Press Briefing Transcripts

Media Availability on CDC Investigation of Human Cases of Swine Influenza

April 25, 2009, 1 p.m. EST

Glen Nowak: Thanks to all of the folks who have dialed into today to this media availability on CDC investigation of human cases of swine influenza. I’m Glen Nowak, director of media relations for the CDC. One of the things I want to note for people, sometimes people may wonder why we don′t start these things at the anointed hour. One of the reasons we don′t is that it takes a while to get everybody into the phone queue. For instance on this call, as with the last couple of calls, we′ve had several hundred people dialing in. It takes about 10 to 15 minutes and no matter what time we set this for, we would be starting 10, 15 minutes after the point of the hour. So, the explanation for why we′re sometimes, we′re often 10 minutes to 15 minutes starting after our announced hour. Today, I have with me, Dr. Anne Schuchat. S-C-H-U-C-H-A-T. Dr. Schuchat is the interim deputy director for science and public health program here at the Centers for Disease Control and Prevention. And she′s joined by Dr. Daniel Jernigan. J-E-R-N-I-G-A-N. Dr. Jernigan is deputy director of the influenza division. I′ll turn it over to Dr. Schuchat. We′ll primarily take questions from the media today.

Anne: Thank you so much for joining us on this call. I hope we will be able to help you in providing you with information. I want to start byconfirming the general concern. We′re worried and we′re acting aggressively on a number of fronts so you don′t have to worry. Our goal here is to address new questions. There′s not a lot new from yesterday to report, but I want to go over some of the information from yesterday so we′re on the same page and be available to clarify things. At present, there are still eight confirmed human cases of swine influenza in the United States. And, there is a serious situation in Mexico. With severe disease and a number of confirmed swine influenza infections among -- generally among adults in parts of Mexico.

These are very dynamic times. And many things will be changing and as you all know from seasonal influenza and from influenza in general, it′s very hard to predict exactly the next step. We need to all be prepared for change and be prepared for what we tell you has been updated, and some of our interim recommendations may change as we get new information. We′re committed to sharing information as we get it and help you keep the public informed.
There are a number of state and local investigations that are going on as we have heightened attention to this concern around the country. The public health and clinical communities have really rallied and looking into a number of possible issues. We don’t have confirmation of new lab confirmed cases from any of those investigations. We work closely with the state and local health departments. But we really appreciate the hard work they′re doing. Typically, they will investigate, use their own state laboratories to evaluate possible cases and CDC is available for confirming suspicious isolates they may have.  So there will be lots of changes and reports from communities. We′ll need to stay connected.

Today, I can tell you that we have teams that are helping in southern California and the California health department. And we do have CDC experts that have arrived in Mexico to help with that investigation as part of the global community. We′re working closely with Mexico and Canada as well as the World Health Organization and our international partners around the world. At this point, we’re really actively looking for new infections in the United States and supporting the state public health systems in detection. We have issued some new information and I encourage everybody to look on our website. Information available around infection control, how to help interrupt -- how to help protect health care workers or how to handle specimens that are being collected. Our website is www.cdc.gov/swineflu. It′s a new site that′s easier to navigate for those of you looking yesterday.

As we mentioned yesterday, there′s an outbreak notice for Mexico. This doesn′t mean travel restrictions or that you can′t go to Mexico. We’d like people who are traveling to Mexico to be aware that there is an outbreak ongoing, and that information is changing, and to take the precautions they would take normally.
A few other key points, many of the actions that you see in your communities or that you hear us talking about are really taken with an abundance of caution. We′re trying to take action early before things get worse. And so, you′ll see a lot going on and it may be different in one community than another because circumstances can differ, and sometimes we can actually learn from those differences. Just to stay tuned to the likelihood that you won′t see exactly the same thing unfolding in different places. I do want to stress a couple of points. We′re very fortunate so far, here in the United States, all of the cases that we are aware of that are confirmed to be swine influenza have been mild. Only one of the eight was hospitalized. That can change. That may change. Of course, we′re concerned about the situation in Mexico, where much more severe disease has been seen. So far, we have been quite fortunate. We want you to know that it′s time to prepare and time to think ahead and really time be ready for some uncertainty and know that the public health and the clinical communities are working hard on this and working together across country lines. I think that – those are probably the key things that I want to communicate. Because I know you have a lot of specific questions. So I think we can probably go to the line for questions.

Glen Nowak: Operator, We′ll take the first question.

Operator: Our first question is from Maggie Fox, Reuters, your line is open.

Maggie Fox: Good morning. I wanted to ask where you′re specifically doing some active investigations. There’s all sorts of reports of supposed clusters of flu?  Can you give me an idea of where there are specific cases you are looking at within the U.S. and Mexico?

Anne Schuchat: Thank you for that question. You know, the way things work for an outbreak in general, including this one, is that state and local public health has the lead on investigating and responding to rumors and concerns and working them up in a typical way. Figuring out what the illness is, has there been spread. Are there laboratory characteristics that would suggest this is caused by this new virus that we’re concerned about.  CDC does not actually do these investigations.  We provide technical assistance, and upon invitation, we may assist. As of now, the California health department has asked for our assistance and we′re helping support the county and state health departments in southern California. Texas has asked for our assistance and the Mexican government has asked for W.H.O. for assistance as a part of that team. So we don’t have a lead in those investigations, we’re really part of a team. And what I can say is that routine public health does this kind of thing all the time. Of course, our alert is much higher right now, but when there′s a cluster of respiratory illness in a special population, public health will be looking into that. That′s why public health is there to a great extent. And fortunately, the public health laboratories throughout the country, have been trained specially for unusual kinds of influenza really based on that bird flu situation, the H5N1 situation (Editor’s Note: This is a correction). We’re fortunate now that we do have public health laboratories able to type influenza and recognize that something is new and that it needs to be forwarded on to us. So, a long answer, but we’re not basically the lead on investigations right now.

Glen Nowak: Thank you, next question.

Operator: Next question is from Carmen Alvarez, Newspaper Excelsior. Your line is open.

Carmen Alvarez: Hello, good afternoon. I would like to ask you in October 20, 2008, there was an information to date, compliments of the U.S., discovering in 1997 of virulent H5N1 strain of avian influenza in the U.S. and the need to implement the so-called Stafford Act to face this problem -- in this specific case of the word of Mexico and the U.S. source, told me that the next step would be the introduction of the Homeland Security Department to face the crisis. I wonder what investigations do you have on these H5N1 virulent strain and two, please what would follow, what work would follow with the homeland department of security and three, what is the update that you have about  a teleconference took place a few minutes ago between Mexico and Switzerland, because we have the president of Mexico, the director of the World Health Organization, Ms. Margaret Chan in Mexico City, taking action in Mexico.

Anne Schuchat: Thank you. Let me clarify a few points.  The H5N1 influenza virus that you were speaking of, many people call that bird flu. That′s the virus that since 1997 (Editor’s Note: This is a correction) has been circulating in some bird populations and a much smaller number of people mainly in Asia. That′s not what we′re talking about here today in the United States or in Mexico. But, because of the H5N1 concern, many increased efforts were made to improve preparedness in the United States as well as around the world. We′re not talking about that particular influenza virus. We′re talking about a new virus; human infections with a new swine flu virus, a combination of a couple of different components of swine, human and bird influenza. The Department of Homeland Security does get involved when there are major emergencies that cross from health to other sectors of society. And, even in routine public health efforts, the Health and Human Services Department or public health often works quite closely with the Department of Homeland Security. We are working with them in regular contact.

In terms of Mexico and the World Health Organization, what I can say is that there are frequent communications right now between leaders in the health communities in Mexico and the U.S. and Canada. And of course, at the World Health Organization in Switzerland. And the World Health Organization has some special roles when it comes to public health emergencies and to the question of pandemic influenza and the W.H.O. has been taking, taking many measures to stay on top of things. When we make ourselves available for press inquiries at a certain time, as I mentioned before, there are a lot of things going on in a lot of places at the same time. What′s going on in Geneva I′m not prepared to report on. But I can tell you that I know the World Health Organization is in close contact with influenza experts and public health leaders in Mexico.  So, just to say that, when I say public health was on alert and engaged not only here in the U.S. but around the world.

Glen Nowak: Thank you, operator, we′ll take the next question.

Operator: Robert Bazell from NBC.  Your line is open.

Robert Bazell: Thank you very much. Two things, the World Health Organization. We all realize you don′t speak for the World Health Organization. It′s our understanding there was a decision just now, not to go into phase four in this, how does this not -- the definition of phase four, human transmission of a new virus and the other thing is, I think again it′s not your responsibility, the entire pandemic flu plan for the world called for isolation early on of a new virus, yet this seems to have gone on in Mexico at least a month before you guys even knew about it. How did that happen?

Glen Nowak: Thank you, Robert. I think I′ll have Dan Jernigan start to answer that question and maybe Anne can offer additional thoughts. Dan?

Daniel Jernigan: There′s a lot of factors that the folks at W.H.O. take into account when they are considering the phases. That activity is ongoing now. There is a committee of individuals that have been selected from various different countries and different backgrounds that inform the W.H.O., so that process is ongoing now. From our understanding there′s not been any changes in the phases. And so, is your question regarding that process?  Can you restate the question?

Bob Bazell: The question is, yeah, why hasn′t there been a change in the phase given by everything that′s written on paper this is a phase four now?

Daniel Jernigan: I think there′s an amount of time they need to be able to respond to that, the information, they want to look at how efficient the spread is from person to person and how sustained the transmission is. I think all of that information is just now being gathered. We look to them to take that information and translate it into changes. At this point, my understanding is they′re still evaluating that information.

Anne Schuchat: Let me add some comments. I think it′s easy to focus on the World Health Organization process and the state, the phases the W.H.O. might decide upon. But what′s really important for people to know, that we are preparing, that we are actively working and a change, from the W.H.O. perspective, whether they decide to do it or not, doesn′t really change our very forward leaning efforts, here, and in Mexico, and in other countries. People are actively looking for this virus and we′re taking steps to prepare for more serious concerns. We are testing the isolate very carefully and preparing it for vaccine production should that be necessary. We′re going through the efforts that might be needed. We′re really not trying to focus on the classification. I think the important thing is changes in the W.H.O. classification will signal a conclusion by an expert committee about how things are and how sure we are that things are at a different point, but then the public health response is quite aggressive right now in case things do continue to evolve in a serious way. Next question?

Operator: The next is from Helen Branswell, the Canadian press.  Your line is open.

Helen Branswell: I was hoping you could answer a couple of questions, one that follows up on Bob Bazell’s question just there. You know, it seems clear that public health authorities are taking this very seriously.  And people who follow the flu are taking it seriously. But I′m not convinced that it′s on the radar of a lot of other people. Dr. Schuchat, you said earlier that it′s time to prepare. Do you have concerns that message hasn′t gotten out just yet?  And I have a second question if I could ask it.

Anne Schuchat: Thank you for that question. I think it′s always a challenge to get messages out. One of the values of the media is to help us with our communication. You know, the situation is serious. We at CDC are worried. We′re in close contact with very high levels of leadership in the United States, in other countries, and at the World Health Organization. I think the fact that the W.H.O. committee was reviewing this issue suggests that people are taking this extremely seriously. What it means for everyone out there in America is a different story. So, I do think we have gotten the message to the leadership engaged in the important decision making that we have a very severe situation going on and that we all need to stay in regular contact.  But I think we also need to put this into perspective about people′s day-to-day lives. I think that we are succeeding in connecting with the public health and the public health community that this is a serious concern and they are, you know, I′m sure we have gotten the message out to them in terms of our very regular communications beyond those that go through the media.

Glen Nowak: Did you have another question?

Helen Branswell: What′s going on in Mexico and whether in fact there′s more severe disease there than so far has been evident in the American cases, or if something else is confusing the picture? That there may be other viruses and I’m not suggesting I’ve heard about other viruses -- I′m wondering if testing CDC has done or anything you have learned suggest that there′s something else out there?

Anne Schuchat: You know, that′s a very good question and one that we′re all asking here. What we know so far, is that severe disease is happening in Mexico and some cases of severe disease has been confirmed to be caused by a swine influenza virus. We also know that mild disease has been detected in the United States, a very small number, and that none – that the same virus appears to be causing this mild disease. We′re actively looking for severe disease here in the United States and we may find some. So far, we haven′t, but we may find some. In Mexico, they were looking for severe disease and they found some. They may not be looking as widely for the milder cases. But with respiratory infections we′re quite challenged because there are many many different causes of respiratory illness and they can look exactly the same. Lots of causes of mild disease and lots of causes of severe disease.  Lots of viruses and bacteria that can cause those illnesses, and not great tests for all of them. So, it can take some time to really put the whole story together. Many people are thinking about why does the pattern look different in the two places? It may look different because we don′t have good enough information. It may look different because the virus is different. It may look different because there is some other co-factor, or circumstance or environmental issue that’s driving a more severe circumstance in one place than elsewhere. We′re at a too early a stage to conclude on that. So what I would say is that’s why intensified investigations is going on in Mexico and why the U.S. public health and clinical community has really raised their alert. We′re looking at other pathogens in concert in Mexico and here in our cases here in the U.S. So I think we′re mindful to the idea that sometimes, infectious diseases don′t behave the way we think they are going to and influenza is notorious for that.

Glen Nowak: Thank you. Next question, operator?

Operator: The next question is from Betsy McKay, "The Wall Street Journal."  Your line is open.

Betsy McKay: Hi. Thanks very much. I wanted to ask a question related to W.H.O.’s communiqué from yesterday. They mentioned that the U.S. in addition to the confirmed cases is investigating nine suspect cases. I wonder if you could give us any information on these cases, and maybe as part of that, more broadly, can you tell us, given what you know about this virus and where it has been identified and its geographical diversity, how widely could it already have spread in terms of around the U.S. and in other countries?

Anne Schuchat: Thanks for those questions. We have a number of active -- excuse me, the public health community has a number of active investigations of suspect illness going on. The state and local health departments in conjuction with the clinical community will be looking at people who have respiratory illness, who travel to Mexico, or who have respiratory illness that′s suspicious and who have exposure to someone with a lab confirmed case of swine flu or somebody who′s been in one of these communities. There′s quite a lot going on. It takes some time for those cases to work through the system to figure out whether they′ll turn out to be confirmed or something else. I would say, it′s impossible to give a static figure for how many cases are under investigation. That′s why we′re focusing on the confirmed cases. But you asked a question about how widespread this might be? We have important information already about that. With definite lab confirmed cases in southern, California, in Texas and in a couple of different parts of Mexico, it′s clear that this is widespread and that is one reason why we have let you know, we don′t think we can contain the spread of this virus. If we found only swine flu -- a new influenza virus in one place, in a small community, we might be able to quench or contain it. But with infections in many different communities as we′re seeing, we don′t think that containment is feasible. On the other hand, that′s not surprising given what we know about seasonal influenza that really goes through many communities around the U.S. So, containment would be fantastic. But, we think there are many, many tools in our tool box to reduce the illness and the suffering that this virus is causing, and reduce transmission even if we’re not in a circumstance where we can contain it So, I think it′s important to know that we do think there′s, having found virus where we found it, we′re likely to find it in many other places. We′re hopeful, that so far the cases in the U.S. have been mild and we′re quite mindful that the situation in Mexico appears to be much different. So we’re really trying to prepare for those different contingencies.   But we do think we are not at a point where we can keep this virus in just one place.

Glen Nowak: Thank you. Operator, next question?

Operator: The next question is from Keith Darce,"San Diego Union Tribune."  Your line is open.

Keith Darce: Thanks for doing this call. There have been mentions of two things that I would like to ask about. First off, two days ago one of the patients here in San Diego county may have traveled to Mexico, prior to being sick, wonder if you can provide any information or details about when that travel occurred and which patient that is in terms of age and gender. Secondly, there also have been reports of possible cases being identified in Mexicali, which is a community just across the border of San Diego County. Can you also comment on that?  What sorts of cases have been identified?

Anne Schuchat: Yeah, you know, I think that San Diego county health department will be your best source on the specifics of the situation. As I understand it, the travel was rather remote. But as Dr. Besser mentioned yesterday, if we honed in on people who had traveled to Mexico, who live in San Diego, it′s almost everybody in San Diego that′s traveling to Mexico at one point or another. The other issue of Mexicali there′s a border infectious disease surveillance system, that’s a collaboration between the U.S. and Mexican governments and those states along the border.  And it’s in that system, that we have been looking at people with several respiratory illness and testing for flu. We have more regular seasonal influenza and as we mentioned to detect the first, the first -- we actually detected two confirmed cases through that border infectious disease surveillance system. So, we′re looking more actively in that area. In terms of Mexico in general, though, I would say that, efforts are just getting organized through the Mexican public health authorities to really implement a broader surveillance system. You know, they′re doing quite a bit in a very intense period. So, as I mentioned, a couple of days ago, you know, some of what we′re finding is really as a result of where we have been looking. Now we′re looking more widely, I suspect us to find more throughout the country. So, I think the key point there is, based on what we know so far, we do expect more cases and we expect them to occur in other communities.

Glen Nowak: Operator. Next question.

Operator: The next is from Sherene Abideen, CNN.  Your line is open.

Sherene Abideen: Thank you. Any thoughts on this seems to be more virulent in Mexico than in the U.S. for example, a matter of increased flu shot protection or about the age of the victims or perhaps, is there a second virus there? My second question is, has president Obama been briefed on the current situation as far as you all are aware? And I would like to ask you, if you can kind of put the transmissibility of this flu into perspective? Are we talking about something that is just like regular flu? Can you get it from a bus, can you get it from your waiter, or do you know yet?

Anne Schuchat: Thank you for those questions. The question about why the virus appears to be more virulent in Mexico, is one that we′re looking intensively into. Rather than speculate about reasons, I think it′s going to be important for science to lead us on this. So there will be some careful evaluations going on to explore a number of hypotheses. I hope we′ll find out the answer to that with better information and with careful evaluations. You asked about the transmissibility. That′s a key thing that we are looking at as part of the routine public health evaluations that are going on. Trying to understand when someone is ill with this, how does it spread. How many people might they infect? We remember with the SARS situation, we had a circumstance where certain people were able to infect a lot of other people and some people really didn’t trasmit too much. Influenza in general is quite transmissible. We′re looking in more detail – Public health is looking in more detail -- to understand the transmission properties of this particular virus. In terms of leadership briefings, I can tell you that public health is working both with federal, state and local levels and across different sectors beyond our public health zone in terms of making sure that leadership is appropriately informed. I think we are certainly working across the Department of Health and Human Services and working with our state and local partners, and I think that leadership is highly engaged. Next question, please.

Operator: The next is from Katie Beck, BBC. Your line is open.

Katie Beck: Hi. Thanks. I was wondering, do you have any more information on the situation at the St. Francis preparatory school in Queens, New York, where 25 students reported flu-like symptoms on Thursday and the New York health department was investigating?

Anne Schuchat: Thank you for that question. New York City has a fantastic health department. They′re actively investigating that school. I defer to the health department to share their findings of their investigation. I can say we are in close communication with the New York City health department. They′re doing as usual a fantastic job.

Operator: Joanne Silberner, NPR, your line is open.

Joanne Silbener: You mentioned that you′re working on isolates on possible vaccines. Can you tell us how long it would take to get the vaccines?

Anne Schuchat: The vaccine production is quite complex and has many steps. We′re taking the initial steps in terms of preparing the seed virus to hand off to the industry partners who produced large quantities. It does take months to produce a vaccine and it′s a very important step to take. The quality control measures and the preparation to gather the right virus isolates and prepare them through the quality control measures so they can scale up. It′s a many months process. When we find a new virus like this, we prepare vaccine candidates. It′s a question of readiness. Working closely with the FDA and with industry. Manufacturing capacity is at an all-time high right now because of the investments that the government has made over the past several years. As you know with the seasonal influenza we have been getting more and more vaccine available. There have been tremendous efforts to prepare both a regulatory production and the scientific communities so we would be able to scale up more rapidly than we used to. There′s a lot of progress on that front. Even with all that progress, we′re not going to have large amounts of vaccines tomorrow. We′re taking that very aggressive forward leaning posture to make sure we can produce a vaccine from this new virus if necessary. Next question.

Operator: David Brown, "Washington Post," your line is open.

David Brown: Thank you very much. There are some basic facts here have been very hard to get. Most important is the epidemic curve in Mexico. Is that -- the outbreak there ongoing, or is it over and they′re simply counting up the cases? If it′s ongoing, are the number of cases being -- is there a rising curve, is it a falling curve, when was the last onset of a fatal illness? Or do you not know the answer to those questions?

Anne Schuchat: Those are important questions. I would like to start by saying I don′t know the answer to those questions. And give you some understanding of why, even with teams and people working actively in Mexico, it may take some time to get those questions. The syndrome that we′re hearing about in Mexico is relatively nonspecific or general, severe pneumonia. There′s a lot of severe pneumonia that happens all the time, separate from an influenza, a new influenza virus. So, the ability to link viral testing with a clinical syndrome is necessary to really tease out what is the background. What are the trends in respiratory illness, pneumonia, or influenza like illness with what is new here. So, even if we do have many new viruses associated with respiratory illnesses they′ll be occurring on a backdrop of other routine baseline respiratory infections. Here in the U.S., we have been looking at our syndromic surveillance systems, to see if we′re seeing any blips in this background. We haven′t seen any such increases yet, but we’re looking carefully at that. I′m going to say it′s going to take some time for the epidemiologic investigation in Mexico to tell us whether things are escalating or over. I would say that we are operating under the assumption that there are ongoing concerns, that there are new infections that are worrisome, and I think that it would be wonderful if that’s not the case. But I think that′s what we should be assuming at this point.

Glen Nowak: Thank you. Next question.

Operator: The next question is from Mike Stobbe, Associated Press, your line is open.

Mike Stobbe: Thank you for taking a question. I have two questions. First, I was looking for an update on lab analysis that CDC had done. Yesterday, you said 14 samples tested from Mexico, 7 positive. Is that still the count? Of those that have been positive, any of those -- were any of those deaths? Part two of that question, you were looking at context family members of the eight people in the U.S., have some of those tests come back negative then?

Anne Schuchat: At this point, the only laboratory positives that we have from Mexico are those that we announced yesterday. The positives do include severe or fatal cases from Mexico. We continue to be doing investigations of contact, we haven′t identified additional laboratory positives from those. There are many investigations ongoing. In our laboratory. And we are prioritizing the testing that we do. So even, I wouldn′t say that you may not assume based on us not having results that -- we′re basically working actively, testing quite a bit and prioritizing the testing that will really change our planning for the most urgent assessments. We have continued to look at the viral characteristics. Based on what we have tested so far in terms of the genetic evaluation, the antigenic evaluation, the strains from Mexico and the United States are the same essentially. But there are additional ways to look at the viruses that are not completed. There are really, I would say frankly, there are phenomenal amount of first-rate laboratory testing going on to understand the situation.

Glen Nowak: This is Glen. To clarify a little bit: much if not all, the first-line testing is happening in state and local labs.

Anne Schuchat: Let me clarify, thank you, Glen. What the routine is, a person who′s being evaluated for influenza, will get a test carried out through their doctor or a healthcare setting, often in a clinic or hospital a test can be carried out, that can tell you rapidly whether this is flu or not and can tell you, A or B or negative. Test isolates can get forwarded to the public health lab where they can do more because we have provided them kits and training in order to do more. They can differentiate this new H5N1 bird flu virus that we’ve been talking about in Asia, they can look at the seasonal influenza strains and they can basically tell us if something is untypable with the test kits they have.  It’s those untypable strains that are influenza A, but untypable, that we’re concerned about.  And those are ones that get forwarded here. Many times when we get an untypable strain from a state health lab, it turns out to be typable in our experience. Sometimes we find something new, and that′s what happened with the swine flu cases. And so, the laboratories, the public health laboratories are testing a lot more right now, because we don′t test every single person with suspected influenza for any virus. Now that they are getting more tests, they′re running them, and when they find the untypables, they are forwarding them to us for confirmation.  There are a few of the laboratories that can do a little bit more themselves. But again, often, CDC is the confirmatory lab. This is really a partnership.  A lot of work happening in the state public health infrastructure and some of the bigger city public health infrastructure. So, next question.

Operator: The next is from Jon Cohen, Science Magazine.  Your line is open.

Jon Cohen: Thank you for taking my question. On that same theme, I want to return to something that Bob Bazell asked and get some more detail about the actual test. Bob asked why did you -- why did you wait until cases in the U.S. surfaced to ask Mexico for samples and following up on that, the test that you do at CDC as I understand it, depends on reagents that other people don′t have.  What are those reagents and why are they not distributed widely to Mexico and to state health departments and county health departments?

Anne Schuchat: You know, the CDC influenza laboratory is an international -- it′s a W.H.O. collaborating center. It′s one of four around the world. And we routinely receive specimens from many countries, including Mexico. So, we get specimens from Mexico all the time. We didn′t wait until we had a problem in the U.S. to ask Mexico to share isolates with us.  They share isolates routinely with us. The second question was about reagents. When you have a new virus, which is what we have here to the best of our understanding, reagents don′t exist and so, they need to be prepared based on the new virus. CDC has been preparing reagents based on this virus and its characteristics and those reagents can be then shared with state health departments. There are some technical things that make it difficult to share reagents.  I’m not sure if your question wants to get into that or if it was just why were we waiting until now. What I can say is, we already shared with the reagents that the public health system needed based on an FDA approval of a new kit. I′ll let Dr. Jernigan give you more details about the reagent situation.

Daniel Jernigan: The CDC actually creates or develops the reagents that are sent out to national influenza centers around the world to help characterize the seasonal influenza virus circulating every year.  Those are kits that we put together and send without cost to those laboratories. We also make other kinds of kits that are for the PCR testing, which is what I think you’re talking about. It′s a more complicated test to help detect the subtypes of influenza. Those kits we also send out around the world and also to about 140 laboratories in the United States. Once we identified this new swine H1N1, we actually fixed our test so it would better detect it. We’re now having those reagents made and we′ll send those out to those 140 participating laboratories. We′ll also make the sequence of those viruses, sort of, if you want to think of the recipe of how to make it, we’ll make that available to the laboratories so they can make these reagents themselves. If there′s any appearance that things are not available to people, I think it′s mainly because it′s a new virus. We′re making the reagents for it and it’s just a matter of time for us to get those out. But we anticipate it will be very soon that those reagents will be available.

Glen Nowak: We have time for two more questions.

Operator: Next question is from Mary Brophy Marcus, USA Today.  Your line is open.

Mary Brophy Marcus: I′m sorry I′m in a loud place right now. I hope you can hear me. As of today, you confirmed eight cases in the U.S. and I was just wondering if you can tell us how many specimens are waiting influenza typing this particular new strain at CDC labs right now.

Anne Schuchat: No, I can′t give you that number, sorry. We receive specimens all the time in large numbers and have gotten, you know, we have quite a few specimens that we′re looking into. Some as background seasonal flu and some for other purposes. Those numbers aren′t really available. I′m sorry.

Glen Nowak: Next question?

Operator: The next question is from Elizabeth Cohen, CNN, your line is open. Go ahead. Elizabeth Cohen, CNN. Please unmute your phone. The next question is from Jonel Aleccia, MSNBC. Your line is open.

Jonel Aleccia: Hi. Thanks very much for taking my question. I′m following up on what a couple of other people have said just to make sure I’m not missing the detail here. I understand that CDC has to be invited to help communities, but I′m wondering about the communities where you are watching very closely, possibly expecting an invitation to help. Can you give us an idea of possibly how many communities or specifically what those communities are in the U.S.?

Anne Schuchat: I would like to give you a bigger picture of our response effort. In this type of likely multistate scenario, we work in a supportive role, helping to provide guidance to all states and communities with regular phone calls and issuance of materials and directives and the state and the locals will be doing these active investigations. So I think this is probably, as we go forward over the next days or even weeks, I think it′s not going to be really a question of where is the CDC? I think it′s a question, where is the country and the world? And we’ll be trying to gather that information and synthesize it. So, in our planning effort, we really imagined that the important questions need to be answered early in the evolution of a new virus. And we know that Mexico is planning to look into questions carefully and that some of the other, you know, Texas and southern California, for instance, will be looking very carefully, but I wouldn’t say we’re expecting every community that has an issue to have a CDC team on the ground or us to be working on it.  You know, the other thing to let you know that, specimens are going to change. We′re at a stage here where we have some important questions to figure out, how transmissible is this virus? How severe is it? What ways is it being transmitted? What seems to be effective in reducing the trasmission and improving the outcomes of illness? And, you know, keeping an eye on the resistance patterns. So far it is a sensitive virus for oseltamavir and zanamavir. These are the kind of questions that we′re looking at now. If things get worse, we′ll be looking at different questions later. Many of these issues are not ones where the CDC field team is the essential factor. The other thing I’d like to say is that public health and the clinical and academic communities are working together on this and that many important findings may come from other sectors and not from CDC.

Glen Nowak: Thank you.  A couple of things for participants. There′s going to be a 3:00 p.m. press briefing by Thomas Frieden with the New York City department of public health. Those interested in that, I have seen the press media advisories. If you don′t have it, you might want to call the New York City Department of Health public affairs office. It′s 3:00 eastern time. We expect we′ll be doing another press briefing, similar press briefing to today, probably sometime early tomorrow afternoon. Thank you. Look forward to talking with you soon. And that concludes today′s press briefing.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES