Human metapneumovirus: hMPV symptoms and what you need to know with Andrea Garcia, JD, MPH

AMA Update covers a variety of healthcare topics that affect the lives of doctors, residents, medical students and patients. From private practices and healthcare system leaders to scientists and public health officials, hear from medical experts on COVID-19, medical education, advocacy issues, burnout, vaccines, and more.

In today’s AMA update, the latest on human metapneumovirus (hMPV), RSV vaccine approvals, changes in state Medicaid coverage, reports on the next CDC director, and data from a new weight loss for kids posted in JAMA Pediatrics with AMA Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Experience Director Todd Unger hosts.

Speaker

• Andrea Garcia, JD, MPH, vice president, science, medicine and public health, American Medical Association

Unger: Hello and welcome to the AMA Update video and podcast series. Today, we have our weekly headline look with AMA Vice President of Science, Medicine and Public Health Andrea Garcia in Chicago. I’m Todd Unger, chief experience officer of the AMA also in Chicago. Welcome back Andrew.

garcia: Thanks Todd, good to be here today.

Unger: And we have a lot to talk about, from RSV to changes to the CDC and so on. Let’s start with this RSV vaccine news, which has been a lot in the last month. And there’s been another development since we last spoke. What’s the latest news there?

garcia: Yes you are right. There has been a lot of really encouraging news about RSV vaccines lately and the most recent news is that last Wednesday the FDA approved Pfizer’s RSV vaccine for the elderly. This is the second vaccine that will soon be available for this age group. We know that early last month the FDA also approved an RSV vaccine from GSK for the elderly.

And then just a few weeks ago, it approved the first-ever vaccine to protect children from RSV. Of course, all of these vaccines need to be considered by ACIP, which is the CDC’s advisory committee. And they’ll make a recommendation to the director of the CDC on the appropriate use of each of these vaccines. And that committee is scheduled to meet on June 21st. Like GSK, Pfizer expects its vaccine to be available in the fall, which is just in time for RSV season.

Unger: Andrea, differences between the two?

garcia: Well, both of these vaccines are comparable in terms of effectiveness. An FDA review of the Pfizer vaccine showed it was 86 percent protective against lower respiratory tract disease, with three or more symptoms. And a similar review of the vaccine by GSK found it was 83 percent effective. Then, as with COVID, people will have vaccines to choose from once they become widely available.

This is great news. RSV carries an increased risk for the elderly. And we know, based on data from the CDC, that RSV causes between 60 and 160,000 hospitalizations each year for adults age 65 and older, and also between 6 and 10,000 deaths each year.

Unger: Well, this is really good news. Andrea, we will keep an eye on these vaccines and upcoming recommendations from the CDC. RSV wasn’t the only respiratory virus that made headlines, however, last week. A new report from the CDC has everyone talking about another virus. What do we need to know about it?

garcia: The CDC released a report in late May saying cases of a virus known as human metapneumovirus, or hMPV, were higher than normal this past winter and spring. That peak occurred in mid-March with nearly 11% of PCR tests showing a positive diagnosis for hMPV. And over 19% of the antigen tests also came back positive for hMPV. To provide some context, in the months leading up to the pandemic, that percentage of hMPV positive tests was actually between 4% and 7%. So it’s been a really nice improvement what we’re seeing.

hMPV is a lesser known virus. But it definitely got a lot more attention after that CDC report. It’s a paramyxovirus, so it’s like RSV and measles and mumps. For most people who get it, though, it will look like the common cold. They will experience symptoms such as nasal congestion, cough, shortness of breath and fever.

Unger: Yes, many friends who have suffered from mysterious illnesses over the past few years have fallen and failed to identify what it was. So maybe that was it. There has obviously been a large increase. Do we know what’s driving an increase like this?

garcia: There really could be a couple of factors at play here. And we know that COVID testing has declined overall. But as a country, we’re really more focused on identifying the cause of any respiratory illness than we used to. And before the pandemic, if someone had cold-like symptoms, he could have just shrugged it off. But now they are more likely to go to their doctor and get tested.

And so these more regular testing has made it easier for us to identify these trends that we’re seeing in things like RSV and hMPV. They are also getting a timing component. As with the peak in RSV cases, it was last year when people really started to emerge from the pandemic. And before that we know that people were more consistently masking up and staying home. Now they dress up less and go out more. And as a result, we may see this resurgence of some infectious diseases.

Unger: We now have quite a long list of viruses that we are concerned about right now. Is hMPV something we need to be extra vigilant about?

garcia: Well, that’s definitely something we’ll continue to keep an eye on. But for the most part it is mild and not a cause for concern. I think having said that, like RSV, it can have more serious consequences for young children, for older adults, for those who are immunocompromised. In general, however, it is a virus that we have lived with for decades. We are used to it.

And while no vaccines are available, doctors are ready to help patients treat their symptoms. And the recovery time is usually three to seven days.

Unger: Very well. I’ll put it in the “don’t worry” column of the virus sheet. Andrea, thank you very much for this overview. In more CDC-related news, there have been some early discussions about who will be the new head of the CDC. What can you tell us there?

garcia: So the White House has yet to make any official announcements. But media reports that President Biden intends to select Dr. Mandy Cohen to lead the CDC. Obviously he will replace Dr. Rochelle Walensky, who will resign on June 30th. Dr. Cohen is an internal medicine physician. She was previously the health secretary of North Carolina.

And he would truly bring both his state and federal experience to the position. So prior to her role in North Carolina, she served in the Obama administration and was a senior official at CMS. She has helped oversee federal health insurance programs that have provided coverage to more than 140 million people. And actually last year the AMA presented Dr. Cohen with the AMA Outstanding Government Service Award for her leadership during the COVID-19 pandemic and her tireless work to close the coverage gap in the state. her. So we will definitely be sure to check this back when more details are available.

Unger: Well, I’m looking forward to learning more about this transition. Another issue that is making headlines is Medicaid. A pandemic-era policy that prohibited states from removing people from the program expired earlier this year. And now we’re starting to see the full impact of that shift. Andrea, tell us more about what’s going on there.

garcia: Yeah, so early data shows that hundreds of thousands of people have lost their Medicaid coverage in the last few weeks. Earlier in the pandemic, Congress passed the Families First Coronavirus Response Act, which included a provision that Medicaid programs must keep people enrolled. As you noted, that provision expired earlier this year on March 31st. So far we’ve seen at least 19 states start removing people.

In Arkansas, 73,000 people lost their coverage in April alone. In the same month, 250,000 people lost coverage in Florida. And I think while we don’t know the exact total of how many people will lose coverage, the federal government expects about 15 million people to be affected. Early data shows that many people could lose coverage for procedural reasons, such as failure to return documents to verify their eligibility or the state was unable to contact them.

So people who were eliminated could still qualify. However, for others, this change has left them with no choice but to seek out other coverage options.

Unger: Well, thanks Andrew. This is just the beginning of a major change that we will no doubt be hearing more about in the coming months. To close out the week, there’s new research in JAMA that has sparked much discussion, weight-loss surgeries among children and adolescents. This is a new thing that we have read about. Is this a trend as we emerge from the pandemic? What’s going on there?

garcia: Yeah, so that data was published in JAMA Pediatrics. And that number of metabolic and bariatric surgeries in 10- to 19-year-olds has been on the rise since 2016. So it was definitely a trend that we were seeing even before the pandemic. Even during the pandemic, however, weight-loss surgeries among young people increased 19% between 2020 and 2021, and surgeries among adults increased 24% over the same period.

Unger: And we know that obesity is an ongoing health problem in the United States, affecting about one in five children and adolescents, according to the CDC. Why are more people turning to surgery now as a treatment for it? And is it safe to have him so young?

garcia: Yes, so that study found that traditionally these procedures have been underutilized due to lack of access and insurance coverage, but also a low referral rate by pediatricians. And earlier this year we saw the American Academy of Pediatrics release new guidelines for the treatment of obesity. And for the first time, those guidelines mandated that adolescents 13 and older with severe obesity should be evaluated for metabolic and bariatric surgery. This study finds that behavioral interventions do not result in long-term clinically important weight loss in severe obesity.

Unger: Well, I’m sure we’ll continue to hear about that as well. Andrea, this concludes our episode today. Thanks so much for joining us. Next week is the annual meeting of the AMA House of Delegates. So we’ll be back with another episode the following week on June 21st. In the meantime, you can find all of our episodes at ama-assn.org/podcasts. Have a good week. Thanks for joining us. Please be careful.

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Disclaimer: The views expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.