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 Update
Malaria cases, RSV vaccine, new maternal mortality & e-cigarette studies with Andrea Garcia, JD, MPH
Jun 30, 2023
Featured topic and speakers
In today’s AMA Update, RSV vaccination recommendation for adults from the CDC’s Advisory Committee on Immunization Practices and CDC health advisories on measles and malaria for summer travelers. AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, also discusses trending studies on e-cigarette sales and maternal mortality, and the USPSTF recommendation to screen adults for anxiety. AMA Chief Experience Officer Todd Unger hosts.
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 series. 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: Thanks. It's really good to be here.
Unger: We've been tracking this for some time and now big news about the RSV vaccine. It came out of the CDC's Advisory Committee on Immunization Practices, or ACIP. We did talk to the AMA's ACIP liaison, Dr. Sandra Fryhofer, earlier this week, but can you share some top-level insights for those that missed that?
Garcia: Yeah. Last week, the ACIP met. The big takeaway from that meeting was their recommendation on RSV vaccines for adults. And as we've discussed here before, this is the first-ever RSV vaccine for adults 60 and older. Those were approved by the FDA last month. The ACIP recommended both of those vaccines under shared clinical decision making, and we have seen the CDC director now sign off on those ACIP recommendations, which we know is the last step in that process.
This is not a full recommendation, which would mean that adults age 60 and older should receive the vaccine. Instead, with shared clinical decision making, patients will decide to get the vaccine with their doctor who will consider their individual characteristics as well as the characteristics of the vaccine.
And for that deeper dive into the ACIP meeting, physicians should definitely check out the interview we did with Dr. Fryhofer. I think she did a really great job of explaining everything physicians need to know about the new recommendations as well as what to expect this fall.
Unger: Andrea, Thanks for that recap. And we'll be sure to include a link to the interview that you just mentioned with Dr. Fryhofer in the episode description. And while we're on the topic of respiratory infections, is there something new that we need to know about in regard to COVID?
Garcia: I do have one update to share, and that is that, at the end of last week, the CDC announced that it's tracking several new COVID variants—one of these variants is EU11, and the CDC estimates that it represents about 1.7% of COVID cases nationwide. It's still far too early to know if EU11 will lead to different symptoms, but it's certainly something that we'll continue to monitor.
Of course, that dominant variant in the U.S. is still XBB1.5. That's the variant that the upcoming COVID vaccines in the fall are going to be designed to target. And we'll talk more about those vaccines as more information becomes available.
Unger: Well, as we head into an all-time high travel weekend for Fourth of July, it's interesting to think the travelers need to be mindful of more than just COVID. The CDC recently released health advisories on measles and malaria. What kind of guidance do they offer, Andrea?
Garcia: Well, measles and malaria pose less of a risk in the U.S. But this year, CDC is really anticipating a return to pre-pandemic levels of international travel, and that means that physicians should be on the lookout for these infectious diseases this summer, especially in their patients who've traveled internationally.
We know that measles is extremely contagious, and the U.S. has seen an increase in measles cases in the first five months of this year. And popular travel destinations like London have experienced measles outbreaks in recent years. And regardless of the destination, people should ensure they're up to date on their MMR vaccinations before traveling internationally.
Unger: Now, malaria is not something we usually need to worry about as much here. Tell us what the scoop is there.
Garcia: Yeah. So when it comes to malaria, almost all cases in the U.S. are usually travel related. The CDC issued a health alert this week, and that was to notify clinicians and the public about five locally acquired malaria cases in Florida and Texas in the last two months. These are the first locally acquired cases that the U.S. has seen in 20 years.
Despite these cases, that risk of locally acquiring malaria remains low in the United States. But malaria is a medical emergency, and if it's not treated promptly, it may progress into a severe life-threatening stage. So CDC is recommending that clinicians consider that diagnosis of malaria in anyone with a fever of unknown origin, especially if they've been to one of those recent areas where we've seen local acquisition of it.
And the CDC has information on treatment of malaria diagnosis and guidelines for clinicians that I would recommend people take a look at if they're not familiar.
Unger: And another story that's been driving headlines is a new recommendation from the U.S. Preventive Services Task Force, which urges primary care physicians to screen their adult patients for anxiety disorders. Andrea, tell us more about that.
Garcia: That's right. So that recommendation was published by the USPSTF. It states that asymptomatic adults age 19 through 64, including those who are pregnant and postpartum, should be screened for anxiety disorders using questionnaires and other screening tools. That recommendation from the task force builds on a previous one we saw from them last October, which encouraged screening for anxiety in children and adolescents aged 8 to 18.
I think these recommendations are a part of a broader effort to address the high rates of anxiety and depression we're seeing in the U.S., and we know many people are living with undiagnosed anxiety disorders. They might not always think to or want to proactively talk to their doctors about their mental health.
While these recommendations from the task force are not mandatory, they are highly influential and following these recommendations could certainly help physicians identify and treat these disorders in their patients.
Unger: Well, Andrea, let's shift gears to touch on another ongoing health crisis in the U.S., which is maternal mortality. A study in JAMA Network Open just added a new perspective to this issue that garnered a lot of attention. What were some of the key takeaways from the study?
Garcia: Yeah. Much of the conversation lately on maternal health has really focused on that rising rate of maternal mortality, which we know is very concerning. The study did show one bright spot and it showed that that rate of pregnant people dying in delivery—of delivery-related causes in the hospital specifically has declined by more than 50% in recent years.
That's good news for maternal mortality rates among in-hospital deliveries, and it also suggests that in-hospital maternal deaths might not be a major cause of the overall rise in maternal mortality. Unfortunately, many maternal deaths still happen outside of the hospital, either during pregnancy or postpartum, and this is very much a crisis that requires our focus and ongoing efforts.
Unger: And that study on maternal health wasn't the only one in the headlines recently. The CDC also published an analysis on the sales data for e-cigarettes, 2020 to 2022. What kind of trends do we see in those numbers?
Garcia: There's really a lot to unpack in that data, but perhaps the biggest takeaway is that the sales of e-cigarettes surged during the pandemic. So you mentioned January 2020 to December 2022, we saw a rise in sales of nearly 47%. I think the positive news there is in the numbers.
The sales tapered off last year, specifically from May to December of 2022. We know that they were down 12%. If we look a little deeper, we can see that unit shares of flavored e-cigarettes increased from 29% to 41%, and unit shares of disposable e-cigarettes increased from about 24% to 51%.
So that data has important implications for policymakers. We know, based on this article at the end of 2022, we saw about seven states and 378 jurisdictions that had restrictions on the sale of flavored e-cigarettes And in states like Massachusetts, that had these comprehensive flavor restrictions that are well-enforced, these saw large declines in the total of e-cigarette sales.
So we know, with over about 2.5 million middle and high school students reporting the use of e-cigarettes, there's still a lot we need to be doing to prevent a new generation from becoming addicted to nicotine.
Unger: Well, as always, Andrea, we really appreciate you keeping us up to date and sharing the news that physicians need to know. That wraps up today's episode. Thanks so much for joining us. We're off next week for the July 4th holiday, but we'll be back the following week on July 12. In the meantime, you can find all our episodes at ama-assn.org/podcasts. Have a great rest of your week and a wonderful holiday.
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.
