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Morning Rounds: Three New Bird Flu Cases In Humans Brings Total To 13 In U.S.
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I'm Brittany Trang, STAT health tech reporter and your new Friday morning host.
One year ago today, several of us from STAT dressed up in pink and saw the Barbie movie together. I'm still thinking about the ambiguity of the movie's last line, and as you'll see below, medical researchers are too.
Bird flu cases in humans now total 13 in U.S.The number of confirmed human infections with the bird flu virus associated with the ongoing outbreak in dairy cattle has risen to 13, the Centers for Disease Control and Prevention announced Thursday, as it confirmed three additional cases in Colorado. They are currently designated simply as H5 and not H5N1 because CDC labs are still working on typing the neuraminidase, the N number in the virus' name, STAT's Helen Branswell reports.
The cases — one of which Colorado had previously announced as a "presumptive positive" — are in people who were culling infected poultry on a farm in the state. Genetic analysis of the virus in that poultry outbreak shows that it is similar to the virus circulating in cows; it's believed this is one of several instances where H5N1 in cow herds has spilled over into nearby poultry operations. Of the 13 human cases, 10 have been detected in Colorado, which also has the highest number of reported infected dairy herds — 51, according to the state's Department of Agriculture. Michigan and Texas have reported two and one human case, respectively.
A paradox of mastectomy for breast cancer patientsWeighing treatment options for breast cancer is an agonizing choice. New research published in JAMA Oncology affirms the prevailing knowledge that excising the cancerous lump, getting a single mastectomy, or a double mastectomy all return about the same rate of survival: over 80% over 20 years of followup.
However, STAT's cancer reporter Angus Chen writes, the new study turns up a puzzling finding: Survivors who ended up developing a second breast cancer in their opposite, or contralateral, breast had a higher risk of death from breast cancer, even though people who got a double mastectomy died at the same overall rates.
"That seems like a paradox," said Steven Narod, a breast cancer researcher and physician at Women's College Hospital in Toronto and the lead author on the study. "If you get a contralateral breast cancer, your risk of dying goes up. But preventing it doesn't improve your survival."
Read more from Angus, including possible explanations for the conundrum.
The striking increase in suicides among Asian-AmericansRecent U.S. Data showed that while suicide rates decreased for young white people in 2018 and 2019, rates went up for Asian-American or Pacific Islander youths. In a recent JAMA Network Open study, researchers examined suicide trends in Asian-Americans ages 10 to 19 years old more closely.
Looking at codes for causes of death in a data set ranging from 1999 to 2021, researchers found that suicide rates started rising for girls in 2004, peaking at nearly 3 per 100,000 people in 2020. For boys, the rates began rising in 2009 and peaked at 8 per 100,000 people in 2019.
The authors couldn't explain what was causing the increases, but suggested this upward trend might have stemmed from economic hardships in Asian-American households during the Great Recession, as well as increased exposure to sexism and racism — especially for Asian-American women and girls — with the proliferation of social media.
If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.Org. For TTY users: Use your preferred relay service or dial 711 then 988.
How Kamala Harris' late mom shaped her health care views
Kamala Harris via Facebook Want to stay on top of health news? Sign up to get our Morning Rounds newsletter in your inbox. I'm Brittany Trang, STAT health tech reporter and your new Friday morning host. One year ago today, several of us from STAT dressed up in pink and saw the Barbie movie together. I'm still thinking about the ambiguity of the movie's last line, and as you'll see below, medical researchers are too. Bird flu cases in humans now total 13 in U.S. The number of confirmed human infections with the bird flu virus associated with the ongoing outbreak in dairy cattle has risen to 13, the Centers for Disease Control and Prevention announced Thursday, as it confirmed three additional cases in Colorado. They are currently designated simply as H5 and not H5N1 because CDC labs are still working on typing the neuraminidase, the N number in the virus' name, STAT's Helen Branswell reports. The cases — one of which Colorado had previously announced as a "presumptive positive" — are in people who were culling infected poultry on a farm in the state. Genetic analysis of the virus in that poultry outbreak shows that it is similar to the virus circulating in cows; it's believed this is one of several instances where H5N1 in cow herds has spilled over into nearby poultry operations. Of the 13 human cases, 10 have been detected in Colorado, which also has the highest number of reported infected dairy herds — 51, according to the state's Department of Agriculture. Michigan and Texas have reported two and one human case, respectively. A paradox of mastectomy for breast cancer patients Weighing treatment options for breast cancer is an agonizing choice. New research published in JAMA Oncology affirms the prevailing knowledge that excising the cancerous lump, getting a single mastectomy, or a double mastectomy all return about the same rate of survival: over 80% over 20 years of followup. However, STAT's cancer reporter Angus Chen writes, the new study turns up a puzzling finding: Survivors who ended up developing a second breast cancer in their opposite, or contralateral, breast had a higher risk of death from breast cancer, even though people who got a double mastectomy died at the same overall rates. "That seems like a paradox," said Steven Narod, a breast cancer researcher and physician at Women's College Hospital in Toronto and the lead author on the study. "If you get a contralateral breast cancer, your risk of dying goes up. But preventing it doesn't improve your survival." Read more from Angus, including possible explanations for the conundrum. The striking increase in suicides among Asian-Americans Recent U.S. Data showed that while suicide rates decreased for young white people in 2018 and 2019, rates went up for Asian-American or Pacific Islander youths. In a recent JAMA Network Open study, researchers examined suicide trends in Asian-Americans ages 10 to 19 years old more closely. Looking at codes for causes of death in a data set ranging from 1999 to 2021, researchers found that suicide rates started rising for girls in 2004, peaking at nearly 3 per 100,000 people in 2020. For boys, the rates began rising in 2009 and peaked at 8 per 100,000 people in 2019. The authors couldn't explain what was causing the increases, but suggested this upward trend might have stemmed from economic hardships in Asian-American households during the Great Recession, as well as increased exposure to sexism and racism — especially for Asian-American women and girls — with the proliferation of social media. If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.Org. For TTY users: Use your preferred relay service or dial 711 then 988. How Kamala Harris' late mom shaped her health care views [caption id="" align="alignleft" width="626"] Kamala Harris via Facebook[/caption] This past Mother's Day, Kamala Harris posted a picture of herself and her sister in brightly colored coats, standing next to their mother on a sidewalk. "My mother, Dr. Shyamala Gopalan, had two goals in life: to cure breast cancer and to raise my sister and me," she wrote.
Gopalan was best known for her research on the relationship between progesterone receptors and breast cancer. She worked at institutions including McGill and Lawrence Berkeley National Lab, served on the President's Special Commission on Breast Cancer under Clinton, and peer reviewed for the NIH before her death in 2009 from colon cancer.
It's uncertain what the future of Biden's Cancer Moonshot and the NIH might be under an administration change. With Harris as the likely Democratic presidential nominee, it's interesting to see what she has said about her mom, health care, and thinking like a scientist, even as a policymaker. Go deeper with this story from STAT's Rohan Rajeev.
Barbie, the SEO queen of gynecology Last summer's Barbie movie spawned endless memes (that even the American Medical Association got in on), songs of the summer from Billie Eilish and Dua Lipa, and a shortage of hot pink paint. But did the iconic last scene — Barbie's very enthusiastic declaration, "I'm here to see my gynecologist" — birth a renewed interest in getting Pap smears? Other high-profile medical mentions — such as Katie Couric's televised colonoscopy and Angelina Jolie's breast cancer essay in the New York Times — led to increases in colonoscopies and genetic testing, so researchers in JAMA Network Open wondered if Barbie did the same thing. Looking at online search trends, researchers reported that while searches for "gynecologist" and "gynecologist definition" spiked 51% and 154%, respectively, at the time of the Barbie movie's release, there was no change in searches for gynecologist appointments. It wasn't clear to researchers whether people needing the definition of a gyno were the same people who require gynecologic care, but the trend overall suggested that an increased awareness didn't translate to an increase in people seeking out appointments. Hot mice unlock the brain's secret to pain placebos The placebo effect is mysterious and often pesky in clinical trials, but new research in Nature offers new evidence for which brain circuit is responsible for the placebo effect in treating pain. A team led by researchers from the University of North Carolina conditioned mice to expect pain relief by putting them in a chamber with two rooms: one with a hot floor and one with a comfortably warm floor. They induced the placebo effect by making both chambers hot, but mice kept crossing into the one they had been conditioned to expect to be less hot. By studying their brains, researchers pinned down which specific neurons seemed to be responsible for convincing the mice that they were experiencing pain relief. Injecting the mice with naloxone, an opioid receptor antagonist, got rid of the placebo effect, suggesting the brain's natural opioid system is involved with modulating those neurons. Though there's still more work to be done, researchers noted that their results indicate that the pathway they identified could be tackled by new pain-relieving interventions like drugs or cognitive behavioral therapies. What we're readingWithout federal oversight, nursing homes will put profit ahead of care, STAT
We bought everything needed to make $3 million worth of fentanyl. All it took was $3,600 and a web browser, Reuters
This past Mother's Day, Kamala Harris posted a picture of herself and her sister in brightly colored coats, standing next to their mother on a sidewalk. "My mother, Dr. Shyamala Gopalan, had two goals in life: to cure breast cancer and to raise my sister and me," she wrote.
Gopalan was best known for her research on the relationship between progesterone receptors and breast cancer. She worked at institutions including McGill and Lawrence Berkeley National Lab, served on the President's Special Commission on Breast Cancer under Clinton, and peer reviewed for the NIH before her death in 2009 from colon cancer.
It's uncertain what the future of Biden's Cancer Moonshot and the NIH might be under an administration change. With Harris as the likely Democratic presidential nominee, it's interesting to see what she has said about her mom, health care, and thinking like a scientist, even as a policymaker. Go deeper with this story from STAT's Rohan Rajeev.
Barbie, the SEO queen of gynecologyLast summer's Barbie movie spawned endless memes (that even the American Medical Association got in on), songs of the summer from Billie Eilish and Dua Lipa, and a shortage of hot pink paint. But did the iconic last scene — Barbie's very enthusiastic declaration, "I'm here to see my gynecologist" — birth a renewed interest in getting Pap smears?
Other high-profile medical mentions — such as Katie Couric's televised colonoscopy and Angelina Jolie's breast cancer essay in the New York Times — led to increases in colonoscopies and genetic testing, so researchers in JAMA Network Open wondered if Barbie did the same thing.
Looking at online search trends, researchers reported that while searches for "gynecologist" and "gynecologist definition" spiked 51% and 154%, respectively, at the time of the Barbie movie's release, there was no change in searches for gynecologist appointments. It wasn't clear to researchers whether people needing the definition of a gyno were the same people who require gynecologic care, but the trend overall suggested that an increased awareness didn't translate to an increase in people seeking out appointments.
Hot mice unlock the brain's secret to pain placebosThe placebo effect is mysterious and often pesky in clinical trials, but new research in Nature offers new evidence for which brain circuit is responsible for the placebo effect in treating pain.
A team led by researchers from the University of North Carolina conditioned mice to expect pain relief by putting them in a chamber with two rooms: one with a hot floor and one with a comfortably warm floor. They induced the placebo effect by making both chambers hot, but mice kept crossing into the one they had been conditioned to expect to be less hot. By studying their brains, researchers pinned down which specific neurons seemed to be responsible for convincing the mice that they were experiencing pain relief. Injecting the mice with naloxone, an opioid receptor antagonist, got rid of the placebo effect, suggesting the brain's natural opioid system is involved with modulating those neurons.
Though there's still more work to be done, researchers noted that their results indicate that the pathway they identified could be tackled by new pain-relieving interventions like drugs or cognitive behavioral therapies.
What we're readingWithout federal oversight, nursing homes will put profit ahead of care, STAT
We bought everything needed to make $3 million worth of fentanyl. All it took was $3,600 and a web browser, Reuters
The CDC's Test For Bird Flu Works, But It Has Issues
The Centers for Disease Control and Prevention says a glitch in its bird flu test hasn't harmed the agency's outbreak response. But it has ignited scrutiny of its go-it-alone approach in testing for emerging pathogens.
The agency has quietly worked since April to resolve a nagging issue with the test it developed, even as the virus swept through dairy farms and chicken houses across the country and infected at least 13 farmworkers this year.
At a congressional hearing July 23, Rep. Brett Guthrie (R-Ky.) asked about the issue. "Boy, that rings of 2020," he said, referring to when the nation was caught off guard by the covid-19 pandemic, in part because of dysfunctional tests made by the CDC. Demetre Daskalakis, director of the CDC's National Center for Immunization and Respiratory Diseases, responded that the agency rapidly developed a workaround that makes its bird flu test reliable.
"The tests are 100% usable," he later told California Healthline, adding that the FDA studied the tests and came to the same conclusion. The imperfect tests, which have a faulty element that sometimes requires testing a sample again, will be replaced soon. He added, "We have made sure that we're offering a high-quality product."
Still, some researchers were unnerved by the news coming four months after the government declared a worrisome bird flu outbreak among cattle. The CDC's test is the only one available for clinical use. Some researchers say its flaws, though manageable, underscore the risk of relying on a single entity for testing.
EMAIL SIGN-UpThe problem came to light in April as the agency prepared to distribute its test to about 100 public health labs around the country. CDC officials detected the issue through a quality control system put in place after the covid test catastrophe of 2020.
Daskalakis said the CDC's original test design was fine, but a flaw emerged when a company contracted by the agency manufactured the tests in bulk. In these tests, one of two components that recognize proteins called H5 in the H5N1 bird flu virus was unreliable, eliminating an important safeguard. By targeting the same protein twice, tests have a built-in backup in case one part fails.
The agency developed a fix to ensure a reliable result: If only one of the two parts detected H5, the test was considered inconclusive and would be run again. With the FDA's blessing, the CDC distributed the tests — with workaround instructions — to public health labs.
Kelly Wroblewski, director of infectious diseases at the Association of Public Health Laboratories, said the results of the tests have not been ambiguous, and there is no need to discard the tests.
Still, the agency has asked a different manufacturer to remake the faulty component so that 1.2 million improved tests will be available soon, Daskalakis said. Some of the updated tests are already in stock at the CDC, but the FDA hasn't yet signed off on their use. Daskalakis declined to name the manufacturers.
Meanwhile, the outbreak has grown. Farmworkers continue to lack information about the virus and gear to protect them from it. Rural clinics may miss cases if they don't catch a person's connection to a farm and notify health officials rather than their usual diagnostic testing laboratories.
Those clinical labs remain unauthorized to test for the bird flu. Several of those labs have spent months working through analyses and red tape so that they can run the CDC's tests. As part of the licensing process, the CDC alerted them to the workaround with the current test, too.
But outside select circles, the news was largely overlooked. "I'm totally surprised by this," Alex Greninger, assistant director of the University of Washington Clinical Virology Laboratory, told California Healthline this week. Greninger's lab is developing its own test and has been trying to obtain CDC test kits to evaluate.
"It's not a red alarm," he said, but he's worried that as the CDC and the FDA spend months developing and evaluating an updated test, the only one available relies on a single component. If the genetic code underlying that fragment of the H5 protein mutates, the test could give false results.
It's not uncommon for academic and commercial diagnostic labs to make mistakes and catch them during quality control checks, as the CDC did. Still, this isn't the agency's first mishap. In 2016, well before the covid debacle, CDC officials for months directed public health labs to use a Zika test that failed about a third of the time.
The CDC caught and worked to remediate the situation far more quickly and effectively in this case. Nonetheless, the mishap raises concern. Michael Mina, chief science officer of the telemedicine company eMed.Com, said diagnostic companies may be better suited to the task.
"It's a reminder that CDC is not a robust manufacturer of tests" and lacks the resources that industry can marshal for their production, Mina said. "We do not ask CDC to make vaccines and pharmaceuticals, and we do not ask the Pentagon to manufacture missiles."
The CDC has licensed its updated test design to at least seven clinical diagnostic labs. Such labs are the foundation of testing in the U.S. But none have FDA clearance to use them.
Diagnostic labs are developing their own tests, too. But that has been slow-going. One reason is the lack of guaranteed sales. Another is regulatory uncertainty. Recent FDA guidance could make it harder for nongovernmental laboratories to issue new tests in the early phase of pandemics, said Susan Van Meter, president of the American Clinical Laboratory Association, in a July 1 letter to the FDA.
Transparency is also critical, scientists said. Benjamin Pinsky, medical director of the clinical virology laboratory at Stanford University, said as a public agency the CDC should make its protocol — its recipe for making the test — easily accessible online.
The World Health Organization does so for its bird flu tests, and with that information in hand, Pinsky's lab has developed an H5 bird flu test suited to the strain circulating this year in the U.S. The lab published its approach this month but doesn't have FDA authorization for its broad use.
The CDC's test recipe is available in a published patent, Daskalakis said.
"We have made sure that tests are out there, and that they work," he added.
As the CDC came under fire at the July 23 congressional hearing, Daniel Jernigan, director of the CDC's National Center for Emerging and Zoonotic Infectious Diseases, noted that testing is just one tool. The agency needs money for another promising area — looking for the virus in wastewater. Its current program uses supplemental funds, he said: "It is not in the current budget and will go away without additional funding."
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Arthur Allen: aallen@kff.Org, @ArthurAllen202
Amy Maxmen: amaxmen@kff.Org
New Pneumonia Vaccine Gets CDC Nod: Should You Get It?
Come this fall, some adults may be rolling up their sleeves to receive an additional vaccine to go with their COVID-19, flu, and RSV shots.
The Centers for Disease Control and Prevention (CDC) recently updated their vaccine recommendations to include the new pneumococcal 21-valent conjugate vaccine (PCV21) as an option for high-risk individuals.[1]
PCV21 was approved in June for adults 18 and older to protect against invasive pneumoccocal disease.[2] This infection can cause contagious and potentially severe illness, such as pneumonia, meningitis, and sepsis.
[3]
What Is PCV21 and What's the Difference From Other Pneumonia Vaccines? The new inoculation, manufactured by Merck under the name Capvaxive, targets distinct groups of pneumococcal bacteria (serotypes) responsible for about 84 percent of invasive pneumococcal disease in adults age 50 and older.[4]
The shot includes eight unique serotypes not covered by other currently approved pneumococcal vaccines — those serotypes were responsible for about 27 percent of invasive pneumococcal disease cases in adults age 50 and older and about 30 percent in adults age 65 and old, according to Merck.
The CDC recommendation follows the recent approval of the vaccine by the U.S. Food and Drug Administration, which was based on four clinical trials demonstrating robust immune responses in different adult populations.
Why Pneumonia Vaccines Matter Pneumococcal bacteria can cause serious and often life-threatening illnesses. About 150,000 people in the United States are hospitalized each year with pneumococcal pneumonia, and between 7,500 and 10,500 of them die, according to the National Foundation for Infectious Diseases.[5] The death rate is even higher among adults 65 years and older, as well as for people with underlying health conditions.
Other infections are less common, but more deadly. Pneumococcal meningitis kills about 1 in 6 older patients who are infected; and blood infection kills about 1 in 8 adults who get it.
The CDC stresses that vaccination is the best way to protect against serious pneumococcal infections.[6]
"Pneumococcal disease is a leading killer of older people and if you don't get vaccinated, you're at increased risk that it could be a life-ending event," says internist Sandra Fryhofer, MD, the American Medical Association's liaison to the CDC's Advisory Committee on Immunization Practices, which unanimously recommended the new Capaxive vaccine.[7]
The side effects from vaccination (such as injection site pain, fatigue, and headache) are minimal, and the benefits far outweigh the risks. Says Fryhofer, who is also adjunct associate professor of medicine at Emory University School of Medicine in Atlanta, and is on staff at several Emory Healthcare hospitals.
Who Should Consider PCV VaccinationThis latest vaccine is recommended as an option for adults age 65 and older who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown.
Individuals ages 19 to 64 with certain risk factors, certain underlying medical conditions — such as heart disease, lung disease, diabetes, kidney disease, or liver disease — are urged to get the shot as well.
The immunization is also advised as an option for adults age 19 and up who have been previously vaccinated with other pneumococcal vaccines — specifically those who have started their pneumococcal vaccine series with PCV13 (pneumococcal 13-valent conjugate vaccine) but have not received all recommended PPSV23 (pneumococcal 23-valent polysaccharide vaccine) doses.[8]
What Are the Advantages of the New Vaccine?Is this new vaccination better than pneumococcal vaccines that have come before?
That's a "complicated question," according to Michael Niederman, MD, a pulmonary and critical care medicine specialist at NewYork-Presbyterian/Weill Cornell Medical Center, whose research has focused on preventing infections associated with pneumococcal disease.
"The trouble with comparing different vaccines is that they cover different strains," he says.
Prevnar20 (pneumococcal 20-valent conjugate vaccine) from Pfizer has been a leading vaccination for adults. While PCV21 covers just one more strain than PCV20, the comparison is more than a matter of numbers.
When it comes to preventing pneumococcal illness, Prevnar20 targets a little over half of likely strains but Capvaxive covers slightly more than 80 percent, according to Dr. Niederman.
"The choice of vaccine depends a lot on your risk factors," he says. "If you're a high-risk person for invasive pneumococcal infection, you get better coverage with PCV21, but there is one invasive strain that's covered by PCV20 that's not covered by PCV21, so there's compromises in any choice."
Dr. Fryhofer adds that PCV21 can also be an option for those who have received earlier versions of pneumococcal vaccination.
"If you're 65 or older and five years out from getting an earlier combination pneumococcal vaccine series [PCV13 plus PPSV23], you have the option of getting either PCV20 or now PCV21," she says. Even if you've received PCV20, you might be advised to get PCV21 depending on how high-risk you are.
Because pneumococcal vaccine recommendations can be complicated, Fryhofer advises patients to get direction from their healthcare provider and stay up to date with the latest CDC immunization schedules.[9]
Having the flu increases the risk of getting pneumococcal disease so protection against the illness is especially important during flu season, according to the National Foundation for Infectious Diseases.[5]
If both vaccines are due, they can be administered during the same healthcare visit.
Capaxive will be available in the United States by late summer, according to a spokesperson from Merck. Out-of-pocket costs individuals will pay depend on their specific insurance plans and coverage. Historically when the CDC endorses a vaccine, insurance plans are more likely to cover costs.
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