Press Briefing Transcripts

Weekly 2009 H1N1 Flu Media Briefing

December 4, 2009, 1:00 p.m.

• Audio recording (MPEG)

Operator:  Welcome. Thank you for standing by. At this time, I would like to remind parties that your lines are in a listen-only mode until the question and answer session, at which time you may press star one to ask a question. Today's call is being recorded. If you have any objections, you may disconnect at this time. I will now turn the call over to Glen Nowak. Thanks you, sir, and you may begin.

Glen Nowak: Thank you and thank you for joining us, both in person and on the phone, for today's briefing on H1N1. Today’s briefing is going to be conducted by Dr. Thomas Frieden, who is the Director for the Centers of Disease Control and Prevention. He'll give you an update on where we stand with respect to disease as well as focusing on vaccination and vaccine supply. So, I'll turn the podium over to Dr. Frieden. 

Thomas Frieden: Thank you, again, for your interest in H1N1 influenza. Vaccine supplies continue to increase. Today we're releasing information on vaccine safety that is reassuring and during this window of opportunity; it's a great time to get vaccinated. As of today, there are 73 million doses of H1N1 vaccine available. That's twice the number that were available a month ago. It's 10 million more than last week. We expect at least another 10 million doses in the coming weeks. Priority groups are still the priority for vaccination and we need to reach particularly groups that have been historically under vaccinated. For example, school kids, usually only about 1 out of 5 school kids gets vaccinated. We have areas of the country which have been very creative in reaching out to school children and in doing school-based vaccination programs. Arkansas, Maine, Rhode Island, to name three states that are telling us that at least half of the kids in many school districts and even higher in some areas, are being vaccinated against influenza. That’s a tremendous accomplishment. It protects those kids, it protects their families and most likely, it protects their communities. That's the kind of program that's building not only a response to this particular virus, with this particular vaccine to this season, but building an infrastructure for the future so that we can vaccinate more children at schools and their pediatricians in the future and dampen the future waves of seasonal influenza in the years to come. In addition, we have an increasing number of obstetricians who are vaccinating their patients or at least knowing where their patients can be vaccinated. That's important. Not just this year but every flu season, because pregnant women are much more susceptible not just to H1N1 but also to seasonal flu and vaccination can protect them. Vaccination not only prevents severe illness, it also protects us from disruption in society and people who are out of school, out of work, infecting others, sick in bed for a few day, all of that has a big impact each flu season and whatever we can do to reduce that, we'll benefit from in this year and in future years. We don't know how likely a future wave of H1N1 influenza is this year, but we do know that the more people who are vaccinated, the less likely we'll have more spread in the coming months.

Now, I would like also to talk a little bit about vaccine safety, because today we're having release of information in the MMWR. We're very committed to transparency. We provide the information on the web. So people can see what reports are actually being submitted without anyone's individual information. And the information is very reassuring. Although still preliminary, although it's still early, we know that the rate of, for example, Guillain-Barre Syndrome, the rare neurological condition that was more common after the 1976 swine flu vaccination campaign. We have not seen an increase that would be significant. That in fact, the likelihood that we'll have a 1976-like problem with this year's H1N1 influenza vaccine is vanishingly remote. So this is reassuring, we do expect to see lots of reports. We particularly expect to see reports when there's a new vaccine in the first year of each new vaccine because people are concerned and we investigate the serious reports and we provide that information openly to the public and you can see the details of that in our MMWR released today. We will continue to intensively monitor for any adverse events and investigate any. We can't be certain of safety, of many things, but we're very confident at this point that the kind of problem we saw in 1976 is really, really unlikely to occur this year with Guillain-Barre Syndrome. Whether there will be other problems with this or other vaccines or treatments, only time will tell and we'll continue to monitor that very intensively.

As there is more vaccine available and more confidence in the vaccine safety, it is a great time to get vaccinated. Next week, there will be public service announcements, particularly for the priority groups on the importance of getting vaccinated. And again, it's a window of opportunity as the disease has continued to ebb and as the vaccine supply has increased, to get vaccinated. Disease continues to decline. There are now 25 states with widespread activity. So there's still a lot of excess influenza, more than we would expect this season around but it is continuing to decline. There's more flu than usual and as it has since the beginning, it affects young people more. Sadly, this week, we document an additional 17 cases of children who died from influenza. That brings the total of laboratory confirmed deaths among children to 210. We're seeing some other viruses, not influenza, but other viruses that cause colds and flu-like symptoms and fever; we're seeing more of those spreading. That's what we expect in flu season. We're still seeing very little seasonal flu, non H1N1 and that's not unexpected for this time of the year. This is around the time of the year we might begin to see that pick up in, December, January, and February.

So we'll see what the future brings and as we've said consistently, it’s not possible to accurately predict what's going to happen with influenza. We don't know how much more H1N1 there will be. Whether there are additional waves and if so, what they will look like. Because there's been such a difference in influenza in different parts of the country. In the spring, there was a 20 or even 100-fold difference between different communities with how much influenza there was. We don't know what the rest of this flu season, which lasts until May, will be like and it's quite possible that some areas will have problems and others not. We just don't know and we'll continue to very intensively monitor it. One of the things that this flu season has allowed us to do is greatly increase and intensify our ability to monitor for influenza, monitor the trends in the virus, in the patterns of disease and in the adverse events, which we reported today. That adverse event reporting also outlines additional systems we have in place to help us try to understand if there is a very rare problem with the vaccine. Of course the challenge of finding a very rare problem is that it's very rare. So whether or not that will be found, we can't say with certainty until later but the information that we're releasing today is reassuring.

I'd also like to mention schools closure. This was something that was a big deal in the spring, where lots of schools closed. If we look back at the month of November, with lots of disease in many places, very few schools closed, consistent with the revised guidance that we issued over the summer. One of the challenges with influenza is to ensure that at the same time we're doing everything possible to reduce the impact and to protect people, we also respond effectively so that we keep sick people out of school and keep our economic activity going, keep kids learning, keep people going to work, whether it's telecommuting or being at work because they got a vaccine and didn't get sick.

So going forward, I think we're still in a period where we're changing gears, from a time when there was not enough vaccine, to a time where vaccine is increasingly available. Vaccine is important; we don't know what the future will bring. It's a great time to get vaccinated. We have even more confidence in the safety of the vaccine and even more availability of vaccine so that people can get vaccinated. We can't predict what the flu will be like; we also can't predict what demand for vaccine will be like. We know that when there's more disease around, people want to get vaccinated more. We know that, when there's less vaccine people want to get vaccinated more. But this is really a great window of opportunity. There's more vaccine available. The focus is the priority group, the people who will benefit the most from the vaccine but increasing numbers of communities and states are providing vaccines to larger groups of people and that's completely consistent with the recommendation of the Advisory Committee on Immunization Practices. Vaccination is the single best thing that you can do to protect yourself and your family against the flu. So I thank you very much. We'll take questions, starting in the room. 

Mike Stobbe: Doctor, Mike Stobbe from the AP. A couple of questions. You said demand is hard to find in the future, what is it now?  Could you define what the demand for the vaccine is like?  Also, do you have from your survey data yet, more information about who's been getting the swine flu vaccine?  I don't mean just the priority groups but by race, by socioeconomic status, those other factors.

Thomas Frieden: Doctors tell us from around the country, that there's still lots of people who want to be vaccinated and haven't had the chance to get vaccinated yet. So there is clearly a lot of people who still want to get vaccinated. The challenge is getting the vaccine out widely enough, so that it’s easier for people to get vaccinated. We want to put the vaccine in the pathway of people, so people ultimately should be able to get it at their own doctor's office, within the next weeks an increasing number of the pharmacy retail stores should have vaccine available. So, we want to see that increasingly readily available. We're still hearing from doctors, a lot of demand for vaccine and many doctors who would like to provide vaccine, haven't yet been able to stock it. And that will change in the coming weeks. I think we're seeing a steady increase in availability. In terms of, who's getting the vaccine; usually we don't know what the situation is with coverage until the very end of the flu season. We've put in some systems now to try to help us get a better handle on that.  We know that in each flu year, the certain groups are very underrepresented in getting the flu vaccine, particularly African-Americans. Where for seasonal flu year after year, the vaccination rate among the high-risk groups of people of African-Americans is about twenty percentage points lower than among whites or Hispanics. So this is a group we're working with states and localities and national and community organizations to reach out to and try to use, coordinate and partner with community leaders to do more to reach out to these groups. Other questions in the room?  Let's go to the phone. 

Operator:  At this time, if you would like to ask a question, press star one and record your name. The first is from Jonathan Serrie from Fox news. Your line is open.

Jonathan Serrie: Thanks for taking my call. In observing H1N1 in the southern hemisphere during what was their winter season, have you been able to draw any conclusions about the affects of weather or temperature on H1N1 cases?  And because the outbreak here in the U.S. isn't following the normal pattern of seasonal flu, is  there any indication that the onset of cold weather this winter will cause another increase at the same time that seasonal flu is expected to appear or does this pandemic appear to act independently of cold weather? 

Thomas Frieden: Only time will tell what this pandemic does. Traditionally, winter is flu season and that's for a lot of reasons, some of which we understand. People are clustered closer together. There's less ventilation, there's other colds that reduce your resistance to infection. So really only time will tell. And the experience of other countries is very useful and valuable. It’s particularly important that we continue to intensively track the genetic characteristics of the virus to see if there are changes and we're doing that and we mentioned earlier this week, there have not been significant changes. But really, all bets are off in terms of what the future will hold for the rest of this year, both for seasonal flu and for H1N1. On the phone? 

Operator: Bob Roos, CIDRAP News, your line is open.

Bob Roos: Thanks for taking my question. I had a question about the kind of the overall severity of the pandemic and the case fatality rate. Dr. Cetron of the CDC recently estimated the case fatality rate at 0.018 percent. It has been suggested that, on the basis on the CDC numbers concerning seasonal flu, this is case fatality rate is much lower than—and this pandemic is much milder than a seasonal flu epidemic. I wonder if you can comment on that.

Thomas Frieden: The key point really is age specific case fatality rates. We've been fortunate, that H1N1 has not affected the elderly, significantly. So while some elderly have gotten infected and those who are infected have sometimes become severely ill and that's why we have emphasized the importance of prompt antiviral treatment of the elderly and others with underlying conditions who are severely ill. What we're finding really is that this virus is a much worse virus for younger people. The number of people, not just children, but young adults under the age of 50, who will get severely ill or die from this virus is much higher than it is from seasonal flu. The fact is that with 210 laboratory confirmed H1N1 deaths, we are really before the beginning of flu season, we don't know whether there will be much more H1N1 or not. We’re already three times the number of deaths among children than we would be in a usual flu season.
Now, that leads me to also mention one other thing that I would like to highlight, which is, antiviral availability. We're seeing, first off, increasing availability of the liquid Tamiflu in pharmacies. So there was a time when supplies were scarce and we sent out antiviral medications from the Strategic National Stockpile on a per capita basis, so that we could plug the gap in availability until the market was able to develop and the manufacturer was able to restock pharmacies and that's now happened, so, as we had planned we bridged a period when there was not availability of influenza --I'm sorry, of Tamiflu, in the stores. At the same time, our monitoring systems from the Emerging Infections Program have shown that there's been a dramatic improvement in the treatment of severely ill children, undoubtedly relating to the amount of attention and focus that there's been with the H1N1 influenza. In most years, the number of kids who are so sick they need to be hospitalized with flu, the proportion of those kids who are on an antiviral drug by the time they get hospitalized is quite small, only about 15 or 20 percent, less than 1 in 5. In this year, it's been over 80 percent. That means that doctors are getting the message that severely ill kids need to be treated, people need to be treated. And that's reducing the number of people who get severely ill, the number of people who have to be hospitalize and the number of people at risk for dying. Next question on the phone? 

Operator: Tracy Potts, NBC. Your line is open.

Tracy Potts: Thanks for taking my question. Actually, I have two questions. First of all, why do you think the rates among children are so low in terms of vaccination, given the fact that we have an unusual number of pediatric deaths and the focus on children?  And also, with the focus being on priority groups, are you not yet recommending healthy adults go out and look for this vaccine.

Thomas Frieden:  In terms of children, let me clarify what I said. In past flu seasons, last year, the year before, usually, only about 1 out of 5 kids get vaccinated. So the fact that there are communities which have been able to vaccine most children or appear to have vaccinated most children is quite striking and is very important for future years because the infrastructure that's been set up to do that is quite difficult. You have to get the consent forms, get the school involved, arrange to bill the insurers who will provide reimbursement of the work that's done, figure out how do it without disrupting classes. It's a big job and it had not been done on a large scale basis really until this year. And we have many states now doing this many communities doing it. That's an important accomplishment for the future, for this year and for the future. Your second question was about -- could you just repeat your second question?

Tracy Potts: Certainly. It was about the fact that you talked about the focus still being on priority groups for now. So does that mean people who are healthy adults should not yet go out and look for this vaccine? 

Thomas Frieden: An increasing number of communities have sufficient vaccine so that they can provide it to healthy adults who want to get it. The number of communities that do that will increase in the coming weeks. This is a challenge because there are still communities that are struggling with insufficient amounts of vaccine for the demand that they have. But, I think this is a time when we'll see an increasing number of state, cities, communities providing vaccine to a larger group of people beyond those initial priority groups and that's completely consistent with the recommendation of the Advisory Committee for Immunization Practices ,which over the summer was very clear, that at the local area, local community, it will be most clear when there's been sufficient attention to the high priority groups so that you can broaden the availability of vaccine to more. And one of the things that will happen in those areas is that as more providers get the vaccine, not only will people, who are otherwise healthy be able to get vaccinated, but more people who are at high risk will be able to vaccinated because their providers will have the vaccine. Next question from the phone? 

Operator: Craig Schneider, Atlanta Journal Constitution, your line is open.

Craig Schneider: Hi. I wanted to talk a bit about the GBS syndrome. And you said that preliminary results indicate that there's very little chance there will be a similar situation to 1976. Can you tell me why you're calling that preliminary and how many cases of GBS you've seen this year with this vaccine and talk a little bit more about that? 

Thomas Frieden: We can get you the detailed number of cases afterward, if you would like. But the bottom line is that in 1976, the increased risk of Guillain-Barre was about eight or ten times. So you were are eight or ten times more likely to get Guillain-Barre if you got vaccinated. We're virtually certain that there isn't that level of increased risk now. Whether there's a risk that it's a little bit more or whether a little bit more likely to get it, that requires even more people to get vaccinated and for us to have more time to pass. Generally, Guillain-Barre would happen in the first four to six weeks after vaccination. Not many people were vaccinated four to six weeks ago. So that's something we correct for in the analysis, but we're quite reassured in terms of any potential problem of 1976-like problem with Guillain-Barre from the information that’s available so far. Next question on the phone. 

Operator: Charles Davis, WebMD, your line is open. 

Charles Davis: Thank you. I have two related questions to vaccination. The first question concerns the possible reassortment of H1N1 and the Avian H5N1 RNA. The World Health Organization and Chinese officials have reported that Avian H5N1 virus has emerged in poultry in China, Vietnam, Indonesia, Egypt and other countries. That's putting Avian H5N1in close contact with the human H1N1 infected population. WHO and the Chinese are concerned that genetic reassortment between Avian H5N1 and H1N1 could produce a virus that could be deadly as H5N1 and contagious as H1N1. So the question is does the CDC share these same concerns?  And does the CDC have any plans to combat such a virus? 

Thomas Frieden: Clearly the issue that concerns us all is what if H1N1 evolves, mutates to remain a virus that spreads quite easily, but become a virus that has higher likelihood of making people very sick like H5N1. One of the pieces of good news is that even if this virus were to become more deadly, it's likely that the vaccine that we currently have would be effective, because the part of the virus that we make the vaccine against is distinct and independent from the part of the virus that determines whether it makes you very sick and is very deadly. For pandemic influenza, the result or the reaction or response would be the same. It's rapid diagnosis on the community level to determine what the problem is, it's a community strategy to reduce the spread and it's treatment to treat those particularly at high risk or who are very ill and it's vaccination as soon as vaccine can become available. One more question on the phone and then we'll go back to the room.

Operator: Miriam Falco, CNN Medical News. Your line is open.

Miriam Falco: Hi. Thanks for taking the question. We've been hearing about the lack of proper or enough vaccination in minority groups. What needs to be done to get that word out and is it something that the CDC is concerned about? 

Thomas Frieden: It is something that we are concerned about. We want to ensure that all groups have the opportunity to get vaccinated. There has been some reluctance or hesitancy to get vaccinated in different groups, there's also less access, less easy access to health care, among some groups. One of the things that we found most effective is to partner with community leaders in individual communities so that respected individuals who are familiar with and known to the community get vaccinated and serve as a model to be vaccinated so others will be vaccinated. Some of the public service announcements that we'll be releasing next week will highlight some of these issues. So this is an area we would like to do more about in the future, and it's one of the things we have provided funding to states and localities for to reach out to groups within their jurisdiction, to try do more. Any more questions in the room? 

Mike Stobbe: Hi, Mike from the AP again. Doctor, a few weeks ago when you gave an update about how widespread swine flu was, you said it was decreasing in regions across the country but there were still two states where is cases were increasing. Are there any states now, where it's increasing?  I also wanted to ask, it's still widespread in the Northeast, given your experience in the New York, why is it so strong up there?  And I'm sorry, one more. You were talking about antivirals in the liquid doses for kids, how many additional doses did Roche make available and could you just say a little bit more, is that problem over?  Is the shortage completed now? 

Thomas Frieden: In terms of the antiviral supply, we think that essentially between the release of the Strategic National Stockpile and resumption of commercial supply that while there may be spot shortages, there should be a comfortable supply of liquid Tamiflu going forward. In terms of the Northeast, different areas had different experiences in the spring. And that means that they may have different experiences now and going forward. New York City's experience has been so far relatively different from the rest of the country. It had more disease in the spring and it had less disease now and it appears that it may be going up gradually; it's very hard to tell. Some of the Northeastern states, it's not clear yet whether they peaked and have begun to go down but the region as a whole has been decreasing and that's the information that we have available on Flu View and I forgot the first question of your three. So I think we still don't know about some of the Northeast states, whether it's peaked or not, but in the region as a whole, it's been coming down. One or two more questions on the phone, if there are any.

Operator: Gail Pascall-Brown, WESH 2 News, your line is open.

Gail Pacall-Brown: Thank you very much. Florida currently has 173 swine flu deaths. I want to bring you down south. Can you give me some idea about how this state compares to the rest of the nation. High low and are there any top five states other than the Northeast, as it relates to the number of deaths in swine flu? 

Thomas Frieden: One of the challenges in looking at Swine flu deaths or H1N1 deaths or deaths from any influenza is that we have a confirmed number and then we have estimates. And the estimates are actually much more accurate than the confirmed numbers. So, it's very hard for us to say, whether one state has more than another because the number of confirmed deaths is really just a small proportion of the number of total deaths. We do know that flu has been widespread in a large number of communities but it did appear to have started more in the South, have spread North and traveled kind of upwards as the season has gone on and we don't know what that will mean for the next few months. Only time will tell, what the rest of the season brings. Thank you all very much. And have a good weekend. 

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES