What illnesses are going around? RSV, COVID-19, influenza, measles outbreak, plus avian flu news – American Medical Association
                            April 17, 2024
                                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.  
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    Which states have found bird flu in dairy cows? Why is measles    coming back? What states are having a measles outbreak? When is    respiratory virus season over?  
    Our guest is AMA's Vice President of Science, Medicine and    Public Health, Andrea Garcia, JD, MPH. American Medical    Association Chief Experience Officer Todd Unger hosts.  
    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. It's great to be here as    always.  
    Unger: Well, let's begin where we left off    last week, and that's with bird flu. Andrea, what updates do we    have on that topic?  
    Garcia: Well, that virus is continuing to    spread among cattle, but I think the good news is there have    been no new reports of human infection here in the U.S. There    was some news according to the CDC that Vietnam has reported    its first human infection with a low pathogenic avian influenza    virus, that's H9N2.  
    It's a different subtype of avian flu than the highly    pathogenic avian flu that's most reported globally and that's    causing the outbreaks in poultry and cattle here in the U.S. At    this time, there is no indication that this human infection in    Vietnam is causing person-to-person spread or poses a threat to    U.S. public health.  
    Unger: Well, that's good news. On the other    hand, you did mention increased spread here among cattle, and    that's obviously a problem. What is that looking like?  
    Garcia: There was a report in Reuters that    indicated North Carolina and South Dakota became the seventh    and eighth states to identify avian flu in a dairy herd. And    just as a reminder, when we talked last week, the USDA had    reported infections across six states, so Texas, Kansas, Ohio,    Michigan, Idaho and New Mexico.  
    So now we're seeing dairy farmers across the country going on    the defensive to try and prevent further spread. Many are    banning visitors and disinfecting vehicles coming onto their    land. Some are even cutting down trees to discourage wild birds    from landing, since that first case in Texas and Kansas appear    to have originated with birds.  
    Many are increasing their safety and cleaning procedures. In    that Reuters article, one dairy farmer described her farm as a    gated community for cows, where only the most essential people    are allowed to go since people can unintentionally contribute    to that spread by carrying in contaminated bird droppings on    their boots or on their vehicles. The good news is that, as we    discussed last week, cows do seem to recover, whereas the    disease is lethal in poultry.  
    Unger: I never thought I'd heard that term    gated community for cattle, but I understand folks wanting to    protect their herds, and that's a big problem. So we'll    continue to pay attention to this. Has the increased spread    change the risk at all to people?  
    Garcia: No. The CDC says that the risk for    most people remains low. However, some dairy farmers are    concerned about a potential drop in demand for milk and cheese    due to fear. The USDA did report finding bird flu in some    unpasteurized milk samples, but agricultural officials say that    pasteurized milk is safe. Farmers are also isolating those    infected cattle and dumping their milk.  
    Unger: All right, Andrea, thank you so much    for the update there. Let's turn now to another disease that is    back in the headlines and continues to be for the past several    weeks, and that's the measles. Andrea, what's going on there?  
    Garcia: Well, two new cases, one in Las Vegas,    the other in Los Angeles, have really put this disease back in    the news. More measles cases have also been reported in Georgia    and here in Illinois. Unfortunately, the cases in both Las    Vegas and Los Angeles were found in people who visited popular    tourist destinations that are often, as you know, filled with    people. The one in LA reportedly visited Universal Studios and    the Santa Monica Pier over Easter weekend. The one in Vegas    reportedly visited the MGM Grand resort on the strip and then    additional nearby locations.  
    So public health officials are warning that unvaccinated    individuals who were at these reported locations during the    designated dates and times may be at risk for developing    measles within 21 days from that exposure date. Last Thursday,    the CDC said that the rapid rise in measles cases in the first    few months of 2024 threatens the U.S. elimination status. And    that's a situation we haven't faced since 2019 when prolonged    outbreaks posed a similar problem.  
    Unger: Well, Andrea, where exactly do we stand    in terms of cases?  
    Garcia: Well, Todd, on Thursday, we saw the    CDC release an analysis of measles activity. And that was from    January 1 of 2020 to March 28 of 2024. That said that cases in    that first quarter of 2024 have risen 17-fold compared to that    mean first quarter average that we've seen from 2020 to 2023.    As of the March 28 data cutoff for that analysis, we had seen    97 cases of measles reported to the CDC, and then as of April    11, we have a total of 121 measles cases reported by 18    jurisdictions. So that number is definitely continuing to    increase.  
    Of those 121 cases, 86 were linked to seven outbreaks,    including a large one here in Chicago where most of those 61    cases that have been identified have been linked to that    outbreak at a migrant shelter. If we look at the measles cases    this year, though, 47% have occurred in children younger than    five. Young children also had that highest level of    hospitalization, at about 65%. And of people infected, 82% were    unvaccinated or had an unknown vaccination status.  
    Of the 20 outbreaks, which we know involves three or more cases    that we've seen since 2020, so far seven of those have occurred    in 2024. And for further context, in all of 2023, we had 58    cases. And we are only in April. So maintaining that measles    elimination status, which we know helps reduce cases, deaths    and costs, means that no outbreaks have persisted for 12 months    or more in a setting where we know the surveillance system is    working well.  
    Unger: So tell us a little bit more about this    status. What do we need to do to help maintain the status?  
    Garcia: Well, CDC has said that really comes    down to increasing MMR vaccination coverage, especially in    those close-knit and under-vaccinated communities. And as a    reminder, that vaccine is incredibly safe and effective. We    know that two shots are about 97% effective at preventing    measles. I think the other steps include encouraging    vaccination before international travel and then rapidly    investigating those suspected measles cases.  
    Most measles cases are still imported. However, of those, 61%    in U.S. residents who were eligible for vaccination but were    unvaccinated or had an unknown vaccination status. So the CDC    is also reportedly seeing a shift this year in overseas regions    where people were likely exposed.  
    So during that study period that we talked about earlier, the    two most common WHR regions where we saw cases were from the    Eastern Mediterranean or the Middle East and Africa, but six of    the 2024 cases were reported to have originated in European and    Southeast Asian regions. So that's a 50% increase from earlier    in the study period.  
    So according to the CDC, along with under-vaccination here in    the U.S. population, there's a global gap in measles    vaccination that is also fueling this rise in cases. And if we    look at those numbers more closely, first dose coverage    declined from 86% in 2019 to 83% in 2022, leaving nearly 22    million children younger than one vulnerable to the virus.  
    Unger: Andrea, besides this huge, as you point    out, global vaccination gap, is there anything else that is    kind of fueling this now? Why is it happening?  
    Garcia: Well, in the U.S., some of it is    driven, of course, by misinformation, which is causing parents    to seek vaccine exemptions. Every year, that number of kids in    kindergarten with measles vaccination is going down.  
    Years ago, a fraudulent study claimed there was a link between    the vaccine and autism. Of course, that study was later    debunked. And other studies have searched for a connection but    failed to find one. So to be very clear, there's no connection    between the MMR vaccine and autism. So here's where physicians    and particularly pediatricians can play an important role in    curbing that spread of misinformation by talking to parents,    being very clear about the evidence and the very real dangers    and potential long-term effects of measles.  
    According to the CDC, in the decades before the measles vaccine    was available, 48,000 people were hospitalized per year. One    thousand people developed dangerous brain inflammation, and 400    to 500 people died.  
    Unger: So big risks there, and we need to    close that gap. The evidence is really clear and getting those    vaccinations, if you haven't already, so critical. Andrea, we    haven't talked about RSV, COVID, and the flu and the array of    other viruses for a while. The weather does seem, of course, to    be getting nicer, thank goodness, it is here in Chicago, and    we're now well into spring. Are we kind of out of the woods    with viruses for the moment?  
    Garcia: Well, it appears so. And according to    a recent report in the Associated Press, which was sharing CDC    data, the 2023, '24 respiratory virus season is slowing for all    three viruses. Overall, respiratory illness activity is    currently the highest in the central U.S. North Dakota is the    only state that is experiencing high activity levels at the    moment.  
    The CDC gauges this activity by tracking doctor visits that    involve a patient showing flu-like symptoms. And for that week    of April 5, those made up only about 2.76% of all visits. The    other metric, as you know, we look at is the test positivity    rate for each virus, which can help inform which viruses are    the most prevalent. While results are delayed for the CDC data    set, flu has had the highest test positivity rate since    mid-December.  
    Hospitalizations, of course, give us that idea of severity    associated with each virus. COVID is hospitalizing people at a    rate of 2.21 per 100,000. That's the highest rate among the    three viruses. However, hospitalization rates for all three    viruses are declining. I think the key takeaway from all of    this as well, activity levels are still elevated. We're seeing    decreasing trends across each of these metrics, which do    suggest that the season is waning.  
    Unger: All right. Well, why don't we finish up    then with that piece of good news. Andrea, thanks so much for    being here and keeping us informed. To all the folks out there    listening, if you found this discussion valuable, you can    support more programming like it by becoming an AMA member at    ama-assn.org/join.  
    We'll be back soon with another AMA Update. In the meantime,    you can find all our videos and podcasts at ama-assn.org/podcasts.    Thanks for joining us today and 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.  
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What illnesses are going around? RSV, COVID-19, influenza, measles outbreak, plus avian flu news - American Medical Association