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Is whooping cough going around? What is the best flu medicine? What is the latest strain of COVID? Is raw milk safe? Why drink raw milk?
AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses rising whooping cough cases, vaccines for whooping cough and effectiveness of antiviral medicine for flu. Also covering milk safety around pasteurized milk vs. raw milk and concerns over bird flu in raw milk. AMA Chief Experience Officer Todd Unger hosts.
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- Bird flu tracking via CDC wastewater surveillance by state.
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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. Good to see you. And great to be here.
Unger: Well, Andrea, last week we talked about the increase in cases of walking pneumonia among children. This week, we learned of another disease that hit record highs in children over the Thanksgiving holiday. Tell us more about that.
Garcia: Well, Todd, we've definitely talked about this before. But pertussis, which is also widely known as whooping cough, hit record highs over the Thanksgiving holiday. This was reported on in CBS News, and figures were shared last Thursday by the CDC. At least 364 pertussis infections were reported over the week of Thanksgiving.
Now, that's the highest number of whooping cough cases for the week of Thanksgiving that we've seen in recent decades. This does top that previous Thanksgiving record, which was 228 cases reported that same week back in 2010. That year, we saw more than 27,000 cases reported in total. We've already surpassed that number this year, with more than 28,000 cases of pertussis already being reported.
These numbers are a bit surprising when you think about how we usually see a slowdown in cases reported over the holidays just because of those delays in testing and reporting, as well as fewer people going to the doctor. This holiday, pertussis surge is continuing to accelerate in several states this week. And we know officials have said that we are now seeing this return to pre-pandemic levels and trends.
Unger: Andrea, it seems like one of those things we haven't heard much about for a long time, and then all of a sudden, we're starting to see a trend of increases. What's driving this?
Garcia: Well, it was talked about in the CBS article. And health officials have cited really a variety of factors here, including gaps in immunity from vaccination or prior infection. And then there was a switch to safer but maybe less effective vaccines back in the 1990s. So much of this comes down to what we were talking about last week, and that is the low vaccination rates for school-aged children for even these routine vaccinations.
And it's a decrease we've seen since the pandemic. And of course, it is now having really obvious repercussions. It could be that children have received that initial vaccine but have not gotten the recommended booster. This article, the CBS article, focuses on Ohio, and the state is experiencing one of the worst outbreaks right now. And one doctor there said that while the majority of patients have been vaccinated, it's unclear if they're up to date on their shots.
A third of the cases in his county, for example, have been in teens who are recommended to get a booster by age 12. We'll add this to our list of growing infectious diseases to watch out for this winter. The advice, though, really remains the same. Stay home if you're sick. Stay up to date on your vaccines. Wash your hands regularly. And of course, call your doctor if your symptoms are worsening or severe.
Unger: Our list is getting as long as Santa's, so lots to talk about here. And again, so important to stay up to date on those vaccines. Staying on the topic of infections to watch out for this winter, let's talk about the flu. There's even more evidence now to show that antivirals can really make a difference in the course of the disease. Andrea, what's the update there?
Garcia: Well, so there was a recent study published in Clinical Infectious Diseases and covered by CIDRAP. And it showed that patients, given the antiviral drug oseltamivir, which is better known as Tamiflu, on the day of hospital admission for influenza A, had less severe disease and were less likely to die or require intensive care than those who didn't receive it. Now, these results are in line with the 2018 Infectious Diseases Society of America guidelines for patients hospitalized with suspected or lab-confirmed influenza, which recommend initiation of oseltamivir treatment as soon as possible.
The study authors wrote that many hospitalized flu patients receive either no or late antiviral treatment and that clinicians could be less likely to prescribe antiviral treatment when more than 48 hours have passed since illness onset. That 48-hour window is often used to identify outpatients who may have a shorter course of illness with antiviral therapy. What the study found, how is that in hospital settings, there is some treatment benefit even when oseltamivir is initiated more than 48 hours after symptom onset. And initiative treatment as soon as possible likely does maximize that benefit.
Unger: That's really good to as we head into the next few months. Speaking of which, how are flu levels looking right now?
Garcia: Well, overall, flu activity is still low. However, according to the CDC's latest update, markers such as test positivity and emergency department visits are beginning to creep up. We are seeing the number of jurisdictions that report low or minimal influenza activity is starting to decline. Those reporting moderate or greater activity are increasing at the state level.
We know that Louisiana and the District of Columbia are at the high and very high level, respectively. Georgia and Arizona are at the lower tier level of high. Most detections so far have been influenza A. And nationally outpatient visits we're seeing are the highest in young children. And that's followed by patients ages 5 to 24 years old.
Unger: All right. Well, how does this compare to other viruses of concern, like COVID and RSV, which we've talked about a number of times over the past few weeks?
Garcia: So last Friday, we did see the CDC upgrade their overall national respiratory virus illness activity in the U.S. from low to moderate. Although COVID levels remain low, the agency does expect to see increases in the coming weeks. Right now, the wastewater SARS-CoV-2 detections remain low. They are at the highest and gradually increasing right here in the Midwest.
The CDC also said the levels of the XEC variant are now at 44% and continue to rise. So we are seeing XEC outpaced that KP.3.1.1 variant, which we know had been dominant the last several months. XEC, as a reminder, is a hybrid of two JN.1 variants.
And then if we turn to look at RSV, activity is currently moderate. And it is continuing to rise across most of the country. As you mentioned earlier, we also continue to see those elevated levels of walking pneumonia in young children. Overall, I think not a terrible situation right now, but things are definitely starting to pick up as we move into the winter. So if you've been putting off getting your vaccines, now is the time to go get them.
Unger: Absolutely. Well, thank you for that update. Andrea, we also continue to see more national headlines about bird flu this week. First, a mandate for national milk testing. What do we need to know about that?
Garcia: So, Todd, last Friday we saw the USDA announced a new federal order that spells out a national strategy for testing milk. A handful of states have already adopted bulk milk tank testing policies, but the new federal order expands that approach to a national level.
So this is a three-part order. It covers the sharing of raw, unpasteurized milk samples. It requires owners of affected herds to share epidemiological information. And then it requires private and state veterinary labs to report positive tests to the USDA.
This comes as we know H5N1 has spread to over 710 dairy herds across 15 states. California is reporting the highest number of infections. And we've seen at least 58 people infected with bird flu, including, as we talked about last week, one child living in the San Francisco Bay Area. According to an NPR story, this testing program is going to be launching first in California, Colorado, Michigan, Mississippi, Oregon and Pennsylvania.
The USDA has said that the purpose of this federal order is to identify where the disease is present, monitor trends and help states identify potentially affected herds. It is another step to try and control transmission, as growing evidence suggests the virus is spreading through dairy operations.
Unger: So, Andrea, have we confirmed or determined that people can get bird flu by drinking milk?
Garcia: Well, I want to be very clear that federal health officials have said that pasteurized milk remains safe to drink. And as a reminder, the bird flu virus is killed by the rapid heating of pasteurization. However, scientists say it's possible that consuming raw milk that contains the virus could lead to an infection. We know that touching your eyes, your nose, your mouth with unwashed hands after contact with contaminated milk could also cause someone to get sick.
This focus on contaminated raw milk has been most evident, prominent in California, where we know the sale of raw milk is legal. In some states, it is not. And last week, we saw the California Department of Public Health issue a widened sort of voluntary recall of Raw Milk LLC, raw milk and cream products due to possible H5N1 bird flu contamination products.
Both are retail and dairy storage, and bottling sites did test positive for bird flu. And the health department is now urging consumers to avoid all of the company's products. For humans, that includes cheese and kefir, and to avoid giving the company's pet food products to animals.
Unger: All right. Well, we know that raw milk posed risks even before the outbreak. So I have to ask, what's the draw with raw milk?
Garcia: Well, I think with these growing concerns, that is a question that we've seen explored both in a USA Today article and in a recent article in The Atlantic. And as you have mentioned, there are really well-documented risks of pathogens found in unpasteurized milk—E. coli, Salmonella, Listeria. And this is all before the recent bird flu outbreak.
Those who drink raw milk do perceive that the health benefits outweigh or even negate those risks. And those benefits, however, haven't been backed by research. According to that Atlantic article, the main health argument in favor of raw milk is that it contains biologically active compounds, or bioactives, which are chemicals whose actions in the body may provide a health benefit.
According to that same article, to reach that daily recommended intake of any particular bioactive, you'd have to drink a lot of raw milk to 4 liters a day. I think the bottom line for most health officials and health expert is that any perceived benefit does not outweigh the risks. So stick to pasteurized milk.
Unger: I absolutely will. I don't think I could drink 4 liters of milk a day, much less have raw milk there, given those risks. Andrea, thank you so much for being here today. That wraps up this week's episode. 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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