weeks ago talking about the FIT testing, the at-home screening for colonoscopies. You add this. Those are really big advances in terms of screenings. Glad that those options are there. Andrea, before we wrap up, there was a new study about cannabis use in pregnancy that also made headlines this week. What can you tell us about that?
Garcia: Well, Todd, this study appeared in JAMA Pediatrics, and it looked at prenatal cannabis use and neonatal outcomes. It was a systematic review and meta-analysis of 51 studies. What it found was that cannabis use in pregnancy was associated with increased odds of preterm birth, small for gestational age, low birth weight and perinatal mortality. The study was actually an update of a previous systematic review and meta-analysis, and through this update, the authors improved the confidence of their findings from low to moderate.
Unger: You'd think that with a number of things that are obviously not beneficial during pregnancy, that people would understand that. But there have got to be implications now for physicians in terms of making sure people understand that. What advice do we have for physicians, Andrea?
Garcia: Well, the authors mentioned in the study that prenatal cannabis use continues to rise, and cannabis is the most commonly used federally illegal drug in pregnancy. So the fact that we're seeing evidence of adverse effects on fetal and neonatal outcomes should give us pause. Patients often think that cannabis use is safe during pregnancy because it's now legal in a growing number of states. The authors recommended that physicians talk with their patients about the impact of cannabis use during pregnancy and use these findings to help guide those conversations.
Unger: That's great advice. And Andrea, thank you so much, as always, for sharing your insights and keeping us up to date each week. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/joinnow. Patients can get involved by joining the AMA's Patients Action Network at patientsactionnetwork.com. As always, 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 video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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