AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
Featured topic and speakers
What sickness is going around right now? Is bird flu worse in fall? What is sloth fever? How is cholera transmitted? When is respiratory virus season 2024?
Our guest is AMA 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 (CDC H5N1 technical report).
- If the CDC issues new health warning, get the latest CDC health alert 2024 via the Health Alert Network (HAN CDC website).
- CDC HAN Increased Oropouche Virus Activity and Associated Risk to Travelers (CDC HAN 00151).
- Looking for more info on Oropouche fever? CDC Clinical Overview of Oropouche Virus Disease (oropouche orthobunyavirus, OROV).
- Ask Dr. Dana: CDC Dana Meaney-Delman, MD answers questions about the Oropouche virus outbreak (OBGYN Q&A).
- CDC FAQ oropouche and pregnancy.
- Will there be a respiratory virus surge? CDC respiratory virus season information.
- CDC Respiratory Illnesses Data Channel.
- Learn more about our AMA advocacy priorities, including:
- Reforming Medicare payment
- Fighting scope creep
- Fixing prior authorization
- Reducing physician burnout
- Making technology work for physicians
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. Good to see you, and great to be here.
Unger: Well, we have, again, a lot to talk about this week, including bird flu, the oropouche virus and present-day cholera and what to expect this fall. Let's start with bird flu. Andrea, last time, we discussed the Missouri patient who had no known contact with an infected animal and yet tested positive for bird flu. This week, we have some more concerning news. What can you tell us?
Garcia: Well, Todd, at the end of last week, there was additional information released by the CDC. First, we learned that the strain of the virus that made the Missouri patient sick is closely related to the H5N1 strain that has been infecting U.S. dairy cattle.
We also learned, through the CDC's weekly influenza report, that a close contact of the Missouri patient was sick around the same time but was not tested for influenza. That report also revealed a second close contact, a health care professional, who subsequently developed mild symptoms but ended up testing negative for influenza.
Just as a reminder, that Missouri patient was hospitalized on August 22, reportedly had significant underlying medical conditions, and the patient was given antiviral medication and has been discharged from the hospital. Thankfully, all of these patients have since recovered.
Unger: That's good news. But I'm curious, what should we take away from all of this?
Garcia: Well, there certainly still are a lot of questions. In a follow-up email on Friday, a CDC spokesperson said that the close contact who became sick was a housemate of the Missouri patient. The spokesperson also said that the simultaneous development of symptoms doesn't provide evidence of person-to-person spread, but rather it suggests a common exposure.
We still don't know exactly how that Missouri patient got sick. That's still under investigation. So far, the CDC has said that there is no clear source. The other 13 human infections reported in the U.S. this year all occurred in people who had close contact with infected animals. That Missouri patient had no such contact. The same was true for their housemate. No links to animals or raw milk have been found. And while that piece certainly remains a mystery, a 10-day follow-up period has passed and no additional cases have been found.
Unger: Well, at least that's good news. We typically worry about viruses more as we head into the fall. Is that also true of bird flu, and should we expect to see more cases?
Garcia: Todd, that's a good question. In an article published by CNN earlier this week, officials said that the risk posed by H5N1 could rise as fall and cooler weather approaches. This is because fall and winter months present more opportunities for H5N1 to spread and change, since both cows and other flu viruses will be on the move. Every time the virus finds a new host, it has the chance to get better at infecting people.
As seasonal flu viruses are picking up steam in the U.S., there's that increased likelihood that a person, particularly a farm worker, could get infected with both bird flu and seasonal flu at the same time. And we know that co-infection could give H5N1 the opportunity to gain genes that enable it to spread more efficiently among people. So we really have to keep a close eye on this and take steps now to prevent that from happening.
Unger: That's not a great combination at all. And I didn't even think about the mutation portion of that particular combination. Andrea, given the seriousness of the potential of that, what steps is the CDC taking?
Garcia: Well, we know that CDC and other federal agencies have taken a number of steps. But most recently on Thursday, the CDC said it was awarding $5 million in funding to five commercial laboratories, which are often used by physicians and hospitals. And they'll be developing tests to detect each five viruses. The agency is also looking to have these commercial labs develop tests for oropouche virus, which is currently causing outbreaks in South America in Cuba.
This is a change in the way that CDC has done things in the past. If you remember back to COVID, we would see the CDC develop tests for pathogens and then share those tests with others. And then, after that, commercial labs would develop their own tests. The agency is now looking to speed up that process with these new arrangements. Commercial labs will be developing new tests for public health responses alongside the CDC, not after
Unger: All right, that sounds like a good idea. Andrea, you mentioned in that last passage about the oropouche virus. It's something we really haven't talked about in a few weeks, but there have been some updates. What's going on there?
Garcia: So just as a quick reminder, this virus is spread by small flies or biting midges and some types of mosquitoes. The virus has been reported in parts of South America, Central America and the Caribbean. It causes sudden fever, severe headaches and chills, and then, in some cases, it causes more severe complications, such as meningitis or encephalitis. It has also been linked to several deaths this year. And there are cases of vertical transmission. Oropouche virus infections have been on the rise. Cuba reported cases of this illness for the first time in 2024, and we know that more than 30 cases have been reported in the us from travelers returning from Cuba.
The CDC said, as of last week, a total of 52 associated travel cases have been reported to them from five states. Local transmission within the U.S. has not been detected. Current guidelines say that people traveling to affected areas should protect themselves from bug bites, and pregnant people should avoid non-essential travel to those areas altogether.
Unger: Andrea, why the special warning on pregnant people for this? What is especially concerning during pregnancy?
Garcia: Well, we know that infection during pregnancy has been linked to fetal death and possible birth defects. We know the virus can be passed from a pregnant person to their fetus. However, the risk of an infected pregnant person passing that virus to their fetus is not currently well understood. The CDC has said that these cases are under investigation. They are working to better understand the potential risks during pregnancy, and they will share updates as they have them.
The agency did publish a new resource called Ask Dr. Dana, where CDC OB-GYN Dr. Dana Meaney-Delman answers questions about pregnancy and the oropouche outbreak. And we'll be sure to share a link to that resource in the description of this episode.
Unger: Great. And on that topic, are there any other resources for physicians who might see this more in patients?
Garcia: Yes. So last week, the CDC released new testing and response guidance, making it easier for physicians to identify cases in their communities. The agency is also now providing clinical diagnostic testing for patients with suspected acute oropouche virus disease in addition to a previously available neutralization test. Specimens should be submitted through state health departments, and those results will be sent back to those departments and shared with physicians for clinical decision-making.
The CDC also has released comprehensive guidance that's to help physicians quickly respond to any imported cases and to help limit spread. We'll also link those resources in the description of this episode.
Unger: All right. That's all good information to know. Now, turning our attention to a different illness that's something we're probably more used to seeing in historical novels than in current news, and yet The New York Times covered it just last week. Andrea, tell us more about what's happening with cholera right now.
Garcia: Well, I think the reason we think of cholera as a disease of the past is because it's preventable. Cholera is transmitted through the ingestion of contaminated food or water. Cholera outbreaks are currently spreading across the globe. And according to an analysis by the WHO, those outbreaks are becoming more deadly. According to that report, fatalities spiked 71% last year, and that far outpaces the 13% rise in cases. Even well-prepared health systems in countries that had not confronted the disease in years are seeing these outbreaks.
Unger: Andrea, what is driving a change like that?
Garcia: Well, the WHO report indicates that much of this increase is being driven by conflict and climate change. Cholera can cause death by dehydration in as little as a single day as the body tries to expel bacteria through vomit and diarrhea. And the primary reason for last year's higher death rate was an increase in what the WHO calls community deaths. So that's people who died of cholera without receiving any care in a health center.
This crisis has been exacerbated by a persistent shortage of vaccines. Demand has outstripped supply for years, and that's ever since key producers stopped making that vaccine. There are 24 countries with cholera outbreaks. The number of cases and deaths does usually spike towards the end of the year, and that's because of weather patterns.
Unger: Conflict and climate change—I remember those being a couple of key ingredients from Dr. Peter Hotez's book about how pandemics start. And so it's interesting to see that and to see the role, the continuing role, that climate change does play in something like cholera. Andrea, before we wrap up, let's do a quick check-in on respiratory season. What can we expect as the fall approaches?
Garcia: Well, we did see an article published by CNN that was reporting on forecasts from the CDC. Those forecasts do suggest that this respiratory disease season will be similar to last year's, which we know brought more than 20 hospitalizations for every 100,000 people in one week at its peak. It was far worse than in pre-pandemic years.
There, of course, is a chance that that burden of disease could be lower. And that game changer to make that happen is vaccination. But it seems like getting people to roll up their sleeves could continue to be a challenge. There was some reporting in the Hill that, while a majority of respondents to a poll said that they have gotten or plan to get this year's flu vaccine, less than half said the same thing about the updated COVID vaccine. So we'll definitely have our work cut out for us as we head into respiratory virus season.
Unger: Well, I'm glad I got both already. I'm ready for the fall. And we'll continue, of course, to track information related to the fall respiratory season. As always, Andrea, thank you so much for being here and sharing all this information. 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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