Public Health

CDC avian flu guidelines, bird flu in eggs, plus TikTok mental health & birth control misinformation


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.

Bird flu outbreak: Can you get avian flu from eggs? Are pelvic exams under anesthesia legal? Are birth control pills safe? What is the self-diagnosis trend on TikTok?

AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, shares the latest updates from the CDC on avian flu in cattle and H5N1 symptoms. Also covering the dangers of TikTok medical advice trends on hormonal contraceptives and the teen mental health crisis. AMA Chief Experience Officer Todd Unger hosts.


  • Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association

AMA Recovery Plan for America’s Physicians

After fighting for physicians during the pandemic, the AMA is taking on the next extraordinary challenge: Renewing the nation’s commitment to physicians.

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 for having me. It's great to be here.

Unger: Well, let's follow up where we started last week, which is about bird flu and the recent case that developed in a person who had been in contact with dairy cattle. Andrea, has there been any update on that situation?

Garcia: Well, there's still only one person in the U.S. known to have tested positive for H5N1, but that virus has continued to spread among cattle. We're now seeing infected herd in Ohio. It was also detected in additional herds in Kansas and New Mexico.

And so the USDA has now confirmed infections in herds across six states in total—three dairy herds in Kansas, two in New Mexico, seven in Texas, and then one each in Ohio, Idaho and Michigan. They've also said that transmission of the disease between cows cannot be ruled out, which is something that continues to be studied and looked at.

Unger: Andrea, do we have any sense of how all of this got started?

Garcia: Well, those initial cases in Texas and Kansas appear to have been introduced by wild birds. And that strain of the virus in subsequent cases in New Mexico, Michigan and Idaho are very similar. This isn't altogether new. Migratory birds have been spreading avian flu around the globe, infecting poultry and other species.

However, last Thursday, the head of the World Organization for Animal Health said that that spread is increasing in the number of species, and it's widening its geographic reach. And that has raised the risk of humans being infected. I think with that being said, scientists still believe the risk for the general public is low.

Unger: Has the CDC provided any additional guidance for physicians or others?

Garcia: They have. So last Friday, we saw the CDC issue an official health advisory, or a HAN, and the purpose of that was really to ensure awareness of that Texas case among physicians, among state health departments, and of course, among the public.

That advisory included a summary of interim CDC recommendations, as well as details around sequencing. They have sequenced the influenza virus genome from the individual who was infected. They've compared that with H5N1 sequences from cattle, from wild birds and from poultry.

And while there were minor changes identified between the two, both cattle and human sequences lacked changes that would make them better able to infect mammals, which is good news. There were also no markers found that would indicate any sort of resistance to our current antiviral drugs. And the virus is closely related to two existing candidate vaccine viruses that are already available to manufacturers, which could be used to make vaccine if needed.

Unger: Well, that all sounds like relatively good news in terms of treatment and spread. Andrea, you also mentioned interim recommendations. Is there anything new that we need to know there?

Garcia: Well, the CDC specifically recommends that physicians consider the possibility of H5N1 virus infection in people who are showing signs or symptoms of acute respiratory illness or conjunctivitis and who have had a relevant exposure history.

So examples of symptoms to watch for include but are not limited to for mild illness cough, sore throat, eye redness or discharge, fever or feeling feverish, runny nose, fatigue, muscle or joint pain, and headache. For moderate to severe illness, which that could include shortness of breath, difficulty breathing and altered mental state or seizures.

Half the dues, all the AMA benefits!

  • Free access to JAMA Network™ and CME
  • Save hundreds on insurance
  • Fight for physicians and patient rights

And if signs and symptoms compatible with avian flu are present, physicians should isolate the patient and follow infection control recommendations, including the use of PPE. And they should also initiate empiric antiviral treatment as soon as possible. Don't delay. Don't wait for laboratory confirmed results. Physicians should also be notifying their state and local health departments. They can help arrange testing.

Unger: Now, you mentioned earlier that the risk to the general public is currently considered low. Is there anything that the public needs to know in terms of prevention?

Garcia: Yeah, the advisory recommended that people avoid being near sick or dead animals or surfaces contaminated with the animal's feces, litter, raw milk or other byproducts when not wearing respiratory or eye protection. As always, people should not prepare or eat uncooked or undercooked food or related uncooked food products, such as unpasteurized raw milk or cheeses from animals who have a suspected or confirmed infection.

We don't have time to run through all of the detailed CDC recommendations here, including those for state health departments, farmers and livestock workers. But we will drop a link in the episode description and report, of course, on anything new as it develops.

Unger: Well, thank you for that update, Andrea. And in addition, we've also started to see headlines this week about bird flu hitting poultry and possibly affecting our egg supply. Andrea, what can you tell us about that?

Garcia: Well, last Tuesday, Todd, the largest producer of fresh eggs in the U.S. said that they've temporarily halted production at a Texas plant after bird flu was found in chickens. Officials have said the virus has also been detected at a poultry facility in Michigan.

The company, which is Mississippi-based Cal-Maine Foods, said in a statement that approximately 3.6% of its total flock were destroyed after the infection was found at a facility in Parmer County, Texas. Cal-Maine said it sells most of their eggs in the Southwestern, Southeastern, Midwestern and Mid-Atlantic regions of the U.S.

But the company has said that there is no known bird flu risk associated with eggs that are currently in the market and no eggs have been recalled. According to the USDA, eggs that are properly handled and cooked are safe to eat.

Unger: Well, this does raise questions about our egg and dairy supply. Will we begin to feel the impact of this, perhaps in terms of rising prices or shortages or any other ways?

Garcia: Well, there was an article in The Hill that posed this very question over the weekend. And that article quotes Amy Hagerman, who is a professor of agricultural economics at Oklahoma State University. And she said that we would expect to see some increase in prices because you're rapidly pulling a large number of potential eggs out of the market for the next 30 to 60 days.

Under normal circumstances, egg prices would usually be dropping after the Easter holiday, when demand is high. But that's not expected to be the case this year. The article notes that egg prices really haven't even fully recovered from an outbreak in 2022 when bird flu knocked out about 10% of the country's laying hens and prices skyrocketed.

And this isn't the same with dairy products, though, because with cattle, the virus doesn't appear to be nearly as deadly or as contagious as it is with poultry. If the virus gets into a poultry block, every animal's infected within a very short period of time. That translates to fewer deaths for dairy cattle and fewer production disruptions for the dairy industry.

Unger: We'll obviously keep our eye on that. Andrea, I want to turn now to a headline from the HHS that ran early last week, announcing that teaching hospitals need to get written patient consent for pelvic exams. What do they need to know and what's driving that decision?

Garcia: Yeah, so there was a letter that went to teaching hospitals and medical schools last Monday. And HHS said that these hospitals must obtain that written informed consent from patients before they undergo sensitive exams, like pelvis and prostate exams, especially if the patients are under anesthesia.

There have been recent articles, both in the mainstream media and in the medical literature, that have brought attention to the practice of allowing supervised medical or clinical students to perform these invasive exams on patients who are under anesthesia. They're often conducted as a part of vital skills for clinical students, skills they must obtain during their training and education.

But the CMS letter makes it clear that patients have the right to make informed decisions on the health care services that they receive. We did see some states who had enacted laws to protect against this non-consensual exam of anesthetized patients. But the new HHS guidance expands these protections nationally.

This is being seen as a step to restore trust between the medical community and patients, particularly vulnerable populations. And it's important to note that failure to obtain informed consent would be a violation of the conditions of participation under Medicare and Medicaid and may be subject to fines and investigations for violation of patient privacy laws.

Unger: That's good to know, especially given that trust is so essential in patient care. Andrea, closing out this week, there's also been some news about social media and health, particularly that patients are perhaps putting too much trust in the information that they find out there on social media. What can you tell us about that?

Garcia: Yeah, so late last month, The Washington Post did an extensive report on how some women were getting off birth control based on misinformation they've received through TikTok and Instagram, including videos that are really vilifying hormonal contraception.

Among some of the misconceptions were women blaming their weight gain on the pill, claims that some birth control can lead to infertility, depression and anxiety. Many of these influencers then recommended natural alternatives, such as timing sex to menstrual cycles as a much—which is a much less effective method of birth control that doctors warn could result in unwanted or unintended pregnancies.

Physicians say that they are seeing an explosion of birth control misinformation online. It's targeting a really vulnerable demographic, people in their teens and early 20s who are more likely to believe what they see on their phones. This is, of course, a part of a larger, very disturbing trend where teenagers are using social media for health-related concerns.

Unger: Gosh. And the natural method you mentioned there, I think in my parents' day, they were called the rhythm method, things like that. We've come a long way. So I'd encourage folks out there to seek proper medical direction instead of TikTok videos. Andrea, have we seen it being used in other ways?

Garcia: Well, for example, an article in The Hill, also published late last month, revealed that teens are increasingly using social media to self-diagnose their mental health issues. There was a poll by EdWeek Research Center which found 55% of students use social media to self-diagnose. And 65% of teachers say they've seen the phenomenon in their classrooms.

So one of the real dangers here is that after self-diagnosis, teenagers might not only fail to understand their actual problems, but they could pursue solutions or even medications that aren't right for them. The poll also found that teenagers are not just using it to diagnose themselves, but they're also diagnosing their friends, based on what they see.

Parents and physicians can definitely use this as a jumping off point for discussions. But experts are also calling for limits on social media sites, which is part of a much larger discussion.

Unger: Indeed, that deserves a lot more discussion, and one we'll continue to watch. Andrea, thanks so much for joining us today. That wraps up today's episode. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at

We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at 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.

AMA Update podcast logo