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
How bad is COVID right now? Are COVID vaccines still free? Is there an mpox outbreak in Africa? RSV vaccine for seniors: What are the CDC guidelines for RSV in 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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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. I appreciate the opportunity to be here.
Unger: Well, mpox continues to make headlines this week. And when we last talked, the World Health Organization chief was thinking about declaring a public health emergency. Now the CDC has issued a health update. Andrea, what do we need to know?
Garcia: Well, Todd, as of this filming, the WHO officials have decided that they are going to convene a committee of experts to determine if this recent mpox activity that we've seen in Africa warrants declaring that public health emergency of international concern. There was a recent press briefing in Geneva, and the WHO director general said he plans to do this, really, as soon as possible. This move and the CDC's health advisory were issued as a result of increased spread that we're seeing in Africa right now.
And as a reminder, this began with an mpox outbreak in the Democratic Republic of Congo or DRC. The CDC actually issued a HAN back in December to notify clinicians here in the U.S. about clade I mpox in the DRC. Clade I has previously been observed to be more transmissible, to cause more severe infection than clade II.
That clade I subtype, which is genetically and clinically distinct, has not been reported here in the United States. The previous outbreak here in the U.S. was clade II. This deadlier clade I subtype has since been confirmed in four neighboring countries, which has raised concerns.
Unger: Andrea, can you give us a perspective on the numbers that we're seeing?
Garcia: The Africa Centers for Disease Control and Prevention has reported that mpox has now been detected in 10 African countries this year, including the DRC, which does have more than 96% of all cases and deaths. The cases are up 160%, and deaths have jumped by 19% compared to the same time period last year. There was a CNN article published earlier this week which noted that the DRC alone has reported 14,000 cases and 511 deaths.
I think it's tragic, officials at the African CDC said nearly 70% of those cases are in children younger than 15, and they also accounted for about 85% of the deaths.
Unger: Wow, that's pretty surprising. Andrea. Isn't there a vaccine for mpox?
Garcia: There is, and it's expected to be effective both against clade I and clade II mpox. However, it's not generally available in the DRC now. The country is actively working on a plan to vaccinate, but it still has a way to go before that vaccine is going to be widely available.
Unger: Now Andrea, you mentioned before that this more transmissible clade, clade I, is showing up around, but not yet within the U.S. When you look at this information, what does it mean for the United States?
Garcia: Well, even with the increased spread that we're seeing, the risk of importation to the U.S. of this particular strain is considered to be very low. That's in part because there aren't many direct commercial flights from DRC or its neighboring countries to the U.S. And we typically see a limited number of travelers coming from this area. Plus, there are no cases of clade I mpox reported outside of Central and Eastern Africa.
I think, nevertheless, we've seen time and time again that disease spread can be difficult to predict. This situation could change rapidly, so we do need to be prepared. Because of this, the CDC is recommending that physicians in the U.S. do maintain a heightened index of suspicion for mpox in patients who've recently been to the DRC or to any country sharing a border with the DRC and who presents with signs and symptoms that are consistent with mpox.
Unger: Andrea, can you remind everybody out there of what those symptoms are?
Garcia: Yeah. They can include a rash that may be located on the hands, feet, chest, face, mouth or near the genitals. And then other symptoms include fever, chills, swollen lymph nodes, fatigue, muscle aches, back ache, headache. And then some respiratory symptoms like sore throat, nasal congestion and cough.
It is spread through close contact with people who are infected, and that does include sexual contact. If you recall, back in 2022, the WHO declared mpox to be a public health emergency of international concern after it spread to more than 70 countries, including here in the U.S. And we know that outbreak did disproportionately affect gay and bisexual men. Before that outbreak, however, the disease had mostly been seen in sporadic epidemics in Central and West Africa.
Unger: Andrea, does the CDC's alert provide any additional direction for physicians here?
Garcia: Yes. Physicians should notify their state health department if they have a patient with mpox-like symptoms and submit lesion specimens for clade-specific testing. Even though we have a vaccine here, we do know that vaccination coverage remains low with only about 1 in 4 people who are eligible to receive the vaccine, having received both doses. So given that the CDC is also recommending that physicians encourage vaccinations for patients who are eligible.
Unger: All right, well thank you for that update, and we'll certainly continue to track that. Staying with the CDC for a moment, the agency also issued new guidance for RSV vaccines. What do we need to know there?
Garcia: Yeah, Todd. So this is not brand new guidance. It's the same update from—coming out of the June ACIP meeting that you've previously discussed with AMA's ACIP liaison, Dr. Sandra Fryhofer. But the reason we're seeing it creep back into the news is that it was published by the CDC in this week's MMWR.
It is good to talk about this now, though, because although eligible adults can receive that RSV vaccine any time of year, we know the best time to get vaccinated is in the late summer or early fall before we see RSV start to spread in communities. In most of the U.S., this corresponds to vaccination from August to October, so we are right at the beginning of that sweet spot.
The big takeaway here is that the CDC has clarified and narrowed its recommendation for which older adults should get that RSV vaccine. It now states that adults 75 and older or those who are 60 to 74 who are at high risk should get the vaccine. And that is a change from last year where all people ages 60 and older were recommended to receive the vaccine. And just a reminder that for now, only one dose of the RSV vaccine is recommended. It is not an annual vaccine.
Unger: Andrea, what prompted this update?
Garcia: Well, based on currently available evidence, the ACIP concluded that the benefits of the RSV vaccine do not clearly outweigh the potential harms in all adults aged 60 to 74. That's particularly true for those who don't have those risk factors for severe disease. However, people in this age range who do have risk factors could still benefit.
So providers should continue to have flexibility in offering the RSV vaccines to patients they assess to be at increased risk for severe disease. We know that real-world clinical safety data mimics what was seen in the clinical trials. That includes a very small increased risk for Guillain-Barré syndrome.
And I think it's important just to remember that while RSV is mild for most people, we can see up to 160,000 older adults hospitalized annually for RSV, and as many as 10,000 die due to complications. That likelihood of needing medical treatment for RSV infection also increases with age. And I would just like to call out that ACIP has also requested more research in this area, so it's certainly something we're going to continue to track.
Unger: And it's an important update, those are still very big numbers, and good information for folks on the vaccination front. Andrea, last time we didn't get a chance to talk about COVID, but I am totally hearing a lot of people getting COVID. Am I imagining that or are we seeing a surge in cases?
Garcia: I'm certainly hearing and seeing the same thing on my end, and COVID does continue to increase across most of the U.S. with an upward trend, really, in all regions, but with some regional differences according to the data from the CDC. This is coming at a time when we know more cases are being driven by those immune-evasive variants.
We're also seeing waning immunity in the general population, either from past infection or previous COVID vaccines. It's certainly been a while since most of us got one. In that latest variant proportion update, the CDC did say that the percentage of KP.3 1.1 sequences did jump from 14.4% to 27.8% over the past two weeks. And we're seeing that national test positivity is at 16.3%. So that's a fairly big number. It's up slightly from the previous week.
Right now, those levels seem to be highest in Texas and the surrounding states. So Arkansas, Louisiana, New Mexico, Oklahoma. That's followed by the Southeast, the Midwest and then the Northwest.
Unger: Now in the wake of all of this, free vaccines may soon be more difficult to find. Is that right?
Garcia: Yeah, and that was reported on in The New York Times, and this is because a program that provided more than a million COVID vaccines to people who are uninsured or underinsured is coming to an end. We know that the vaccine can cost over $100 out of pocket, plus that charge to administer it. If you remember, after the COVID vaccines transitioned to the commercial market last fall, the CDC did step in to ensure adults without insurance or those whose insurance plans didn't fully cover the vaccine could receive those vaccines for free through the agency's Bridge Access Program.
We did see the CDC announce in made that the funding for that program, which clinics had expected to last through December, was going to run out in the end of August. So a spokesman from the CDC has said that the agency is currently discussing strategies to increase vaccine access for people. We know that's going to be especially important when an updated COVID vaccine becomes available in the fall. Right now, some clinics and community health centers report that they are scrambling to offer these shots just as people need them the most.
Unger: Well, Andrea, hopefully they can find some solution before the fall. As we know from past experience, we'll likely see more surges during that time. Well, that's all we have time to talk about today. And as always, Andrea, thanks for being here and sharing all that information.
If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. And as always, you can 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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