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
Is there a shortage of BD BACTEC bottles? How does bird flu spread to humans? Is there a H5N1 bird flu pandemic? What is the new HIV medicine for 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).
- Report any supply chain challenges and suspected adverse events due to the shortage of blood culture bottles: [email protected]
- CDC HAN 512 for Disruptions in Availability of Becton Dickinson (BD) BACTEC Blood Culture Bottles.
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.
Garcia: Thanks, Todd. Good to see you and great to be here.
Unger: Well, earlier this week, there was a health alert from the CDC about a supply shortage. Tell us more about what's going on and why it warranted this high of an alert.
Garcia: Yeah, Todd, there was that health advisory that was issued this past Tuesday. And it's about a critical shortage of Becton Dickinson or BD BACTEC blood culture media bottles. And to provide some context, most blood cultures in this country are performed using what's known as continuous monitoring blood culture systems.
These systems can operate unattended by a lab worker, and then an alert will sound when a foreign microorganism is detected in a blood culture. And as physicians know, blood cultures are used to assist in the diagnosis of bloodstream infections and related conditions so sepsis or endocarditis. And they can help identify the type of bacteria or other microorganism causing an infection.
And that helps physicians treat patients with appropriate antibiotics. According to the CDC, that BD BACTEC continuous monitoring blood culture system is used in about half of us laboratories. And it's only compatible with its own blood culture media bottles. So this blood bottle shortage is no small issue.
Unger: Well, given that kind of amount of use, do we have any idea just how broadly this is going to affect patient care?
Garcia: Well, the CDC Alert did say that this shortage has the potential to significantly disrupt patient care by leading to delays in diagnosis, misdiagnosis, or making the management of patients with infectious diseases more difficult. It may also lead to missed infections that need treatment. And there was a CNN article that pointed out some studies have found that bloodstream infections have been more common in the U.S. in recent years, so this could further compound that issue.
While blood cultures are needed in a variety of health care settings, experts say that hospitals are going to be most acutely impacted by this shortage because the tests are often needed to respond quickly to serious conditions. On a recent call related to this shortage, one hospital system reported receiving a shipment of 10 bottles for its 1,700-bed health system.
And the medical director said it faced the very real possibility that they were going to run out entirely. So, it's definitely already affecting patient care.
Unger: Well, Andrea, that sounds pretty serious. What are physicians and hospitals being asked to do in response to the shortage?
Garcia: Well, in the case of hospital systems, like we were just discussing, they cut the volume of blood cultures by more than half with a few key mitigation strategies. That includes scaling their initial testing back to one culture instead of two, and then waiting 48 hours to retest. It's not ideal, but strategies like these can help ensure patients who need it can at least receive one culture.
The idea has been floated to use blood culture bottles that are past their expiration date. However, FDA has not yet weighed in on that. The CDC Alert outlined some specific steps physicians and others can take to help mitigate the impact.
For one, the agency is asking that physicians and anyone else impacted by this shortage develop plans immediately to manage the situation. And these plans should include good stewardship of bottles. And we need to optimize their current supply to minimize those effects on patient care.
Unger: Well, tell us a little bit more about that. What should be included in plans like these?
Garcia: Well, those plans, the keys there are really ensuring that no bottles go to waste, that we're reducing unnecessary testing, and if needed, prioritizing blood cultures for those patients highest at risk. There's should be a renewed focus on best practices for blood collection.
So think about routine disinfection of skin prior to taking blood. That can help minimize the risk of contamination of the blood culture. And then ensuring proper blood volume collection, that can help eliminate the need to collect additional samples. It's also important to use safe blood collection and transfer devices to minimize the risk of damage to blood culture media bottles.
The shortage may stretch until September. And health care professionals are really being encouraged to report any supply chain challenges or suspected adverse events that they experienced because of this shortage to device shortages at fda.hhs.gov.
Unger: All right. Well, thank you so much for that update, Andrea. It's certainly a situation we'll continue to monitor. Andrea, now we're going to turn to two topics that we've talked about a lot over the most recent few weeks—extreme heat and bird flu. Now, one seems to be affecting the other. Can you talk more about that?
Garcia: Well, first, we should note that The Washington Post reported that global temperatures have hit the highest levels ever recorded this past week, or at least since the last Ice Age more than 100,000 years ago. And that sort of comes on the heels of 13 straight months of unprecedented temperatures. And according to The Washington Post article, the hottest year scientists have ever seen.
Now, in terms of how this is connected to HPAI or the bird flu outbreak, according to The Colorado Sun, extreme heat may have contributed to those human bird flu infections in poultry workers. There was a poultry farm. And it was reported that the heat actually made it very difficult for poultry workers who were handling infected chickens to wear PPE. Six of those individuals have tested positive.
This cluster of six cases is the largest outbreak of human cases in the U.S. from the current strain. It's the only time in this country that more than one person has been confirmed to be infected from a single incident. And thankfully, those workers experienced relatively minor illness—conjunctivitis, mild flu-like symptoms like fever and cough.
They were offered Tamiflu. They were asked to isolate. None required hospital treatment. But Colorado does seem to be the epicenter of this outbreak right now.
Unger: Now, Andrea, I know the concern here is the potential for human-to-human transmission. Have we learned anything about that?
Garcia: Well, genetic sequencing of the virus collected from the poultry workers closely resembles what is circulating in dairy herds. And that is suggesting that the cattle have introduced the virus into the poultry flock. As you noted, the bigger concern with a cluster of human cases is that increased potential for those people to pass the virus on to others. We particularly worry about those who are immunocompromised.
By most accounts, the virus working its way through dairy cattle is still fundamentally well suited to infect birds, not people. And to be clear, there's no evidence of human-to-human transmission of the virus, which is why CDC is still saying that the risk to the general public is low.
There has been some reporting both by STAT and NPR on a recent study by a team at the University of Wisconsin-Madison, which found evidence that the virus may have acquired some ability to bind to receptors found in the upper respiratory tract of humans, though other labs have produced conflicting data around that question.
Unger: So Andrea, what should we take away from all of this?
Garcia: Well, I think in the Madison study, you have to keep in mind that these researchers artificially generated these receptors. Attach them to a piece of plastic, and then added the virus to see if it would stick. This was done in a lab. The results need to be interpreted with caution. At the same time, some scientists have indicated that the virus is more infectious in mammals than previous avian viruses.
In that same stat article. Michael Osterholm, who is an infectious disease expert who has appeared on AMA Update, said that without more data, it is too soon to say what the risk is with the situation in Colorado and more broadly. He said if we get seven or even 70 more cases of conjunctivitis, what does that mean?
Could this be a precursor to a respiratory infection to influenza being transmitted people-to-people? No one really knows. Continued surveillance is important. We need to understand the routes of transmission, so we can stop the virus from evolving and adapting to better infect humans.
Unger: All right. Well, again, thank you for that update. We're going to end the AMA Update today with a bit of good news—some groundbreaking advancement in HIV prevention. Andrea, tell us the news there.
Garcia: Well, Todd, this is exciting news. And it was a new study published in The New England Journal of Medicine. And it showed that twice yearly injections of lenacapavir, which is sold as Sunlenca, offered 100% protection against HIV.
Now, the study looked at a group of about 5,000 young women and girls in South Africa and Uganda. No infections were identified in the group that was given the injections. There was another group that was given daily prevention pills. And roughly 2% of them ended up acquiring HIV in the study period.
There was a director of an AIDS Research Center in Durban, South Africa, who was not part of the research, but said to see this level of protection is stunning. Because of these results, the study was actually stopped early. And all the participants were offered the injections.
This injectable prescription medication is made by Gilead. It's sold as Sunlenca. And right now, it is approved in the U.S., Canada, and Europe and elsewhere, but it's only as a treatment for HIV. The company is waiting for results of clinical trials in men before they're going to seek approval to use the product as prep to protect against infection. This really does seem to be a game-changer given the gaps we see in uptake of adherence with currently available prep options, so definitely good news.
Unger: Indeed. That's great news and a great way to finish off the week. Andrea, thank you so much, as always, for being here and for sharing your information and 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 podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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