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
Can you die from E coli? Does E coli die when cooked? What are the symptoms of bird flu? Which carrots are being recalled? Does McDonalds still have E coli?
AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses recent E. coli outbreaks linked to organic carrots, baby carrots and fast food. Also covering Mpox cases in the US, rising bird flu cases, as well as getting COVID and flu vaccines ahead of the holiday season as respiratory illnesses increase. AMA Chief Experience Officer Todd Unger hosts.
- The AMA is your powerful ally, focused on addressing the issues important to you, so you can focus on what matters most—patients. We will meet this challenge together. Join us.
- Live CDC webinar on the latest flu, COVID-19 & RSV vaccine recommendations "Leading the Way to a Healthier Winter" (Thursday, Nov. 21)—submit questions and register.
- CDC COVID-19 vaccine recommendations and COVID Vaccination Clinical & Professional Resources.
- 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).
- Get the latest CDC Mpox updates.
- Clade 1 Mpox in Central and Eastern Africa (CDC travel advisory Central Africa).
- Get CDC mpox vaccine recommendations.
- Googling "mpox vaccine near me"? Visit for more.
- 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. Andrea, welcome back. It's been a few weeks since our last update.
Garcia: It has been. It's good to see you, and of course, great to be back as well.
Unger: Well, a lot has happened since we last talked, so we have a lot to cover today, including another E. coli outbreak, more news on bird flu and mpox and even more reasons to get vaccinated before the holidays.
Andrea, let's start with E. coli. Last time we talked, there was a growing nationwide outbreak tied to McDonald's and slivered onions, now we have a new concern that hits even closer to home and that's organic carrots. What's the story Andrea?
Garcia: Well, let's first briefly revisit that outbreak tied to slivered onions, which were served at McDonald's on their quarter pounders. We know that. So far, in total, that outbreak has sickened more than 100 people, 34 people have been hospitalized, and at least four have developed a life-threatening kidney disease and one person has died. In response, we know that McDonald's pulled the quarter pounders from their menu, served in several states. And they stopped using those slivered onions from its supplier, Taylor Farms, in 900 restaurants.
As a precaution, we saw other large, fast food chains temporarily pull onions from their menus as well. Last Wednesday, McDonald's announced that they had identified an alternate supplier for its onions. And over the past couple of weeks, restaurants have resumed selling those quarter pounders with onions.
However, as you mentioned, we do now have another E. coli outbreak. This time, the culprit could be sitting in your own refrigerator. It's organic carrots. According to the CDC, this outbreak is linked to multiple brands of recalled organic, whole bagged carrots as well as baby carrots sold by Grimmway Farms.
That—Grimmway Farms may not sound that familiar, but these carrots are sold under a number of different brand names at a wide range of retailers, including Trader Joe's, Wegmans, Whole Foods 365 brands, Good & Gather from Target, GreenWise from Publix, Simple Truth from Kroger, Nature's Promise from Food Lion, among others.
Unger: That's pretty scary, Andrea. How many people have been affected so far?
Garcia: According to the CDC and The New York Times as of Sunday, one person had died, 39 people had become ill and 15 people had been hospitalized. We do expect that number to grow since the baby carrots had expiration dates ranging from September 11 to November 12. And those whole carrots were on shelves from August 14 to October 23.
Those affected carrots are likely no longer in stores, but if you have them in your fridge, the CDC is recommending throwing them away and washing all surfaces or items that came into contact them—with them in hot, soapy water. Definitely call your doctor if you—develop symptoms and they become severe.
E. coli infections typically start four days after a person consumes contaminated food. Those symptoms can include diarrhea and severe stomach cramps. If those symptoms do last more than two days, or if you're experiencing a fever that's higher than 102 or you become dehydrated, medical care may be required. However, according to the CDC, most people do recover without treatment after five to seven days.
Unger: All right. Well, thank you for that update with both of these recalls. We're dealing with contaminated raw vegetables. Is that something that's on the rise? It seems to be something we're hearing more about.
Garcia: We are hearing more about it. The FDA considers most of those pre-cut raw vegetables to be high risk because we're breaking that natural exterior barrier of the produce and that increases the risk of bacterial growth and contamination.
Fruits and vegetables can be contaminated with animal waste when manure is used to fertilize produce in the fields or they can be contaminated with water that is being used on the produce. Any additional processing, such as prepackaging, then gives that bacteria opportunities to spread.
We are used to hearing about lettuce and sprouts being connected to foodborne illness, but this obviously can occur with other produce as well. As with other foods, cooking vegetables usually kills the pathogen. So if you are concerned, you can opt for cooked vegetables.
Unger: All right, well, that's good to as we head into the holidays. Andrea, let's turn our attention now to a different kind of outbreak and that's mpox. We've had more news and it's not exactly what we want to hear at this point. Tell us more about it.
Garcia: Well, it has been some time since we've talked about mpox. But if you recall, there are two clades or types of mpox. Clade II has been linked to the outbreaks we've had here in the U.S. It is thought to be less serious. The other clade, clade I, is thought to be more serious. And it's largely been circulating in Africa and a few other countries, but it had yet hit the United States. That has now changed.
On November 15, we saw the California Department of Public Health confirm the first reported case of clade I mpox here in the U.S. The U.S. is now the sixth country outside of Africa to confirm a case of this strain since August. The CDC has issued a health alert, or a HAN, with recommendations for clinicians about preventing, diagnosing, treating and reporting mpox cases.
Unger: Andrea, what do we know about the individual who was diagnosed here?
Garcia: Well, we do know that individual had recently traveled to areas experiencing clade I mpox transmission. They sought medical care for mpox symptoms in the United States, specifically in San Mateo County, just South of San Francisco. The patient was treated based on their travel history and symptoms. They're now isolating at home and recovering. The case is reportedly relatively mild.
The CDC, along with local and state health departments, are investigating potential contacts. But as of November 18, no additional cases have been detected. The CDC does say that the risk of clade I mpox to the public in the U.S. remains low, but obviously we know the agency has been preparing for a clade I mpox case here in the U.S. since March.
Physicians are advised to be aware of mpox symptoms and ask patients with comparable signs and symptoms about their recent travel history and other risk factors and also consider mpox testing. Of course, all of those cases should be reported to state, local and territorial public health authorities as soon as possible.
And, as a reminder, CDC does recommend people who are eligible for the mpox vaccine to get it. It is a two-dose course, so get that first dose as soon as possible. And if you've only received one dose, make a plan to get that second dose.
Unger: All right. And we'll certainly keep an eye on that. Let's turn now to a different topic—that's bird flu. Andrea, it sounds like more human cases are cropping up. What can you tell us about that?
Garcia: Well, the case that has largely been capturing headlines this week was a teen with H5N1 bird flu in Canada. Unlike the cases we've seen here in the U.S., this individual is in critical condition. This is Canada's first locally acquired case of H5N1 avian influenza in a person.
Health officials in British Columbia have been investigating how this teenager came down with the disease, despite having no known links to poultry farms. The most—that's the most common sites where bird flu has been detected in Canada. And so far, no one who's come into contact with the teen has fallen ill.
Unger: So, a bit of a mystery here, Andrea. What do we know about this team that might influence finding out?
Garcia: We know that the otherwise healthy teen went to a hospital emergency room on November 2 with initial symptoms of pinkeye, fever and cough. They were sent home but shortly after began having difficulty breathing. That's when they were admitted to BC Children's Hospital in Vancouver.
H5N1 has not been detected in Canadian dairy farms, but at least two dozen poultry farms have detected the virus since October of 2024. In line with this, the National Microbiology Laboratory in Winnipeg confirmed the infection in the teen was caused by the H5N1 virus and genetic sequencing then showed that it is the genotype that's found in wild birds, not the version circulating in dairy cattle here in the U.S.
Unger: All right. And speaking of the U.S., Andrea, any updates on what's happening here?
Garcia: Well, Oregon is the latest state to confirm a human case of H5N1 bird flu. Oregon health officials said that the individual's connected to a poultry operation and only experienced mild illness and has fully recovered. Based on the CDC data, we've seen 53 cases of H5 bird flu in people across the country. Nearly all of them have been farm workers.
In recent weeks, the CDC has called for more testing of employees on farms with H5 bird flu outbreaks after a new study showed that some dairy workers had signs of infection, even when they didn't report feeling sick. The CDC has said that those farm workers who are in close contact with infected animals should be tested and offered treatment, even if they are not showing any symptoms.
Unger: All right. Well, thank you for that. Andrea, before we wrap up, as we head into the holidays next week, we're reminded once again of the importance of getting vaccinated. What message do you want people to hear?
Garcia: Well, Todd, I think that message is there is still time to protect yourself. If you've missed that early fall push for flu and COVID vaccines, it's definitely not too late to get vaccinated. We know, according to health officials, that it's important to get vaccinated ahead of the holidays when we know respiratory bugs tend to spread with travel and indoor celebrations.
While the amount of acute respiratory illness causing people to seek health care is low nationally, we are starting to see increases in ED visits for flu and RSV. It does take your body about two weeks to build up immunity after a vaccine, so it's best to get vaccinated as soon as possible. You can get the flu and COVID vaccines at the same time.
For physicians, we do have a special partner webinar with the CDC and others happening on Thursday, November 21 from 12:00 to 1:00 PM Eastern time called "Leading the Way to a Healthier Winter." You can join us for the latest updates on flu, COVID and RSV, including the latest vaccine recommendations.
The AMA's vaccine expert, Dr. Sandra Fryhofer, will be a part of that panel. It'll be a great way to help physicians prepare for respiratory season. We'll drop a link to the description where you can register for that webinar and submit questions beforehand.
Unger: All right. That particular webinar, again Thursday, November 21 from 12:00 to 1:00 Eastern time, "Leading the Way to a Healthier Winter." It sounds like that will be a very, very valuable session.
Well, Andrea, that sounds like a good place to end this week. And thank you again for being here, as always, with your perspective.
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 video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
Subscribe to AMA Update
Get videos with expert opinions from the AMA on the most important health care topics affecting physicians, residents, medical students and patients—delivered to your inbox.
