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 long is whooping cough vaccine good for? Is there a link between alcohol and cancer? What's the new flu vaccine name? What is a challenge study for vaccine development?
AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses alcohol and cancer risk, FDA flu vaccine approval and pertussis vaccine schedule. AMA Chief Experience Officer Todd Unger hosts.
- The AMA is your powerful ally, focused on addressing the issues important to you, so you can focus on what matters most—patients. We will meet this challenge together. Join us.
- CDC FluView Weekly US Map & Influenza Summary Update.
- FDA Vaccines and Related Biological Products Advisory Committee (VRBPAC meetings).
- Learn more about our AMA advocacy priorities, including:
- Reforming Medicare payment
- Fighting scope creep
- Fixing prior authorization
- Reducing physician burnout
- Making technology work for physicians
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. Andrea, welcome back.
Garcia: Thanks, Todd. It's great to be here.
Unger: This week, we're talking about whooping cough, a newly approved flu vaccine, and the connection between alcohol and cancer. Let's start with whooping cough. Andrea, this is the first time we're talking about whooping cough this year. What's the news?
Garcia: Well, Todd, cases are surging now. And the CDC reported on Friday that according to preliminary data, cases of pertussis or whooping cough have more than quadrupled what they were at this point last year with more than 14,000 infections to date. This is the highest number of whooping cough infections we've seen since 2014.
And according to a CDC spokesperson, those cases are really not showing any sign of slowing down. Cases of whooping cough dropped to unusually low levels during the pandemic. And that's likely due in part to the mitigation measures we had in place for COVID. But before that, cases had been trending upward.
Unger: Now, the term pertussis, of course, the official name really for whooping cough. Andrea, why is pertussis so concerning?
Garcia: Well, pertussis is a respiratory illness. It's caused by a type of bacteria. And if left untreated, it can lead to severe coughing fits that can be painful. It gets the name whooping cough because of the whooping sound a person makes as they try to catch their breath. And these coughing fits can be so severe that they can cause people to vomit or even break ribs.
In its early stages, pertussis can be treated with antibiotics. However, it can be really difficult to diagnose early because those initial symptoms look a lot like a cold, so runny nose, sneezing, a low-grade fever, a cough. It's not until a week or two later that the infection moves into a new stage with that deep cough. But by then, it's too late. And after that, the only treatment available is really comfort care with plenty of rest and fluids while that infection runs its course.
Unger: Now, isn't there a vaccine for pertussis?
Garcia: There is. And young children typically receive five doses of a vaccine against pertussis, called DTaP, which can also protect against tetanus and diphtheria. And that's by the time they're age six years old. Children also receive a routine adolescent booster of Tdap at the age of 11 to 12. And then, boosters are recommended every 10 years.
Pregnant people are recommended to get vaccinated against the infection between 27 and 36 weeks of gestation. And that's because those maternal antibodies transfer to the newborn, providing protection against pertussis before the baby is eligible for the vaccine. While the vaccines we have do offer strong initial protection, that protection does tend to wane. So there have been discussions around the development of new vaccines that might confer longer lasting protection and reduce transmission.
On Friday, we saw the FDA's Vaccines and Related Biological Products Advisory Committee, or VRBPAC, convened to hear from labs in Canada and the UK as they presented their models for human challenge trials for pertussis. And just as background, those human challenge trials involve the intentional exposure of the test subject to the condition.
Unger: Tell us a little bit more about that human challenge trial. What does that involve exactly?
Garcia: Well, this was actually detailed pretty clearly in our recent article on CNN. And manufacturers typically will need a large number of people with an infection to test a new vaccine. But infections like pertussis, that cycle, make doing these trials especially difficult. Challenge trials, as you can imagine, are ethically complex.
Human challenge trials can be used safely for diseases for which there's a rescue therapy available that can quickly bring the participants back to good health. So because whooping cough is curable with antibiotics in its early stages, study volunteers could be protected from harm. The advisory committee meeting, there were some concerns noted that the model wouldn't necessarily be able to measure how well a formulation prevents severe disease.
It would also be potentially difficult to determine if people are getting stronger protection than existing vaccines. So those models were met with some mixed reactions by the committee. Some felt the studies had not been fine tuned enough. So definitely something we'll continue to keep an eye on.
Unger: Thank you, Andrea, for that update on whooping cough, pertussis. And we'll keep an eye on that. Andrea, let's stick with the topic of vaccines for another moment and talk about a new development with the flu vaccine last week. What can you tell us about that?
Garcia: Yeah, so on Friday, we saw the FDA approved the first ever flu vaccine that can be self-administered at home. However, it won't be available for this respiratory virus season. The vaccine itself, FluMist isn't new. It's a nasal spray manufactured by AstraZeneca that has been used to protect against the flu in the U.S. for more than 20 years.
FluMist is currently the only needle-free option available for flu vaccination in the U.S. And it's available in pharmacies and other health care settings for people ages two to 49 who have a prescription. The new part is really the self-administration piece.
Adults will soon be able to give it to themselves at home. And children will be able to receive it with the help of a caregiver. AstraZeneca is planning to make that vaccine available for self-administration through a third-party online pharmacy, which will prescribe and ship the vaccine after reviewing a screening and eligibility assessment. That option should be available in time for the start of next year's respiratory virus season.
Unger: Andrea, do we expect something like this to increase flu vaccination rates?
Garcia: Well, I think that really remains to be seen. When the FDA announced last year that it was reviewing the possibility of self-administered flu vaccine, some physicians told CNN that they really welcomed more accessible options, but they didn't expect that self-administration would change vaccination rates significantly. That said, Dr. Peter Marks, who's the director of FDA's Center for Biologics Evaluation and Research, said in a statement that it will provide greater convenience, flexibility and accessibility for individuals and families.
We know that based on CDC data, that flu caused at least 35 million illnesses, 400,000 hospitalizations and 25,000 deaths during the '23-'24 flu season. However, vaccine update uptake has fallen in recent years. Last season, only about half of adults and children in the U.S. got their annual flu vaccine. So really, anything that we can do to make vaccination easier and more accessible is a step in the right direction.
Unger: Andrea, I know that some people are scared of needles, and so I'm sure this option will be appealing to them as well. Turning to another public health challenge that we haven't talked about in a while, which is cancer, a new report strengthens the tie between alcohol and the disease. Andrea, tell us more about that connection.
Garcia: Well, this report actually made several headlines last week, including in the New York Times. And as we've discussed before, although overall cancer death rates have fallen, adults under the age of 50 have been developing breast cancer and colorectal cancer at increasingly higher rates over the last few decades. This new report is by the American Association for Cancer Research. It says that alcohol may be one of the factors driving that trend.
That report found that excessive alcohol consumption increases the risk for six types of malignancies, including esophageal squamous cell carcinoma, and certain types of head, neck, breast, colorectal, liver and stomach cancers. We know that about 5.4% of cancers in the U.S., so just over 1 in 20 cancer diagnoses, were attributed to alcohol consumption in 2019. And that is the most recent data that we have available. The report estimates that about 40% of all cancer cases are associated with modifiable risk factors, that's including reducing alcohol consumption, avoiding tobacco, maintaining a healthy diet and weight, exercising, avoiding ultraviolet radiation, and minimizing exposure to pollutants.
Unger: Now, Andrea, I know there's been a lot of confusion of late because there was once a belief that moderate alcohol consumption was considered protective against heart disease. I think there's been a lot of news on that particular thing. How do we reconcile that with the current guidelines?
Garcia: Yes, they were certainly starting to see studies that show that that may not, in fact, be true for everyone. Just last month, there was a large study that followed more than 135,000 older British adults for over a decade. And it found that moderate and light drinkers did not benefit from a reduction in heart disease when compared to occasional drinkers.
Both moderate and light drinkers experienced more cancer deaths than occasional drinkers. As one expert points out in the New York Times article, we can talk about the myth that red wine has potential cardiovascular benefits, but there are many ways to keep your heart healthy. And these potential benefits don't really outweigh your cancer risks.
Unger: So what can we do about it?
Garcia: Well, the author said we really need to raise awareness through public messaging campaigns and adding cancer-specific warning labels to alcoholic beverages. More than half of people surveyed didn't know that alcohol increases your risk of cancer. Another study found that fewer than one third of women age 18 to 25 knew that alcohol use increased their risk of breast cancer. While the factors driving the increase in early-onset colorectal cancer are not well understood, studies have shown that frequent and regular drinking in early and mid-adulthood is associated with a higher risk of colon and rectal cancers in later life.
Unger: Well, we will certainly do our part to raise awareness on that front. Andrea, that wraps up today's episode. And thank you so much for being here and sharing this information.
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 video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
Subscribe to AMA Update
Get videos with expert opinions from the AMA on the most important health care topics affecting physicians, residents, medical students and patients—delivered to your inbox.
