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How many measles cases in 2025? Can CT scans cause cancer? What is the best treatment for gonorrhea? What states have bird flu? What animals are affected by bird flu?
AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, covers measles outbreak states, latest bird flu news, treatment for gonorrhea and CT scan radiation. 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: It looked at data from 2023, when there were 93 million CT exams. And the model projected that these exams would result in approximately 103,000 future cancers.
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. Always great to be here.
Unger: Well, last week, the CDC's Vaccine Advisory committee met for the first time this year, and it made several notable new recommendations. Andrea, can you walk us through Those
Garcia: Sure, Todd. And I would start off by just saying it was good to see that that advisory committee meeting after that February meeting had been postponed. The new recommendations had to do with vaccines for meningococcal, RSV and chikungunya. For the meningococcal vaccine, ACIP recommended the use of the new pentavalent vaccine from GSK, which protects against the A, B, C, W and Y serogroups, and then additionally, recommended lowering the age for the RSV vaccine. And that's to include adults aged 50 to 59 who are at increased risk of severe disease.
And then we also saw them recommend the newly approved chikungunya vaccine from Bavarian Nordic for adults who are traveling to an area with an outbreak or who are likely to be exposed to the virus. These recommendations are pending approval by the CDC. And of course, anyone who would like more information on the recommendations should be sure to check out your interview later this week with Dr. Sandra Fryhofer, who is the AMA's immunization expert, and of course, liaison to ACIP.
Unger: Yes, I'm sure it'll be a great discussion with Dr. Fryhofer, as usual. Now let's check in on the measles outbreak in the Southwest that we've been following. I remember when we were talking about counts in the 60s. It's a lot bigger than that now, Andrea, tell us more.
Garcia: Well, Todd, to start nationally, as of April 17, there are a total of 800 confirmed measles cases that are now being reported by 25 jurisdictions. About 85% of those cases are tied to that outbreak in the Southwest. As of yesterday, that case count in the outbreak surpassed 700. In Texas alone, that total number of cases currently stands at 624.
In New Mexico, there have been 65 cases. And in Oklahoma, there are now 13 cases in total. We've also been keeping an eye on measles cases in Kansas. That number continues to climb as well. As of last Wednesday, there have been 37 cases identified in the state. And we know that the CDC is continuing to closely monitor the situation and work with state and local health departments to track the outbreak and help those who have been affected.
Unger: Now, the CDC scientist who is leading the response to this outbreak provided some additional perspective during the ACIP meeting. Andrea, can you tell us more about that?
Garcia: Yeah, Todd. Those remarks came from Dr. David Sugarman, who is a senior scientist with the CDC. One of the notable things he mentioned is that there are likely a large number of cases that have gone unreported. He shared that when he's talking with families, they may mention a prior case where an individual recovered but never received testing or treatment.
This led Dr. Sugarman and his team to suspect there is under-testing, and therefore underdiagnosis and underreporting. And he actually addressed the U.S. elimination status for measles, which is something we've talked about before as well. He said that based on the trends we're seeing four months into this outbreak, we could risk losing our elimination status around January 20 of next year.
Unger: Well, that's certainly important context for us to keep in mind as we're discussing the latest case counts. In recent weeks, there have also been a few updates related to bird flu. Andrea, bring us up to speed on that.
Garcia: Well, there have been new cases identified in cattle and poultry flocks, and we saw new guidance from the World Health Organization. Let's talk about those new cases first. Over the last 30 days, there have been 31 H5N1 avian flu detections in dairy cattle in four states, specifically California, Idaho, Arizona and Nevada.
As for cases in poultry, over the last 30 days, there have been detections in 22 flocks, 33 of those in commercial flocks, and 19 in backyard flocks. So this is affecting almost 0.4 million birds. There have been no new cases of H5N1 detected in humans in the U.S. in recent months, but there was a recent fatal H5N1 case in Durango, Mexico. And sequencing revealed that that case involved the D1.1 genotype, which we've talked about before, has been linked to serious infections in the U.S. and in Canada.
Unger: And Andrea, talk a little bit more about the update from the World Health Organization.
Garcia: Yeah. So earlier this month, the WHO released new guidance on surveillance for human infections with H5 avian influenza. It said the goal of the guidance is really to help detect and characterize human infections so that they can properly trigger public health responses, assess risk and inform global pandemic preparedness. In the episode of this description we'll include a link for that guidance for reference.
In the U.S., we've seen the USDA Animal, Plant, Health, and Inspection Service recently announced a $15.3 million in funding for research projects that are related to diseases that threaten U.S. livestock. And really, since the start of this outbreak, we've been focused on the U.S. response to the spread of bird flu across the country. But clearly, this has global health implications, and it's something that the WHO is also watching closely.
Unger: Absolutely. And thanks for that update, Andrea. Another story making the headlines last week was a potential new treatment for gonorrhea. Andrea, what can you tell us about that?
Garcia: Well, according to a study published in The Lancet, a drug called gepotidacin has been found to be safe and effective in treating gonorrhea in late-stage trials. That drug works by preventing bacteria from replicating in the body. And if it's approved to treat gonorrhea, it would be the first new antibiotic for it in decades. This is significant because gonorrhea and other sexually transmitted infections are getting harder to treat as they become more resistant to the existing antibiotics that we have.
Unger: That is important. And how effective is this new antibiotic compared to the existing one?
Garcia: Well, the CDC currently recommends treating gonorrhea with a 500-milligram injection of the antibiotic ceftriaxone. In the study, a combination of ceftriaxone and azithromycin was found to be 91% effective in treating gonorrhea. Comparatively, gepotidacin was 92% effective. So if this new drug is approved, it could be a strong alternative to the current treatment. In recent years, we know that gonorrhea cases have been on the decline, but it's still the second-most common STI in the U.S., and in 2023, there were over 600,000 cases based on CDC data.
Unger: A lot of cases, so that's good news. Andrea, that wasn't the only study in the spotlight recently. New research in JAMA about the risks associated with CT scans also drove headlines. What's the story there?
Garcia: Well, this study worked by using a statistical model to project cancer diagnoses from CT examinations. And it looked at data from 2023, when there were 93 million CT exams. And the model projected that these exams would result in approximately 103,000 fewer cancers. It went on to say that these findings suggest that cancers associated with CT scans could eventually account for 5% of all new cancer diagnoses annually.
Now, we've known that radiation from CT scans can increase a person's cancer risk, but this procedure is also being used a lot more than it once was. And the study actually notes that its use has gone up by about 35% since 2007. These findings are a good reminder of the need to be mindful about exposure to radiation and to limit it to cases when it's really necessary.
Unger: Andrea, is there any reason why there's been such a big increase in CT scans?
Garcia: Well, the study attributes this growth to a rise in low-value and potentially unnecessary imaging. It notes that our aging population could also be a contributing factor as well. Even with all of this, I think it's important to keep in mind that patients shouldn't forgo necessary medical imaging. Their physicians will need to continue to balance the benefits and risks of these exams, talk openly with patients about their options.
It's complex, and there's no simple solution that is going to work for everyone. In certain cases, physicians might be able to offer imaging options that don't use ionizing radiation, such as ultrasound or MRI. But more broadly, efforts to reduce that amount of radiation used in CT scans and to standardize that dose across imaging centers could help further mitigate the risk.
Unger: Well, thank you for breaking that down for us, Andrea. And as always, we appreciate you joining us each week and keeping us up to date. 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 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 podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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