Public Health

Disease outbreaks: measles, Mpox, tuberculosis, meningococcal, and bird flu 2024

. 11 MIN READ

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.

AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, AMA Chief Experience Officer Todd Unger hosts.

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  • 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. I'm Todd Unger, AMA's chief experience officer. Welcome back, Andrea.

Garcia: Thanks, Todd. It's great to be here.

Unger: Andrea, we have got a lot to talk about, including this first topic that I thought maybe we wouldn't ever talk about again. And that's H5N1, otherwise known as the bird flu. Andrea, why is this making headlines this week?

Garcia: Well, Todd earlier this week, we saw Texas health officials report that an individual who had been in contact with dairy cattle contracted H5N1. H5N1 is a type of influenza virus that causes highly infectious and severe respiratory disease in birds. That's why we call it avian influenza, or bird flu.

This is only the second human case ever reported in the U.S. And it's the first case that we've seen that is linked to cattle. There was a statement released by the Texas Health and Human Services Agency noting that the patient experienced eye inflammation or infective—infection of the conjunctiva. And that was their only symptom. The individual was tested for flu by the state late last week. And then over the weekend, the CDC performed a confirmatory test.

That patient is reportedly doing well, is being treated with the antiviral drug oseltamivir, which is sold commercially as Tamiflu. And that individual was instructed to isolate to reduce the risk of infecting others. And to date, there is no indication of the disease spreading further among humans.

Unger: Well, that's the question I wanted to ask, just to touch—go a little deeper there. Do we have to worry about potential spread here? Or is this isolated?

Garcia: Well, according to that statement from the Texas Health and Human Services Agency and an article in Stat News, the risk here to the general public is low. In that Stat article, the Principal Deputy Director of the CDC, Dr. Nirav Shah said the fact that there are not other samples to test right now is reassuring. This means that the CDC is not currently aware of other individuals who are symptomatic following an exposure to livestock.

Dr. Shah was careful to point out, however, that the agency is working with state public health officials to make sure those who report signs and symptoms of illness know how to get tested. As we see increasing prevalence of H5N1 in cows, testing those farm workers and dairy workers is going to be important.

Unger: So Andrea, we got one case in Texas. And fortunately, the patient does seem to be doing well. Why do you think this has set off so many alarm bells?

Garcia: Well, H5N1 bird flu has been of concern to health experts for decades. I think the concern here is, as this virus spreads to mammals, it could make it easier for the virus to infect humans. And over time, we've seen nearly 900 human infections across 23 countries. Just over half of those infections were fatal.

And up until now, cows have not been on the list of animals that have known to be susceptible to this virus. But this virus has been detected in other big mammals—big cats, bears, foxes, skunks and seals. And in recent years, the strain of the virus found in many parts of the world, including the U.S., does seem to trigger human infections less frequently than earlier versions of the virus did. And when human cases caused by this strain do occur, they typically are mild. However, that could change if we continue to see additional mutations.

Unger: Absolutely. Well, at least that's a piece of good news. Andrea, what does this mean for our dairy supply now that it's been found in dairy cattle? And has been found in cattle beyond Texas?

Garcia: Now, so the only known person infected from cattle is in Texas. There are four other states, Texas, Kansas, New Mexico and Michigan, that have recently reported H5N1 outbreaks in cattle. And Idaho has also reported presumed cases. While the virus doesn't kill the cattle, the milk production is lower, and the animal feeding is reduced. Owners of those implicated herds have been told to destroy the milk product from those infected cattle.

If milk from the infected animals did make its way into the food chain, the CDC said that the pasteurization process could kill the virus. As of now most, experts believe that risk of H5N1, that the risk it poses has not changed by the infection of cattle. But this is something that will certainly continue to keep an eye on.

Unger: All right, excellent. Well, last week, we were also greeted with another health alert from the CDC. Andrea, tell us more about that new alert.

Garcia: So the CDC issued a health advisory, or a HAN, last Thursday. And that was in response to a rise in rare but severe forms of meningococcal infections in the U.S. And these bacterial infections can cause potentially life-threatening inflammation of the membranes around the brain and spinal cord.

To put this into context, the CDC says that 422 cases were reported in 2023, which was the highest annual number we'd seen since 2014. Of the 94 cases that have a known outcome, 17 of them died. Now, since March 25 of this year, 143 cases have been reported to the CDC. That's 62 more cases than what was seen over the same time frame in 2023.

So we're well on our way to surpassing last year's numbers. I think the spike is also notable in that it's disproportionately affecting certain populations.

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Unger: Well, tell us more about that. What are those populations? And what do physicians need to know?

Garcia: Well, physicians need to know that invasive meningococcal disease can affect people of any age or demographic group. The current increases in disease are disproportionately affecting people ages 30 to 60 years of age, Black or African-American people, and people with HIV. The CDC also noted in the HAN that infection may present with unusual symptoms.

So typically symptoms of meningitis infections include fever, headache, a stiff neck, or aversions to light, and nausea. However, the reported cases don't have these symptoms. Instead, about two-thirds of the patients have bloodstream infections. And about 4% have had septic arthritis.

Immediate treatment with antibiotics is critical in these cases because initial symptoms can get worse quickly. And they may be life-threatening within hours. And it's also important for physicians to help ensure that people recommended to receive meningococcal vaccination are up to date on their vaccines.

Unger: All right, excellent. Well, turning our attention to another bacterial infection that's also been on the rise—tuberculosis. We certainly haven't heard about tuberculosis in a while. Andrea, what do people need to know there?

Garcia: The TB cases have increased year over year in the last three years following a nearly 30-year decline. And according to a CDC report, tuberculosis rates in the U.S. rose by 16% in 2023. As you know, TB is a bacterial infection. It can attack any organ in the body, though it usually attacks the lungs. Some people don't develop symptoms after infection, which is referred to as a latent TB infection.

Unger: Andrea, how widespread is the problem? And do we have any sense of what's driving the increase?

Garcia: Well, 40 states reported increases in the number and rate of TB cases in 2023. Case counts increased among all age groups and among people born in the U.S. and non-U.S.-born people. The CDC report did say that the U.S. still has one of the lowest TB rates in the world.

The increase in case counts here in the U.S. and globally is likely due in part to the COVID pandemic. We know that, during the pandemic, staff and resources for TB programs were diverted to deal with COVID. That caused timely diagnosis and TB treatment to suffer. And disruptions in health care access that occurred during the pandemic also played a role. I think we're all going to need to work together, both domestically and globally, to renew our progress toward TB elimination.

Unger: Absolutely. And keeping with this week's theme, I guess, is another disease that we haven't talked about in a while, and that is mpox. Andrea, what's the story there?

Garcia: Well, unfortunately, mpox cases in the U.S. are almost twice as high as they were at this time last year. And according to CDC data, there have been more than 570 cases reported this year, and that's through March 28. If we compare that with late March 2023, there were fewer than 300 cases. So transmission rates are far below the levels we saw from 2022 when we saw the outbreak, where there were tens of thousands of cases here in the U.S. However, vaccination rates are low, which is leaving people at risk.

Unger: Absolutely. Andrea, on those lines—along those lines, then what do physicians and patients need to know right now?

Garcia: Yeah. So as you may recall, mpox typically spreads through close contact. That includes intimate or sexual contact with a person with mpox as well as through contact with contaminated materials. One of those most common signs of infection is a rash on the hands, feet, chest, face, mouth or near the genitals. And other symptoms mirror those of respiratory illnesses. So think fever, chills, exhaustion, headache.

The JYNNEOS vaccine is recommended for those aged 18 and older who are at risk of mpox infection. And vaccination should also be offered as PEP, or post-exposure prophylaxis, after a known or presumed exposure. That vaccine consists of two doses. It may be given subcutaneously or intradermally under the FDA EUA. And there are currently no recommendations for an annual booster for that vaccine. Locations offering the vaccine can be found on the CDC's website.

Unger: All right. Well, before we close out, let's finish up with the latest news about measles. We've been speaking for the past several weeks about outbreaks in the U.S. Are things looking any better?

Garcia: Unfortunately not. According to data from the CDC as of March 28, there have now been 97 measles cases in the U.S. That far surpasses the 58 reported cases in all of 2023. There have been seven outbreaks, which are defined as three or more related cases so far in 2024. 72% of cases are outbreak associated, and 53 of those reported cases are here in Chicago.

The number of cases is still lower than it was in 2019. That year, there were more than 1,200 reported measles cases. Still, I think this milestone serves as a reminder that measles remains a persistent threat to public health. And getting vaccinated continues to be important.

Unger: All right. Well, we've covered a lot of ground in this episode, Andrea. Thanks so much for being here and keeping us up to date. 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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