Latest bird flu news, Long Beach tuberculosis outbreak, and CDC Mpox Clade 1 DRC update – American Medical Association
The AMA Update covers a range of health care topics affecting the lives of physicians and patients. Learn more about the latest in bird flu and policies from the 2024 AMA Annual Meeting.
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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.
How does bird flu spread to humans? Can bird flu kill humans? Is there a tuberculosis outbreak in California? Is tuberculosis curable? Are Mpox cases on the rise?
Our guest is AMA’s Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.
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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 for having me.
Unger: So let’s get right into it and start talking about bird flu. Andrea, it depends on what site you look at. Some are very alarming, others not. Why does something that the CDC says is low risk for most of us continue to make such headlines this week?
Garcia: Well, Todd, it’s a good question, and I think one of the key concerns here is the potential for mutation. We know that influenza viruses have the potential to constantly change, and the wide geographic spread of H5N1 bird flu viruses in wild birds, poultry and some other mammals is really creating additional opportunities for people to be exposed to these viruses.
This past Wednesday, we saw USDA release a preprint study describing, for the first time, their investigation of 220 viral genomes from infected cows. And from this, we’ve learned that the spread to dairy cattle likely started from a single spillover event from birds in the Texas panhandle back in early December. And as a reminder, the USDA hadn’t confirmed the presence of H5N1 in a Texas herd until March 25. So that means this has been circulating for about four months without detection.
There was a recent New York Times article that was talking about that same study, and it indicated the virus had already acquired dozens of new mutations, none of which on their own are really cause for alarm, but something that we certainly really need to keep a close eye on.
Unger: So not an issue right now, but of course, mutation is always problematic and possible. Andrea, what do we take away from all of the findings? Help us put this into context, I guess.
Garcia: There was a recent piece in the Boston Globe that I think captured well the thinking on this. And it’s if we’ve learned anything from the COVID pandemic, a virus can adapt and we need to be prepared.
In that article, the author, who was a physician, said it’s time to prepare, not panic. And I think that that is where we are. We need to increase testing and do what we can at this point to limit the spread. We know that lactating cows are housed close to each other and frequently moved across state lines, and that, obviously, increases the risk of spread. Farms that have dairy cows also have other animals, too.
According to that article in the Globe, it’s especially important to prevent infection in pigs because pigs are believed to have the potential to serve as mixing vessels for influenza viruses. So that means in theory, if a pig is infected with avian and mammalian flu at the same time, flu genes could reassort and create a highly pathogenic strain adapted to mammalian transmission. And that’s certainly something that we want to avoid.
Unger: Absolutely. Well, let’s talk a little bit about testing and tracking. How are we doing on those fronts?
Garcia: Well, as a reminder, we learned last week that there will be required testing for herds that are brought across state lines, and that will help, but many will still be missed. And the authors of the USDA preprint are hoping that their findings will prompt large scale surveillance, not just of affected farms, but for those without reported infections as well.
The CDC is tracking emergency room visits and positive test results to detect an early signal if people start to get sick, but we are seeing some epidemiologists and virologists who are also calling for the utilization of wastewater surveillance.
Unger: All right, that makes sense. Andrea, on the treatment front, is there any news out there?
Garcia: While those two existing candidate vaccine viruses are expected to provide good protection against the circulating virus, planning is underway to scale up production and deployment if needed. We also have antiviral medications in supply that target influenza viruses, including tamiflu. And as a reminder, for this strain so far, we’ve seen only two human cases in the U.S.—the one just a few weeks ago in Texas from exposure to dairy cattle, and the other was in 2022 due to exposure to chickens.
However, I think the concern is, is that we may be missing cases now in dairy workers in this current outbreak, and the number could actually be much higher. It can definitely be difficult to measure illness in farm workers in rural areas, and that’s for a number of reasons—their remote location, a reluctance to seek out health care, a lack of health insurance, and of course, concerns about immigration status, to name a few.
Unger: Makes sense. Well, that’s something we’ll certainly continue to watch and track. Let’s move on to a different topic. Another disease that we don’t hear much about appeared in the headlines this week, and that is tuberculosis. Andrea, what’s going on there?
Garcia: Yeah, so those headlines are largely coming out of Long Beach, California, where there is a tuberculosis outbreak among residents of a single room occupancy hotel. As of April 29, 14 cases had been associated with that outbreak, and investigators have identified 170 people who may have been exposed and are in the process of being screened. Of the 14 cases, one person has died, and nine others have been hospitalized. A local public health emergency has been declared, and that’s going to help secure resources to contain the outbreak.
Long Beach city officials have said that the risk to the general public is low, and that the current outbreak is really isolated to a population of people with significant barriers to care, including homelessness, housing insecurity, mental illness, substance use and serious medical comorbidities.
It’s also important to just remember that tuberculosis is curable. It’s treated with antibiotics. There are several treatment regimens recommended in the U.S. And it can also be prevented with routine screening and making sure people who are infected finish their course of treatment.
Unger: Now, Andrea, we are talking right now about a kind of a localized outbreak, but is this a trend that we’re seeing? And how widespread is tuberculosis itself?
Garcia: Well, on a global scale, according to the WHO, a total of 1.3 million people died from TB in 2022. And that’s the latest year that we have data for. Common symptoms include a prolonged cough, sometimes with blood, chest pain, weakness, fatigue, weight loss, fever and night sweats. But a patient can also develop latent TB infection, which means they’re infected with the TB bacteria and may need antibiotics, but those germs don’t make them sick.
According to a recent CDC report, the U.S. is still among the lowest in the world for TB. However, the disease has been increasing here since 2020. And preliminary data show that TB disease cases increased 5% in 2022, but they still haven’t returned to pre-pandemic levels.
Unger: All right. Another disease that we haven’t talked a lot about lately quietly resurfaced in the headlines over the past couple of weeks, and that’s mpox. Andrea, will you update us on the latest there?
Garcia: Most of the mpox headlines are about the concerning outbreak happening in the Democratic Republic of Congo, or DRC. And as you may remember, the CDC issued a Health Advisory, or a HAN, back in December to notify clinicians about the occurrence, the geographic spread, and sexually associated human-to-human transmission of mpox in the DRC.
What’s new here is that a recent preprint article of a genetic sequencing analysis identified a novel variant of mpox that might more easily spread among people, including through sexual contact. So this has alarmed researchers who feel another worldwide outbreak may occur, like we saw in 2022.
It’s important to note that there are two subtypes, or clades, of mpox—clade I, which is thought to be more severe and can kill up to 10% of people infected, and clade II, which is the one that triggered that global outbreak in 2022. That’s less severe. More than 99.9% of people with clade II mpox survive.
Unger: Now, is the concern that clade I is causing the recent outbreak in the DRC?
Garcia: Yeah, so the ongoing outbreak in the DRC has been driven by clade I mpox. And this recently discovered novel strain of clade I, which some are calling clade Ib, seems to have enhanced transmissibility and the ability to evade detection by some tests.
The physician who led the study identifying that new strain indicated in news reports that the lesions reported by most patients are milder. They also are mostly on the genitals, which makes them trickier to diagnose. In previous outbreaks in Africa, those lesions were mostly seen on the chest, hands and feet.
I think importantly, we have not seen sexually acquired clade I m-pox before late last year, and it also seems that this new version of clade I can also be sexually transmitted. Actually, almost 30% of the confirmed infections so far this year in the DRC have been in sex workers.
Unger: So Andrea, what does this mean in the big picture? I guess, everybody wants to know, does this foretell another outbreak?
Garcia: I think it’s too soon to tell. Mpox infections have waned globally since 2022, but they’ve been trending upwards in the DRC. Last year, they reported more than 14,600 suspected infections and more than 650 deaths. Health officials are concerned, and representatives of the DRC and 11 nearby countries met earlier in April to plan a response and to commit to stepping up virus surveillance.
According to the CDC, there have been no cases of clade I mpox reported here in the U.S. at this time. And the risk to the public in the U.S. from this type of mpox circulated in the DRC is very low.
Unger: Now, Andrea, don’t we have vaccines for mpox?
Garcia: Yeah, the vaccine JYNNEOS was developed to protect against mpox and smallpox. And a recent study reconfirmed that strong protection against mpox from that vaccine. However, access to the vaccine has been an issue. In 2022, we saw many wealthy countries offer the vaccine to individuals at high risk of contracting the disease, but few vaccine doses have reached African countries.
The DRC is currently considering regulatory approval for the vaccines, and the U.S. has reportedly committed to providing DRC with enough doses to immunize 25,000 people. Japan has also said it will provide vaccines. But a vaccination drive in DRC would require hundreds of thousands, if not millions, of doses to inoculate those at risk of infection. So we will have a lot of work to do if we want to contain this outbreak.
Unger: All right, well, we’ll continue to follow that as well. Andrea, thanks so much. That wraps up today’s episode. Appreciate you 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.
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. 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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