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Should I be worried about measles? What is long COVID and why is it so complex? How long does long COVID last? How many people have long COVID? Is measles endemic?
Get the latest on the measles outbreak, MMR vaccines, U.S. measles endemic status and childhood antibiotics with AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Transcript
Garcia: The first study was in BMJ Global Health, and it looked at the prevalence of long COVID in patients from 13 different countries. What it found was that 25.1% of participants reported symptoms of long COVID, with the most common symptoms being sleep disorders, joint pain, fatigue and headaches.
Unger: Hello and welcome to the AMA Update video and podcast. Today is our weekly look at the public health issues facing physicians and patients across the country 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: Well, positive comments are not necessarily the hallmark of today's internet. But I do just want to say how much we appreciate the positive feedback and comments you leave us on our YouTube channel—and one in particular, Andrea, that referred to us as the dynamic duo of lucidity, which I'm going to trademark. So with that in mind, let's turn our attention to the news.
Andrea, the first topic that we want to talk about today is measles outbreak in the Southwest and across the country. A new Kaiser Family Foundation poll shows that patients are watching news about the outbreaks as well. What did the study have to tell us about how patients are feeling about this?
Garcia: Well, Todd, the findings from this survey had a lot of people talking last week—and for good reason. They showed that many patients are paying attention to these outbreaks. And unfortunately, the false claims about measles are getting more attention as well. According to the survey, about 56% of adults were aware of the rise in measles cases this year, and 51% said that they were at least somewhat worried.
The survey also asked people if they had read or heard some of the false claims about measles or the MMR vaccine. It found that one in three adults had encountered the false claim that getting the MMR vaccine is more dangerous than getting infected with measles. That number is up 15% since March of 2024. On one hand, it is great to see that patients are aware of these outbreaks, but the growing spread of misinformation is concerning.
Unger: It really is. And that brings me to another thing that I wanted to ask you about. Last week, a new study shed more light on the risk that we're facing if the vaccination rate for measles continues to drop. Can you tell us more about that?
Garcia: Yeah. So this study appeared in JAMA, and it used a simulation model to assess the spread of vaccine-preventable infections across the U.S. When it comes to measles and the MMR vaccine, it found that even at our current vaccination levels, it's possible for measles to become endemic again.
If we saw a 10% decline in vaccination, the model estimated that we could see a result in 11.1 million cases over 25 years. And with a 50% decline, the estimated number of cases jumps to 51.2 million. But even at our current vaccination level, we're already seeing serious consequences. Just last Friday, we learned that there have now been a total of 884 confirmed measles cases reported by 30 jurisdictions.
We need to do everything we can to combat misinformation and to continue to be a trusted source of information. And that includes continuing to remind people that getting vaccinated is the best way to prevent measles.
Unger: Absolutely, and it's certainly something we're going to continue to do in our discussions. Andrea, let's shift gears now and talk about a series of new studies looking at the likelihood of developing long COVID. What were some of the findings there?
Garcia: Well, this month, we saw three new studies in various journals on this topic. The first study was in BMJ Global Health, and it looked at the prevalence of long COVID in patients from 13 different countries. What it found was that 25.1% of participants reported symptoms of long COVID, with the most common symptoms being sleep disorders, joint pain, fatigue and headaches. For context, long COVID in this study was defined as the presence of patient-reported symptoms at 180 days after a COVID infection.
The second study was published in BMJ Public Health. It also looked at the rate of long COVID, but it focused on patients in China. And it used the World Health Organization definition of long COVID. As a reminder, the WHO defines long COVID as the continuation or development of new symptoms three months after initial COVID infection, with these symptoms lasting for at least two months with no other explanation.
This second study found that 30.2% of people reported experiencing at least one long COVID symptom. In this study, the most common symptoms were fatigue, cough and expectoration, which means coughing up fluids or phlegm.
Unger: Those seem like really high rates—25%, 30% There also was a study that looked at the rate of long COVID in health care workers. Andrea, what did that find?
Garcia: Well, this study was also in BMJ Public Health. And unlike the others, this study was a systematic review and meta-analysis. It looked at studies from December of 2019 to February of 2022 that had primary data on the prevalence of long COVID in adult health care workers. Through this analysis, it found a long COVID rate of 40% for this group, with the most common symptoms being fatigue, neurological symptoms, and loss or decrease of smell and/or taste.
It's important to note that because of the way this study was structured, data quality limitations, and an inconsistent definition of long COVID, it impacts how much we can generalize these findings. Even so, the study does help to paint a clearer picture of the risk that long COVID poses for health care professionals. And it shows where more research is still needed.
Unger: Now, I think I understand the math here and different bases. But back in March, we talked about a study from the CDC that found that prevalence of long COVID was just over 8%. Why are we seeing such a big difference? Because we're looking at 25%, 30%, 40%. And those are people, obviously, that had COVID to begin with. Is that the difference?
Garcia: Well, there are a lot of reasons why those rates of long COVID can vary so much from study to study. So, for example, the design of the study, the definition that is used for long COVID, the population that's being studied, those are all things that will affect the outcome. Other variables at play include the vaccination rate of the study participants. The variant of COVID that they were infected with could also play a role.
I think, with that being said, we have consistently seen studies that have found rates of long COVID that are higher than 8%. In November of last year, researchers at Mass General Hospital actually used AI to identify long COVID cases and estimated that 23% of people in the U.S. have had long COVID at some point.
No matter what the specific rate is, when you look at all of these studies, I think the thing that's really clear is that long COVID is impacting a significant number of people. And it's something that definitely continues to require our attention.
Unger: Absolutely. Andrea, another new study I want to talk about has to do with the link between antibiotics and chronic health conditions in children. What's the news there?
Garcia: Yeah, Todd, that study you're referring to actually appeared in the Journal of Infectious Diseases. And it found that antibiotic exposure before age two was associated with a higher risk for asthma, food allergies and hay fever. Stronger associations were observed following multiple antibiotic courses. This study looked at over two decades' worth of EHR data from the UK's clinical practice research Datalink, which amounted to data on more than a million children.
It also evaluated a range of potential variables that could bias the results and even compared exposures and outcomes in siblings from the same mother. The study adds to a growing body of evidence about the risks of early exposure to antibiotics. And it's a reminder of the need to be judicious in using antibiotics, particularly during infancy and early childhood.
Unger: Andrea, did the study give any explanation for this kind of finding and the links between antibiotic use in early years and these outcomes that you're talking about?
Garcia: It did. And I think it's important to note that this is an observational study, so it doesn't prove that antibiotic exposure caused these conditions. The study is based on the hypothesis that microbiome disruption from antibiotics plays a role in the development of a host of pediatric conditions. And this hypothesis stems from the work of one of the study's co-authors, Dr. Martin Blaser, who has conducted previous studies that found similar associations between antibiotic use and in children.
The microbiome in infants and young children is more dynamic. And at the same time, it's in those early years when they're still developing their immunity, metabolism, and cognition. So this is a really sensitive period. Still, more research will be needed to confirm these associations and to better understand the potential mechanisms behind these outcomes.
Unger: Andrea, you said one of my favorite words, microbiome. There's so much to learn there. And there have been a lot of studies lately on the impact that the microbiome can have on the body. And it's certainly an area of research we're going to continue to watch. Andrea, thanks so much for all of the insights and for keeping us up to date each week. If you found this discussion valuable, you can support more programming like this. Physicians can join the AMA at ama-assn.org/joinnow.
And patients can get involved by joining the AMA's Patients Action Network at patientsactionnetwork.com. As always, 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 podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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