Health

(NEW YORK) — Dr. Deborah Horn wants to give her patients with obesity the best possible care. But too often, the conversation in appointments isn’t focused on picking the best treatment options, which sometimes includes anti-obesity medication.

Instead, the conversations are focused on cost and insurance coverage.

“When we’re sitting in front of a patient and thinking, how can we best help this patient, and if medication is the best route, coverage should really be the last thing we think about,” says Horn, the medical director for the UTHealth Houston Center of Obesity Medicine and Metabolic Performance. “Unfortunately, with the state of access, coverage becomes the first thing.”

Over 40% of adults in the United States have obesity, which the Centers for Disease Control and Prevention defines as a body mass index of 30 or higher. While body mass index is not an indication of health, obesity is linked with heart disease, stroke, type 2 diabetes and certain types of cancer.

Newer anti-obesity medications like semaglutide (the active ingredient in Wegovy and diabetes medication Ozempic) can be highly effective for people with obesity. But analysis and reports show that drugs used for weight loss aren’t often covered by Medicare, most Medicaid programs, and some commercial insurances, limiting access to the drugs — which can cost over $1,300 out of pocket for a month’s supply.

“If patients are on Medicare or Medicaid, the conversation is about what patients can manage for themselves financially,” Horn says. “That’s a frustrating conversation for patients.”

As conversations around semaglutide and other similar drugs continue, Impact x Nightline explores issues surrounding the drugs, and the effects they’re having on patients who have been struggling with weight loss in an episode now streaming on Hulu.

Medicaid coverage for anti-obesity drugs vary state by state.

“States have the option, but are not required, to cover weight loss medication,” a Centers for Medicare & Medicaid Services spokesperson said in an email to ABC News.

Coverage doesn’t map neatly onto obesity rates in states.

“Louisiana, for example, has a pretty high rate of obesity, they cover anti-obesity medication in their Medicaid program,” says Timothy Waidmann, a senior fellow in the Health Policy Center at the Urban Institute and author of the report Obesity across America.

Colorado’s Medicaid program doesn’t cover these types of drugs, and they have the second lowest obesity rate in the United states, according to America’s Health Rankings.

While Medicare doesn’t cover these types of drugs, beneficiaries enrolled in Medicare Advantage plans might have the medications covered.

However, this leaves a majority of Medicare enrollees without coverage for these types of drugs, forcing them to pay high out-of-pocket costs, or go without.

The coverage gaps could deepen economic and racial disparities around obesity, experts say. Patients who can afford to pay out-of-pocket for the drug are the ones who are able to access treatment.

“The biggest struggle we have in clinic is equity in care,” Horn says.

Horn, other experts, and obesity advocacy organizations are pushing for Congress to pass the Treat and Reduce Obesity Act, which would (among other things) expand anti-obesity medication coverage for people on Medicare.

Right now, coverage of anti-obesity medications by commercial insurance plans is mixed, and often varies by employer to employer, Horn says. But if Medicare covers the drugs, other plans would likely follow, she says.

“If we can get Medicare to cover the medications — no one wants to be worse than Medicare,” she says.

The success rates of the newer drugs like semaglutide and the new awareness around them might help move the needle and push more commercial insurance and Medicaid programs to cover the medications, experts say.

“I think, broadly, the popularity will only work to increase the number of states that offer coverage,” Waidmann says.

Older anti-obesity medications weren’t nearly as effective for weight loss as semaglutide and the other newer compounds, like tirzepatide (the active ingredient in diabetes medication Mounjaro), Horn says. They lead to around the same amount of weight loss as bariatric surgery — which Medicare and most Medicaid programs do cover.

“They’ve closed the gap,” Horn says. “We have medications that are as efficacious or almost as efficacious as surgery. Patients should be given a choice.”

But for now, patients who could benefit from these medications are stuck in a bind. Horn says she has a patient who lost over 100 pounds on semaglutide, but his insurance recently changed, and the drug will no longer be covered.

“He’s sitting at home thinking, ‘what is going to happen next?’ He knows his physiology,” Horn says. “You’re left feeling like your hands are tied.”

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(NEW YORK) — The news that the U.S. Department of Energy now believes with “low confidence” that the COVID-19 pandemic “most likely” was the result of a laboratory leak in China, resulted in a firestorm of debate across the internet.

First reported by The Wall Street Journal and not independently confirmed by ABC News, the DOE, which oversees a system of laboratories in the U.S., changed its stance from undecided — becoming the second agency, after the FBI, to believe a lab accident resulted in the global health emergency.

Four other U.S. agencies believe the virus was a result of natural transmission and that the virus, known as SARS-CoV-2, jumped from animals to humans at a wet market. Two other agencies are undecided.

“There’s just no consensus across the government,” John Kirby the National Security Council Coordinator for Strategic Communications told reporters Monday. “The President believes that it is important that we get to the bottom of this.”

Without seeing the report that made the DOE reach its conclusion, “it really becomes impossible to speculate,” said Dr. John Brownstein, an epidemiologist and chief innovation officer at Boston Children’s Hospital, and an ABC News contributor.

“Without it, it’s very hard to make any type of judgment on what took place,” he said. “And I think, ultimately, all hypotheses remain on the table. While this headline is very attention grabbing, it doesn’t really change the game in any significant way.”

What we know from the report

The Journal acknowledged that it has not seen the report and relied on the account of people who have read the document.

One of the only details known is that the conclusion was reached with “low confidence.”

“The fact is that the Department of Energy changing its position to ‘low confidence’ means that the amount of evidence in the direction of lab leak or natural spillover is still very limited,” Brownstein said.

It also means the DOE is not dismissing the natural transmission theory.

“Academic molecular biologists are of this position, that this was a natural event, just as the other two coronavirus transmissions from wild species to humans were: first SARS, and then MERS,” Dr. William Schaffner, an infectious disease specialist and a professor of preventive medicine at Vanderbilt University Medical Center, told ABC News.

This is in reference to severe acute respiratory syndrome (SARS), which resulted in a global outbreak in 2003 and Middle East Respiratory Syndrome (MERS), which caused an outbreak in 2012. Both are “cousins” of SARS-CoV-2.

“Now, we have these two positions,” Schaffner said. “We don’t know on what basis this last report came to its conclusion, but I don’t think it’s going to resolve the issue to the satisfaction of everyone.”

What the report doesn’t tell us

Because the public hasn’t seen the report, it’s unclear what evidence caused the DOE to change its mind, where that evidence came from and what the term “lab leak” even means.

Dr. Stuart Ray, a professor of medicine at Johns Hopkins University, said when people hear “lab leak,” there’s a few scenarios they might come up with.

“One is that people imagine that someone in a lab was engineering mutations into a coronavirus genome, and making a bioweapon or something like that, and that it leaked out,” he told ABC News. “Others might be thinking that people were collecting specimens from bats or other animals and growing them in the lab and then some of that virus leaked out.”

Ray continued, “I can imagine that some people are imagining they were just handling bats and someone in the lab got infected in the lab and then went out. There’s a wide range of things that might be meant, but because this report has not been shared, we don’t know what they meant by that.”

Lab leak and natural transmission?

Experts told ABC News that even if the COVID-19 pandemic did occur as the result of a lab leak, it doesn’t mean that natural transmission didn’t occur.

In fact, it could mean a hypothetical patient zero was infected at the laboratory before spreading the illness elsewhere.

“You could see them operating in sequence,” Schaffner said. “Let’s say the lab leak were correct and the virus then began to infect people and some of those persons then went to the wet market.”

He continued, “And that wet market then became an amplification location where many, many people were infected, and that then set off the epidemic. That’s a possibility.”

Why knowing the origins matters

The experts said we may never know the origins of SARS-CoV-2, similarly to how we don’t know the origins of other viruses, such as Ebola.

However, knowing the origins can help us determine if biosafety protocols weren’t followed so they can be addressed and revised, if necessary.

“I think we want to know that publicly funded research or that all research is done responsibly,” Ray said. “And we want to know whether there are dangers associated with this type of research…I think we’d want to know if that is the case. If it turns out that that virology research does pose a risk, then we want to understand those risks and how best to manage them.”

Ray also added that research into SARS and MERS helped pharmaceutical companies develop a vaccine, so virology research doesn’t necessarily equal dangerous.

Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, told ABC News. He acknowledged there is a scientific and public health benefit to knowing the virus’ origins but said the knowledge won’t change how the world was disrupted.

“Some people may say that it’s important for accountability or reparations of some sort, but, for me, it’s already happened, and it shouldn’t be an excuse for why we don’t need to continue to try to control this as a global community by the tools that we have,” he told ABC News.

He also said the real focus should be learning lessons from the COVID-19 pandemic so we can be better prepared to respond to future epidemics and pandemics.

“You have to be open to the possibility of either situation, but it shouldn’t take away from what do we have to do now, which is the continue to make sure that everyone’s protected, not only from this, but from future outbreaks and pandemics,” Chin-Hong said.

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(ST. LOUIS) — For over nine months, Delayne Ivanowski of Kirkwood, Missouri, kept a secret from her dad that ended up saving his life.

Delayne Ivanowski, a 25-year-old nurse at Mercy Hospital in St. Louis, donated her kidney to her dad John Ivanowski, who told his daughter for months that he did not want her to be his donor.

“I told her, I’m not taking your kidney,'” John Ivanowski, 60, told ABC News. “I told her that flat out.”

John Ivanowski was diagnosed two years ago with IgA nephropathy, a type of kidney disease that can lead to kidney failure, according to the National Institutes of Health.

The disease ultimately led John Ivanowski to be on dialysis for four to five hours, four days a week, a quality of life that his daughter said was not right for him.

“He likes to walk my dog and run with my dog and he wants to do all this stuff, but now he’s hooked up to a machine,” she told ABC News. “I don’t think that’s any way that anybody should have to live.”

Delayne Ivanowski said while her dad on dialysis, she made the decision to try to donate her kidney to him, despite his opposition. She said she knew that without her becoming a living donor for her dad, he could wait years to find a donor.

“I was like, ‘I’m going to do it. I don’t care how mad he is at me. I don’t care if he kicks me out of the house or hates me or doesn’t say a word to me for the rest of my life,'” she said. “At least he’ll be living a good life and not hooked up to a machine.”

Without Delayne Ivanowski’s intervention to donate her own kidney, John Ivanowski could have remained on the transplant waiting list for several years, according to his doctor, Dr. Jason Wellen, kidney and pancreas transplant surgical director at the Washington University & Barnes-Jewish Transplant Center.

“There are over 100,000 people in the country right now waiting for a kidney transplant,” Wellen told ABC News. “The one way we can get people transplanted within a few months is if they come to us with a living donor.”

Wellen added that, as a father of three, he understood John Ivanowski’s concern for his own daughter, but said living donors face no additional medical risks.

“We spend a tremendous amount of energy and resources and effort to work on every person that comes forward as a living donor,” he said. “To the point that we feel extremely comfortable knowing that if we approve for them donation, that they’ll have no higher risk for the rest of their life of renal failure or any other medical issues.”

John Ivanowski said his opposition to his daughter donating one of her kidneys to him came from not wanting anything to happen to her, now or in the future. He said he was especially concerned after losing his son, Delayne Ivanowski’s only sibling, to neuroblastoma, a type of cancer, nearly 16 years ago.

“I thought, I lost my boy and if anything happened to Delayne, I don’t know what I would do,” he said. “It was a big concern.”

Knowing her dad’s opposition and concerns, Delayne Ivanowski went through the months-long process of getting approved to be her dad’s kidney donor in secret, even while living at home with him and her mom.

The secret mission, she said, included dozens of phone calls with social workers, doctors and nurses out of hearing range of her dad, as well as undergoing blood work and countless medical tests, often at the same clinic as her dad, all without him knowing.

John Ivanowski said he had no idea what his daughter was up to, but does remember getting the life-changing phone call last August that the transplant team had found him a donor.

“They called me at work and said, ‘We’ve got an anonymous donor,’ and I about dropped the phone and thought are you kidding me?,” he recalled. “People can be on the [kidney waiting] list for five, six, seven, eight years and go through dialysis for that long, and I just couldn’t believe it.”

On the day of the transplant, Feb. 16, the team at Washington University & Barnes-Jewish Transplant Center took special precautions to make sure John Ivanowski would not see his daughter, according to Wellen.

“We had to figure out how to put them in separate areas of the pre-op area and how to make it so they didn’t see each other in the post-op area and make sure that they were in different parts of the floor until she was ready to let him know that she was the donor,” Wellen said. “It took a lot of teamwork and effort behind-the-scenes to respect her request to make sure that he didn’t know it was her.”

After a successful transplant surgery, during which the father and daughter were in side-by-side operating rooms, Delayne Ivanowski and her dad recovered in rooms just steps away from each other on the same floor.

The day after the surgery, John Ivanowski learned his anonymous donor was his daughter when she walked into his room wearing a hospital gown.

“I knew right away,” he said. “I was upset. I was just in shock. I looked at my wife and was like, ‘Are you kidding me?'”

A video Delayne Ivanowski posted of the moment she walked into her dad’s room has gone viral on TikTok, garnering hundreds of thousands of views.

John Ivanowski — who will be on anti-rejection medication for the rest of his life, but no longer needs dialysis — said the shock and anger have since subsided, saying, “I wouldn’t change a thing. I feel so much better.”

Delayne Ivanowski, who should have no lasting side effects or complications from the transplant, said she also wouldn’t change anything about the way she helped her dad, saying, “I’m not good at being told no.”

She said she hopes her family’s story helps raise awareness of the need for organ donation. Over 104,000 people are currently on the waiting list in the United States for a lifesaving organ transplant, according to UNOS.

“If anything, I’ve saved one life and hopefully I can, with awareness and other things, save other lives by encouraging people to become donors or to take that next step and go get the testing done to become a match,” said Delayne Ivanowski. “It hurts, but all the pain is worth it in the end, I think.”

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(NEW YORK) — Zero-calorie sweetener erythritol, widely used in sugar replacement or reduced-sugar products, has been linked to an increased risk of cardiovascular events including heart attacks and strokes for older adults consuming high amounts and already at risk of heart disease, according to a new study published Monday.

The study first published in Nature Medicine, discovered that higher levels of erythritol were found among patients who experienced a major adverse cardiovascular event, which includes stroke, heart attack, blood clots and cardiovascular death, over three years of observation.

Researchers caution that more research is needed. It’s too early to definitively say that erythritol causes problems for people who consume it regularly, especially as the study’s results may not be generalizable to everyone.

Erythritol is a sugar alcohol that is naturally found in fruits such as watermelons, pears and grapes, but has since been processed as a food additive used to sweeten and enhance the flavor of foods, according to the U.S. Food and Drug Administration (FDA.)

The total U.S. population’s daily intake of erythritol has been estimated to reach up to 30 grams per day in some participants, according to data from a National Health and Nutrition Examination Survey filed by the FDA.

Due to a growing obesity epidemic worldwide, artificial sweeteners are becoming increasingly common ingredients found in soft drinks, “diet” foods and other processed products. Although federal regulatory agencies like the FDA have deemed most artificial sweeteners as safe, little is known about the long-term health effects.

Sweeteners without erythritol

The average U.S. adult, teenager and child consumes nearly 17 teaspoons, or 270 calories worth, of added sugar a day, according to a Harvard report.

Dietitian Anna Taylor spoke to the Cleveland Clinic and listed fresh or frozen fruit as the healthiest way to sweeten food or drinks.

Taylor also suggests looking for other sugar substitutes like Stevia-based sweeteners that are herbal as opposed to artificial. However, the study warns that erythritol is often combined with other sugar substitutes to help add bulk to the sweeteners.

Natural sugars like raw honey, maple syrup, agave nectar and raw sugar provide more nutrients than table sugar, including antioxidants, vitamins and prebiotic gut bacteria, but there are often hidden ingredients like high-fructose corn syrup, which has been linked to long-term metabolic complications, according to Taylor.

Overall, the healthiest sweetener to use is no sweetener at all. The American Heart Association recommends drastically lowering added sugar in a daily diet to help slow the risk of obesity and heart disease and to focus on more whole foods like a wide variety of fruits and vegetables.

Taylor suggests breaking the sugar habit by weaning off sweeteners in everyday snacks and foods or substituting sweetened foods for other options.

“That’s true whether it’s in soda, sweet tea, fruit drinks, packs of sugar or sugar substitute for coffee or tea, or artificially sweetened flavor packets for water,” Taylor said to the Cleveland Clinic. “Drink plain water! At the very least, drink unflavored tea, coffee, bubbly water or water with fruit infused in it.”

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(WASHINGTON) — While no firm conclusion has yet been made among health and government officials as to where COVID-19 came from, the U.S. Energy Department has now reportedly indicated it believes the virus was most likely the result of a lab leak in China — one of two prevailing theories under investigation along with natural human exposure to an infected animal.

The view of the Energy Department, which oversees a network of national labs, some which conduct bioresearch, was reported Sunday by The Wall Street Journal based on a classified intelligence report but has not been confirmed by ABC News.

People who read the report said the assessment was made with “low confidence,” according to the Journal, referring to the lowest of three confidence intervals in the intelligence community.

It’s the latest development in the ongoing work, in the U.S. and internationally, to determine where COVID-19 came from: to both trace back the virus in order to hold any responsible parties to account and to understand its inception in order to prevent the next pandemic.

But with no “smoking gun” and limited access to raw data, discussion of the science has played out in a haze of circumstantial evidence.

At the same time, the virus’ origins have become a contentious wedge issue at home while the Chinese government vehemently denies COVID-19 could have come from one of its labs in Wuhan.

A spokesperson for the Energy Department did not comment Sunday on the Journal’s new article but said in a statement to ABC News that the department “continues to support the thorough, careful, and objective work of our intelligence professionals in investigating the origins of COVID-19, as the President directed.”

A spokesperson for the House Oversight Committee said in their own brief statement that the Office of the Director of National Intelligence had “provided a response to Oversight Committee Chairman James Comer and Select Subcommittee Chairman Brad Wenstrup’s February 13th letter requesting information about the origins of COVID-19 and we are reviewing the classified information provided.”

The White House’s national security adviser, Jake Sullivan, said in an appearance on CNN on Sunday that he could not confirm or deny the Journal report but that “right now there is not a definitive answer” from the intelligence community on where COVID-19 started.

“Some elements of the intelligence community have reached conclusions on one side, some on the other. A number of them have said they just don’t have enough information to be sure,” Sullivan said. “Here’s what I can tell you. President [Joe] Biden has directed, repeatedly, every element of our intelligence community to put effort and resources behind getting to the bottom of this question.”

“If we gain any further insight or information, we will share it with Congress, and we will share it with the American people,” Sullivan said.

The White House declined on Sunday to say if Biden had been briefed on the Energy Department’s view, referring to Sullivan’s comments.

In 2021, the president launched a 90-day push for the U.S. intelligence community to “redouble their efforts” to find a more definitive conclusion regarding the source of the virus.

In a declassified summary of that work, released in August 2021, U.S. intelligence agencies said they remained “divided on the most likely origins of COVID-19” but that the two key hypotheses remain possible: either natural exposure to an infected animal or an accidental lab leak.

Consensus among top officials in the Biden administration has similarly been that the pandemic originated in one of those ways.

Four elements of the U.S. intelligence community said in 2021 that they had “low confidence” COVID-19 was initially spread from an animal to a human, while one element assessed with “moderate confidence” that the first human infection was the result of a “laboratory-associated incident, probably involving experimentation, animal handling, or sampling by the Wuhan Institute of Virology,” and pointing to the “inherently risky nature of work on Coronaviruses.”

The agencies, however, generally agreed that the virus was most likely not developed as a biological weapon and that China’s leaders did not know about the virus before the start of the global pandemic.

This analysis marked something of an evolution from the earliest prevailing view after the pandemic began in early 2020 when, despite some fringe skepticism — often emanating from voices with a long record of criticizing China — the idea that COVID-19 jumped from animal to human somewhere in nature became the overwhelming consensus.

Political voices in favor of the lab-leak theory, particularly from former President Donald Trump, served to polarize the issue further and largely pushed the scientific community away from a willingness to consider that possibility.

The U.S. intelligence agencies said in their 2021 summary that baring new information, a more definitive explanation would not be possible without Beijing’s cooperation.

“Origins tracing is a matter of science,” Chinese Foreign Ministry Spokesperson Zhao Lijian said following the report’s release. “China always supports and will continue to participate in the science-based origins study.”

A joint World Health Organization-led team had presented a range of options in its own March 2021 report, calling a lab leak “extremely unlikely” but offering pathways for further investigation.

Team members voiced frustration with the lack of cooperation from the Chinese government — echoed in international criticism that politics had stymied science.

Since then, the WHO has become increasingly receptive to the possibility that the virus resulted from a lab leak. In July 2021, WHO Director-General Tedros Adhanom Ghebreyesus acknowledged that ruling out a lab leak theory was “premature” and recommended audits of the Wuhan labs in further studies.

China’s subsequent rebuff left the WHO to proceed without them as part of the U.N. agency’s recommended phase two study.

ABC News’ Will Steakin contributed to this report.

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(NEW YORK) — Growing rates of obesity are contributing to more heart disease risks during and after pregnancy, experts warn.

People with obesity are more at risk of potentially lethal pregnancy complications like diabetes, hypertension, and pre-eclampsia. Those conditions increase the risk of heart disease and stroke, according to a recent report from the American Heart Association — a major concern, because heart disease is already the leading cause of pregnancy-related deaths.

“When comparing heart disease and poor pregnancy outcomes in women, we notice that obesity is a link,” Dr. Sadiya Khan, lead author of the paper and assistant professor of medicine at Northwestern University Feinberg School of Medicine, told ABC News.

Obesity is an inflammatory condition that can damage blood vessels and make cells resistant to insulin, experts say. This ultimately contributes to the development of diseases like high blood pressure, high cholesterol and diabetes.

Obesity mixed with the expected hormonal changes during pregnancy, creates a perfect storm that can be detrimental to the pregnant person and baby, Khan says. The combination of changes from obesity and changes from pregnancy can lead to gestational diabetes, for example, she says.

Obesity is also linked to abnormal development of the placenta, research shows. That can increase the risk of pre-eclampsia, a complication characterized by high blood pressure and organ damage.

Regardless of weight, high blood pressure or diabetes during pregnancy can go away after delivery. However, people who had those conditions during pregnancy still have a higher chance of getting heart disease in their lifetime, research shows.

One study, published earlier this month, found pregnant people who had high blood pressure, diabetes, pre-eclampsia, a premature birth, or delivered a small baby were at risk of developing heart disease up to 46 years after delivery.

“There are two potential reasons that these complications during pregnancy cause heart disease long term, ” Khan said. “Either the complication itself directly induces heart disease, or the complication is a reflection of someone’s underlying risk.”

Not everyone is equally at risk. Black women have a disproportionate risk of complications during pregnancy, like preeclampsia. Black women also have significantly higher rates of pregnancy-related death than white women in the United States, according to data from the Centers for Disease Control and Prevention.

“There is a growing awareness of the black maternal mortality crisis,” Dr. Natalie Bello, Director of Hypertension research at the Smidt Heart Institute at Cedars-Sinai Medical Center and Co-Chair of the American College of Cardiology Reproductive and Cardio-Obstetrics Section, told ABC News. “We need to address the issues surrounding social and systemic barriers these women are faced with.”

Screening and treating people for cardiac complications during pregnancy — whether they have obesity or not — can help reduce long-term risks, Bello says. In addition, anyone who has a complication during pregnancy should be monitored for heart disease, she says.

“Pregnancy may be the only time someone gets medical care,” Bello said. “At that point they may not realize they carry a large risk, like obesity, for heart disease and complications during their pregnancy, so it is best to be screened early on in life to protect them during pregnancy and across the lifespan for their and their family’s heart health.”

With heart disease being the leading cause of death in women year after year, experts agree that lifestyle intervention during their entire life course needs to be the main driver to help reduce these unfavorable statistics.

“Blood pressure screening, a healthy weight, good sleep hygiene, are some examples someone can take to assure they are at a good place in regards to their heart health,” Bello said. “The next steps would be to check how to maintain these healthy parameters so they can go into their pregnancy heart healthy for themselves and their baby.”

Lily Nedda Dastmalchi, D.O., M.A., is a cardiology fellow at Temple University Hospital and a contributor to the ABC News Medical Unit.

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(ATLANTA) — The Centers for Disease Control and Prevention issued a health advisory Friday about an increase in an antibiotic-resistant strain of the Shigella bacteria.

Shigella is highly infectious and causes around 450,000 infections in the U.S. every year, according to the CDC.

Shigella is transmitted in several ways, including changing the diaper of a sick infant, by getting the bacteria on your hands and then touching your mouth, through sexual contact or by contaminated food and water, the CDC said in its advisory.

Usually, people recover without treatment, but those with severe cases or with underlying conditions that weaken the immune system may need to be treated with antibiotics.

The bacteria is easily transmissible and there are few antimicrobial treatment options for medical staff treating patients with the drug-resistant XDR strain of Shigella, according to the CDC, which prompted the warning.

The agency has asked health care professionals to be alert about suspecting and reporting cases of the XDR variant of Shigella to local and state health departments “given these potentially serious public health concerns.”

Last year, 5% of Shigella infections reported to the CDC were caused by the XDR strain of the bacteria. In 2015, there weren’t any infections from the XDR strain reported to the public health agency.

The increase in antimicrobial-resistant Shigella infections is primarily among men who have sex with men, people experiencing homelessness, international travelers and people living with HIV, the CDC reported.

The CDC said that health care staff should also educate their patients and communities who are most at risk of infection about prevention and how it is spread.

ABC News’ Sasha Pezenik contributed to this report.

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(NEW YORK) — Britney Alba remembers the day she and her husband, Frankie Alba, received the news they were expecting twins. It had only been six months since they had welcomed their twin sons.

“Frankie and I were not trying but it just happened. We just found out we were pregnant … so we go and get our ultrasound,” the mom of four recalled to ABC News’ Good Morning America. “And Frankie was like, ‘Are you sure it’s not two?’ He was joking around and [the ultrasound technician] was like, ‘Let me check one more time.’ And she checked again and sure enough, there was a second heartbeat.”

“I was definitely in shock,” Frankie Alba, 25, recalled. “But I was excited at the same time. They’re definitely a blessing.”

The Albas said twins don’t run in either of their families and for them to expect twins twice was astonishing.

“I would have never guessed in a million years that I would have one set of twins, much less a second set,” Britney Alba, 27, added. “So we were super excited. Super excited. But it was like a laughing-and-crying-at-the-same-time moment.”

The Albas’ first set of twins — Luka and Levi — were monochorionic-diamniotic (MoDi) identical twins, meaning they shared the same placenta but separate amniotic sacs. But their second set of twins — Lydia and Lynlee — turned out to be monoamniotic-monochorionic (MoMo) identical twins. The girls ended up sharing both the same placenta and amniotic sac.

“It was already rare for there to be identical twins back to back, but particularly just my twins because MoMo twins make up 1% of all twin pregnancies. It’s very rare,” Britney Alba said of what her doctors told them. “So just their pregnancy alone was rare. But then to have identical twin brothers right before them made it even more rare, so definitely a unique situation.”

There is not much research data available on the rarity of such twin pregnancies, but one Journal of Perinatology study estimates MoMo twin pregnancies happen once out of every 10,000 pregnancies, while another comparative study estimates MoDi twin pregnancies occur in 0.3% of all pregnancies.

In addition to being rare, a MoMo twin pregnancy is considered high risk. Having to share the same placenta and amniotic sac increases the risk for problems with blood flow to each twin and increases the risk that the umbilical cords could become entangled. Britney Alba was admitted to the University of Alabama at Birmingham Women and Infants Center at 25 weeks and spent over 50 days there before the girls were delivered.

The Albas welcomed Lydia and Lynlee in Oct. 25, 2022 and the newborn girls spent their first six weeks in the neonatal intensive care unit under the care of nurses and doctors.

They were able to go home to Tuscaloosa, Alabama, for the first time on Dec. 7, according to the Albas, and today, the family of six is settling into what they call their “new normal.”

“It is nonstop, fast paced, but we love it,” Britney Alba said. “The boys are great with the girls. Their main focus is just to play and have fun but when they do see the girls and they’re around them, they’re very sweet. They have gentle hands, sweet hands. And they’re just really good around their sisters.”

Both Albas say they feel “extremely blessed” and “extremely grateful” for their family.

“Even on those nights where we feel like we want to pull our hair out, and none of our children want to sleep, we just have to remind ourselves how lucky and how blessed we are to be able to have these children,” Britney Alba said.

“Life has definitely changed dramatically and very quickly but it’s a huge blessing for us and we are just looking forward to what the future holds with these babies because they’re special,” Frankie Alba added. “We can’t see life without our babies.”

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(WASHINGTON) — While no firm conclusion has yet been made among health and government officials as to where COVID-19 came from, the U.S. Energy Department has now reportedly indicated it believes the virus was most likely the result of a lab leak in China — one of two prevailing theories under investigation along with natural human exposure to an infected animal.

The view of the Energy Department, which oversees a network of national labs, some which conduct bioresearch, was reported Sunday by The Wall Street Journal based on a classified intelligence report but has not been confirmed by ABC News.

People who read the report said the assessment was made with “low confidence,” according to the Journal, referring to the lowest of three confidence intervals in the intelligence community.

It’s the latest development in the ongoing work, in the U.S. and internationally, to determine where COVID-19 came from: to both trace back the virus in order to hold any responsible parties to account and to understand its inception in order to prevent the next pandemic.

But with no “smoking gun” and limited access to raw data, discussion of the science has played out in a haze of circumstantial evidence.

At the same time, the virus’ origins have become a contentious wedge issue at home while the Chinese government vehemently denies COVID-19 could have come from one of its labs in Wuhan.

A spokesperson for the Energy Department did not comment Sunday on the Journal’s new article but said in a statement to ABC News that the department “continues to support the thorough, careful, and objective work of our intelligence professionals in investigating the origins of COVID-19, as the President directed.”

A spokesperson for the House Oversight Committee said in their own brief statement that the Office of the Director of National Intelligence had “provided a response to Oversight Committee Chairman James Comer and Select Subcommittee Chairman Brad Wenstrup’s February 13th letter requesting information about the origins of COVID-19 and we are reviewing the classified information provided.”

The White House’s national security adviser, Jake Sullivan, said in an appearance on CNN on Sunday that he could not confirm or deny the Journal report but that “right now there is not a definitive answer” from the intelligence community on where COVID-19 started.

“Some elements of the intelligence community have reached conclusions on one side, some on the other. A number of them have said they just don’t have enough information to be sure,” Sullivan said. “Here’s what I can tell you. President [Joe] Biden has directed, repeatedly, every element of our intelligence community to put effort and resources behind getting to the bottom of this question.”

“If we gain any further insight or information, we will share it with Congress, and we will share it with the American people,” Sullivan said.

The White House declined on Sunday to say if Biden had been briefed on the Energy Department’s view, referring to Sullivan’s comments.

In 2021, the president launched a 90-day push for the U.S. intelligence community to “redouble their efforts” to find a more definitive conclusion regarding the source of the virus.

In a declassified summary of that work, released in August 2021, U.S. intelligence agencies said they remained “divided on the most likely origins of COVID-19” but that the two key hypotheses remain possible: either natural exposure to an infected animal or an accidental lab leak.

Consensus among top officials in the Biden administration has similarly been that the pandemic originated in one of those ways.

Four elements of the U.S. intelligence community said in 2021 that they had “low confidence” COVID-19 was initially spread from an animal to a human, while one element assessed with “moderate confidence” that the first human infection was the result of a “laboratory-associated incident, probably involving experimentation, animal handling, or sampling by the Wuhan Institute of Virology,” and pointing to the “inherently risky nature of work on Coronaviruses.”

The agencies, however, generally agreed that the virus was most likely not developed as a biological weapon and that China’s leaders did not know about the virus before the start of the global pandemic.

This analysis marked something of an evolution from the earliest prevailing view after the pandemic began in early 2020 when, despite some fringe skepticism — often emanating from voices with a long record of criticizing China — the idea that COVID-19 jumped from animal to human somewhere in nature became the overwhelming consensus.

Political voices in favor of the lab-leak theory, particularly from former President Donald Trump, served to polarize the issue further and largely pushed the scientific community away from a willingness to consider that possibility.

The U.S. intelligence agencies said in their 2021 summary that baring new information, a more definitive explanation would not be possible without Beijing’s cooperation.

“Origins tracing is a matter of science,” Chinese Foreign Ministry Spokesperson Zhao Lijian said following the report’s release. “China always supports and will continue to participate in the science-based origins study.”

A joint World Health Organization-led team had presented a range of options in its own March 2021 report, calling a lab leak “extremely unlikely” but offering pathways for further investigation.

Team members voiced frustration with the lack of cooperation from the Chinese government — echoed in international criticism that politics had stymied science.

Since then, the WHO has become increasingly receptive to the possibility that the virus resulted from a lab leak. In July 2021, WHO Director-General Tedros Adhanom Ghebreyesus acknowledged that ruling out a lab leak theory was “premature” and recommended audits of the Wuhan labs in further studies.

China’s subsequent rebuff left the WHO to proceed without them as part of the U.N. agency’s recommended phase two study.

ABC News’ Will Steakin contributed to this report.

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(COLUMBUS, Ohio) — The measles outbreak in central Ohio that left 85 children infected has officially been declared over, Columbus Public Health announced Thursday.

“CPH has received the last pending test result, which was negative for suspected measles cases,” the agency tweeted. “We have surpassed 42 days, or two incubation periods, since the last rash onset, which fits the CDC’s definition of the end of an outbreak.”

According to data from CPH, no cases have been recorded since Dec. 24.

Over the course of the outbreak, which began in November 2022 and was seen across several schools and day cares, 80 of the 85 children infected were unvaccinated.

Four had received at least one dose of the MMR (measles, mumps, rubella) vaccine and one patient had an unknown vaccination status.

An overwhelming majority, or 65%, of cases occurred among children between ages 1 and 5 with children under age 1 being the next most affected group.

In total, 36 children were hospitalized, but none of the sickened children died.

“We did have several children that required intensive care,” Kelli Newman, communications director at CPH, told ABC News. “Most cases that were hospitalized were due to dehydration, which is common in young children like that.”

Measles is a very contagious disease with the Centers for Disease Control and Prevention saying every individual infected by the virus can spread it to up to 10 close contacts, if they are unprotected including not wearing a mask or not being vaccinated.

Complications from measles can be relatively benign, like rashes, or they can be much more severe, like viral sepsis, pneumonia or brain swelling.

The CDC says anybody who either had measles at some point in their life or who has received two doses of the MMR vaccine is protected against measles.

In the decade before the measles vaccine became available, an estimated three to four million people were infected every year, 48,000 were hospitalized and between 400 and 500 people died, according to the federal health agency.

One dose of the measles vaccine is 93% effective at preventing infection if exposed to the virus. Two doses are 97% effective.

Children are recommended to receive their first dose between 12 and 15 months old and their second dose between ages 4 and 6.

According to a report from the CDC published in January, during the 2021-22 school year, 88.3% of kindergartners in Ohio had received two doses of the MMR vaccine, less than the national average of 93%.

“I think this is kind of a wake up call for all of us,” Newman said. “While this outbreak is behind us, and we’re grateful for that, we know that the next outbreak could just be one missed vaccine away.”

Newman said CPH spent a great deal on the ground working with community partners and pediatricians to get the MMR vaccine out into the community, as well as educate on the importance of vaccination, in response to the outbreak. This included setting up special vaccine clinics and having pediatricians call parents whose children were behind the schedule to remind them to bring them in for their second shot.

In 2000, measles was declared eradicated from the U.S. thanks to the highly effective vaccination campaign.

However, last November, a joint report from the CDC and the World Health Organization declared measles to be an “imminent threat” around the world.

The report found that in 2021, nearly 40 million children — a record-high — missed a dose of the measles vaccine. Specifically, 25 million missed their first dose and 14.7 million missed their second dose.

The authors stated much of the progress that was made in beating back the disease was lost due to the COVID-19 pandemic.

In the U.S., a May 2022 study found one-third of American parents reported a child with a missed vaccination due to barriers imposed by the COVID-19 pandemic.

Newman said that many parents of the unvaccinated children infected with measles had chosen not to have their kids receive the MMR shot due misconceptions that it causes autism, a theory that has been widely debunked across the scientific community.

“Many of these kids were vaccinated for everything, but MMR because there was a lingering misconception that it caused autism,” Newman said. “That’s what we heard in feedback when we worked with parents during the case investigation and so that was something we had to provide a lot of education and engagement around, and we’re continuing to do that.”

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