Public Health

CDC updates on international travel, new COVID variant HV.1, Beyfortus, and congenital syphilis


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Wondering how to avoid COVID this holiday season? AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, breaks down the best time to get vaccinated and provides updates on the latest COVID variant and the surge in RSV and flu cases. Plus, the sharp decrease in vaccination rates among children and the alarming increase in syphilis infections in newborns. AMA Chief Experience Officer Todd Unger hosts.


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

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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 in Chicago. I'm Todd Unger, AMA's chief experience officer also in Chicago. Welcome back, Andrea.

Garcia: Hi, Todd. It's good to see you. Thanks for having me.

Unger: Well, we're about to head into the big Thanksgiving holiday week. And it's one of the busiest travel periods all year. The CDC announced that it will be conducting additional monitoring at all major airports. Andrea, tell us more about that and what it's going to mean for travelers.

Garcia: Yeah. So this additional monitoring is being conducted through the CDC's Travel-based Genomic Surveillance Program or TGS and that began during the pandemic. And it acted really as an early warning system to detect new COVID variants. That program really consists of a couple of different approaches.

One of them is voluntary nasal sampling of arriving international travelers. There's airport iterator drain sampling. And then airplane wastewater sampling. According to the CDC, that TGS program has been remarkably effective at detecting many variants entering the U.S. up to six weeks before they have even officially been reported nationwide. Earlier this month the agency said that they're expanding a pilot program and that's going to include testing for flu, RSV and other respiratory viruses.

Unger: Good work, CDC. Andrea, tell us more about how the pilot expansion is going to work.

Garcia: Yeah. So we know that there are seven international airports that participate in the COVID surveillance efforts. Under the pilot, TGS is going to be expanding to test for more than 30 bacteria antimicrobial targets and viruses. And that's specific to four airports, so Boston, San Francisco, Washington Dulles and JFK in New York. The pilot is going to last for several months. And it's time to come ahead of the winter months when we know those respiratory viruses are circulating more heavily. CDC says that this expanded program could potentially help prevent tens of thousands of infections.

Unger: Wow. That is very smart. Andrea, you said expanded testing and monitoring. Let's talk about how we go beyond that. We know that vaccines are also another big tool here in the armament. What does the CDC say about getting vaccinated ahead of the holidays?

Garcia: Yeah. So in an interview with CBS News I think it was about a week ago Dr. Mandy Cohen, who we know is the director of the CDC, said that best window to get vaccinated to protect yourself and your family before any gathering is about two weeks out, because we know it takes 1 to 2 weeks for COVID and flu vaccines to boost immunity. However, given where we are now, we know we're just days away from Thanksgiving. It's important to keep in mind that it's never too late to get vaccinated and protected against these respiratory viruses, which we know can cause severe illness and even death in some populations.

As we've talked about before, the CDC expects to see flu, COVID and RSV circulating at the same time this season. We know that high vaccination levels can help lessen the severity and impact of these diseases. And this year we're lucky because we do have vaccines available for all three viruses for the first time ever. Unfortunately, we still have a ways to go to reach those high vaccination levels.

Unger: Andrea, last time we talked we hadn't seen a significant rise in RSV, COVID or the flu yet. Is that still the case?

Garcia: Well, according to the flu review put out by CDC most recently we know that flu activity is now increasing in most parts of the country. That's most noticeable in South Central, the Southwest and the West Coast regions. We also know that RSV and COVID cases are increasing in some jurisdictions.

We have a new COVID variant called HV.1 that we do need to keep an eye on. It's just been a few short weeks and HV.1 has become the variant responsible for most COVID cases here in the U.S. As a reminder, CDC recommends that everyone six months and older get that updated COVID vaccine and this year's seasonal flu vaccine. And a common question is can they be administered together? And the answer to that is absolutely, yes they can.

Unger: Andrea, one of the things we've talked about over the past few weeks is just overall low vaccination rates. And one of the reasons that underlies that has been kind of a rocky rollout that we experienced with the updated COVID shot and supply shortages that we ran into with the RSV vaccine. Any updates there in terms of how that's been going?

Garcia: Yeah. There has been some good news for parents who we know have been trying to protect their babies against RSV. Last week, we heard the CDC announce the release of more than 77,000 additional doses of Beyfortus, that's that long-acting monoclonal antibody that is designed to protect infants from severe RSV disease.

These additional doses are going to be distributed immediately to physicians and hospitals through both the VFC program and commercial channels. That should help improve availability of the shot for eligible infants, particularly those at risk of severe illness. CDC and FDA have said that they're going to continue to be in close contact with the manufacturers to help ensure the availability of additional doses through the end of this year and into early 2024 to try and meet that demand. CDC is asking physicians to prioritize those doses for those infants that we know are at highest risk during this period of constrained supply.

That includes young infants up to six months and American Indian Alaska native infants among other groups. And at the same time, CDC and FDA are also encouraging physicians to use that RSV maternal vaccine, which is not facing those same supply challenges as the monoclonal antibody, that can help protect babies against RSV before they're born.

Unger: All right. Well, staying on the topic of children and vaccines, a new report came out that provided insight on overall vaccination rates among children. Andrea, what are the key takeaways there?

Garcia: Well, Todd, it's not particularly good news. According to a recent report from the CDC, the childhood vaccine exemption rate, that's the number of kids who are not getting their routine childhood vaccines, has reached an all-time high. That report specifically looked at kindergartners whose parents or caregivers have opted them out of vaccines.

And CDC found that as a national average 3% of children entering kindergarten in the 2022-2023 school year were granted a vaccine exemption from their state. This is the highest vaccine exemption report ever reported in the U.S. 41 states saw a rise in exemption in 10 states including Arizona, Hawaii, Michigan, Nevada and Wisconsin, that exemption rate was over 5%. And Idaho had the highest exemption rate with more than 12% of children entering kindergarten with a vaccine exemption in 2022. CDC indicates that exemption rates over 5% increase that risk for outbreaks of vaccine preventable diseases like measles, mumps, and polio.

Unger: These are really concerning statistics. Andrea, do we have any idea why this is happening?

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Garcia: Well, this specific report did not go into the reasons for that increase in exemptions. Given this, it's not really clear whether they reflect a true increase in opposition to the vaccine, vaccine hesitancy or if parents are asking for non-medical exemptions because of barriers to vaccination or if there are even other factors involved. I think CDC is trying to get a better understanding of the reasons at play so it can use that information to inform policy that will help increase vaccination rates and stop a reoccurrence of diseases that we know are preventable.

Unger: Speaking of preventable diseases, syphilis has been making headlines. However, it's not in the way that you would think. It's affecting newborns. Andrea, what's going on there?

Garcia: There has been an alarming increase in syphilis infections in newborns. When a pregnant person with syphilis passes the infection to the baby during pregnancy, we know that's called congenital syphilis. According to a CDC report, more than 3,700 babies were born with syphilis in the U.S. in 2022. That's a 32% increase from the year before and a 1,000% increase from 2012.

Syphilis, if left untreated in a pregnant person, can have devastating consequences for the baby. Babies born with congenital syphilis in 2022, about 300 of them died or were stillborn. In addition to stillbirth, we know that untreated syphilis can damage the baby's organs and bones and harm vision and hearing, which we know can lead to lifelong health problems.

Unger: Andrea, any idea why this is happening now?

Garcia: We know that each congenital syphilis case is considered a never event. It's a tragic outcome that should never happen because it's nearly always preventable if it's caught and treated in time. According to the CDC, newborn syphilis occurs when people who are pregnant don't receive that timely testing and treatment during pregnancy. It's a single course of penicillin given at least a month before the end of pregnancy and that nearly always prevents infected mothers from passing the bacteria to their babies.

But the CDC findings show that almost 90% of congenital syphilis cases in 2022 could have been prevented with timely testing and treatment. More than 50% were among people who tested positive for syphilis during pregnancy, but they didn't receive that timely inadequate treatment. 40% were among mothers who received no prenatal care and that has to change.

Unger: Andrea, what can physicians do about this particular problem?

Garcia: So there's a need to really focus on reaching those at-risk populations and getting them screened and tested. CDC is really encouraging treatment following a rapid syphilis test during pregnancy if there's a chance that patient might not be available for follow up care. They're also recommending rapid syphilis testing and treatment in places like emergency departments and syringe service programs, prisons and jails, as well as maternal and child health programs.

There's an education piece here that needs to focus on prevention. We need to address syphilis before pregnancy in counties where we know there are high syphilis rates. And we need to proactively screen sexually active women and their partners who have risk factors for syphilis. CDC called this a failure of the U.S. health system. And I know that we are seeing too many people who are not being tested and treated for syphilis.

Unger: And that's definitely something we'll be hearing more about. Andrea, again, thanks so much for joining us today and sharing these updates. That wraps up today's episode.

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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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