Press Briefing Transcripts

CDC Media Availability on Human Swine Influenza Cases

April 27, 2009, 1 p.m. EST

• Audio recording (MP3)

 

Glen Nowak: Thank you, this is Glen Nowak.  I′m Director of Media Relations at the Centers for Disease Control and Prevention, and we welcome you today on the briefing for the swine influenza situation. Today’s speaker is Dr. Besser is Acting Director of the Centers for Disease Control and Prevention. He′s going to provide an update on the cases as well as where we stand in terms of public health and CDC action. For those of you in the room, when we take questions from the floor I would ask that you wait until we get the microphone to you. We will take questions today from those present and also the phone.  I will turn the conference over to Dr. Richard Besser.

Richard Besser: Thank you very much and good afternoon. I know there′s a lot of concern around the country about this situation here around swine flu and the situation going on in Mexico. I hope this afternoon to share with you the current status of our investigations and the work that′s going on both here and around the world to understand this better and to control this outbreak of swine flu.

This situation is evolving very quickly.  It′s changing quickly and so you will continue to hear information that seems in conflict. You will see numbers in one place that may be different from another. Today I′ll give you the numbers as we have them, but ask you to focus a little less on the specific numbers and more what it tells us. What we learn from the numbers is how disease may be spreading and where it′s not spreading.

It tells us something about transmission and I′ll share that information with you. We continue to approach this investigation and our control efforts aggressively.  That′s because you don′t know going into an outbreak what it will look like in the end, and we want to be aggressive. We want to take bold action to minimize the impact on people′s health from this infection.

Where are we today in terms of cases?  We are officially reporting 40 confirmed cases in the United States in five states.  These are the same states that we reported yesterday: New York, Ohio, Kansas, Texas and California. The only change in confirmed cases from yesterday is 20 additional cases in New York City and these are associated with the same school outbreak that we talked about yesterday and really represent additional testing in that group, not an ongoing spread of that cluster. Of the 40 cases, we are only aware of one individual who is hospitalized and all people who have been infected and were sick have recovered.

The median age is 16 years with a range in age of 7 to 54 years and as I′ve been trying to stress, as we continue to look I expect that we will see cases in other parts of the country, and I will fully expect that we′ll see a broader range in terms of the severity of infection.

Thankfully, so far we have not seen severe disease in this country as has been reported in Mexico. So far, CDC has confirmed 26 cases in Mexico, but, clearly, from the reports coming out of Mexico this is a small fraction of what they′re seeing. These are the number of cases that we have confirmed here in our laboratory.

I want to talk about some of the public health actions that CDC has taken and that state and local public health are taking and that the global community is taking. We continue to work with state and local public health to investigate and understand what′s going on. We′re continuing to provide support in the laboratory testing that′s taking place and as we investigate we′ll continue to learn more about how this disease and how this infection is transmitted and how it can be prevented and controlled.

We′re working with the World Health Organization. We′re working with The Pan-American Health Organization and working as part of a tri-national team that′s on the ground in Mexico trying to investigate and understand the disease transmission there. We have folks on the ground and we will be sending additional personnel to the ground to understand this -- this outbreak.
Yesterday the Department of Health and Human Services declared a public health emergency. This is in recognition that this is a serious event and we′re taking it seriously and acting aggressively, but what it also does is it gives us additional authority. It allows us to move products and dispense drugs in a way that we couldn′t before and streamlined the process by which the government works and so it′s primarily a reflection of that. It′s something that we do whenever we feel that we want to have the ability to move quickly and swiftly.

We will be distributing yellow cards at ports of entry. These will provide information on swine flu so that people coming into the United States will have information about this outbreak and what to do if they become sick and what things they can do to prevent the likelihood that they do become sick.
Later today we will be releasing a new travel advisory for Mexico. This is out of the abundance of caution and we will be recommending that non-essential travel to Mexico be avoided. We′ll also be including in there steps people can take should they need to travel to Mexico during this time.

Again, this is out of an abundance of caution as we learn more. You can look to see our travel recommendations reflect that. Yesterday we announced the release of materials from our Strategic National Stockpile.

This is a stockpile of medications and other supplies that can be very helpful in managing an outbreak and again, as a forward-leaning move we released 25% of the state′s allocation of the stockpile.

This is 11 million courses of antiviral drugs. These are en route to affected states of California, New York and Texas as well as other states around the country. Yesterday we issued on our website and we′ve sent out new guidance, refined guidance on what communities can do when they have a case of swine flu in their community. This provides guidance on what people who have that infection should do and clearly, that′s stay home. Don′t go out in the community during the period of your infection which is about seven days, but you should stay home until at least one day past your symptom period.  If you do go out, it provides guidance into how you can interact safely in the community.

It provides recommendations in terms of contacts, again, avoiding crowded places and trying to stay home as much as possible. It talks about the closure of a school or dismissal of students at a time when there′s an identified case in the school. Again, this is out of the abundance of caution while a health department is looking to see whether there′s been additional transmission and it talks about other gatherings. We know that in some communities where there′s been a case, they′ve canceled school functions related to that affected school. We think that makes sense. All of these guidelines need to be tailored based on the local situation and we expect to see and it′s appropriate to see different application of these guidances in different parts of the country.
I -- I always like to make the point that control of an outbreak of infectious disease is a shared responsibility and there are things that individuals need to do and there are things that communities need to do and there are things that the government needs to do and it′s important that individuals realize they have a key role to play in reducing their own likelihood of getting infected. Those are the typical guidelines for respiratory infection. Frequent hand washing if you don′t have access to soap and water, use an alcohol gel and covering your cough or your sneeze, that′s very important. If you′re sick, and if you have a fever and you′re sick or your children are sick, don′t go to work and don′t go to school. That can help reduce the likelihood that you will share that infection, but it′s also time for people to be thinking about,  “What would I do if my child′s school were closed? What would I do for child care?  Would I be able to work from home?”  It′s time to think about that so that you′re ready in the event that there were a case in your child′s school. It′s time for businesses to review their plans and think about what would I do if some of my workers couldn′t come to work? How would my business function? Think about that.  There′s been tremendous planning that′s been going on around the country over the past number of years. It′s time for people to review those plans and think about what they would do. It′s time for schools and faith-based organizations to think about as well, what would I do if there were an ongoing outbreak in my community?  Hopefully this outbreak will not progress, but leaning forward and thinking about what you would do is one of the most important things individuals and communities can undertake right now.

It matters less what we call this than what actions we take, and we are acting aggressively based on what we know today and whether the term changes, that′s not going to change our approach to that situation and that′s a very important point. We trigger our actions based on what′s going on in the community and not based on what label is put on a particular outbreak. There′s no single action that will control an outbreak, but the combined actions that we are proposing and that are being undertaken around the country will help to stem the tide of any infectious disease outbreak and this one in particular. I want to reiterate that everyone has a responsibility and it′s been absolutely incredible to see people around the country standing up and taking responsibility and doing the things that they need to do to help reduce the impact of this outbreak. I want to recognize that much is unknown.
We will continue to give your information as we know it and provide as many opportunities as possible for your questions to be answered.

And lastly, I really want to recognize the incredible work being done by the medical provider community and the public health community.

These periods of uncertainty where we′re working with very limited knowledge, and very limited information are very difficult and people are doing an outstanding job across the country, trying to understand this.

So, thank you and I′d be happy to take your questions. Thank you. We′ll go around the room and then we′ll go to the phones.

Reporter: Dr. Besser, Fox News.  Is the CDC working on a vaccine specifically for this new subtype of swine flu or are existing vaccines effective so far?

Richard Besser: We don′t think that any of the existing vaccines are effective and whenever we see a new strain of influenza we look to create what′s called the seed stock (Editor’s note: This is a correction) and that′s the stock of the virus that would be used in the event we decide to make a vaccine. There are discussions ongoing about whether to make a vaccine and whether that should be undertaken. It′s not an easy decision.  It would involve looking at what vaccine is needed for next year′s flu season. Whether this is a strain that we want to look to include and there are tradeoffs there, but those discussions are under way so that if we decide to manufacture a vaccine we′d be ready to start that process.

Reporter: WSB television in Atlanta. So far the illness is more severe in Mexico and less severe among the cases here. Is that optimistic to you? Do you think that -- that pattern or is it too early to tell?

Richard Besser: That is a critical question, what we need to know is why we′re seeing a different disease spectrum in Mexico than we′re seeing here. I wouldn′t be overly reassured by that.  There are many reasons that could explain that and as we gather information, we hope to sort that out, but I wouldn′t -- I wouldn′t rest on the fact that we have only seen cases in this country that are less severe. As we continue to look I expect that we will see additional cases and I expect that the spectrum of disease will expand.

Reporter:  I was told that some government agencies in neighboring state, Alabama, that workers are being ordered to wear masks at work.  In a workplace where there has been no active sign of disease is that recommended at this point?

Richard Besser: I′m not aware of any states undertaking that.  In terms of our recommendations we would not recommend that people generally wear masks in their workplace as a precautionary measure. As a doctor and as a parent the issue of masks come up, and people say, “Wow, should I wear masks? Is that going to protect me?” Anything that you can do to prevent infection are critically important.  Masks, the evidence of their value outside of healthcare settings and outside of settings where you are coming direct face-to-face with someone who has an infectious disease, the evidence there is not very strong.  I know some people feel more comfortable having a mask and there are certain circumstances where that may be of value, but I would rather people really focus on hand washing, not giving that little kiss of greeting when you′re meeting somebody right now. Doing those sorts of things and covering your cough and your sneeze and then if you feel more comfortable with a mask, if you′re in a community or setting where there′s ongoing disease transmission and then you can think about that, but the other things where there is that evidence are the things we′re really trying to push.  On the phone?  Okay.

Operator: Daniel Steinberg with CBS news.

Daniel Steinberg: Where is the CDC and other health organizations where are they in tracking the origin, perhaps pig farms and other cases?

Richard Besser: We are undertaking work with the USDA on that fact and the issue of where did this come from?  It reminds me of an important point. Some people worry about pork products because we call this the swine flu. You can′t get this from eating pork. Cook your pork appropriately so that you don′t get other infectious diseases, but influenza is not transmitted by eating pork or pork products. They are safe.  

What we do as we investigate the cases we look for any connections and see if any of the individuals who have been sick have been exposed to pigs or swine and we′re not finding that linkage here.  I know that in the investigations in Mexico they′ll be looking as well to see is there any connection? Can we understand how this may have first started? I will take I question from the phone.

Operator: Again on the phone lines if you would like to ask a question, please press star one.  Our first question comes from Betsy McKay, Wall Street Journal.

Betsy McKay: Hi, Dr. Besser.  Thank you. I have a couple of questions. One is, as you probably know, W.H.O. has a panel meeting right now whether to raise the pandemic level alert. So I′m wondering if that does happen and if it′s raised to level four or five, what specific actions would that trigger here in the United States?

The second question I wanted to ask was you′ve talked about how much better prepared we are since SARS and definitely a lot of money has gone into preparedness, but you face a couple of limiting factors right now.  One is that the HHS Secretary hasn′t been confirmed and secondly, state and local health departments are facing a real funding crunch in the recession and I′m wondering if you can address those two.  What do you need to more effectively do your job and are those limiting you?

Richard Besser: Your first question about W.H.O., the expert committee is meeting today to look at the current situation and see whether any changes need to be made in terms of phases.

That goes on a comment I made earlier about it, it doesn′t really matter from our perspective what you call this.  Our actions are based on what′s taking place in our country and in our communities. It may have more relevance to a country that has yet to see cases in terms of what they would start to do.  Here, we are acting aggressively and whether they go from phase three to a phase 4 would not change anything that we are currently doing.  In terms of public health infrastructure whether you′re looking at the federal level or state or local level, it′s critical to our success in recognizing outbreaks and being able to respond to outbreaks.  The lack of a Secretary of Health has not in any way led to diminished activity in our department approaching this problem. We have an outstanding Department of Health and Human services that is aggressively addressing this issue.  We look forward to having leadership in positions, but that hasn′t impacted our ability to respond. 

You asked a question about state and local public health infrastructure and I have to be honest on that the economic realities that been very hard on state and local public health. We as a nation rely on public health personnel at the state and local levels to identify these outbreaks and identify them quickly and be able to respond and we have an outstanding public health system, but it is in a tough situation.  We hear about tens of thousands of state public health workers who are going to be losing their jobs because of state budgets and it is very important that we look at that and we look at that resource because this outbreak was identified because of a lot of the work going on around preparedness.  Mexico, yes, had been having an outbreak of flu, but the first case of swine flu was identified in San Diego as part of a study that was part of preparedness, to try and develop new test kits that doctors can use in their office.  That kind of investment in preparedness is what led to this. As we′re looking now at how are we -- how are we supporting states, one of the things we′re doing is we′re helping states support themselves and so we′re sending test kits to states so that states will be able to do their own testing to determine do they have this isolated flu?  We′re not sending it to all states at first.  We′re rolling this out, but that infrastructure, that ability and the laboratory network that′s been built over the past decade is one of the backbones that we count on to be able to identify and control outbreaks.  Another question from the phone?

Operator: Thank you. Our next question comes from Joanne Silberner, National Public Radio. Please go ahead.

Joanne Silberner: Hi and thanks. Has anyone had a chance to look back, you mentioned San Diego, has anyone looked further back to see whether the virus was around weeks and months ago in this country?

Richard Besser: That′s a good question and we had not seen this virus in this country. In addition, we′ve been assisting the Mexican government in looking at the strains of flu that they′ve seen through their season and in looking at the analysis from that, this was not something that they were seeing circulating there, we know at least until March and the analyses of the later strains I don′t think has been completed, but we are trying to understand where it first arose and where it may have first arose and what that may tell us about where it came from and how it can be controlled.

Operator: Our next question comes from Helen Branswell, The Canadian Press.

Helen Branswell: Hi, thank you very much for taking my question. Dr. Besser, yesterday you said that so far in the United States, I think you said, anyway, there′s only been one case where known human-to human transmission occurred. I′m wondering whether you tell us whether that′s still the case or if you′re seeing generations of spread and I would have a follow-up if I could, please.

Richard Besser: We only have one case of documented by viral testing person to-person spread, but I wouldn′t be reassured by that.  We′re seeing significant rates of respiratory infection among contacts, and I would expect that some of those individuals will end up testing positive for the swine flu virus.  So, yeah. Thanks for that question. I don′t want that to be too reassuring. This virus is acting like a flu virus and flu virus is spread from person to person.

Helen Branswell: Great. The other question I wanted to ask you about how you strike a balance to have a measured response because obviously there′s been tons of planning done in the past few years in response to the threat of H5N1, the stockpiles and that, but those resources are expensive to put together and they are precious and I would imagine that you might not want to blow through a whole bunch of the stockpiled antivirals, for instance, at this point because who knows how this virus is going to continue to behave in the future or how H5 will continue to behave in the future. How do you strike the balance?

Richard Besser: That′s a great question. Every outbreak is unique.  Every new strain of virus is unique and until the outbreak has progressed you don′t know what it′s going to do and so it′s a matter of making decisions with incomplete information and so if you look at some of the decisions we′ve made, the decision about providing antivirals and material to people around the country, we are sending for 25%. We′re not sending for the entire stockpile and we′re sending out supplies so that in the event this were to become something more serious, the health department and doctors would have what they needed to take care of people.  As information changes, our level of response can change. If we were to start to see a much more severe course of illness in the country, we might recommend different control measures and communities than we′re currently doing.  Right now, I think we′re at the right level in terms of what we′re recommending for response based on what we know. A question here in the audience.

Reporter: What are the odds that swine flu is in metro Atlanta?

Richard Besser: I think as we continue to look for cases of swine flu we′ll find them. The recommendations we have in terms of individuals, knowing what the signs and symptoms are. If you have fever and flu-like illness you should talk to your doctor. Your doctor can talk to you about whether testing is -- or treatment is appropriate. In particular, if you have -- if you traveled to Mexico and you have those symptoms we should see your doctor because that′s an area where we know transmission is occurring. I don′t know the odds of somebody in Atlanta has this infection, but it′s important that people in Atlanta and people in Dallas and people in Philadelphia and people in small towns know about this, that they pay attention and that they understand that they have a responsibility here in terms of protecting themselves and also knowing what the signs are and what they should do if they′re ill. Another question in the room?

Matt Gupman: Matt Gupman, ABC News. You mentioned earlier there have been 40 cases detected in the U.S. last 20 were all from the same school in New York. What does that tell us about the spread of the virus? Is it spreading?

Richard Besser: It really doesn′t tell us very much. The additional cases from New York represent additional testing, not ongoing transmission and so it doesn′t tell us very much. We′re continuing to look around the country.  Health officials around the country are looking and doing testing. So, you know, the good news is that we haven′t identified it in additional states, but I wouldn′t put too much on that. Over the course of the next week or two, we′ll know a lot more about disease transmission and how this may go.  We′ll take a question from the phone.

Operator: Our next question comes from Elizabeth Weiss, USA Today.

Elizabeth Weise: Hi, thanks for taking my call. On the flu call earlier today they said that the CDC has already been able to culture the wild type virus and you guys were already incubating it in eggs which is the first step toward the creation of a vaccine. I just wanted to confirm that is the case.

Richard Besser: I think that′s what I was describing before in terms of growing a seed stock that would be used for vaccine manufacturing. That′s a more technical description of what I laid out.

Operator: Thank you. Our next question comes from Mike Stobbe, Associated Press.

Mike Stobbe: Hi. Thank you for taking the call. Two questions, actually. The first one has to do with symptoms.  Doctor, initially CDC described respiratory illnesses in confirmed U.S. cases, but in these New York ones it sounds like it′s more of a stomach problem, gastrointestinal. Are there different sets of symptoms or is everyone experiencing respiratory and I have a follow-up question.

Richard Besser: That′s a good question. The primary symptoms that we hear about of fever, cough, respiratory symptoms are still ones people need to look for. We do know that there are individuals who have had gastrointestinal symptoms of diarrhea and vomiting and so if you have those symptoms it doesn′t rule out the fact that this could be swine flu. Some of the cases have reported that, and I can -- we can get back at a future brief in terms of what proportion of the cases. The more the cases are investigated, the better sense we′ll have of the full spectrum of disease here in the United States as well as what we′re hearing from Mexico.

Mike Stobbe: My second question had to do with infectiousness. Do we have any information yet on whether these are large droplets that only spread about five feet out or small droplets that fill a room from ten feet out in the super spreader type situation?

Richard Besser: It′s too early to be able to address that question.

Operator: Thank you. Our next question.

Ken Miles: Ken Miles with the Atlanta Journal Constitution. Are state and local health agency requesting guidance in dealing with this and what are they being told?

Richard Besser: We are working very closely with state and local public health. In some of the states we have teams on the ground assisting in California and Texas. We have a lot of guidance posted on our website in terms of what people should look for, in terms of signs and symptom, what doctors should look for and how testing should be done. We have information on infection control practices that should be applied in health care settings and we recently yesterday posted the guidance on what communities should do if there′s a case in your community.  We’re going to continue to post guidance and expand on that as this goes forward. A question from the phone?

Operator: Thank you, our next question comes from Rob Stein, Washington Post.

Rob Stein: Hi, Dr. Besser, thanks very much for doing this. I had a couple of questions.  One was over the total 40 cases, what is the total number of hospitalizations so far and do you have -- New York is reporting 17 probable cases. Do you have a total, a tally of probable cases that are pending in the United States and the last question was I was just wondering what you thought about the comments from the E.U. health minister today about not traveling to the United States.

Richard Besser: In the United States of the 40 cases that are confirmed, there′s been one hospitalization. In New York City, I don′t have a numbers on probable cases, but probable cases in general, we have a definition on the website so that would be someone that had compatible symptoms with an epidemiologic link for which there hasn’t been testing done and so it’s not confirmed.  In terms of reported comments from the E.U. about travel to the United States, based on the situation in the United States right now I think it is quite premature to put travel restrictions on people coming to the United States. We have 20 cases of swine flu. We′re doing active surveillance. So far we′ve seen one hospitalization. As the situation changes, then that needs to be evaluated by individual countries and different countries will take a different approach and have a different level of concern, but from what we know today I think it′s premature on put a travel restriction on people coming to the United States.

Operator: Thank you. Our next question comes from Maggie Fox, Reuters.

Reporter: What has happened that has indicated to the CDC that the problem is getting either better or worse?

Richard Besser: As we look around we are going to continue to see more cases and it′s really over time we′ll be able to see more about that. In terms of getting better, we would love to see in Mexico that the number of cases is going down and that people are recovering, and that would be a wonderful thing to see. If we see numbers of cases going up, that′s not something we′d like to see. It′s hard to know what the course of an outbreak is going to look like until you′re much further into it.

Another thing that′s important to note is that we′re nearing the end of flu season and often in outbreaks of influenza you′ll see a decline in the number of cases because it′s the end of flu season and we can′t rest too comfortably on that because sometimes those come back again in the fall when flu season comes back. So we′ll be watching closely to see the number of cases and the severity of cases and age group of cases and that sort of thing. Two more questions from the phone.

Operator: Thank you.  Our next question comes from Maggie Fox, Reuters. Please go ahead.

Maggie Fox: Wanted to ask how much the stress continues to be on personal responsibility.  I know under President Bush that was the focus. Will CDC continue to recommend that focus now?

Richard Besser: I think that there′s responsibility at many levels, but it is so important to start at the level of individual responsibility for health.  Whether you′re talking about the importance of eating right and exercising for prevention of chronic disease or washing your hands, covering a cough and not going around other people when you′re sick for infectious disease, it starts with personal responsibility, but it doesn′t end there. There are so many things that take place at the community level and at the governmental level that are so important in terms of controlling an outbreak of infectious disease.

Operator: Thank you. Our next question comes from Elizabeth Landau, CNN.

Elizabeth Landau: Hi, thanks for taking my question. First of all, at the beginning you said you shouldn′t even, like, give a little kiss of greeting.  Is that only in affected areas and is that for everyone and secondly, there′s been a water shortage in Mexico City, could that possibly have anything to do with it?

Richard Besser: Would you mind repeating the first question? I missed that.

Elizabeth Landau: Oh, sorry.  When you were talking about precautions such as, you know, covering your cough and not -- You know, don′t even give people -- you know, a kiss of greeting. Is that only affected areas or is that for everyone?

Richard Besser: I think covering your cough is something you should always do. It′s very -- it′s an appropriate way to reduce the likelihood of transmission of an infectious disease.  In terms of how you greet somebody, if you′re in an infected area or if you have the swine flu it′s probably best not to -- to not give a kiss, but we′re not recommending an end of affection during the period. I think it′s a period of time when we need a little more affection, but doing it in a way that isn′t going to transmit a respiratory disease would be the CDC approach. One last question from the room.

Reporter: You talked a little bit on Friday about, you know, if it was striking healthier, younger people, not usually a group that we see with seasonal flu.  Have your people learned anything on the ground about what′s happening from and why it seems to be hitting hard, younger people?

Richard Besser: We′re just starting to get some information there and so it′s a little early to say, but that′s an important thing that we′ll look at because the age distribution can be useful when you′re looking at an emerging infectious disease, in telling you something about whether certain parts of the population would have built-in immunity and whether the agent is causing problems by itself or because of how the host is responding. It could tell us a lot but it′s too early to say anything that′s going on in Mexico. Thanks very much.

Glen Nowak: Thank you all for attending today′s press briefing. We′ll probably be back here again tomorrow. Thank you.

End

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES