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Featured topic and speakers
Why is there an outbreak of measles? How do I know if I had the measles vaccine? When will Opill be available? Can you test for colon cancer without colonoscopy?
Our guest is AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.
- CDC measles surveillance.
- CDC measles fact sheet (PDF).
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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. It's great to be here.
Unger: Well, this first story hits a little close to home for both of us, and it's about measles. And I glanced up on the TV this morning and saw Chicago was in the news. Andrea, tell us more about what's happening.
Garcia: Yeah, let's talk about Chicago first since it's our backyard. When we last filmed, Chicago had five reported cases of measles. And at the time of this filming, just a few days later, we're now at 12 confirmed cases with nearly 100 potentially exposed people who are currently being tracked by the health department. I wouldn't be surprised if that number increases by the time that this episode airs.
The Chicago Department of Public Health has reported that 10 of those 12 confirmed cases are among migrants who are living in a shelter in the city's Pilsen neighborhood. Six cases are in adults. Six are in children. Two of those children are Chicago Public School students. Unlike other students, CPS students who are migrants are not required to be vaccinated to attend school, and that's because there's an exemption for children who are living in unstable housing.
Unger: It's funny because it doesn't sound like that many people, but because of how communicable this disease is, it is causing a lot of issues and a lot of relocation here as you're talking a little bit about—talk a little bit about how the quarantining situation works.
Garcia: Yeah, so of those 1,900 migrants in the shelter, 1,000 had immunity. About 900 of them needed to be vaccinated and now need to quarantine for 21 days. We know that at least 98 migrants, which includes 48 children, have been taken to a Chicago area hotel to quarantine for the next 20 days, and that's to help further curb spread.
Some of those families removed from the shelter include pregnant people and babies who were too young to get vaccinated. This outbreak also captured the attention of the CDC, who we know has sent a team of experts to Chicago last Tuesday to help contain the outbreak and help the city and state work through some of these challenges.
Unger: It's good that the CDC, of course, is on this because you don't want it to turn into an out-of-control situation. I'm just curious, from the standpoint of timing, when does the CDC typically get involved in something like this and what's their role?
Garcia: Yeah, so we usually see the CDC send in its experts when that's requested by state and local authorities. In Chicago, they've worked closely with the city and state health departments to help identify people who may be at risk for getting sick. We know that team also provides clinical guidance, helps coordinate testing and works with those on the ground to educate those influential community leaders and clinicians who can help emphasize how important it is to get vaccinated.
The agencies also provided guidance on a vaccination campaign, covering certain schools, shelters and other congregate settings, along with bringing some extra vaccines to ensure that there is an adequate supply for both adults and kids.
Unger: And of course, Chicago is not the only place where this is happening. This is a national and global trend, actually. Andrea, what updates do you have on that front?
Garcia: Well, on the national level, state and local authorities have announced at least 55 confirmed or suspected cases of measles. That's across 17 states. And to provide some context for these numbers, measles hasn't circulated widely here for decades, and that's because of vaccination.
Outbreaks have been increasing since 2010, and that's because it's easily imported by unvaccinated travelers. And then it can spread in underimmunized communities. In 2019, more than 1,200 cases of measles were reported in the U.S., and that's the highest number we saw in decades. In 2022, it was 121 reported cases here. And then in 2023, we had 58 measles cases reported. And of course, we're on the verge of surpassing that number from last year, and it's only March.
Unger: Andrea, we've talked about a few other states that have had outbreaks. Is there anything else that we need to know there?
Garcia: Well, the Pennsylvania outbreak that we talked about earlier has been declared over. The Broward County School District in Florida also says that its measles outbreak is also officially over.
Last week, a hospital in Sacramento, California made national news when it began contacting about 300 people who were possibly exposed to measles after an infected child who had returned from international travel was evaluated and treated in the ED there. The hospital has said that the situation is under control and that there are no additional potential exposures at UC Davis Medical Center beyond those people who have already been identified and contacted.
Unger: Andrea, I'm sure with this situation, there are a lot of people who are worried and can't remember or not whether they got vaccinated. It's been obviously a long time since my childhood. What do people do who are unsure if they've been vaccinated or not, and whether or not they have protection?
Garcia: Yeah, well, contacting your physician is always a great course of action. They can help look up your immunization record, determine if you have received the vaccine. The other possibility is a blood test, which can determine your immunity for measles by antibodies developed by either previous exposure or vaccination. If you're not immune and you've been exposed, you really need to get that vaccine right away because that can help prevent you from getting measles.
The CDC also recently updated its travel guidance. So Americans planning to travel abroad should consult their physician at least six weeks before traveling if they're unsure about whether or not they are up to date on their vaccines. The agency recommends that all travelers be fully vaccinated against measles when traveling to any international destination.
There was a report published March 8, and the CDC said the WHO has noted a significant increase in measles cases worldwide with a 30-fold increase in Europe. Those are popular international tourist destinations for Americans—like England. So it's definitely best to check your vaccination status before traveling.
Unger: Well, we'll keep tracking the story on measles as it develops and will become increasingly important as we head into spring break travel season. Andrea, changing gears to better news. Something we talked about a few months ago is finally become a reality, and that is over-the-counter birth control. Tell us more about that.
Garcia: Yeah, earlier this month, we learned that the first over-the-counter birth control pill will be available in U.S. stores later this month. That will allow women and teens to purchase contraceptive medication as easily as they buy aspirin. The manufacturer Perrigo said it began shipping the medication, which is called Opill, to major retailers and pharmacies in early March.
A one-month supply costs about $20. A three-month supply costs around $50. It's also going to be sold online. The manufacturer did say it's going to provide a cost-assistance program to help qualified low-income and uninsured individuals obtain Opill at low or no cost.
This is the most effective birth control method available without a prescription. Research shows it's more effective than condoms, spermicides and other non-prescription methods. It's important to note that Opill is not a new medication. It was approved for prescription use 50 years ago. What's new is its over-the-counter status.
Unger: All right. And that's an important point, Andrea. Any reactions from the AMA on this issue?
Garcia: Yeah, the AMA issued a press release attributed to our AMA President, Dr. Jesse Ehrenfeld, earlier this month, applauding the move. In that statement, he said over-the-counter availability of oral contraception is critically important and a long overdue reality. At a time when reproductive health care access is restricted in certain states, broader access to safe, effective oral contraception is really more essential than ever to limit unintended pregnancies.
With this barrier broken, the AMA also continues to urge FDA and HHS to consider a variety of oral contraceptive options for OTC use. Let this be the first of several to earn FDA approval. Patients should have options when they're choosing which type of birth control works best for them.
Unger: All right, well, thank you so much for that update. In other positive news, we could soon have a blood test that can help detect colon cancer. Andrea, what's the latest there?
Garcia: Well, we all know that a barrier to identifying colorectal cancer or colon cancer for sure is that people may be less than enthusiastic about getting a colonoscopy. That's a problem given that colon cancer is now the second highest cause of cancer death in the United States. The results of a new clinical trial could help change that, though.
Published last week in the New England Journal, the trial showed that a blood-based screening test detected 83% of people with colorectal cancer. The test was developed by Guardant Health and it's called The Shield. It can be done from a blood draw. And the company says the test detects cancer signals in the bloodstream by identifying circulating tumor DNA. If the FDA approves it, the blood test would be another screening tool to detect cancer at an early stage and could help reach people who may be more likely to have a blood draw than an invasive test.
Unger: And that is a big development. Andrea, what are the next steps there?
Garcia: Well, Guardant Health has already filed for approval with the FDA, and a decision is expected to come later this year. I think it's important to note that even if the a blood test is approved, it will not replace the colonoscopy. If the test is positive, the next step would be a colonoscopy. We know that colonoscopies are still the gold standard because they can detect precancerous lesions that can be removed and prevent cancer from forming in the first place.
However, we know that over 50 million eligible Americans do not get recommended screenings for colon cancer. And while colon cancer is still rare in young adults, that rate has been increasing. There are about 20,000 people in the U.S. under the age of 50 who are diagnosed each year. So the tool could help detect cancer at a time when it's much more treatable.
Unger: Absolutely. And that sounds like a good place to wrap up this particular episode. Andrea, thanks so much for being here and keeping us all informed. 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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