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AMA Update
What viruses are going around right now? COVID-19, mpox, human parvovirus and Oropouche virus disease
Aug 21, 2024
Featured topic and speakers
Featured topic and speakers
Is there a new COVID-19 vaccine for fall 2024? Can you die from mpox? What is parvovirus b19? Can adults get fifth disease? What is Oropouche fever outbreak?
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, the AMA's chief experience officer. Welcome back, Andrea.
Garcia: Thanks for having me. It's great to be here.
Unger: Well, we've talked for the past few weeks about mpox. And it looks like there's an update there. Andrea, what do we need to know?
Garcia: Well, Todd last time we talked, WHO officials had planned on convening a committee of experts to determine if the recent mpox activity we've seen in Africa warrants declaring a public health emergency of international concern under international health regulations. And at that meeting, the committee did decide that it was worthy of a public health emergency declaration. And then last Wednesday, the agency issued this alert for mpox. And it's the second time we've seen this level of alert for mpox in two years.
As a reminder, this is the WHO's highest level of alert. It can help accelerate research funding and also international public health measures to help contain the disease.
Unger: Now, I guess the big news here is this is not the same strain of virus that fueled the alert two years ago. And I think from what we're talking about, it might be more dangerous. Can you give us the details on that?
Garcia: Yeah, so as a reminder, with mpox, there are two distinct viral clades, clade I and clade II. A strain of clade II, known as clade 2B, was responsible for the global spread of mpox in 2022. That has been the only clade reported here in the U.S. to-date. Clade II is typically less serious. According to the CDC, more than 99.9% of people survive infections with this clade. It's still capable of causing severe illness, particularly in people with weakened immune systems.
So prevention, including vaccination, is important. Clade I, however, can cause more severe illness and death. Some previous outbreaks have killed up to 10% of people who've gotten sick. Although more recent clade I outbreaks have had lower fatality rates, the strain spreading in DRC and neighboring countries is clade 1B. Clade 1B seems to be more transmissible through routine close contact, including sexual contact.
Unger: All right, so let's just talk a little bit about what this means to the U.S. at this point.
Garcia: Yeah, in the U.S., mpox cases have declined considerably since that peak in 2022. The average daily cases actually fell to 0 in the week ending August 1. And the CDC has confirmed as recently as last Friday that we have no cases of clade I mpox here. However, we learned late last week that clade I has been spread beyond Africa, and there a travel related case that was reported in Sweden. The European Center for Disease Prevention and Control warned that more imported clade I infections are highly likely. And they've urged countries to take preparedness steps.
Infectious disease experts have been seeing that it's really only a matter of time before the disease spreads beyond Africa. So this is not completely unexpected. However, it increases the chances that at some point we'll see cases here in the U.S.
Unger: So, Andrea, with a view to that kind of future, are we prepared?
Garcia: Well, we heard the U.S. Department of Health and Human Services say last week that we are well prepared to detect and manage clade I cases that might arise. And we know health officials are monitoring for mpox through clinical testing and wastewater surveillance. There's also some reason to believe that we'd see a lower morbidity and mortality rate than in the DRC. And I think that's in part because the JYNNEOS vaccine is more widely available here and it's thought to be protective against both clades.
So at least some of those at high risk would be protected through vaccination or even possibly previous infection. We shouldn't be complacent, though. The CDC does recommend two doses of the vaccine for those who are 18 years of age and older with risk factors for mpox, such as gay and bisexual, and other men who have sex with men. The CDC is also asking physicians to be alert for mpox infections and those who've recently spent time in the DRC and its neighboring countries.
The agency has issued an advisory for people traveling to the DRC and its neighboring countries to practice enhanced precautions.
Unger: Well, we'll certainly continue to keep an eye on that. And if there's any question about the vaccine, please talk to your physician. We've also seen increases in another virus, we have not talked about to-date, that prompted the CDC to issue an advisory this past week. Andrea, tell us what this new virus is?
Garcia: Yeah, what we're talking about here is parvovirus B19, which is better known as fifth disease or "slapped cheek" disease by some because of the face rash that it can cause. As you mentioned, it is currently on the rise, and that's particularly true among children ages 5 to 9. The CDC issued its advisory last week after its European counterpart reported a high number of parovirus cases in 14 countries. There was an article in The Washington Post that says the illness is typically mild in children and healthy adults and doesn't require significant treatment.
But there are certain groups, including those who are immunocompromised or pregnant, who do face an increased risk.
Unger: Now, you mentioned the face rash as a possible symptom. Any other symptoms that folks need to watch out for?
Garcia: Actually, there are a good portion of cases that go undetected because so many people infected with parvovirus are asymptomatic. In fact, many of us have likely had it without even realizing it. The CDC estimates that about 50% of adults have detectable antibodies by age 20, and that increases to more than 70% by age 40. Those who do develop symptoms, the infection usually begins with a fever, muscle aches and pains, cough, a sore throat and malaise.
And then later in the illness, children often develop a facial rash, which can be followed by a body rash and/or joint pain. In adults, the most common symptoms usually include a rash on the trunk and joint pain. The disease is spread through respiratory droplets and is highly contagious in the beginning phases of the illness. But by the time that rash develops, you are generally no longer contagious.
The CDC is recommending those that are at higher risk to consider wearing a respirator or mask when around others and that pregnant people seek medical care if they've been exposed to a person with a suspected or confirmed case.
Unger: All right, again, we'll continue to track that story as it develops. Andrea, one more virus for today's AMA Update. Last week, the CDC issued a warning about something else for physicians to be on the lookout for. And this one is spread by small flies and some types of mosquitoes. Tell us more about it?
Garcia: Yeah, so this latest warning was just issued last Friday and references Oropouche virus. Cases have been climbing in endemic areas and also in new areas outside of the Amazon Basin. Two deaths have been caused by Oropouche virus. They were reported for the first time in July. There are also concerns over possible vertical or mother-to-child transmission of the virus, which is associated with fetal death and/or congenital abnormalities.
As you mentioned, this disease is spread by small flies and some types of mosquitoes, and it causes a sudden fever, headache and chills. The CDC Advisory does recommend that pregnant people reconsider non-essential travel to Cuba, which reported its first confirmed case in June.
Unger: Now, Andrea, how many cases are we talking about here?
Garcia: According to that CDC Advisory, between January 1 and August 1 more than 8,000 cases were reported in the Americas. That includes the two deaths in Brazil this year. And those were in women who were otherwise healthy. Transmission of the virus during pregnancy resulted in one fetal death, one miscarriage and four cases of newborns with microcephaly, which is a condition characterized by an abnormally small head. These were the first reported deaths and associated adverse birth outcomes, from mother to baby transmission of the virus.
Unger: It's very serious. Is it already here in the U.S.? And is there a treatment available?
Garcia: So there have been no locally acquired cases, but both in the U.S. and in Europe, we've seen travelers returning from Cuba and Brazil who've been diagnosed with the condition. Florida has reported 11 travel-related cases this year, according to their state health department. There are no vaccines to prevent the disease or medications to treat it. The CDC has said the best form of protection is prevention. So avoiding bites from midges and mosquitoes.
Unger: Well, thank you, Andrea. And before we wrap up, let's check one more time. I'm on COVID. Andrea, how are cases looking this week?
Garcia: Well, Todd, there was CDC data published late last week that showed the variant KP31.1 is now making up nearly 40% of cases. That's a 14% increase over the last two-week period. The data also shows that 32 states and one territory have reported very high levels of wastewater viral activity nationwide. Essentially, this is the largest summer wave we've seen in two years.
However, the most recent COVID headlines that we're seeing haven't been about the summer surge, but about where we stand on vaccines for the fall. Some sources are reporting that the FDA could approve updated mRNA vaccines from Moderna and Pfizer as early as this week. Those target the KP.2 strain of the virus. It's unclear whether the agency would simultaneously authorize Novavax's updated vaccine, which targets the JN.1 strain.
As a reminder, in June, the CDC did recommend that everyone six months and older receive both an updated COVID vaccine and a flu shot this year.
Unger: I'm definitely ready to get both of those as soon as they're ready. So, thank you for that update. We'll continue to keep an eye out on all of that. And that's it for this week. Andrea, thanks again for being here and sharing all this information.
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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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