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What is going on with eggs in the U.S.? Is there a new strain of bird flu? How do you treat tuberculosis (TB)? How is TB transmitted? What is the most recent Ebola outbreak?

Today's episode covers tuberculosis cases in the U.S., the outbreak of TB in Kansas City, and the emergence of a new bird flu strain H5N9. AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, also breaks down the ongoing Ebola situation in Uganda. She highlights the implications of these health threats, outlines the importance of infectious disease monitoring, virus tracking, and timely public health response strategies. 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

Garcia: There is a wave of tuberculosis cases hitting the Kansas City, Kansas metro area, which has caused dozens of illnesses and at least two deaths, according to the state health department. 

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 be here. 

Unger: Well, let's begin with a bird flu check-in. Last week, we heard about the first outbreak of a rare bird flu strain in poultry. Andrea, have we learned anything new about that, or is there anything else we need to know? 

Garcia: Well, Todd, let's start with a quick recap. This new strain is known as H5N9. It was detected on a duck farm in California, alongside the H5N1 strain that we've been talking about. The USDA did indicate that this was the first confirmed case of H5N9 in poultry in the United States. 

We haven't heard much more about this particular strain this week, but there have been dozens of newly confirmed cases of bird flu in wild birds in recent weeks. And we continue to see news reports really emphasizing that bird flu is entering a new phase. Unlike dairy cattle, wild birds can be infected with bird flu and show no signs of illness, and that allows them to spread the virus to new areas and potentially expose domestic poultry. This could also wreak havoc for farmers and continue to exacerbate the egg shortages that we've seen so far. 

Unger: Well, let's talk about that for a moment. I've been in some grocery stores that literally don't have any eggs on their shelves. What can you tell us about that? 

Garcia: Well, we do know that bird flu has now hit the second largest egg producer in the U.S., Rose Acre Farms. That outbreak affected its layer farm in Seymour, Indiana, which has 2.8 million birds, and the company said it's already rigorous biosecurity measures have been tightened. They're working with state officials and monitoring their other facilities. 

Since the first of the year, outbreaks at layer farms have led to a loss of at least 13 million birds. So I suspect this egg shortage we're seeing may continue. 

Unger: Andrea, could the spread among wild birds have any consequences beyond the egg shortage that we just talked about? 

Garcia: It certainly can. And the virus is being spread as these wild birds co-mingle with birds in commercial poultry operations. It's been reported that changes in migratory patterns may be worsening the issue in Northern states, which are now seeing certain wild birds staying for the winter because water sources aren't freezing. There's a lot of H5N1 out there. There's a lot of human seasonal flu circulating. 

We haven't heard much about H5N9 yet, but the USDA has confirmed that the duck farm case does stem from re-assortment of the H5N1 virus circulating in U.S. birds. And while H5N9 is not currently considered a serious threat to humans, some experts are concerned that, given the level of virus circulating, re-assortment could be happening more frequently, and it could result in a virus with potential pandemic potential that is more easily transmitted between people. 

Unger: Well, that's certainly something we'll continue to watch. Also making the news this week is another disease that we haven't talked a lot about lately. And that is tuberculosis. It's causing an outbreak in Kansas. Andrea, what can you tell us?

Garcia: Well, Todd, as you mentioned, there is a wave of tuberculosis cases hitting the Kansas City, Kansas metro area, which has caused dozens of illnesses and at least two deaths according to the state health department. We first started hearing about cases related to this outbreak back in January of 2024, so over a year ago. 

Last week, a spokesperson for the Kansas Department of Health and Environment said that this outbreak is still ongoing, which means that there could be more cases. As of January 31, 2025, there have been at least 67 confirmed cases of active TB disease and 79 confirmed cases of latent TB. People with latent TB infection are infected with the TB bacteria, but they do not have TB disease. 

Most of these cases were diagnosed in early 2024 and then throughout the summer. According to reports, the Kansas Department of Health is currently managing 384 people who are at various different stages of TB testing, diagnostics and treatment in connection with the outbreak. 

Unger: Andrea, how does this outbreak compare to other TB outbreaks that we've seen before? 

Garcia: There was actually some confusion about that. So some of the headlines have been calling this a record-breaking outbreak or the largest TB outbreak since the CDC has started keeping track of cases. But since then, there has been some clarification. This outbreak has seen the country's highest case numbers over a one-year period, but not the total highest case count. 

That belongs to two other TB outbreaks within the last decade, one that lasted from 2015 to 2017, when the disease spread through Georgia homeless shelters, and another after patients around the country received contaminated bone grafts in 2021. According to a CDC spokesperson, the Georgia outbreak was linked to 170 active TB cases and over 400 latent cases. In the 2021 outbreak, there was a total of 113 patients who were treated after receiving contaminated bone grafts. However, the Kansas outbreak is still ongoing, so I think it's too early to make those comparisons to prior outbreaks. 

Unger: Andrea, can you just remind folks out there how is TB spread? 

Garcia: Yeah, TB is an infectious disease. It most often affects the lungs. It's caused by a type of bacteria. It is spread when an individual with active TB in their lungs coughs, speaks or sings, releasing tiny droplets that can then be inhaled by others. It's not spread by casual contact like hugging, shaking hands or brief encounters. It typically requires prolonged close contact with someone who has active TB. 

People with latent TB infections cannot spread TB bacteria to others, but those latent infections can develop into TB disease. In Kansas, people who test positive are being further screened to determine whether they have active TB disease or latent TB infection.

Unger: And is there treatment for this? 

Garcia: There is. The disease is curable. There are several treatment regimens recommended in the U.S. for TB disease. Treatment can take four, six or nine months, depending on the regimen. And according to the CDC, the case counts for TB in the U.S. did increase in 2023 among all age groups in most jurisdictions. But overall, it's important to note the U.S. has one of the lowest TB rates in the world. And most U.S. residents are at minimal risk for TB. 

About 10 million people around the world do fall ill with the disease. And even though it is preventable and curable, about 1.5 million people die. So it is known as the world's top infectious killer according to the WHO. 

Unger: All right, again, thank you for that perspective. Andrea, another disease we've been tracking—but thankfully further from home—is an Ebola outbreak in Uganda. What do we need to know? 

Garcia: This is making news again because last Thursday, it was reported that a nurse in Uganda died of Ebola, the first recorded fatality since the country's last Ebola outbreak that ended in early 2023. Here's what we know. The 32-year-old male nurse was an employee of Mulago Hospital, which is the main referral facility in the capital of Kampala, after developing a fever. He was then treated at several locations in Uganda before those lab tests confirmed that he'd been suffering from Ebola. 

Unfortunately, he died. And the Sudan strain of Ebola was confirmed following postmortem tests. There are at least 44 contacts of the victim that have been identified, including 30 health workers and patients at Mulago Hospital. That's according to Uganda's Ministry of Health. 

The WHO has indicated that six people who were in contact with the case have become ill. Contact tracing is going to be key here to stem the spread of Ebola. There are no approved vaccines for the Sudan strain of Ebola. Uganda's last outbreak was discovered in September of 2022, and it killed at least 55 people before it was declared over in January of 2023. 

Unger: Now, Andrea, you said there's no approved vaccine, but I thought I read something about a vaccine trial. Is that accurate? 

Garcia: Yeah, so on February 2, it was reported that Ugandan officials are preparing to deploy a trial vaccine as part of efforts to stem this outbreak. Scientists are currently developing research protocols related to the planned deployment of a candidate vaccine against the Sudan strain. The WHO said in a statement that its support to Uganda's response to this outbreak includes more than 2,000 doses of that trial vaccine, and research teams are being deployed to the field to work along the surveillance teams as approvals are awaited. 

Todd, I think the other thing that is important here is, you know, we may be unlikely to see a case here in the U.S., but physicians here should be ready to promptly identify suspected cases, take a patient's travel history, and consider Ebola in patients who present with a fever, myalgia, severe headaches, abdominal pain, vomiting, diarrhea or unexpected bleeding. Those patients then need to be isolated in a private room. 

And health care professionals need to implement standard contact and droplet precautions. And then, of course, notify hospital infection control and your state health department as soon as possible. Certainly, this is something we'll continue to watch. 

Unger: All right. Well, thank you so much, Andrea. As always, we appreciate you coming by and keeping us informed. 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 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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