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AMA Update
How to prevent measles, who should take Paxlovid, plus the latest research on COVID and pregnancy
Jan 31, 2024
Featured topic and speakers
How is measles spread? In this episode: MMR vaccine age, signs of measles, new studies on maternal COVID vaccination, who should get Paxlovid and chronic COVID-19.
AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, shares what doctors need to know about why measles cases are on the rise both here and abroad. Also a look at COVID vaccination during pregnancy and its positive impact on newborns, as well as new research data on the long-term effects of COVID known as "chronic COVID". AMA Chief Experience Officer Todd Unger hosts.
- CDC measles cases and outbreaks.
- CDC measles fact sheet (PDF).
- New COVID 19 pregnancy study: Respiratory distress in SARS-CoV-2 exposed uninfected neonates followed in the COVID Outcomes in Mother-Infant Pairs (COMP) Study in Nature Communications.
- NIH website for Paxlovid drug interactions.
- New study in Science Translational Medicine on SARS-CoV-2 viral clearance and evolution varies by type and severity of immunodeficiency.
- The AMA is your powerful ally in patient care. Join now.
Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Transcript
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. I appreciate the opportunity to be here.
Unger: Well, in virus watch, we've been talking a lot about COVID, RSV and the flu. But this past week, another disease crept into the headlines. And that is measles. Andrea, what's going on with this?
Garcia: Well, last week, we saw the CDC issue an alert that measles cases are increasing. And they're urging physicians and others to watch for that disease, particularly among unvaccinated children. The alert comes after seeing nearly two dozen cases of the disease. And that's between December 1 and about January 23.
CDC has asked physicians to keep an eye out for patients with the rash and fever and to pay attention in particular to patients who've recently traveled internationally. Most of the measles cases we've seen have been in young children and adolescents who were eligible but didn't receive that MMR vaccine. A CDC spokesperson did confirm that this is the first nationwide alert to clinicians about these latest measles cases.
Unger: Is there anything specific in terms of areas to watch?
Garcia: Well, it's pretty spread out. Since December 1, we've seen outbreaks in Philadelphia. And those are tied to a children's hospital, and later, a daycare facility, a family gathering that led to six cases in Washington state. But then we've also seen documented exposures at two international airports in the Washington, D.C., area, a separate case in Atlanta. And then New Jersey also recently reported a case as well.
There was an article in USA Today. And Michael Osterholm, who's the director of University of Minnesota's Center for Infectious Disease Research and Policy, is quoted as saying that the U.S. is at a canary in the coal mine moment, with rising cases among children, really, a large drop in vaccinations. And we're seeing that record level of vaccine exemptions among kindergartners. Being given all those factors, we're seeing Osterholm and others predict that we're going to see a lot more of these outbreaks.
Unger: Indeed, you mentioned about traveling internationally as one of the factors. Are we seeing the same trend that's outside the U.S., obviously?
Garcia: Yeah, unfortunately, it's happening globally. And after years of declining vaccination rates, we're now seeing that fallout around the world. The WHO indicated that Europe in particular has seen an exponential increase in recent measles cases. We know researchers from the CDC and WHO issued a report in November, highlighting increases in those global measles cases and deaths the previous year.
And to give that some context, there were 9 million cases, 136,000 deaths, mostly among children in 2022. And most of these were likely preventable. This is a disease that we really need to take seriously.
According to the CDC, about one fifth of people who get measles will be hospitalized. One in 1,000 who get the virus will develop brain swelling that can lead to brain damage. And about one in three in 1,000 will die. Yet we continue to see more and more parents who don't want their children to receive these recommended vaccines.
Unger: Those are really serious numbers, 9 million cases, 136,000 deaths, mostly among children. It's very sad for a preventable illness like this. Measles is very, very contagious. How does it usually spread?
Garcia: Yeah, it's highly contagious for people who are not vaccinated or immune. The virus spreads via respiratory droplets, usually after a person coughs or sneezes. But transmission also can occur by small aerosolized droplets that we know can remain airborne for up to two hours after a person with the disease have left the room.
Symptoms typically appear a week or two after exposure. They can include a runny nose, cough and high fever, with a reddish or hyperpigmented rash that develops first at the hairline before spreading down to the neck and then further downward. The MMR vaccine, though, is highly effective. Two doses of the measles vaccine are about 97% effective at preventing the disease if you're exposed to the virus.
That's a two-dose vaccine series. The first dose is given between 12 and 15 months. And then the child receives a second dose when they're between 4 and 6 years old. If your child has missed those milestones, though, you can start that series at any time.
Unger: Well, that's really a huge wake-up call to get those vaccinations. It's just so important. Staying on vaccines for a moment, we also have further data to support getting the COVID vaccine during pregnancy, how important that is. Can you tell us about that?
Garcia: Yeah, there was a new study published last week in the journal Nature Communications. It found that unvaccinated pregnant people who contracted COVID were more likely to have babies who suffered from respiratory distress. This was from a team of researchers at UCLA. They looked at 221 pregnant people for the study. That included 151 who were unvaccinated before they were infected with COVID.
That team then found that being exposed to COVID in utero may activate an inflammatory cascade in the airways of newborns. And that results in respiratory distress at birth or shortly thereafter. Those odds of respiratory distress were up to three times greater in babies born to those who were unvaccinated versus those who were vaccinated. More research is needed here. But the big takeaway is that maternal vaccination against COVID not only protects against maternal disease severity but also reduces that likelihood of neonatal respiratory distress.
Unger: That is big news. And just again, more reasons to get vaccinated. Switching gears to treatment side for a minute, we talked about Paxlovid a few weeks ago and how those who would benefit from the treatment aren't always taking it. This week, we have even more evidence to support this trend. Andrea, tell us more on that front.
Garcia: Yes, the last week, there was a new study from the Veterans Health Administration. And that was published in CDC's MMWR. It showed that many patients that are at high risk for severe COVID outcomes are not being offered antivirals. We've talked about this before. We know that antiviral drugs reduce the rate of progression to severe COVID when they're given to patients with mild to moderate disease within 5 to 7 days of symptom onset.
The CDC is asking physicians to consider antiviral treatment options for all eligible patients. So that includes older adults, especially those 65 and older, patients who aren't up to date on their COVID vaccinations, and then people with medical conditions. That can make them more likely to get very sick with COVID, such as those with weakened immune systems. For that clinical guidance, including how to manage those drug-to-drug interactions, physicians can visit COVID-19 Treatment Guidelines at nih.gov.
Unger: That's good to know. Thank you for that perspective. Another topic on the COVID front that we've talked about, of course, is long COVID. This week, a lesser-known condition that's called chronic COVID has also made headlines. Andrea, tell us more about chronic COVID versus long COVID. What do we need to know about that?
Garcia: Yeah, so just to quickly review, with long COVID, that acute infection subsides but the symptoms persist. Chronic COVID is different. With chronic COVID, the virus just doesn't leave. And it can sometimes stay in patients' bodies long enough to mutate into new variants.
This usually happens with people whose immune systems are compromised, whether through disease or treatment, leaving them vulnerable to infections that can last weeks or months. Or even according to one article, there's been a known case where it lasted a year.
Unger: Wow. So how does this new research on chronic COVID—what does it tell us?
Garcia: Well, this research was published last Wednesday in Science Translational Medicine. It looked at two things. How long does it take for people with different levels of immunity to clear the virus? And how does the virus evolve?
The research really helps us understand the varied levels of risk for COVID becoming chronic, so high levels of risk for people with blood cancers requiring bone marrow transplants to lower risk for people who are taking immune-suppressing drugs for autoimmune disease, and then little risk for those with intact immunity. There were 56 people who were immunocompromised in the study. They had a variety of conditions.
The commonality is they fell into this category of the many people who've been overlooked as we've moved on from the pandemic. And STAT News actually published a really great Q&A with the study's coauthors, talking about the findings of this research.
Unger: What were the key takeaways from that conversation?
Garcia: Well, overall, they found that patients who were mildly or moderately immunocompromised did seem to clear the virus well. That wasn't true for those severely immunocompromised patients. But by putting that risk into context, this study can help physicians figure out which patients are at the greatest risk of not being able to clear that virus or a chronic infection.
Now, there's still a lot we need to learn about chronic COVID and the best course of treatment for these patients. That's, of course, important for the health of the individual. But it's also important for public health by reducing that risk of transmission and maybe even preventing the formation of future variants.
As the rest of the world moves on from the pandemic, there are many people who are immunocompromised, who we know are still being very careful. They're not as protected by vaccines. They're more likely to have severe outcomes. So while many have moved on, these are the people who are getting left behind.
Unger: And we'll certainly continue to talk about this. Andrea, thanks so much for keeping us up to date on this and for being with us today. That wraps up today's episode. We'll be back soon with another AMA Update. In the meantime, if you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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