Claim:
Former U.S. President Donald Trump once said, with regard to possible medical treatments for COVID-19: "And then I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning."
During the first presidential debate of the 2024 presidential cycle, U.S. President Joe Biden referenced a claim that has repeatedly been spread regarding former President Donald Trump and his response to the COVID-19 pandemic.
"We had an economy that was in free fall," Biden saidduring his opening remarks on June 27. "The pandemic was so badly handled. Many people were dying. All he said was it's not that serious, just inject a little bleach in your arm. You'll be all right."
The claim has spread since April 2020, when Trump's remarks during a White House press briefing spread online. Publications like Politico reportedTrump suggested injecting bleach. Biden himself has also repeated the claim, with PolitiFactfact-checking comments he made about it in March 2024.
We previouslyfact-checked the claim, where we found Trump had discussed injecting "disinfectant" to fight COVID-19. Here's the official White House transcriptof Trump's remarks (emphasis added) from April 2020:
TRUMP: ...And then I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning. Because you see it gets in the lungs and it does a tremendous number on the lungs. So it would be interesting to check that. So, that, you're going to have to use medical doctors with. But it sounds it sounds interesting to me.
Trump saidhe was "asking a question sarcastically" to reporters "just to see what would happen" the day after the press briefing. The Trump campaign has continuouslysated what he said was taken out of context, telling PolitiFact what Biden said in March 2024 was "more misinformation and lies."
RB, the maker of Lysol, issued a statement after Trump made his remarks that said disinfectantscould not be used as a treatment for COVID-19.
To get more fact-checks of what Biden and Trump said during the debate, you can find our fact-checking of what happened which we covered in real timehere.
CNN Staff. "READ: Biden-Trump Debate Rush Transcript | CNN Politics." CNN, 28 June 2024, https://www.cnn.com/2024/06/27/politics/read-biden-trump-debate-rush-transcript/index.html.
Evon, Dan. "Did Trump Suggest Injecting Disinfectant Could Be COVID-19 Treatment?" Snopes, 24 Apr. 2020, https://www.snopes.com//fact-check/trump-disinfectants-covid-19/.
McGraw, Meredith & Stein, Sam. "It's Been Exactly One Year Since Trump Suggested Injecting bleach. We've Never Been the Same." Politico,https://www.politico.com/news/2021/04/23/trump-bleach-one-year-484399. Accessed 28 June 2024.
O'Kane, Caitlin. "Lysol Maker Warns against Injecting and Drinking Disinfectants as a Coronavirus Treatment." CBS News. 24 Apr. 2020, https://www.cbsnews.com/news/lysol-injecting-trump-disinfectants-coronavirus-treatment/.
"Remarks by President Trump, Vice President Pence, and Members of the Coronavirus Task Force in Press Briefing." Trump White House Archives, 23 April 2020,https://trumpwhitehouse.archives.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-31/. Accessed 28 June 2024.
Snopes Staff. "Fact-Checking the 2024 Presidential Debate." Snopes, 27 June 2024, https://www.snopes.com//news/2024/06/27/presidential-debate-live-updates/.
Specht, Paul. "Biden Exaggerates Trump's Pandemic Comments about Disinfectants, UV Light." PolitiFact, https://www.politifact.com/factchecks/2024/mar/28/joe-biden/biden-exaggerates-trumps-pandemic-comments-about-d/. Accessed 28 June 2024.
Timm, Jane C. "Trump Says He Was Being Sarcastic with Comments about Injecting Disinfectants." NBC News, 24 Apr. 2020, https://www.nbcnews.com/politics/donald-trump/trump-says-he-was-being-sarcastic-comments-about-injecting-disinfectants-n1191991.
Flu is generally a health concern in the fall and winter, but this spring and summer, influenzaspecifically avian influenza, or bird fluis dominating headlines and weighing heavily on the minds of health experts.
H5N1 is infecting chickens in at least 48 U.S. states and cows in at least 12. So far, only three peopleall dairy workershave had recorded infections, but health officials are keeping a close eye on whether the virus is getting better at infecting humans. Preparing for that possibility includes readying a vaccine.
Here's what to knowalong with if, and when, you might be recommended to get immunized.
There are three. The U.S. Food and Drug Administration (FDA) has approved H5N1 vaccines made by Sanofi, GSK subsidiary ID Biomedical Corporation of Quebec (IDB), and CSL Seqirusall of which also make seasonal flu vaccines.
Most of these are made using traditional flu-shot technology, which takes months. Manufacturers first grow the virus in chicken eggs or mammalian cells, then purify the virus and include them in the vaccine.
Sanofi received the first license in 2007 for an H5N1 shot, using chicken-egg manufacturing. IDB's vaccine, approved for adults in 2013, is also egg-based and is the first against H5N1 to include an adjuvant, or an ingredient that generates a stronger immune response. CSL Seqirus shot also contains an adjuvant and was approved in 2020 for anyone 6 months or older. The company makes vaccines in two ways: by growing H5N1 in cells in its U.S. facility, and by growing it in eggs in its U.K. facility.
Read More: We Are Not Safe from Bird Flu Until We Protect Farmworkers
The approvals allowed all three companies to manufacture doses for the National Pre-Pandemic Influenza Vaccine Stockpile to have ready in case of a potential outbreak, but not to be sold for public use. The doses haven't yet been made available and only will be if there are bird flu outbreaks in humans, and health officials determine people need to be vaccinated.
The national stockpile now contains hundreds of thousands of doses of H5N1 vaccinemostly from Seqirusthat could be deployed in a matter of weeks, according to a spokesperson for the Administration for Strategic Preparedness and Response (ASPR), the government organization that oversees preparedness for health emergencies. But the doses aren't necessarily ready to ship: the stockpile is more like a warehouse of vaccine components targeting different strains of H5N1, rather than a storage facility for final shots.
Before the vaccines can be released, they need to go through the final stages of production known as "fill and finish," and also receive an additional final clearance from the FDA. Working with authorities at the U.S. Centers for Disease Control and Prevention (CDC), the FDA, and the manufacturers, the team at ASPR constantly evaluates the makeup of the stockpile to make sure there are enough materials to produce vaccines against the currently circulating strain.
Read More: How to Stop Bird Flu From Becoming the Next Pandemic
The U.S. government recently ordered an additional 4.8 million doses of the companys vaccine to include in the stockpile. According to spokesperson from the company, Seqirus plans to provide these during the summer in preparation for a potential outbreak in people.
It's still unclear how effective they would be, since there havent been enough people infected with H5N1 to conduct proper studies on how well they would protect against illness. But studies in healthy people analyzing the immune responses generated by the vaccines suggest that the shots should provide sufficient protection against illness from the currently circulating strain. In addition, the specific strain causing the current outbreak could differ slightly from the ones in the vaccines.
Seqirus is prepared to deliver 150 million additional doses within six months; those doses will be made from existing raw materials that are currently part of the stockpile and ready to be processed into finished vaccines.
Because a traditional flu shot takes months to make, CDC director Dr. Mandy Cohen said that the agency is continuing to invest in new technologies, especially ones that will lead to faster production of doses. The goal is to "have the ability to scale up extremely quickly, and we want do that with an mRNA platform which allows for faster manufacturing, she said at the Aspen Ideas: Health conference on June 21. During the COVID-19 pandemic, manufacturers were able to produce vaccines in about six-to-eight weeks using that technology, compared to the months it can take with egg- and cell-based platformsand they continue to deliver in that short time frame when updating the shots to target new variants.
Read More: A New Bird Flu Death Is Making Experts Uneasy
Several academic institutions and pharmaceutical companies are working on an mRNA H5N1 vaccine. Pfizer and Moderna are both in the early phases of testing their candidates.
For now, you can't, since all of the doses are contained in the national stockpile and have not been released. The CDC is monitoring the current outbreak in cattle and other mammals, as well as checking for H5N1 in wastewater to spot any signs that the virus is moving into people. If that occurs, health officials from various agencies are ready to release the necessary doses of vaccine from the stockpile.
The CDCs vaccine committee is meeting June 26 to June 28 to discuss H5N1 and what, if any, guidance the agency should provide with respect to H5N1 vaccination plans. Even if they decide vaccination is warranted, it likely won't immediately be for everyone. People at highest risk for bird flu exposure, such as dairy workers and health care workers, would probably be vaccinated first. Then those at high risk of complications from the flu, such as the elderly and those with weakened immune systems, might be next. Only if outbreaks become severe or widespread would other people be vaccinated as well.
This is the only influenza-associated pediatric death reported for the 2023-2024 influenza season so far, according to the Maine CDC.
AUGUSTA, Maine The Maine Center for Disease Prevention and Control (CDC) announced Friday it has identified a child death associated with influenza.
According to a news release issued by the Maine CDC, this is the only influenza-associated pediatric death reported for the 2023-2024 influenza season so far.
The Maine CDC reported the child tested positive for influenza B Victoria.
Influenza is at its highest levels of circulation throughout the state between early October and mid-May, but that doesn't mean you can't catch it year-round.
Following the child's reported death, the Maine CDC is urging clinicians to encourage annual influenza vaccination in all children six months and older who don't have contradictions, remain aware that respiratory symptoms can be caused by the flu at any time of year, and consider flu testing and treatment in patients who have respiratory symptoms at any time of year.
"Influenza illness is more dangerous than the common cold for children," the release stated. "Each year, millions of children get sick with seasonal influenza; thousands of children are hospitalized, and some children die from influenza."
It's common for children to need medical care due to influenza, especially children who are younger than five. About 80 percent of children who die nationally because of the flu are not fully vaccinated, the Maine CDC said. Additionally, about half of influenza-related deaths occur in children who have no underlying medical problems.
"Getting vaccinated has been shown to reduce influenza illnesses, medical visits, missed school days, and the risk of influenza-related hospitalization and death in children," the release said. "Even if vaccinated children get sick, vaccination has been shown to reduce illness severity."
It's even more important for children under the age of five who have certain medical problems to receive flu vaccinations, as they are at a higher risk of developing serious influenza-related complications that can lead to hospitalization and death, according to the Maine CDC.
As of Friday, the Maine CDC said flu activity in Maine is low, but cases continue to be reported, especially of the influenza B Victoria strain in recent weeks.
The Maine CDC has reported flu-related deaths in six children since 2019, and the U.S. CDC has reported 609 flu-related deaths in children nationally within that same period.
"During the 20232024 influenza surveillance season, which ended May 18, 2024, Maine CDC followed up on 75 outbreaks of influenza, facilities reported over 663 individuals hospitalized with laboratory-confirmed influenza, and influenza was listed as a cause of death on 53 death certificates," the release stated.
The Maine CDC recommends the following tips to help keep you and others safe from the flu:
Children under the age of 19 can receive a flu vaccine at no cost by the state. For more information, contact the Maine Immunization Program at 800-867-4775 or immunizeme.dhhs@maine.gov.
It's also important to consider available treatment options for influenza.
"Early antiviral treatment can reduce influenza morbidity and mortality," the release said. "Early antiviral treatment works best. Treatment may offer benefit when started up to 45 days after symptom onset in hospitalized patients."
Tamiflu, Relenza, Rapivab, and Xofluza are approved antivirals for influenza, according to the Maine CDC.
Parents should seek immediate medical care if their child is experiencing any of the following symptoms:
For more information about the flu, click here. To view Maine CDC's weekly influenza surveillance reports, click here.
The CDC's Advisory Committee on Immunization Practices (ACIP) endorsed new COVID-19 and influenza vaccines for the 2024-2025 respiratory virus season on Thursday.
In a unanimous 11-0 vote, the ACIP recommend that everyone 6 months of age and older should receive an updated COVID-19 vaccine, similar to last year's recommendation.
The committee also voted unanimously that everyone 6 months of age and older should receive an updated 2024-2025 influenza vaccine, with rare exceptions. Also, in another unanimous vote, members voted that high-dose inactivated (HD-IIV3) and adjuvanted inactivated (aIIV3) influenza vaccines are acceptable options for influenza vaccination in solid organ transplant recipients.
Shortly after the meeting, CDC Director Mandy Cohen, MD, MPH, endorsed the recommendations.
In a final unanimous vote, members recommended that the new 21-valent pneumococcal vaccine (PCV21; Capvaxive) is an option for adults ages 19 years and older who currently have a recommendation to receive a dose of pneumococcal conjugate vaccine. Clinical recommendations that explain the different options of pneumococcal vaccines will be forthcoming, committee members said.
COVID Vaccines
The most recent data, presented at the meeting, indicate that COVID-19 continues to take a significant toll on adults ages 65 and older and young infants. According to CDC data, more than 916,300 people were hospitalized in 2023 due to COVID-19 and more than 75,500 people died of COVID-19.
From October 2023 through May 2024, population-based hospitalization rates among adults ages 75 and older were about 800-900 per 100,000 population -- more than three times as high as among adults ages 65 to 74, Fiona Havers, MD, MHS, of the National Center for Immunization and Respiratory Diseases, told committee members. "Rates among adults ages 65 to 74 and infants less than 6 months of age have roughly equal rates," she pointed out.
American Indian/Alaska Native, Hispanic, and Black populations were also more likely to be hospitalized for COVID-19 than whites during that time period.
Adults ages 65 and older during that period comprised 82% of all in-hospital deaths, Havers noted.
Waning patterns of the 2023-2024 COVID-19 vaccine effectiveness in preventing critical illness appeared to be similar to previous vaccine formulations, reported Ruth Link-Gelles, PhD, MPH, of the CDC. For example, vaccine effectiveness in preventing hospitalization in adults decreased over time from about 49% at 7 to 59 days after vaccination to 14% at 120 to 179 days.
"I think it's really important to keep in mind that this should be interpreted as incremental or additional effectiveness in a population with a lot of underlying immunity," Link-Gelles said, pointing to the fact that the majority of the population has had at least one COVID-19 infection along with multiple vaccinations.
Earlier in June, an FDA advisory committee voted unanimously to recommend that the COVID-19 vaccines for the 2024-2025 season target a JN.1 lineage of the virus, though FDA recently advised vaccine makers to be even more specific and target its descendent KP.2 if possible. Updated COVID-19 vaccines will be available from Moderna, Novavax, and Pfizer later this year. ACIP's recommendation will take effect as soon as the new vaccines are available, the CDC said.
Influenza Vaccines
The committee reaffirmed that most individuals 6 months of age and older should receive an influenza vaccine. All influenza vaccines for the 2024-2025 season will be trivalent, and will protect against an H1N1, H3N2, and a B/Victoria lineage virus. The composition of this season's vaccine compared with last season's has also been updated with a new influenza A(H3N2) virus.
In addition, the committee voted unanimously to recommend high-dose inactivated (HD-IIV3) and adjuvanted inactivated influenza vaccines as options for solid organ transplant recipients ages 18 through 64 who are receiving immunosuppressive medication regimens, without a preference over another age-appropriate IIV3 or RIV3.
Solid organ transplant recipients require lifelong immunosuppressive medications, making lower respiratory infections more severe, with high hospitalization, mechanical ventilation, and mortality rates. "We believe that transplant patients really suffer from a lack of good protection from the lower standard dose [influenza] vaccine," commented ACIP member Camille Kotton, MD, of Massachusetts General Hospital in Boston, noting however that the high-dose influenza vaccine is not covered by insurance for many people with solid organ transplants because of age restrictions.
"We've been in a situation where we have to fill out prior authorizations every single time you want to give an influenza vaccine. We're hoping that if we voted in favor of this change, that it would enhance equity and protection for this vulnerable population," she said.
Pneumococcal Conjugate Vaccines
In a final vote of the day, the committee unanimously voted to recommend the new 21-valent pneumococcal conjugate vaccine (PCV21) as an option for adults ages 19 years or older who are already eligible to receive a dose of pneumococcal conjugate vaccine.
The vaccine recently received FDA approval for preventing invasive pneumococcal disease and pneumococcal pneumonia in adults ages 18 and older. Based on epidemiologic data from the CDC, the serotypes included in the vaccine together cause roughly 84% of the cases of invasive pneumococcal disease in adults 50 and older. By comparison, the 20-valent pneumococcal conjugate vaccine (PCV20) covers the serotypes responsible for 52% of cases in this age group. The single-dose vaccine contains eight unique serotypes that are not covered by other available vaccines (15A, 15C, 16F, 23A, 23B, 24F, 31, and 35B).
The ACIP's Pneumococcal Vaccines Work Group agreed that available evidence supported the use of PCV21 for adults ages 19 or older who already have a recommendation to receive a pneumococcal conjugate vaccine. However, despite the FDA approval for adults ages 50 and up, the Work Group could not reach a consensus on whether the current age-based recommendation for PCV21 should be lowered from adults ages 65 or older to adults 50 or older, without a risk-based indication.
The committee did not recommend use of PCV21 among adults ages 19 to 49 who currently do not have a risk-based pneumococcal vaccine indication.
Currently, the CDC recommends the PCV15 or PCV20 for adults who never received a PCV and are ages 65 years or older, or ages 19 through 64 with certain risk conditions. If PCV15 is used, it should be followed by a dose of PPSV23. Adults who received an earlier PCV (e.g., PCV7 or PCV13) should talk with a vaccine provider to consider available options to complete the pneumococcal vaccine series. Adults 65 or older have the option to get PCV20 if they have already received PCV13 (but not PCV15 or PCV20) at any age and PPSV23 at or after the age of 65. These adults can talk with a vaccine provider and decide, together, whether to get PCV20.
Current recommendations for the pneumococcal vaccines are "just confusing," James Loehr, MD, chair of the Pneumococcal Vaccines Work Group group, told committee members. Despite acknowledging that lowering the eligible age for the PCV21 vaccine to age 50 would improve vaccine equity, "We were also torn by the confusion that would be in place if we lowered the recommendation for PCV21 to age 50, but not for PCV20, because then we would have three recommendations for people in their 50s," he said.
The ACIP plans to revisit this issue at their October 2024 meeting.
All recommendations from ACIP are not considered final until published in the CDC's Morbidity and Mortality Weekly Report.
Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.
Disclosures
Havers, Link-Gelles, Kotton, and Loehr reported no conflicts of interest.
The Centers for Disease Control and Prevention issued recommendations on Thursday that nearly all Americans over 6 months old get an updated COVID-19 and flu shot this fall.
The CDC said that as soon as updated COVID-19 shots from Moderna, Novavax and Pfizer are available later this year, the public should get an updated vaccine, regardless of past vaccination status.
Earlier this month, the Food and Drug Administration provided updated guidance for COVID-19 vaccine makers, calling for them to formulate a shot that better targets more recent strains of the virus. The FDA said that fall 2024 COVID-19 vaccines should target the KP.2 variant of the virus, which is a descendant of the JN.1 variant that widely circulated throughout the U.S. during the winter.
Related story: COVID cases on the rise in 39 states, marking the start of an anticipated summer surge
Additionally, the CDC said that updated flu shots should be sought in September or October for most people. Pregnant people who are in their third trimester and children who need two doses of the flu vaccine could get a flu vaccine sooner. The CDC also said some people who are unable to get vaccinated in September or October should consider getting an updated flu vaccine as soon as it becomes available.
Our top recommendation for protecting yourself and your loved ones from respiratory illness is to get vaccinated, said Dr. Mandy Cohen, director of the CDC. Make a plan now for you and your family to get both updated flu and COVID vaccines this fall, ahead of the respiratory virus season.
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 inmedicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
Featured topic and speakers
What is the cause of bird flu? How does bird flu spread to humans? Is bird flu contagious? What are the symptoms of avian flu in humans? Is milk safe to drink?
Our guest is Jay Butler, MD, deputy director for infectious diseases at the CDC. AMA Chief Experience Officer Todd Unger hosts.
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're getting an update on the ongoing H5N1 bird flu outbreak from the Centers for Disease Control and Prevention. Our guest today is Dr. Jay Butler, deputy director for infectious diseases at the CDC in Anchorage, Alaska. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Butler, thanks so much for taking time to talk with us today.
Dr. Butler: Well, thank you very much for giving me the opportunity to speak with you today.
Unger: Well, for those that follow the AMA Update, they know that we've been keeping a close eye on bird flu these past few months, and physicians and patients still have a lot of questions, as the virus continues to spread. Dr. Butler, can you start by giving us an update on the current status of the outbreak?
Dr. Butler: Well, as of June 24, H5N1 influenza has been detected in dairy cows in 120 premises in 12 different states. To date, three human cases have been detected in the U.S., all occurring in individuals who had exposure to cows that were in infected herds. The first case was in early April, in Texas, and then two cases were identified in late May, in Michigan. All three infections were relatively mild. The first two cases manifest only as conjunctivitis. The third case involved some burning, watery eyes, but also some mild respiratory symptoms, such as sore throat, runny nose and cough. All three individuals were treated with neuraminidase inhibitors, recovered and there were no instances where there was evidence of person-to-person spread.
Unger: Well, I think a lot of what you just said will help answer the question I'm about to ask, and that's the question about the risk level to the public right now. I think, so far, the CDC has repeatedly said that the risk to the public is low, but why don't you walk us through why that is, who's at risk and what could cause that risk level to increase?
Dr. Butler: So, CDC currently assesses the risk to human health for the general public from H5N1 influenza to be low. However, people with close, prolonged or unprotected exposure to infected birds or other animals, including now, livestock, or to environments contaminated by infected birds or other animals, have a greater risk of infection. So, for example, occupations that we would include that are in a higher risk category include dairy workers, slaughterhouse workers, milk processing facility employees, poultry farm workers, veterinarians and veterinary assistants.
Now, there's a few things that we're watching for very closely that would change the risk assessment for the public. First of all, if we identified multiple simultaneous instances of influenza H5N1 spreading from birds, cattle or other animals to people or certain genetic changes in circulating viruses, that could raise the alarm that could indicate that the virus is adapting and may be able to spread more easily among people. If limited, non-sustained person-to-person spread with this virus were to occur, that would also raise the public health threat level, because it would mean that the virus is adapting to spread among people. And finally, sustained person-to-person spread, which would be the hallmark for a pandemic, would certainly be a major concern and lead to sounding an alarm.
Unger: Absolutely. And, of course, that's why the CDC has been closely monitoring the outbreak and working hard with state and local partners to contain it. Dr. Butler, what are some of the efforts underway right now?
Dr. Butler: Yeah, so, there's four main ways that CDC is responding to the current situation with H5N1 influenza. First, we're supporting public health, as well as agricultural agencies, at the state, local and even tribal levels, to be able to basically have a One Health approach, as much, as possible, recognizing that animal health can influence human health and vice versa. Second, protecting human health and safety. We're supporting strategies that protect dairy and other agricultural workers who may be at higher risk than the general population. This includes making recommendations on use of personal protective equipment when working with infected herds.
As we learn more about the virus, these recommendations may change, but these are available on the CDC website. And also supporting states in monitoring people who have exposure to cows, birds or other domestic or wild animals that are infected or potentially infected with H5N1.
Third, understanding the risk to people from this virus. Again, this is a relatively new virus. We want to be able to determine whether or not there is evidence of spread that we're not detecting. So we've continued our wintertime flu surveillance through the summertime, especially in areas that have infected cattle. Also, this enhanced strategy involves more testing during summer months of persons who become symptomatic with influenza, as well as wastewater monitoring as well.
The fourth area is assessing influenza A viruses for genetic changes that could indicate that the virus is adapting to humans. So far, there have been no major mutations in the hemagglutinin gene, which would suggest an adaptation to humans. Also, I'll just add, there's been no major changes that would suggest high levels of resistance to oseltamivir, or other neuraminidase-inhibiting drugs or other antiviral agents.
Unger: And let's hope it stays that way. Dr. Butler, with bird flu spreading so much among dairy cattle, a lot of patients have questions about the safety of the milk supply. What should physicians tell their patients?
Dr. Butler: Yeah, that's a great question, because, as many of the listeners may be aware, the highest concentration of virus from the cattle has actually been in the milk. So, based on the current evidence from FDA, it does appear that pasteurization makes milk safe to consume. An important message for both public health professionals and providers is to continue to support the consumption of pasteurized milk and dairy products made from pasteurized milk and avoiding raw milk. Health care providers should educate patients of the risk of consuming unpasteurized milk, particularly emphasizing that unpasteurized milk or related products can contain bacteria or viruses, including H5N1 influenza that can adversely impact human health.
Certainly, we have seen, in the past few years, outbreaks of campylobacter, salmonella, E. coli, staphylococcus. There's the ongoing risk of exposure, potentially, to brucellosis. So, there's many reasons to really stick with pasteurized milk. CDC continues to monitor routine food safety surveillance systems for any unusual activity. Thus far, there's been no indication of anything related to H5N1.
Unger: That's good news. A couple of questions from patients, number one, about symptoms of bird flu, and then we'll talk a little bit about the vaccine. Let's start with the symptoms first. What do patients need to know there?
Dr. Butler: First, it's important to emphasize that clinicians should consider the possibility of H5N1 influenza in persons showing signs or symptoms of conjunctivitis or acute respiratory illness and who have relevant exposure history. It's a little difficult to talk about spectrum of disease, given that, right now, we have an N of three. The first two cases manifest primarily as conjunctivitis. The third case had some eye symptoms, but also mild respiratory illness.
We do know that H5N1 more broadly can cause more severe illness, sometimes relatively mild, with a flu-like illness, with cough, body ache and fever. There's also the possibility of abdominal pain, and vomiting, and diarrhea. And the progression to lower respiratory tract disease is always of concern. While we've had no hospitalizations in the United States globally, what we've seen with H5N1 influenza have included clinical signs of hypoxemia and signs of pneumonia. Laboratory findings include leukopenia, lymphopenia and mild to moderate thrombocytopenia. Radiographic findings include patchy, interstitial lobar and/or diffuse infiltrates and opacities.
If a person is symptomatic with relative exposure, CDC recommends isolation and notification of your local health department or state health department as soon as possible. Any symptomatic person among those being monitored after exposure should be started on empiric oseltamivir as soon as possible, even before test results become available.
Unger: All right, so, thank you for that overview on the symptoms front. Let's talk now about vaccines. What do patients need to know about the vaccine, should this situation change?
Dr. Butler: Yeah, vaccines are always an important part of the public health toolbox to prevent or lessen severity of disease. Given where we are in this current situation, there's no immediate recommendation to start vaccination of the general public or specific at-risk populations. CDC and partners in the government, including ASPR, are actively planning for potential H5 vaccination if it should be needed, and that includes beginning to stockpile vaccine. ASPR has recently placed an order for fill and finish for several million doses of an H5 vaccine.
We're putting things into position, so that we can deploy vaccines quickly and efficiently. And I would encourage everyone to get the seasonal flu vaccine this fall, because the more we can control seasonal flu, I think the less diagnostic confusion we'll see, particularly among people with occupational exposure to animals that could potentially be infected with H5.
Unger: Dr. Butler, before we wrap up, is there anything else that you'd like physicians to know in regard to bird flu?
Dr. Butler: Well, I think it's important to monitor this situation. It's unusual and concerning for a couple of reasons. First of all, dairy cattle are a new mammalian host for H5 influenza. Second, the instances of transmission from dairy cattle to humans, are the first instances of mammal-to-human transmission. In the past, all transmission of H5 influenza to humans has been from birds.
And, finally, the clade of H5 virus that's spread from cattle emerged in late 2020, and subsequently spread globally in migratory fowl. The viral genome analysis suggests that this virus jumped to dairy cattle around the end of 2023. Thus, while there have only been three human cases associated with exposure to infected dairy herds, and each case has been mild, this is an evolving situation. The CDC and state health departments have information available on their websites, but the outbreak status and recommendations may change as we learn more. If we know nothing about influenza, it is predictably unpredictable. So, please stay in touch.
Unger: And we absolutely will. Dr. butler, thank you so much for joining us to provide this important information and update, and we appreciate everything that you and the CDC are doing to address the outbreak. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. That wraps up today's episode and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us. 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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The UK government has ordered tens of thousands of doses of a bird flu vaccine to boost immunity against the deadly H5N1 virus.
This comes after the European Commission signed a deal for 40 million doses of a bird flu vaccine. Finland has also announced it will be the first country to administer bird flu vaccines to people, with farm workers receiving two jabs from next month.
Although the risk to humans is currently classified as "low" because the virus can only be passed on from affected animals, said the i news site, the move "marks a stepping-up of readiness" for a "possible new pandemic" if the virus makes the "genetic leap" to human-to-human transmission.
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A former director of the US Centers for Disease Control and Prevention told NewsNation that "it's not a question of if, it's a question of when" a bird flu pandemic will break out. And two flu experts warned in the British Medical Journal that "the risk of a major outbreak" is "large, plausible and imminent".
With the Covid pandemic still fresh in our minds, we "must take steps now" to "minimise the number of times we roll the dice on a new pandemic", said Dr Thom Rawson, a maths modeller from Imperial College London, in The Telegraph.
Between 2003 and 2022 there were 868 reported cases of human infection with the "particularly nasty" H5N1 variant, which is currently sweeping through the US dairy industry. The "alarming" 53% human mortality rate shows that "something needs to be done", but "exactly what isn't so simple".
"In an ideal world," Dr Jayna Raghwani, a biologist from the UK's Royal Veterinary College, told the BBC, there would be more surveillance for the virus close to farms.
We could "do more general monitoring of wildlife close to places we know outbreaks are occurring and more in domestic animals," she said, "to better understand how the virus changes between species."
Reducing flock sizes would be impossible because of current demand levels, and giving birds more space to reduce the threat of infection would require "sheds as big as Windsor Castle", said Rawson. Enhanced biosecurity measures are already in place.
But as consumers we can "educate ourselves more on exactly what the stickers on chicken carcasses mean" and choose products with labels that "indicate a greater level of oversight into bird health while rearing". If "consumers demonstrate a willingness to pay for those increased costs associated" more suppliers will "adopt" the practices.
The UK government agency risk assessment still regards outbreaks among humans not linked to contact with infected birds or animals as between "highly unlikely" (10-20%) and "unlikely" (25-35%).
This rating is "still a long way off" from level 6, when there would be sustained human-to-human transmission, the point at which the government would have to make official public health announcements to the population, said inews.
But the "good news" is that, unlike when Covid first emerged, there are already tailored vaccines in production, so if there were an outbreak in the UK, jabs would be "rolled out quickly".
Summing up the danger, Dr Ed Hutchinson, from the MRC-University of Glasgow Centre for Virus Research, told the BBC that "it's not February 2020" but the threat "does demand our close attention".
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FRIDAY, June 28, 2024 (HealthDay News) -- As a summer wave of COVID infections rolls across the country, U.S. health officials have recommended that all Americans over the age of 6 months get one of the updated COVID vaccines when they become available this fall.
The recommendation was issued Thursday by the U.S. Centers of Disease Control and Prevention after its vaccine advisory panel weighed in on who should get the shots. The panel made the same recommendation for flu vaccinations this fall, with rare exceptions.
Our top recommendation for protecting yourself and your loved ones from respiratory illness is to get vaccinated, CDC Director Dr. Mandy Cohen said in a statement. Make a plan now for you and your family to get both updated flu and COVID vaccines this fall, ahead of the respiratory virus season.
By now, nearly all Americans have had a COVID infection, gotten a COVID vaccine or both, but the updated vaccines offer a timely boost as immunity wanes and the virus continues to evolve, the CDC said.
Professionals and the public in general do not understand how much this virus has mutated, said Carol Hayes, the CDC vaccine advisory committees liaison to the American College of Nurse-Midwives, the New York Times reported.
COVID is still out there, and I dont think its ever going away, Dr. Steven Furr, president of the American Academy of Family Physicians, told the Times.
For Americans who decide to get the latest COVID shots, there will be a choice among this year's vaccines: The Novavax shot will target JN.1, the variant that prevailed during the winter, while the Pfizer and Moderna shots will take aim at KP.2, which until recentlyseemed poisedto become the dominant variant.
But two related variants, KP.3 and LB.1, now account formore than halfof new cases. All three variants are descendants of JN.1.
While mutations are thought to help the variantsevade immune defensesand spread faster, there is no evidence they cause more severe illness, the CDC has said.
The biggest risk factor for severe illness is age. Americans 65 and older account for two-thirds of COVID hospitalizations and 82 percent of in-hospital deaths, according to the CDC. Yet, only about 40 percent of Americans in that age group were immunized with the COVID vaccines that were offered last fall, the Times reported.
This is an area where theres a lot of room for improvement and could prevent a lot of hospitalizations, said Dr. Fiona Havers, a CDC researcher who presented the hospitalization data, the Times reported.
Children -- particularly those under the age of 5 -- are also vulnerable, but only about 14 percent got COVID vaccines last fall, the Times reported.
Even if children do not fall ill themselves, they can fuel circulation of the virus, especially once they return to school this fall, Furr said.
Theyre the ones that, if theyre exposed, are more likely to bring it home to their parents and to their grandparents, he said. By immunizing all groups, youre more likely to prevent the spread.
It is also critical that pregnant persons get vaccinated, not only to protect themselves but also to protect their infants until they are old enough to be vaccinated, panelist Dr. Denise Jamieson, dean of the Carver College of Medicine at the University of Iowa, told the Times.
During the advisory panel meeting, CDC researchers did say they have detected that Pfizers COVID vaccine may trigger four more cases per 1 million shots of a rare neurological condition known as Guillain-Barr syndrome.
More information
The CDC has more on COVID vaccines.
SOURCE: U.S. Centers for Disease Control and Prevention, news release, June 28, 2024; New York Times
The U.S. Centers for Disease Control and Prevention (CDC) has launched a vaccination campaign promoting updated COVID and flu shots in preparation for the upcoming fall and winter seasons as infection rates climb in some parts of the country.
In a statement issued Thursday, the CDC recommended taking updated COVID and flu vaccines to protect against severe outcomes of COVID-19 and flu, including hospitalization and death.
Last year, over 916,300 people were hospitalized with severe COVID-19, resulting in 75,500 deaths. Additionally, during the 2023-2024 flu season, around 44,900 individuals succumbed to flu complications.
"Our top recommendation for protecting yourself and your loved ones from respiratory illness is to get vaccinated. Make a plan now for you and your family to get both updated flu and COVID vaccines this fall, ahead of the respiratory virus season," CDC director, Dr. Mandy Cohen, said in the statement.
As summer peaks, COVID-19 is resurging, causing emergency rooms to handle 15% more cases and seeing a 25% increase in severe hospitalizations. California, Nevada, Arizona, and Hawaii report the highest rates of positive COVID tests, exceeding 10%. COVID-19 deaths have come to around 273 in the week ending June 1. Despite this, the current spike in COVID cases is considered modest compared to past summer waves.
The current recommendation for the COVID vaccine is for everyone aged 6 months and older, regardless of their previous vaccination status. This is because of continuous changes to the SARS-CoV-2 virus and the waning protection provided by COVID-19 vaccines over time.
"Receiving an updated 2024-2025 COVID-19 vaccine can restore and enhance protection against the virus variants currently responsible for most infections and hospitalizations in the United States. COVID-19 vaccination also reduces the chance of suffering the effects of Long COVID, which can develop during or following acute infection and last for an extended duration," the statement read.
Individuals can avail both COVID-19 and flu vaccines at the same visit.
Most individuals require only one flu shot each season.
The CDC recommends most people get the flu vaccine in September or October. Vaccination in July and August is generally not advised, except for:
Adults, especially those 65 and older, and pregnant women in their first and second trimesters should avoid July or August vaccinations unless vaccination in September or October is not possible.
The new COVID-19 subvariants collectively nicknamed FLiRT are continuing to increase their dominance nationwide, fueling a rise in cases in Los Angeles County and growth in the coronavirus levels seen in California wastewater.
Taken together, the data point to a coronavirus resurgence in the Golden State one that, while not wholly unexpected given the trends seen in previous pandemic-era summers, has arrived earlier and is being driven by even more transmissible strains than those previously seen.
It remains unclear how bad the COVID situation may get this summer, however. Doctors have said that by the Fourth of July, we may have a better feel for how the rest of the season will play out.
The U.S. Centers for Disease Control and Prevention estimates that the FLiRT subvariants officially known as KP.3, KP.2 and KP.1.1 make up a combined 62.9% of specimens nationwide for the two-week period ending Saturday. Thats up from 45.3% a month ago.
Experts say the new subvariants are more contagious than the winters dominant subvariant, JN.1.
California is now one of 15 states with high or very high coronavirus levels in sewage, according to the CDC. Those states are generally in the West and the South, as well as New England. Besides California, they are Alaska, Colorado, Connecticut, Florida, Hawaii, Idaho, Missouri, Nevada, New Hampshire, New Mexico, Tennessee, Texas, Utah and Wyoming.
Coronavirus levels in California wastewater overall have sharply increased since early May, a contrast to national trends, which indicate a slower rise. Californias latest weekly wastewater viral activity level was near the peak seen last summer.
In Santa Clara County, Northern Californias most populous, the levels in wastewater are considered high across a wide swath of Silicon Valley, from San Jos to Palo Alto.
Coronavirus levels in L.A. County wastewater have remained generally stable after rising last month. For the week ending June 8, the most recent available, levels in sewage were at 15% of the peak from the winter of 202223 up from 13% the prior week, but down slightly from 16% the week before that. Last summer peaked near the end of the season, when levels in sewage were at 38% of the 202223 winter height.
Reported COVID-19 cases continue to rise, though. For the seven-day period that ended June 16, there were an average of 154 per day reported in L.A. County, up from 121 the prior week. Reported cases are an undercount, as they indicate only tests done at medical facilities, and dont include at-home tests. Nor do they reflect that far fewer people are testing for COVID when theyre sick.
The daily average number of people with COVID in L.A. County hospitals is also ticking up. There were an average of 138 per day for the week that ended June 15, up from 126 the week before.
COVID deaths remain stable, at fewer than one per a day, on average, for the week that ended May 28.
The percentage of COVID tests at Californias medical facilities that are coming back with positive results continues to climb. For the week that ended June 17, 7.5% of statewide COVID tests came back positive, well above the 3.1% rate from a month ago. Last summers peak was 13.1%, recorded at the end of August.
The California Department of Public Health in June updated its guidance for older adults, especially those with weakened immune systems. Officials urged older people to stay up to date on vaccines, seek medication if sickened with COVID, and to consider extra precautions, such as wearing a mask in crowded indoor areas, opening windows and doors to increase ventilation, staying away from sick people, washing their hands often, and covering up coughs and sneezes.
The increases in certain coronavirus tracking data come as the U.S. Food and Drug Administration in mid-June released new advice for vaccine manufacturers. In a June 13 statement, the agency urged that manufacturers, if feasible, design this autumns vaccine formula against KP.2 one of the FLiRT subvariants instead of its parent, JN.1.
The new recommendation overrides guidance from just a week earlier, when the agency had advised the vaccines to be designed against JN.1.
This change is intended to ensure that the COVID-19 vaccines (2024-2025 formula) more closely match circulating SARS-CoV-2 strains, the FDA said in a statement, referring to the formal name of the COVID-19 virus.
By this autumn, the prevailing COVID subvariant will probably be closer to KP.2 than they would have been, perhaps, to JN.1, said Dr. Peter Marks, director for the FDAs Center for Biologics Evaluation and Research, in a press briefing Friday.
The mRNA-based vaccines, made by Pfizer and Moderna, will be able to produce shots this fall for KP.2. But the protein-based vaccine, made by Novavax, will remain designed against JN.1 as mRNA vaccine manufacturing can be done more quickly, Marks said.
What you can do when youre making a protein-based vaccine versus an mRNA vaccine is different in terms of the agility to react to whats coming up, Marks said. Still, the difference between getting a vaccine designed against the newer KP.2 subvariant versus the slightly older JN.1 subvariant will probably not result in that big of a difference.
Were not going to have a preference, Marks said, in terms of making a recommendation of the Pfizer or Moderna vaccine over Novavax. The best vaccine for going into this fall season is the one that you put in your arm.
Marks said a vaccine designed against KP.2 perhaps brings a little benefit over one against JN.1. By essentially using the freshest update, we hope to provide protection immunity that will last longer, Marks said, into the late autumn and the winter.
Its like trying to give people the greatest edge, right? The one-hundredth of a second extra that you win [a race] with, Marks said. But I think the most important thing for people to know is, either way, either of these is perfectly good to get.
Federal officials expressed hope that the COVID vaccine would be made available earlier this year than in 2023. Last years rollout was complicated because the updated COVID vaccine came out slightly later than the seasonal flu shots, making it more difficult for people to get both vaccinations at the same visit if they wouldve preferred that.
COVID-19 continues to remain a disease to guard against, doctors say. About 45,000 COVID deaths have been reported since Oct. 1 nationally, and doctors say those most at risk are older and immunocompromised people who havent received an up-to-date vaccination.
This isnt just going away into the night. Its hanging around, Marks said.
