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Why was the flu shot meeting cancelled? Can you die from measles? Why have measles come back in the U.S.? Why are eggs so expensive? How does bird flu spread to humans?
AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses the ongoing measles outbreak in Texas, USDA's bird flu response, new research on long COVID in kids, as well as FDA canceling a flu vaccines meeting. 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
Garcia: Unfortunately, we've seen the first death from the measles outbreak that's been going on in West Texas and a neighboring county in New Mexico. The patient was an unvaccinated, school-aged child, who had been hospitalized in Lubbock, Texas.
Unger: Hello everyone and welcome to the AMA Update video and podcast. Today is our weekly look at public health issues facing physicians and patients across the country, 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. It's great to be here.
Unger: Well, one of the biggest developments that people are still talking about is the FDA canceling a meeting about next year's flu vaccines. Andrea, can you walk us through what happened?
Garcia: Sure, Todd. So the FDA has a panel of experts that advise the agency by reviewing and evaluating data on the safety and effectiveness and appropriate use of vaccines. This panel is called the Vaccines and Related Biological Products Advisory Committee, or VRBPAC.
It had been scheduled to meet on March 13 to discuss the composition of this fall's flu vaccine. Last week, the members of this panel reportedly received an email from the FDA saying that this meeting had been canceled and there was no reason given for the cancelation. In a statement, the FDA did confirm the cancelation and said that it would make its recommendations to manufacturers in time for updated vaccines to be available for the 2025-'26 influenza season. And that is what we know so far.
Unger: Well, Andrea, this development has many public health experts concerned. What's your take on it?
Garcia: Well, the FDA VRBPAC meeting to discuss flu vaccine strains happens every March. The timing, we know, is critical to help ensure that manufacturers have enough time to produce the updated flu vaccine for the fall. Cancelation of this meeting is highly irregular.
We know that advisory committees do allow agencies to obtain advice from experts outside of government. They provide an open and transparent process. They also allow opportunities for public comments. But it is the FDA that makes the final decision on all matters that come before the committee. Last week, the WHO held its meeting on flu vaccine composition for the 2025-'26 flu season. And representatives from the CDC and FDA were able to participate. It does sound like the FDA will move forward with making a recommendation to manufacturers without advisory committee input.
This is something we'll be keeping an eye on, and we'll be sure to share updates once we know more.
Unger: And given that we're in a record-breaking flu season this year, that's just such an important development and we'll report more as it comes. Andrea, that wasn't the only big story over last week. There was also a tragic development in the measles outbreak that we've been covering. What happened there?
Garcia: Well, unfortunately, we've seen the first death from the measles outbreak that's been going on in West Texas and a neighboring County in New Mexico. The patient was an unvaccinated, school-aged child, who had been hospitalized in Lubbock, Texas.
For context here, the U.S. achieved measles elimination in 2000 after documenting a year of no endemic spread of the virus. Since that time, it's been pretty rare for us to see deaths from measles. This latest tragedy is really a sobering reminder of the severity of measles. And it's all the more concerning because the outbreak in Texas is still ongoing.
Unger: It is, indeed. And speaking of that, have the case counts changed since we talked last time?
Garcia: Well, as of today, the number of measles cases in West Texas has risen to 146. That's up from 90 when we talked last week. 20 patients have now been hospitalized, which is up from 16 the week before. Most of these cases continue to be in children age 5 to 17, who are either unvaccinated or whose vaccination status is unknown.
And as we've discussed, this outbreak has also spread to a nearby county in New Mexico. Last week, that county had nine measles cases, and I'm glad to report that no new cases have been identified in New Mexico.
Unger: Andrea, given that continued spread, what efforts have been made to contain the outbreak?
Garcia: Well, in Texas, local health departments have expanded vaccination and testing to help slow the outbreak. We saw HHS Secretary Robert F. Kennedy Jr. direct federal health agencies, including the CDC, to provide support to Texas Health authorities. We know CDC continues to be in close communication with health officials in Texas. And in a statement, the CDC did remind parents that vaccination remains the best defense against measles infection.
Long term, hopefully, these efforts will make a difference. In the short term, we know that cases will likely continue to rise.
Unger: Andrea, unfortunately, measles isn't the only outbreak that we're tracking at the moment. Bird flu is still spreading extensively among poultry. And the USDA recently unveiled a plan to address that. Andrea, what is the USDA proposing?
Garcia: Well, Todd, the USDA is proposing a five-pronged approach to combat bird flu and reduce egg prices, which it initially announced in an op ed in the Wall Street Journal. That plan includes investing $500 million to enhance biosecurity measures to keep bird flu out of farms. Additionally, it will expand a pilot program that started under the Biden administration that sends USDA inspectors to farms to assess their current biosecurity measures.
The plan also includes approaches that are meant to help farmers who've been impacted by bird flu and to bring down the cost of eggs. For example, the plan notes that the government will consider temporarily importing eggs to reduce prices.
Unger: Andrea, how much of an impact do you think a plan like this is going to have?
Garcia: Well, Todd, first of all, I'd just say that we're glad that the USDA is making bird flu a priority. As for the impact of these specific efforts, we know the next couple of months will be really critical to see if they're making a difference or if more interventions are necessary. I do think it's essential that we keep working to contain the spread of bird flu. This plan from the USDA is a step in the right direction.
Unger: Now, we've talked about the spread of bird flu among poultry. We're going to stay with the topic of bird flu. But this time, let's talk a little bit about human transmission. Andrea, there's some more information about recent cases of H5N1 in humans. What do physicians need to know about that?
Garcia: That's right, Todd. The CDC shared sequencing findings on samples from two people with H5N1 avian flu infections. One was from the patient in Wyoming, and the other was from a patient in Nevada. The sequencing revealed that the D1.1 genotype, which is circulating in wild birds and poultry, and it's also recently made the jump to dairy cows in Nevada and Arizona.
The CDC found some notable mutations the virus in Wyoming, that patient had the E627K mutation in the PB2 protein. That has been linked to efficient replication in people and mammals. And then the Nevada patient, the virus had the D701N mutation in PB2, which has also been linked to more efficient replication in mammals. With that being said, for both of these patients, the CDC didn't identify any genetic changes in the virus that would impact the efficiency of antiviral medications or the H5 candidate vaccine virus.
Unger: Well, Andrea, Thank you so much for breaking that down. Last topic, two new studies about long COVID in kids. What can you tell us about them?
Garcia: Well, Todd, one study was published in radiology and the other was from the CDC and published in JAMA Network Open. The study in radiology included 54 patients. It used an advanced form of MRI called free breathing. These resolve functional lung MRI on children and teens with long COVID. And it found that they had lung abnormalities.
These abnormalities correlated to specific long COVID symptoms like chronic fatigue and an overall loss of blood flow in the lungs. What's notable about the study is the type of MRI imaging they used, which is radiation-free and contrast-free. This makes it more suitable for children, and it means it can be used to help diagnose long COVID in these patients and track their recovery.
Unger: It seems like COVID is in the rear view mirror for a lot of folks, but obviously, there are still people suffering from long COVID. And diagnosing long COVID remains a real challenge, so this is a welcome development. Andrea, what about the study from the CDC?
Garcia: Well, Todd, that study from the CDC looked at how effective the mRNA COVID vaccine was on reducing the risk of long COVID in kids. It found that vaccination lowered the risk of having two or more long COVID symptoms by 73% and one or more long COVID symptom by 57%. And that was in children ages 5 to 17.
We know that long COVID can be debilitating and incredibly disruptive for anyone, especially children. This study reinforces the benefits of children staying up-to-date with their COVID vaccinations. But right now, that's really just not what we're seeing. According to the CDC, the current vaccination rate for children aged six months through 17 years is around 12%. And it was largely the same the year before. Hopefully, studies like this that demonstrate the benefits of vaccination will help encourage parents and guardians to take action.
Unger: Well, Andrea, it's not only protection against COVID, but obviously from long COVID as well. It's certainly something we'll continue to advocate for as well. Andrea, thank you, as always, for being here 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 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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