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What are the statistics on vaccines? Are people getting vaccinated? What are common vaccines for children? Can kids get bird flu? Is it COVID season?
AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses the latest trends in respiratory illnesses, what causes vaccine hesitancy and low seasonal vaccination rates for RSV, influenza and COVID-19. Also covering H5N1 in children, how bird flu spreads to humans and avian influenza symptoms in humans. 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
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. Welcome back, Andrea.
Garcia: Thanks, Todd. It's great to be back.
Unger: Well, going into the holiday, respiratory viruses were generally stable or low, which was great news. But public health experts are now sounding the alarm. Andrea, why are they concerned?
Garcia: Well, Todd, as you may have seen, there was a recent Washington Post headline that I think really captured the concern here. And it is that Americans are just not getting seasonal vaccines, meaning COVID, flu, and in some cases, RSV, ahead of the holidays. And we've now finished up a busy holiday travel weekend with many large family gatherings. And we're obviously going to be turning to even more of those in the coming weeks.
And these respiratory illnesses, as we know, typically peak from December to February. Many people are heading into these next few months unprotected, and experts are worried that this is ultimately going to lead to an increase in outbreaks and hospitalizations, and of course, put additional stress on our health care system.
Unger: And we've seen this before, of course, in past years. How do the numbers this year compare to last year's?
Garcia: So as of November, we've seen about 37% of adults having received a seasonal flu shot. Only 19% have received that updated COVID vaccine, and it's around 40% of adults 75 and older—and that's that group at greatest risk—who have gotten an RSV vaccine.
As you pointed out, unfortunately, we have been here before, and these rates are similar to the figures we saw last year. So if we look in comparison in December of 2023, that percentage of adults who had received the flu vaccine was only slightly higher at 42% The COVID vaccination rate was 18%, so virtually the same as this year. And only 17% of adults 60 and older had been vaccinated against RSV. This year, that number did jump to more than 31%. But overall, as the Post article points out, these numbers reflect a persistent public health challenge for us, and vaccine uptake is just not there.
Unger: Absolutely. I'm curious, are we seeing this with certain groups more than others?
Garcia: There are some trends that are worth noting here. For example, coverage both this year and last year was the lowest among people without insurance who said they are just not likely to go and get their flu or COVID vaccines. According to the Post article, people in the cities and the suburbs are more likely to get vaccinated than people in rural areas, and young people also seem to be less likely to get vaccinated than their older counterparts.
Unger: Speaking of young people, how is this all playing out in children?
Garcia: Well, COVID vaccine uptake, in particular, is extremely low. Although we know that the COVID vaccine is recommended by the CDC for everyone ages six months and older, only about 9% of children younger than 18 have received this year's shot. The flu vaccine is slightly better, but still not where it needs to be. It's at about 33%.
And then RSV is the other one we have to consider here, too. To protect infants from RSV, vaccination is recommended during pregnancy, or the monoclonal antibody treatment is advised for babies younger than eight months entering their first RSV season. And as of March, only about 41% of eligible infants had received the RSV antibody treatment.
Unger: Now, Andrea, we've talked about before the public health campaigns that try to remind people to get vaccinated, and this is something we tend to do every year. But the message just doesn't seem to be getting through. What is driving the low numbers?
Garcia: Well, we do continue to see this swarm of misinformation on social media and the internet, which in many instances has overshadowed the public health campaigns that you mentioned. As one expert points out in The Washington Post article, it's likely less about a broad anti-vaccine stance for most people and more about vaccine confusion. People simply don't know what to believe, so they don't do anything.
Vaccine hesitancy was already a concern before 2020, and we definitely saw that worsen with the COVID vaccine campaigns during the pandemic. Experts say that's now affected other routine vaccines. And it's not just social media. People are also influenced by their friends and the experiences that they encounter in their day-to-day lives. We do know that people still trust their doctors, and it's really going to be important, and it's going to be on them to shoulder a lot of this responsibility for helping to motivate patients to get vaccinated, particularly with their older or immunocompromised patients.
Unger: That's a big point. It's that trust with physicians and the critical role that physicians play here. How are the numbers looking post-Thanksgiving? Have we seen any kind of significant change?
Garcia: No. The numbers are still trending low right now, but it's really still too early to see any of the significant bumps we may expect to experience after the holiday. We typically see an increase in cases about a week after Thanksgiving, and how quickly those cases increase between now and the Christmas holidays will give us a better sense of what the season is going to look like.
There was a recent CNN article earlier this week, and as we discussed prior to Thanksgiving, we've seen a relatively slow start to the respiratory virus season. The CDC is predicting that this season could have a similar or lower number of combined peak hospitalizations due to COVID, influenza and RSV compared to last season. But the peak rate of respiratory virus hospitalizations will likely still be well above what they typically were in the years before the pandemic.
For now, though, COVID levels in the U.S. are nearly the lowest they've been since the start of the pandemic. That's according to CDC data from December 2. And the wastewater data suggests that flu and RSV are also circulating at low levels. But emergency department visits for both of those viruses have started to rise. As we know, a lot can change over the next few weeks.
Unger: Absolutely. And of these three that you were talking about, is there one that we should be watching more closely than another right now?
Garcia: Well, if we look at that latest CDC data, the test positivity rate for RSV is rising faster than it is for flu or COVID. As we know, RSV infection is typically mild for adults, but infants and older adults do face that high risk of severe disease. And the hospitalization rate is rising quickly among children. There were about three RSV hospitalizations for every 100,000 children during that week ending November 23. That's twice as many as a month earlier. There were also at least 21 hospitalizations for every 100,000 infants that week. And that's up from less than 14 a month earlier.
Unger: Now, Andrea, we talked a couple of episodes ago about another trend in children that's walking pneumonia. I'm curious how the numbers are looking there. What can you tell us about that?
Garcia: Yeah. As we did talk about a couple of weeks ago, that trend is continuing. Walking pneumonia is currently spreading rapidly among young children. Children hospitals are continuing to feel the strain. The CDC did first warn of an increase in these infections in October. The trends haven't really improved. And we do know that cases actually started rising globally back in 2023. But surveillance data from the U.S. this year suggests that hospital visits peaked in August, and they've stayed elevated since then, especially among children.
According to the CDC, the increase in children ages 2 to 4 is particularly notable, and that's because walking pneumonia typically isn't a leading driver of disease for that age group. So this is something we'll certainly continue to keep an eye on.
Unger: Well, let's turn our attention now to another virus of concern, and that is bird flu. We haven't talked about it in a few weeks. Andrea, what's happening there?
Garcia: Well, Todd, right before the holiday, there was a case of H5 bird flu confirmed in a child for the first time in the U.S. That child lives in California. And according to the press release, the virus was detected through influenza testing and reported to the California Department of Health through influenza surveillance. The release also said this marks 55 total cases reported in the U.S. this year, 29 of them being in California. And we do know that that total has since risen to 57 cases in the U.S.
Reportedly, the child only had mild symptoms. He received flu antivirals and are now recovering. According to the CDC, there is no evidence of person-to-person spread of H5 bird flu from the child to others, and there still has been no person to person spread associated with the virus reported in the U.S. overall.
Unger: Well, thankfully, the cases we've seen here have been mild. Do we know why that's the case?
Garcia: Well, Stat News recently actually dove into this exact question by talking to 21 researchers in the field. At the moment, of course, these are only hypotheses, but they do pose some interesting theories. One is that the amount and the way the virus is being transmitted is limiting the severity. So in humans, transmission seems to be occurring largely through the eye. That's why we're typically seeing conjunctivitis or pink eye. The eye is typically an area where the virus can be contained. And sometimes these infections can spread to the upper airways, but not always.
The Stat article pointed out that we did see this happen with the Canadian teenager that we talked about a few weeks ago. That teen's infection began as conjunctivitis but progressed to severe pneumonia. And we do know that that individual does continue to remain on a ventilator.
The other theory is that the volume of virus that is triggering the infections may be smaller and therefore less severe. One other theory includes that the version of H5N1 circulating right now may be inherently less dangerous to people or that people are simply less susceptible to severe infection from H5N1 than we used to be.
Unger: Well, whatever the reason, we are certainly thankful that the cases continue to be mild. And on that note, we'll wrap up this week's episode. As always, thank you so much for being here, Andrea. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. You can always 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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