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Featured topic and speakers
Featured topic and speakers
Why is bird flu such a big deal? What happens if a human gets the bird flu? What is monkeypox? Is there a new COVID booster? Where can I get a COVID vaccine?
Our guest is AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.
Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
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 here.
Unger: Well, we got a lot to talk about today. But before we get started, we got a lot of nice feedback on last week's segment from folks in the long COVID community. And I just want to say to the folks out there, if you see something that you like on this or—and especially if you see a physician doing something you really appreciate, give them a shout-out and let them know that you saw the segment.
Andrea, today we've got a lot to talk about across bird flu, mpox and the COVID vaccine rollout. And why don't we start with bird flu? There's a concerning new development. What do we need to know?
Garcia: Yeah, Todd. This past week was the first human case we saw of highly pathogenic avian influenza, or bird flu, that was not tied to a known exposure with a sick or infected animal. This patient was in Missouri. The case was reported by the CDC this past Friday. This does mark the 14th case of H5 reported so far in the U.S. this year, and according to a recent CNN article, the first to be detected through the country's national flu surveillance system as opposed to targeted surveillance of the ongoing bird flu outbreak in animals. This case is still under investigation by the Missouri Department of Health and Senior Services. So, we are waiting to find out more.
Unger: Andrea, what do we know about the Missouri patient so far?
Garcia: Well, not much is being shared in order to, of course, protect the patient's privacy. But what we know is the person did have underlying medical conditions. And they were hospitalized in late August. At that time, the patient tested positive for influenza A. They were treated with influenza antiviral medication. And they're now recovering at home.
When that initial test didn't match seasonal flu, a sample from the patient was sent to the CDC. Confirmatory testing then indicated that the case was a type of bird flu.
Flu viruses are classified based on two proteins that sit on the surface of the virus, H protein and a N protein. And a spokesperson from the CDC said the agency had confirmed that the type is H5. They have not yet determined the N protein type. They're working on isolating the virus, reading its genetic sequence. Scientists at the CDC do hope to have more information on the genetics of the virus in the coming days.
Unger: Andrea, why is it so important to know the genetic sequence?
Garcia: Well, determining that sequence will tell researchers how closely related the virus in this case is to the viruses currently causing outbreaks in chicken, cows and other mammals. There are currently no reported cases of bird flu among cattle in Missouri. But there have been outbreaks in poultry. And I think it's really important to understand as much as we can about the chain of transmission here.
There were some experts quoted in a recent U.S.A. Today article. They noted that understanding the origin is really crucial for understanding the threat that the virus may pose to the general public. Acquiring that virus without animal contact does raise concerns because it could be an indication that the virus is evolving to transmit from human to human. But we'll need more information, of course, to know if that's the case.
It does not appear that the patient spread the virus to anyone else, as the patient's close contacts have remained asymptomatic throughout that typical observation period. That's good news. And overall, the CDC does still consider the risk to the general public to be low.
Unger: That's important information. Any other theories on how this patient might have gotten sick?
Garcia: Well, there are a couple that are being reported on in the news. Michael Osterholm, who is a noted public health expert, said it is possible that the patient has a new strain of the virus that they may have gotten after coming into close contact with an infected migratory bird. He pointed out that late summer is when many birds are migrating. So the virus is moving. He said something as simple as a backyard bird feeder could be the kind of exposure that would not be uncommon in this case. I've seen other individuals question whether raw milk could have been the cause in this case.
Public health officials have been concerned, of course, about bird flu for some time because it has been lethal in about half of the people known to have contracted it worldwide, though, obviously, the human cases we've seen during the outbreak here in the U.S. have been relatively mild. Just this week, there was an opinion piece published in JAMA that was calling for more investment in public health, including a vaccine strategy to address H5N1 both in the U.S. and abroad. This is, obviously, something we'll continue to watch as more details become available.
Unger: And we'll publish a link to that JAMA piece in the description of this episode so you can take a look. Andrea, I want to move on now to another virus that we've been talking about. And that's mpox. There have been some developments over the last several weeks. What's new?
Garcia: Well, as a quick refresher, we've been discussing the fact that there are two clades of mpox. Clade II is the clade we saw here in the U.S. as a part of the outbreak we experienced in 2022. It's typically less severe and less deadly. For example, during the outbreak in 2022, more than 99% of people survived their infection, according to the CDC.
Although the peak of the clade II mpox outbreak decreased by early 2023, cases do continue to still be reported at low levels in countries today, including the U.S. case counts here have remained pretty consistent at about 250 a month since October of 2023.
The CDC does say that the risk to the average person in the U.S. from mpox remains low. But in an updated assessment that was published on August 30, it said that the risk for men who have sex with men, or MSM, with more than one sexual partner is now low to moderate. That same risk does apply to people, regardless of gender, who have sex with MSM.
A vaccine is available. And there was a CDC study that indicated that getting two doses of the mpox vaccine does work to prevent many mpox cases and reduce the severity of those symptoms. It is rare for people to get mpox after they've been fully vaccinated or recovered from a prior infection. And this protection is thought to protect against both clades.
Unger: What about clade I, the more dangerous of the two? Has there been any additional news there?
Garcia: Well, clade I is fueling outbreaks in Africa. The outbreak began in the Democratic Republic of Congo, which has been the epicenter of that global public health emergency. According to the Associated Press, that first batch of 100,000 vaccines arrived in Congo's capital last Thursday. Another 100,000 were delivered on Saturday. Overall, about 380,000 doses of mpox vaccines have been promised by Western partners, such as the EU and the U.S. And that sounds like a lot. But it's actually less than 15% of the 3 million doses that authorities have said are needed to end the mpox outbreaks in Congo.
Unger: Andrea, what are the numbers looking like there?
Garcia: Well, according to the Africa Center for Disease Control and Prevention, since that start of 2024, Congo alone has reported more than 4,900 confirmed mpox cases, with more than 629 associated deaths, according to the WHO. As of last Thursday, there have been more than 24,800 reported cases of clade I mpox overall this year.
This is a sharp increase in both infections and fatalities compared to previous years. And I think even more devastating is that most of these infections have been in children under the age of 15. Both of these clades can spread through close contact, including intimate or sexual contact with a person who has mpox, as well as through contact with contaminated materials. The Africa CDC said it's working on a unified response plan for the outbreaks, which will be presented to African heads of state or consideration at a meeting later this month.
Unger: Andrea, is the U.S. taking any precautions in case clade I were to come here?
Garcia: Yes. And it is possible, of course, that clade I will show up here. As a reminder, travel-related cases of clade I have been confirmed in both Sweden and Thailand already. The U.S. has taken steps to increase testing and surveillance. And they've also tried to help ensure that those vaccines are readily available at local pharmacies and community health centers.
In a briefing on Friday, senior U.S. officials said that any physician in the U.S. can now order an mpox test, which can be processed through a national laboratory chain. Positive tests that are not the older strain of mpox will then be sent on to the CDC for confirmatory testing.
The government has also added testing for any form of mpox to its wastewater surveillance system and said that there is good coverage in most major cities. As a next step, they're working to add that clade I-specific testing and make rapid tests available. And those tests could be available in the coming months.
Unger: Well, thank you for that update on mpox. Andrea, before we wrap up the week, let's do a quick COVID check-in. Last time, we talked about the vaccine rollout. How is that going?
Garcia: Well, Todd, there have been some hiccups. And according to an article by NBC News, while major pharmacy chains like CVS and Walgreens have been able to roll out the vaccine, some of those independent pharmacies and even, we're hearing, some health systems have been waiting for that vaccine to arrive still. Many say they're facing delays in getting their shipments. And that's leading to longer wait times for patients to get vaccinated.
Both Pfizer and Moderna have denied prioritizing those larger chains over smaller independent stores and said there is substantial supply available. They did acknowledge that buying the vaccine through wholesalers could slow down the process slightly. Hopefully, we'll begin to see those outlets receiving their shipments sometime this week, though.
Unger: And we'll continue to watch the rollout as we head into the fall. As always, Andrea, thanks so much for being here and sharing 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 video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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