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THE VILLAGE SPEAKS
CDC H1N1 Flu Media Briefing
1106 Atlanta GA
NOTE: This is a rough, unedited transcript and
transcription errors may appear.
Operator: Welcome and thank you for standing by. I would like to remind
parties your phones are in a listen only mode. Press star 1 to ask a
question. You may begin.
Glen Nowak: Thank you all for coming or calling in for today for the press
briefing on H1N1. Todayís speaker is the director of the national center of
the center of disease control and prevention. Sheíll give you an update on
the disease activity in the country as well as the vaccine supply. I turn
the podium over to Dr. Anne.
Anne Schuchat: Thanks, Glen. Good afternoon. The pace or our progress is
picking up. Today, we have twice as much vaccine available as we had two
weeks ago. Iím going to touch on three areas, an update on the flu itself,
the disease and the vaccine supply then the efforts. Flu is still
widespread. 48 states have widespread influenza activity. Everything we are
seeing is the 2009 H1N1 virus. The rates of disease are higher than normal
for this time of year. We wouldn't expect this many states to have this
widespread of a disease. Flu can last until May. We don't know what we will
see with this virus in general. Most of the illness is in younger people.
More than half the hospitalizations are in people under 25. 90% of the
deaths are in people under 65. A flip-flop from what we see with seasonal
flu. The pediatric deaths are high. Children have died from flu where the
typing wasn't done, but that's an increase from last week's number.
Two-thirds of the children who died from the H1N1 virus have underlying
condition that is increase their risk of this problem. The leading
underlying conditions in children who have died are severe neurologic
problems like cerebral palsy and muscular dystrophy and asthma in terms of
contributing to the severe outcomes. Fortunately, antiviral are effective
treatment against flu, including the flu complications. we have updated
information on our website for clinicians about some of the myths and
misconceptions about antivirals. we are seeing a better supply horizon in
the community and we think they ought to be used when there's a severe
illness like anyone hospitalized and people with respiratory systems with
underlying conditions like pregnancy and asthma. people are getting worse.
they are not getting better, antivirals may be important. the next thing I
want to catch people up about is the vaccine effort. today, we have twice
the vaccine available as two weeks ago. today, there are 38 million doses of
H1N1 vaccine available for ordering by the states. the majority of this is
injectable doses. about a third of it is the spray form that's recommended
for people who are healthy between the ages of 2 and 49 years of age.
today's number is up more than 11 million doses from last friday's amount.
that is progress. if all goes well, we are expecting about 8 million doses
to be available in the week ahead that's if everything goes well. as vaccine
supplies increase, we think things should go better. we still don't have
enough vaccine. we know that communities are seeing lots of demand and the
supply hasn't caught up with that. many places need more. we think we are
toward a path of improvement at this point. state and local health
departments are going to be in the best position to determine how to
effectively use and direct the vaccine doses that become available. the key
now is focusing on the priority groups, children and young adults up through
age 24, pregnant women, parents or caretakers of babies under 6 months of
age. People with chronic conditions and health care workers. Those five
groups are key and the focus area for the states and locals. Our goal,
really, is to put vaccine in the path of people who are in those priority
groups to make it as easy as possible for them to be vaccinated and to
really support the state and local health departments that are managing the
effort. We know that vaccine is being offered in a variety of venues with a
variety of strategies and our goal, really, is to have vaccine accessible in
these groups at this point. I want to mention one nice effort we have heard
about in the Champaign-Urbana Public Health Department in Illinois. They
created a nice department between the private providers and the state
special services program. Children with special needs had an easier way to
be vaccinated through the clinic. When parents bring the kids in with
special needs, they don't have to get out of the car, a nurse comes out.
Itís been an innovative program. I want to congratulate them for coming up
with this partnership. In closing, I want to remind folks progress is being
made, but we need to extend that in the weeks ahead. Priority groups are the
focus of our activities. We are expecting variation state to state and
community to community in finding the best ways to reach the high priority
populations. We know the state and local health departments and their
partners in health care are working hard to reach these groups. Itís really
important for every available dose to be used as quickly and effectively as
possible. This will become more and more of a challenge. Weíre going to
continue to have a challenge. We aren't at the supply challenge we want, but
better than a couple weeks ago. Thereís much you can do before you are able
to be vaccinated. Stay home when you are sick. Cover your cough and sneeze.
Wash your hands. Stay informed. Find out about the warning signs to watch
for. Thereís a lot of good information at flu.gov. Letís go to questions.
Weíll start in the room. Maybe start over here. Okay. Iím looking for the
Michelle Merrill: thank you very much. Iím Michelle Merrill with hospital
health newsletter. I spoke with someone at a major medical center who
received zeroH1N1 vaccine. Many hospitals received a small portion of their
order, maybe 10%. We had a report that corporations have been getting
vaccine. So, Iím wondering, why are hospitals not the absolute highest
priority? They have at-risk patients and does CDC have plans to take more of
an active role in determining who gets the first doses of the vaccine and as
a secondary question, I understand many hospitals have not received their
complete seasonal flu vaccine order. I think that's not being produced right
now because of the push to get H1N1. Will they eventually be getting that
Anne Schuchat: Thanks. The state and city health departments are doing an
incredible job directing vaccine to places to reach high priority
populations. In our survey of the states, what we understand is that
hospitals were highly prioritized by the majority of states. It doesn't mean
they got everything ordered. The initial amounts were relatively small.
Hospitals that were able to reach health care workers and high priority
groups were heavily targeted. We know there are a variety of places to reach
people at risk. We think doctorsí offices, health departments, schools,
hospitals employee clinic that is reach priority populations are reasonable
places for it to go. The key thing is to vaccinate as many people in the
groups as effectively as possible. Sometimes, focusing on putting the
vaccine in the path of where people will be is the strategy. We work closely
with the states in support of their efforts and have been emphasizing the
importance of the population. You asked about the seasonal flu. I forgot to
update you on that. There are 90 million doses that have been shipped out so
far. This is a private sector enterprise. The public health system is not
that involved in seasonal flu. Up to 114 million doses of seasonal flu
vaccine may be produced this year. Exactly the timetable for getting the
doses, I don't know. We have seen increased doses coming out each week. 91
million as of the latest update. We are reminding people that the seasonal
flu can occur and it's important to be vaccinated. We think there's time.
Usually seasonal flu strains don't increase until December through May. Now,
everything we are seeing is the H1N1 virus. Hopefully, there will be
additional supplies. They may not be ample to reach the tremendous demand
that we are seeing this year. So, I think we can do another from the room.
Jennifer Ashton: Dr. Jennifer Ashton. There have been isolated reports of
cases out of Pittsburgh of pediatric H1N1 with the complication of
encephalitis. I know it's reported as a problem. What are you seeing and is
it an emerging trend?
Anne Schuchat: Thanks for the question. We did facilitate the report of
neurologic problems last spring and are hearing the reports now. I don't
have the updated information of how widespread it is. Itís recognized with
seasonal flu, some people can develop that problem. Itís worrisome to get
it. Itís something we can look into further. Letís do another from the room.
Mike Stobbe: Thanks, doctor. Mike Stobbe. Two questions. You said swine flu
is widespread in 48 states. Itís the same number as last week. Do you think
it's leveling off? I want to ask about the Harvard poll that half the people
surveyed didn't know where to go to get the swine flu vaccine. Could you
comment on that, too?
Anne Schuchat: Sure. We are seeing substantial disease, as I said widespread
disease in 48 states. Influenza-like illness is at about the same level this
week as the week before its 7.7% of doctorsí visits for flu-like illnesses.
Itís still way higher than we would see at this time of year, even though we
had a slight downtick in that statistic. I can't say what's going to happen
in the weeks ahead, even at the point where there's a peak of disease in one
community. Half the cases are still to come. What we have seen in seasonal
flu is that after the milder illness, the outpatient illness peaks, one has
a delay before hospitalization and a further delay before death's peak. I
don't think we are at peak as a nation as a whole. What I can say is that
disease continues to occur at very high levels now. The other thing to
mention is that in pandemics in the past, it's been tricky to predict too
far ahead. In 1957 there was a substantial amount of disease in the fall.
People thought, pretty much gave the all-clear sign, then there was an
increase in severe disease. Another wave in '58. We are very mindful that
there's a long flu season ahead and we are going to be attentive to the
needs of the population, the efforts to try to protect people going forward.
The second question you had was about the Harvard poll. We have seen the
data. I think it's understandable that people were finding it difficult to
find vaccine at the time of the poll because we were and still are at a
point where the supply is relatively limited in comparison with the demand.
The result of the poll was nine out of ten people who looked for vaccine and
didn't get it planned to try again. They weren't giving up. They recognize
the value of trying to protect them with vaccine and sticking with it
through the next several weeks. You know, Iím very mindful of the
frustration people have had, whether from information gaps or just the basic
availability of the vaccine. I think it should be getting better over the
weeks ahead. A question from the phone?
Operator: If you would like to ask a question over the phone, press star 1.
Reporter: Thanks for taking the call. I have a question today about the IV
antivirals. They purchased the drugs. Can you tell me, what level of demand
have you seen from doctors wanting this treatment for the most ill patients
and whether you expect that demand to rise and whether you expect that there
will be enough of the oral antivirals.
Anne Schuchat: Itís the first antivenous viral. We are providing that to
clinicians who request it. The indication is for a severely ill person who
cannot tolerate other roots of administration where the intravenous route is
preferred or necessary. We know there are other intravenous medicines under
review. Maybe we will get more products in the future. At this point, demand
for that product is from critical care personnel to care for their patients.
We have had more than 300 requests through our system, so far. We believe
that our supply will be fine, given the recent order of product and we will
not have to have an interruption in supply. Okay. Another from the phone.
Operator: John Cohen, Science Magazine, your line is open.
John Cohen: Thanks for taking my call. Could you give us specifics of what
triggered that? If it was corporations receiving the vaccine, was there
evidence they were using the vaccine in low-risk groups? If so, what
corporations and what happened?
Anne Schuchat: We have no evidence providers were giving vaccine outside the
recommended priority populations. We were aware of concerns and reports and
the letter was sent out to the health officers as a reminder to emphasize
how important it is, at this time, where supply is limited, that we focus on
the best ways to reach the populations targeted for vaccine. Next question
from the phone.
Operator: CNN medical news, your line is open.
Reporter: Thanks for taking the question. Itís a follow up to the
corporation question. Some folks think that the CDC may have been able to do
a better job of communicating that corporations are also a place to get
vaccinated and get the vaccine to high-risk groups. All though, the
guidelines you put out for businesses do say that. Whose job is it to more
clearly tell their folks that this is what we decide or do you think looking
forward that the CDC may need to do more to communicate that information
Anne Schuchat: There are a variety of places where vaccination can reach
high priority populations. We think the state and local health departments
are in the best position. They know their communities and population and
providers, they know the capacity of the care system. What we are seeing
state to state and city to city is a variation. A lot of vaccine going to
hospitals for health care workers, going to health care departments, managed
care organizations and can reach them. Vaccine in many states, going for
school located clinics reaching a large number of young people who don't
have that many doctor's visits. Weíre seeing vaccine going to employer based
occupational clinics. When you look at adults and where they get vaccinated,
the workplace is a common place for adults to be vaccinated. Itís convenient
and accessible. Thereís nothing wrong with an employer based clinic. Our
focus is helping the states and locals reach the priority populations.
Pregnant women are in the work force. Adults with health conditions like
asthma, diabetes, we recommend vaccine for that group. Parents of children
under 6 months. I think there are many different ways where the adult
populations can be reached and we want to support the states and locals in
getting the vaccine as quickly and effectively out to them. Next question
from the home.
Operator: ABC, your line is open.
Reporter: Could you go into detail on the status of production, whether
there are new glitches, are the old ones still resolved and give me a best
case, worst case scenario of when you think it's going to field to the
public like there's plenty of vaccine out there and they don't have to wait
Anne Schuchat: Iím not aware of new glitches in vaccine production. People
have heard, the vaccine strain has been slow-growing and the manufactures
have had a challenge in getting a yield that we are reliably producing
batches week to week that met their predictions. Thereís been intense
outreach between the services and manufacturers trying to get the best
information. Our secretary reached out to the manufacturers to help where
it's possible. Iím not aware of new problems. Looking forward, it's
extremely difficult to predict when things are going to feel easier in one
community. I want to go through a couple things with this because I have
been asked that quite often recently. The supply is increasing. We have
twice as much vaccine today as two weeks ago. It might not feel like that
wherever you are. The demand for H1N1 vaccine and seasonal flu vaccine is
high now. This could change area to area. It can change week to week. So,
when we get to that sweet spot where there's ample vaccine and demand can be
met easily, is hard to predict. Iím expecting in the next several weeks
things will get better and better. We have all been burned on prediction.
Iím not going to get more specific than that. Next question from the room.
Is there one in the room? Okay. Sure.
Reporter: I just want to follow up from the earlier question ant about the
poll survey that half of Americans didn't know where to go. What do we draw
from that? I have one more question. have we learned any lessons from Europe
that say some have been more efficient and effective of finding the people
and getting them in for appointments. Any lessons learned or things we can
copy from Europe?
Anne Schuchat: Right. I think it's not surprising that many people didn't
know where to get vaccine. I think the first few weeks of the program;
vaccine has been in very limited supply. In some states, vaccine was sent
out to providerís offices so patients could get it through their doctor. It
wasn't publicly advertised. In many cases they were directing the vaccine
for school located clinics, they were really focusing on children. There
wasn't that much product being offered to the general population either to
doctors and health care workers or schools. The other people who had
priority conditions weren't necessarily able to find vaccine. There are a
number of states that held mass clinics that were accessible to the
community at large. Many, many states have vaccine in the local health
departments offering it through mass clinics or appointments. The hospitals
have gotten vaccine they can share. I think the principle is that when you
have limited supply, advertising is difficult because you don't have enough.
You don't want to frustrate the demand. What I can say is we have all
learned how important communication is. Even if there aren't public clinics
this week, they have been trying to get the planning going forward settled
so that people would be able to look at the website at flu.gov and look at
the locator. Thereís nothing in my community this week, but in two or three
weeks perhaps that pharmacy will have it. Itís a challenging environment. In
terms of Europe, it sounds promising. Iíll talk with you later about which
countries you are talking about. A number of states have been working well.
Some states have immunization registration and can figure out where things
are with that. I know the health plans are using their information systems
to identify, okay, let's make sure we have a handle on our people with
asthma or other conditions and we know how to reach them and let them know
they should come in for vaccine. Itís a good way to make sure you reach
priority groups and innovative communication efforts. We have been working
with faith based organizations, community based groups and provider
organizations to find best ways to reach people that might not be watching
it have or reading the newspaper for the announcements. Question from the
Operator: USA Today, your line is open.
Reporter: Thanks. Two quick questions. Do you have any idea about how many
doses of vaccine have been delivered or actually administered up to this
point? And my second question is, there are a lot of folks who have gotten
flu-like illness with high fevers, the characteristics of flu, but haven't
been tested. I get a lot of questions about whether they should be
vaccinated any way.
Anne Schuchat: We don't have great estimates, yet, about how many people
have been vaccinated. We are carrying out coverage surveys done by telephone
to track at a national lever and p state by state, the percent of population
that received the H1N1 vaccine. The information we have gotten is the
baseline before there was much vaccine out there. Very, very low levels.
What we are expecting is to be able to report to you the figures as we get
them. The second question was about people who believe they have had the
H1N1 infection, fever and cough, but didn't get tested. Should they get the
vaccine? We recommend it. The vast majority of people would not know, for
sure, if they had the strain, the H1N1 virus. Thereís not that much testing
capacity and we don't think there's harm getting vaccinated. Many things
that look like influenza or the H1N1 influenza are something else. The
recommendation, if you are in the priority group, when it's available in the
community. Another question from the phone.
Operator: Fox news, your line is open.
Reporter: We know up to this point, theH1N1 virus has shown no signs of
mutation. Can you quantify the risk of this happening in the future? It is
unlikely or something you expect with happen with this virus?
Anne Schuchat:Well, influenza viruses change. Thatís inevitable. Mutations
with occur. The key part is will we see something in the near future that
makes it change markedly to something more severe than what we are seeing or
is there a change that would occur to leave the virus to escape the vaccine?
Both of those changes are possible. Fortunately, we haven't seen any of
those, yet. We have been testing many of the viruses. It hasn't changed
genetically or the immune characteristics. The vaccines we are making
available are very good matches with the virus. It is -- it has been seen
with pandemics in the past that over the couple years after a new strain
emerges, it starts to change a bit. It starts to drift and become something
that would need a change in vaccine formulation, so that's one of the
reasons we make up new vaccines every year for seasonal flu. Viruses may
change from year to year and we may need to modify the vaccine. Another
question from the phone.
Operator: Wall Street Journal, your line is open.
Reporter: Hi, thanks. One of my questions was answered, but I wanted to ask
you about the number of doses being delivered in the coming week. I think
you said 8 million are expected in the next week or weeks. In the past two
weeks, there were 10 million or more new doses. I just wondered if, you
know, you could talk about why the slowdown, if that is a slowdown and
secondly, I wonder if you have more detail on formulations that are
currently available. I know you talked about injectable versus nasal spray.
How many single-dose vials and pediatric formulations. Do you have that
Anne Schuchat: I don't have the specific details of the formulations.
Thereís several. Pediatric single dose syringes, multidose vials, they are
multiple companies. I can say the majority is injectable, not the mist. The
majority is the multidose vials, but there are single-dose syringes. The
other question was about whether we should read into expecting 8 million
doses of vaccine this week and having gotten about 11 million and 10 million
the weeks before. I wouldn't read into it. Whatís happening is batches of
vaccine are being prepared and produced. The batches have to be ready. Itís
not something where week by week you can directly compare. We are expecting,
if everything goes well, we will have another 8 million doses this week and
going forward, we'll get more information about what to expect. I don't
think there's anything to be read into an 8 million expectation for next
week versus11 million this past week. Based on everything I know. Another --
time for two more questions from the phone.
Operator: Web MD your line is open.
Reporter: Thank you very much. I would like to follow up on Betsyís
questions. we have seen 10 million this week and 8 million next week, can we
see the flow is about 8 million to 10 million a week and is that the flow
you are expecting or will it vary from week to week? Iím not sure what the
flow looks like.
Anne Schuchat: I think we have been trying to stay away from getting too far
ahead of the flow. We were wrong in the past when we did that. But, I think
that Iím not actually aware of what happens after the 8 million that we are
expecting this next week. You know, that's what I can say. Did you have a
second question? Or that was -- okay. Next I guess the last question from
Operator: Minnesota public radio, your line is open.
Reporter: Thank you for taking my call. Some of the estimates we have heard
suggest that the waves of illness last six to 12 weeks. Here in Minnesota,
we saw a jump in illness ten weeks ago. What are your calculations in terms
of how long the wave has been going on and is it similar to what they saw in
the southern hemisphere in their flu season?
Anne Schuchat: Thatís a great question. We have been trying to look
community to community in how long things are lasting. What we are seeing is
different in different communities. You know, as we said, the southeastern
states, some of the southeastern states has rises as early as august. Quite
a lot of disease in September and October. A number of those states are
seeing drops. They are not down to baseline, they are still elevated. About
to say how long does it last is tricky. We have seen parts of a city, then
another part of the city. I wish I could tell folks in your community what
to expect, but it's difficult to. Thanks everybody. I think Tuesday we will
be on, again or somebody will be out here Tuesday.
CDC H1N1 Flu Media Briefing
1103 Atlanta GA
As physicians it's frustrating
for us not to be able to give vaccines to the patients
NOTE: This is a rough, unedited transcript and
transcription errors may appear.
Operator: Your lines have been placed on a listen only mode until the
question and answer portion of today's conference. The call is now being
recorded. If you have any objections to please disconnect at this time. I
would now like to turn the call over to Dave Daigle, thank you, sir. You may
Dave Daigle: Thank you, operator. Thank you for joining us either in the
room or on the line. I'm Dave Daigle with CDC media relations. Today the
director of CDC will update us on 2009 H1N1.
Tom Frieden: good afternoon. And welcome to our routine briefing about H1N1
influenza. The virus continues to spread and we're having a steady vaccine.
Flu continues to be widespread and virtually all the flu we're diagnosing is
still H1N1. So almost no seasonal flu yet. What the rest of the season will
hold, only time will tell. It's important, though, to recognize that if you
have a fever, if you have a cough you may or may not have H1N1 influenza.
For people with asthma and other underlying conditions it's particularly
important to get vaccinated when vaccine becomes available and also if you
have fever and cough to get treated promptly. People with asthma account for
about 1/3 of all of the people hospitalized with H1N1 influenza. We know
only half of those people with asthma when they got sick with flu, all
people with asthma when they got sick with flu sought care from a medical
provider. So if you have asthma or another underlying condition seek care
promptly when you have fever with cough.
As of today there are 31.8 million doses of flu vaccine available. We are
therefore on track to hit the 10 million increase that we had been hoping
and anticipating for in the current week. We'll update you Friday as to
whether the 10 million mark was met and where it has been shipped. The
amount that was available as of earlier in the week. That is a continuing
steady increase. That's encouraging. We know it's not nearly as much as we
would have liked. We know it's frustrating, inconvenient and disruptive for
people to try to get the vaccine and not to be able to. As physicians it's
frustrating for us not to be able to give vaccines to the patients. As
health officials it's frustrating because we know in part many people who
seek vaccine will not get vaccinated later. They would have benefitted from
it. When the vaccine wasn't available they didn't get vaccinated and might
not come back. We ask people to continue to be persistent. We know people
are coping well for the most part. People are being creative and seeking
vaccine the way there have been along the lines. We regret that. People
understood that sometime sit's difficult to avoid that. And the supply does
continue to improve day after day. Different states are taking different
approaches to vaccinating people. Some states are sub prioritizing. But
because there are different vaccine forms with the live continuing vaccine
only for healthy people ages 2 to 49, the live vaccine, the nasal spray is
primarily used for health care workers and healthy children. We're also
continuing to see really unprecedented demand for seasonal flu vaccine. This
is something that unlike the H1N1 vaccination effort is handled by the
market. Only about 10% of all seasonal flu vaccine is purchased by the
government, and nearly 90 million doses have been distributed to providers
throughout the U.S. We continue to hear that people are unable to get the
vaccine. We think this year will be the highest ever up take on seasonal flu
vaccine. We anticipate there being around114 million doses of seasonal flu
vaccine available through the market by the end of the year. It may be there
is even greater demand than that by the end of the season.
Antivirals are effective at reducing the effect of severe illness. If you're
severely sick with flu. If you're having trouble breathing, if you got
better and then got worse again, or if you have an underlying condition such
as asthma, heart disease, lung disease, diabetes, then seek care promptly.
It does make a difference and it reduces the likelihood that you'll get
severely ill or hospitalized. If patients are hospitalized increase the
likelihood we'll get out sooner and healthier. And protect others around you
by staying home if you're sick. Protect yourself and others by washing your
hands frequently and covering your mouth when you cough and sneeze. Flu
season lasts until May. We don't know what will happen. We will continue to
monitor and we will continue to do absolutely everything that we can to help
people and prevent the -- or reduce the spread of flu and reduce the
likelihood that people who do get flu become severely ill. With that I'll
stop and be happy to take any questions that you may have. Starting in the
room. Joanne --
Joanne Silberner: Thanks. You mentioned before the idea that half the people
with asthma once they've gotten sick have not come in. Where does that
number come from?
Tom Frieden: this is from telephone survey day that that we have. We call
randomly households. We identify a subset of people who have had
influenza-like illness in the previous 30 days. Then for the subset we ask a
series of questions about what conditions they have and what they did to
seek care. We don't know what the baseline is for that. We haven't asked
that survey, that question on that widespread basis before. We know we would
like more people to seek care if they have an underlying condition with
Joanne Silberner: From the survey you don't have a sense of what happened to
them because you didn't seek care. You know that from other information.
Tom Frieden: They were still answering the phone and answering our questions
a few weeks later. In that regard, we think nothing terrible happened.
Diana Davis: Diana Davis from WSB Atlanta. You said most of the stuff going
around is still H1N1. Are you starting to see any signs of seasonal flu at
Tom Frieden: there's almost no seasonal flu so far. A few strands here and
there. Overwhelmingly it's still H1N1, and it remains very tightly matched,
the vaccine strain and with no changes that would suggest an increase. Let's
go to the phone for a couple of questions.
Operator: our first question from Marian Falco, CNN Medical News.
Miriam Falco: Hi, thank you for taking the questions. I have two. The first
question is something you've addressed in the past. You said we're still
waiting for data. Can you talk about obese people and what risk they may
have from the H1N1 virus?
Tom Frieden: people who are very obese, a body mass index of 40 or above are
at increased risk of complications of flu. Most people with a body mass
index that high also have health problems such as diabetes or heart disease
that may increase their risk of getting complications for the flu. So for
those at an intermediate level of obesity with a body mass index in the 30
to 40 range the data is more mixed. It may be people in the range are at
increased risk of complications, but that's not entirely clear at that
Miriam Falco: My second question is about a report we're getting out of
Pennsylvania that 6,000 flu shots had to be discarded because they were
improperly stored. Evidently they were kept in a refrigerator in the school
and not at the proper temperature. Given that folks are desperately trying
to get a hold of these, what do you say about something like this happening?
Tom Frieden: Keeping the cold chain at the right temperature in any
vaccination program is extremely important. It's obviously frustrating, and
we regret it when there's any loss of vaccine. You think about we have had
30 million doses out there. There have been only a few examples of improper
handling that have led to vaccines being disregarded. Either if it's frozen
because that inactivates the vaccine or out of temperature. It's something
that is important to monitor and track. Why it's not easy to scale up
vaccination programs. Not everyone has the right kind of refrigerators. This
kind of thing is inevitable to happen virtually. We're glad it's been
relatively rare. Next question on the phone.
Operator: Next question from Tom Maugh from the Los Angeles Times.
Tom Maugh: I'm assuming you've seen the report today on the hospitalizations
and deaths in California. Was there anything in there that you found
surprising or out of the ordinary?
Tom Frieden: We see a continuing high level of hospitalizations particularly
in the country. Children under the age of 25 account for most
hospitalizations. We continue to see high rates of hospitalizations in
places where there's more flu. In terms of specific report, we haven't
reviewed it in detail.
Operator: The next question is from Martin Enserick of Science Magazine.
Martin Enserick: Hello. Thank you for taking my question. The world health
organization says it believes that the United States will start delivery of
donated vaccines in early December. But the health secretary was quoted
saying that oh, groups will be vaccinated first. Can you tell me when the
U.S. will start sending vaccines to developing countries?
Tom Frieden: The U.S. government has been in touch with the world health
organization to explore ways of getting other countries vaccines around the
world. There has been difficulty with production. There are shortages and
different countries are at different points of readiness inbeing able to
vaccinate. In terms of specifics of when other donations will be available
and when they'll be made, that has to be determined as the production
schedule becomes more clear in the weeks to come. Next question from the
Operator: Our next question from Robert Bazell from NBC News.
Robert Bazell: Thank you very much. This goes back to the paper from the
California health department being published this afternoon. One, it comes
up with a warning. Even though you repeatedly said this disease strikes
young people preferentially. It also says that other people can be at high
risks of complications, including death. Question number one is, is there a
chance that because everybody is familiar with this being a disease that
strikes people who are mostly young, is it that cases in older people might
be overlooked by patients or providers themselves. You said you haven't
taken a look at this data. How can something come from the largest health
department in the country, the largest state health department in the
country and you haven't had a chance to thoroughly review it?
Tom Frieden: The article talks about the severity of illness in different
age groups. What we've seen in that article as in our own data and data from
around the country and the world is that the level of severity among those
who become ill is similar to seasonal flu. So if they get it, it can be
every bit as severe as seasonal flu. That data, which is referred to in the
article you mentioned is quite consistent with the data that we've seen from
our own data around this country as well as globally. And it does emphasize
that providers should have -- should think of H1N1 influenza in all age
groups. It doesn't change what our recommendations would be for vaccination.
Still the number of people who are affected by H1N1 influenza are people
under the age of 65. Next question on the phone.
Operator: Next question from Alice Park from Time Magazine.
Alice Park: I want to follow up on the question about obesity. One
paraphernalia seems to indicate the people with higher BMIs tend to have a
greater vulnerability with respect to H1N1. Is there any evidence they did
not see the similar sort of increase among folks with seasonal flu? Is there
any reason or indication that there is something different about H1N1 in the
way it works in the body that would put folk who is have high BMI at greater
Tom Frieden: I think that would be very theoretical given the better
information we have in some situations and the much higher attack rate of
H1N1 influenza for people in the middle years of life, younger adults and
others. We are in the midst of an epidemic of obesity. Obesity has doubled
in adults and tripled in children in the past few decades. We're still
understanding what all the implications are for people's health and increase
of susceptibility to infections is one. Reduced respiratory reserve and the
ability to fight off infections is another. This is something we need to
learn more about and all of the evidence and information that's provided
helps us to determine what more we need to know and how we can better
Operator: Our next question from David Brown from the Washington Post.
David Brown: Thank you very much. Dr. Frieden, I was wondering if you could
elaborate more on the contributions. My understanding is originally when the
pledge was made it would be in November. Now I guess it's going to be in
December. Are the American demands going to be totally satisfied before you
assign some of the production to WHO? Talk to me more about when that is
going to happen and who is making the decisions?
Tom Frieden: In the U.S. government we're looking at a variety of options
for how to support the efforts of other countries and recognizing the
responsibility that we have to the American people. One reason that we have
difficulty with vaccine availability is because other countries have
insisted that vaccines made in their countries are used in their countries.
One of the challenges is with a scarce resource how do we ensure it's most
equitably distributed. Right now the maximum activity of the virus is in the
temper --areas. Generally the most virus circulation. We still don't have
the degree of predictability that we would want. I think it will be
difficult to say with certainty when and how much vaccine we'll provide to
other countries. This will be discussed at a broad level within the U.S.
government. Next question on the phone.
Operator: The next question from Karin Zeitvogel from AFP.
Karin Zeitvogel: Hi, thanks for taking my question. I have a question about
vaccine production and in particular cell based technology. Back in June the
department of health and human services announced a $35 million contract for
a U.S. company that's developing a flu vaccine using insect cell technology
and at the time Kathleen Sebelius said that we believe the technology has
advanced to the point where it could help meet a surge in demand for
seasonal and pandemic flu. Well, it would seem that we have that surge in
demand. So are we taking this any further?
Tom Frieden: right now we're using the egg-based method of vaccine
production. There are some newer methods. We hope they will be ready within
the next couple of years. They're not ready now. We're not cutting any
corners. The procedures used are complex and cumbersome. They involve growth
and testing mechanisms and are time consuming and take a long time to be
done. We need to have better vaccine production methods, but they're not
ready yet. This is an investment for the future. And we hope that in future
years, probably not -- certainly not this year and probably not next, but in
the not too distant future that we might have newer vaccine methods -- newer
methods of producing vaccine that would be able to provide vaccine at a more
rapid pace to adjust to the types of strains circulating more promptly. The
challenge we have is a challenge not unlike what happens each year. Each
year we decide in February what strains to put into the vaccine that will be
given in September, October, November, December. If the virus circulation
changes between the wintertime and the following fall/winter, we may miss
the strains that are circulating. So whether it's for a pandemic such as
H1N1 or for the changes in flu that happen each year, we do need better
technologies. We've been investing in them. We need to continue to invest in
them. Maybe two more questions for the phone.
Operator: The next question is from Andy Pollack from the New York Times.
Any Pollack: I was wondering if you had information on how many health care
workers are hospitalized or have died from this flu. And if you do have
that, do we have indication whether they are catching it from their patients
or from some other source?
Tom Frieden: we have limited information so far about the number of health
care workers who have gotten the flu. When a health care worker gets flu
whether they got it at home or in the workplace, and in the workplace
whether nay got it from a patient or another worker are all things that need
to be determined. One preliminary piece of information we have that is
somewhat encouraging is to seasonal flu vaccine we're seeing a higher up
take of influenza vaccination by health care providers this year so far than
in previous years. We have to wait to see how high that goes and how
extensive it is. But at least we've seen an uptake in health care workers
getting vaccinated. On the phone.
Operator: Our next question from Maggie Fox from Reuters.
Maggie Fox: You said one of the problems has been that other countries have
insisted on having vaccines made within their borders, used within their
borders. Other than Australia, where else has that happened?
Tom Frieden: that's been the primary example of that occurring. Were there
any other questions within the room? Okay. Well, thank you all very much.
Thank you for your interest.
CDC H1N1 Flu Media Briefing
1030 Atlanta GA
This is a younger
In a usual flu season,
90% of the deaths are among people over the age of 65
In H1N1, 90% of the
deaths are in people under the age of 65
In the past two months,
we've seen more hospitalizations in people under the age of 65 than in most
entire flu seasons
NOTE: This is a rough, unedited transcript
and transcription errors may appear.
Operator: Welcome and thank you all for standing by. At this time I would
like to remind parties that your lines are in listen-only mode until the
question and answer session. At which time you may press star one to ask a
question. Todayís call is being recorded. If you have any objections you may
disconnect at this time. Iíll turn the meeting over to Dave Daigle.
Dave Daigle: Iím Dave Daigle, CDC media relations. And today there's another
media update with the CDC director on 2009 H1N1.
Thomas Frieden: Good afternoon, everyone. What we have today is essentially
more virus, more vaccine and more treatment. The disease continues to be
widespread and is currently widespread in 48 states. Weíre seeing some
states decrease, particularly in the southeast of the U.S... But we don't
know whether that's a decrease before an additional wave. Itís only the end
of October and flu season lasts until May. In the past two months, we've
seen more hospitalizations in people under the age of 65 than in most entire
flu seasons. So we know that there's been a lot of disease from influenza,
from H1N1, in virtually all of the influenza we're seeing is still H1N1.
Genetically, the virus has not changed. Itís still closely matched with
vaccine. We have not seen mutations that would suggest that it would become
more deadly. And some of our recent survey data helps us understand what
people are doing in response to the data. Iím sorry, in response to the
virus. One of the things that we've been surprised to see is that even among
people who have an underlying condition, such as asthma or heart disease or
lung disease, only half sought care for influenza-like illness. Only half
went to their provider. This emphasizes that whether or not vaccine is
present and whether or not people recognize that they have an underlying
condition, people with underlying conditions, who have fever and cough,
should see their provider promptly. Children are particularly high priority
for prevention and for treatment. This is a younger people's flu. In a usual
flu season, 90% of the deaths are among people over the age of 65. In H1N1,
90% of the deaths are in people under the age of 65. Up until now, there
have been 114 laboratory confirmed deaths among children. More than
two-thirds of those have been children with underlying conditions. In terms
of the numbers of cases, hospitalizations and deaths, our focus is to
prevent cases as effectively as possible. And to encourage treatment.
Counting cases, particularly the numbers of people who had influenza-like
illness, is not something that's likely to be productive or accurate. We
know that there have been many, many millions of cases. In terms of
hospitalizations and deaths, we can provide information and we do on our
website, each year, of the number of confirmed laboratory confirm
hospitalizations and deaths. We know that that's an underestimate of the
total. Because there are people who don't get reported or laboratories that
don't test. Or laboratory tests that are falsely negative. And over the
coming weeks, we hope to be able to give you the best available estimate of
the number of hospitalizations and deaths to date. The number that you're
familiar with, of 36,000 deaths per year from influenza in a normal flu year
is based on estimates. Based on the best available scientific data of the
burden of influenza. and we will having learned as much as we can from the
pattern of H1N1, particularly in the communities where we have very
intensive monitoring of hospitals and other sites of care, be able to
estimate how many cases that are likely to have been or a range or an
at-least number. H1N1 vaccine supply is increasing steadily. Thereís not
enough for all providers or people who would want it. And this understands
to be frustrating. But the gap between supply and demand is closing. Last
week, we had 16.1 million doses available. As of Friday morning, 5:00 a.m.,
for shipment. As of today, we have 26.6 million doses available for
shipment. Thatís an increase of 10.5 million doses in that seven-day period.
With that vaccination, with that increase in vaccine availability, we're
seeing more schools doing vaccine clinics. Weíre seeing more health care
workers getting vaccinated. More people at high-risk are being vaccinated.
More providers are getting the vaccine. But it's not nearly as available as
we'd like. Also, we're seeing really, very strong demand for seasonal flu
vaccination. And Iím sure that all of the media attention to influenza is
driving that. But we are not seeing any spread of seasonal influenza yet.
But there's no reason to think that we won't have a flu season this year.
With other strains of flu. Only time will tell. So we do continue to
recommend seasonal flu vaccine. But we recognize that of the 89 million
doses that have already been distributed, by the manufacturers, the
overwhelming majority has already been given. Manufacturers report that
they'll be providing additional vaccines in November/December. So additional
vaccine should become available. And the seasonal vaccine program is not run
in the same way that the H1N1 vaccine program is run. In the seasonal
vaccine program, it's the manufacturers selling directly to providers. And
providers who order more, may be able to get more. But there's right now,
not enough seasonal flu vaccine for all who would want to receive it. We
continue to do everything that we can to reduce the impact of H1N1
influenza. One of the issues that's arisen is a shortage or spot shortage in
some areas of the liquid form of Tamiflu. On October 1, we released 300,000
courses from the strategic national stockpile. We are now releasing an
additional 234,000 courses of liquid Tamiflu from the strategic national
stockpile. That is the entire supply from the SNS. We held back some portion
before, because in early October, it wasn't clear whether some parts of the
country might need more than others. And we kept it back for that purpose.
Itís now clear that with disease throughout the country, it makes sense to
release what we have. And to get more from manufacturers as soon as they can
provide it. In addition to the liquid Tamiflu, we have worked with many of
the national chains, which are willing to compound, to make the syrup from
the adult Tamiflu. something that is safe for a pharmacist to do. Please
don't try this at home. This is something that should be done by a
professional pharmacist. And this is something that the pharmacy can do by
taking adult Tamiflu capsules and carefully measuring it, putting it into a
syrup that's palatable for children. And with this, it should be possible
sometimes with more effort than we would have liked, but should be possible
for people who want to get Tamiflu, need to get Tamiflu, to get it. And
we're appreciative of the cooperation of the pharmacy chains in that effort.
When we released from the stockpile, it's done on a population basis to all
parts of the United States and territories. Weíre also working hard to
improve vaccination efforts. And I want to take a moment just to reiterate
some of the basic information, nothing new. But we continue to hear that
there's confusion about who should get vaccine and when. We have left for
each state, jurisdiction, to have some flexibility within the priority
groups, if they want to subprioritize. But the overall priority groups
remain as shown on this slide. Five priority groups -- and the slide
outlines which of them -- there we go, which of them can be used for, can
receive which types of vaccines. pregnant women, at this point are only
recommended to receive the injectable vaccine. Care-givers of infants under
the age of six months can receive either the intranasal spray or the
injection. Unless of course, they have an underlying condition or are
pregnant. Children and young adults age six months to 24 years of age can
receive either the intranasal spray or the injection. Unless of course, they
have an underlying condition or are pregnant. People aged 25 to 64 with an
underlying medical condition, should receive the injection. And health care
or emergency medical service workers can receive either the spray or the
injection. Of course, again spray only if they don't have an underlying
condition and are not pregnant. These are the five priority groups. There
are some places that have subprioritized within that. And that's up to
jurisdictions, that may depend on local supply and availability. the
availability of large amounts relatively speaking of the intranasal spray,
which is most easily used for health care workers, and for school children,
is facilitating work in that area. There is a little bit of an urban legend
that health care workers shouldn't get intranasal spray. Itís an attenuated
virus that is cold-adapted. So it can't cause a continuous chain of
infection. It does not present a risk to patients. In contrast, in
unvaccinated health care worker does present a risk to patients. So we
encourage health care workers to get vaccinated. In closing, I want it
reiterate that we have more virus, we have more vaccine and we have more
treatment. We encourage the prompt treatment of people with underlying
conditions and we recognize that states have real challenges to balance the
increasing supply with the large demand. And there will always be some
mismatch between supply and demand. But we're all working as hard as we can
to get the vaccine out as rapidly as possible. And as widely as possible, to
those five high-priority groups. And of course, it's always something that
everyone of us can do, to stay home if we're sick. Cover our cough and
sneeze and wash our hands. And for more information, always check flu.gov.
Thanks very much and we'll take questions starting in the room.
Reporter: Dr. Frieden, the figure that you gave on pediatric deaths, 114,
how much of an increase does that signify over the previously-reported
Thomas Frieden: For laboratory confirmed? Itís an increase of 19. Laboratory
confirmed, pediatric deaths one week to the next.
Reporter: When was the prior figure reported, last week?
Thomas Frieden: Itís a weekly report. Mike?
Mike Stobbe: Mike Stobbe from the AP, thanks, doctor. of the first with the
pediatric deaths, that's the largest or one of the largest single-week
jumps. can you explain what happened? is it the volume of disease in
general? And then I wanted to ask about the swine flu vaccine doses. Do you
know who is getting them? Has there been a breakdown? Is it mostly children?
Thomas Frieden: Thereís a certain rhythm of flu spread in a community where
we see first an increase on the number of cases generally first in children.
Then in older people. Then an increase in hospitalizations, as people
develops complications. And then tragically, deaths following that. And the
hospitalizations may follow by about a week. The number of the peak in
cases, peak in hospitalizations can happen about a week later. And the peak
in deaths, two to three weeks after the peak in cases. So we are expecting
to see, sadly, increasing numbers. And one of the reasons we've emphasized
that only half of the people who have underlying conditions have even sought
care. Let alone gotten treatment. but sought care for their influenza-like
illness. If you have asthma or heart disease or lung disease, if you're
pregnant and you get the flu, see your provider right away, it's important.
In terms of who is getting the vaccine, about half has gone to children and
half to older people, only about 1% to 2% to people over the age of 65 at
most. That, however, is very preliminary and partial information. We hope to
have more in the coming week about who's been receiving the vaccine. Our
focus has been to get it out and getting reports in on who has been
vaccinated has taken more time. We know that in some states and
jurisdictions they've done a terrific job of getting kids vaccinated in
school-located clinics and have also welcomed others in the community to get
vaccinated in those same clinics. Clinics during the school day, for
example. Where people can just, school kids can get vaccinated without
disrupting their learning, to be brought out of class for one period of
time, one part of class at a time. Thatís been a very successful model and
an important one. because in future years as we try to increase seasonal flu
vaccination, that's the kind of infrastructure and experience that's being
established, that is an investment and will help us to address seasonal flu
in the years to come. Betsy?
Betsy McKay: Just a couple of questions. About the virus itself, do you
think it's still mostly children who are getting this? We hear so much about
schools. You don't hear a lot about workplaces, adults. I know there are
adult deaths and deaths of pregnant women, so there have to be adult
illnesses. Is it still mostly limited to the younger people? And the second
question is, maybe it's early to ask this, but do you have any information
on adverse events from vaccination?
Thomas Frieden: Weíre seeing increases first in kids. But also in young
adults and adults up to the age of 50, we've seen pretty substantial
increases in many areas. So it's not just kids who are getting the disease,
we're seeing a fair amount in younger adults. For adverse reactions, it is
early. But we have systems in place to see are there more adverse effects,
adverse events than we would anticipate. As we know, every time there's a
vaccine given, there's a risk of something bad happening. Something bad
could happen whether or not the vaccine is given. And for more information,
we'll be coming out shortly, about what are the expected background rates of
serious bad things happening, like Gullian-Barre syndrome, sudden death,
heart attack, miscarriage. Those are some of the things we look at. Just
because something happens after vaccination, doesn't mean it happened
because of the vaccination. Weíve seen a small number of deaths following
the vaccination for all of those things that we have investigated. Thereís
been a clear explanation that it's not vaccine or infection or condition. So
it does not appear that the vaccine was related in any way. Weíll see a
small number of people with allergic reactions that are concerning, but not
higher than anticipated. So it's still early. If there were a problem, to
have seen it. But nothing we've seen so far is concerning. On the phone?
Operator: Thank you, at this time if you'd like to ask a question, press
star 1 on your touch-tone phone. Our first question is from Jeffrey white,
"Dallas morning news."
Jeffery Weiss: Iíve been watching the per capita delivery of the vaccine as
your shipment numbers have come out week to week. And taking a look at
today's most recently-released numbers, there's still a petty broad
difference. 8.4 doses per 100 in Alaska and Vermont. Down to Florida, at 4.1
doses per 100. And there's a pretty good range. And I know that the
allocations are being done on based on population. Do you have any
explanation for why the shipments don't seem to be matching that?
Thomas Frieden: Weíre working very closely with the states. Some of them are
leaving vaccine in their allocation because they want to have it shipped
directly to schools. Where they're doing a school-located clinics. Others
have had some challenges in getting the system up and running. Weíve worked
very closely with each of the states. Itís quite a challenge. Weíve report a
global number. But there are actually multiple different products. Thereís
not just the intranasal versus the injection. But for the injection, there
are different formulations of it. And that has to be broken down by 100s or
in some states, thousands of providers and sent out to the providers. so
it's not such an easy job to get the vaccine out in the first days of
vaccine being available, there was a lot more variability than there is now,
in the proportion that's being drawn down. Weíre at over 80% of everything
that's being indicated rapidly, and we want to increase the number sometimes
the number that we provide you the snapshot and so the vaccine reporting is
available. So there's a little bit of a lag that can make it look like it's
not being drawn down as rapidly as it is. In some situations where there's
been slower-than-anticipated ordering, we've worked directly with the states
to see what we could do to report it. And whether there are any issues that
need to be addressed. On the phone?
Operator: Rob Stein, "Washington Post," your line is open.
Rob Stein: Hi, Dr. Frieden thanks very much for taking the questions. I was
curious about your thoughts for recommendations that came out this morning
for the W.H.O.'s stage committee on vaccinations sort of suggesting that
kids may only need one shot, not a booster shot as well. I was curious what
you thought about that.
Thomas Frieden: Weíve looked at that. The NIH has done clinical trials and
they're anticipating perhaps as early as next week, additional data on that.
The preliminary data did not show the kind of response in younger children
that we would have hoped for in order to say -- a single dose would be
sufficient. But only the data will show. Throughout this entire response,
our approach is, look at the data and follow the data. Follow the best
science that's available. We hope to have that within the next week or two.
And working with NIH, if the data show the difference, we will reconsider
our recommendations for the time being. Weíre sticking with what the ACIP
Operator: Steven Smith, the "Boston globe," your line is open.
Steven Smith: Good afternoon Dr. Frieden, thank you for taking the call.
Clearly in regions such as New England and elsewhere in the nation, we have
seen sharp rises in reports of influenza-like illness, visits to medical
offices. The ILI data in Massachusetts released today showed visits
happening at a rate above the peaks of the past two flu seasons. Iím hoping
you can assess, based on the constellation of surveillance data at your
disposal, whether this truly means more people are stricken with flu than
previous years, or conversely, to what extent this is actually reflect
patients seeking care more aggressively than in previous years. Which would
potentially skew the sense of the rapidity of spread.
Thomas Frieden: Thatís a great question. What we're seeing is quite
characteristic in many places. A steady increase in the proportion of people
in emergency department who are there for influenza-like illness. And an
exact mirror image of that, of people who are, who have influenza-like
illness and get admitted to the hospital. That suggests that people are
going to emergency department who don't need to be there. If you're sick
with flu and you wouldn't have gone to the hospital emergency department
before you ever heard of H1N1, you probably shouldn't go now. on the other
hand, if you have an underlying condition, if you have asthma, heart
disease, lung disease, trouble breathing, or you got better and then get
worse again. Or you've gotten very sick with flu, by all means, seek care
promptly. But yes, we do think that a significant proportion of the demand,
particularly for emergency department care, is related to the lack of, to
the concern and the media attention to influenza at this time. However,
where we have intensive monitoring of about 25 million people in various
states in the country were able to seek a hospitalization rate for flu. That
hospitalization rate, which wouldn't, we think really be much affected by
people who are coming in to just because they're concerned, that
hospitalization rate is higher than an average flu season already. And we're
still early days, nationally, in the spread of H1N1. So we do think that
there is truly, more disease this flu season. Joanne?
Joanne Silberner: Thanks, Joanne Silberner from NPR. Iím a little confused
about the Tamiflu issue. Yesterday I heard something about you could break
up the capsule and mix it with chocolate chirp. And you're saying not to
kpaund, what's the difference?
Thomas Frieden: There are adult capsules and pediatric capsules. The
pediatric capsules can be mixed with syrup or chocolate, something sweet to
make the medicine go down. For the compounding that pharmacists do, taking
the adult capsules. So if the pediatric dose, you can mix the pediatric dose
you can mix it with something sweet to give it to the kids. If the
pharmacist, him or herself wants to make you a liquid and give you a liquid
from an adult capsule, then only the pharmacist should do that.
Tom Regan: Dr. Frieden, two questions, please, Tom Regan with channel 2
news. You mentioned the pediatric deaths earlier. Do you have any update on
adult deaths since last week? I had one other question, I forgot it. But if
you could respond to that one, first.
Thomas Frieden: I forgot the second question you asked, anyway. Adult
deaths, we have to estimate. We can't know exactly how many adult deaths
there are for many reasons. Some people die outside the hospital. Some
people die without being diagnosed in the hospital. Some people who are
tested have the test be falsely negative, or inconclusive, or aren't tested
at all in the hospital. Or aren't recognized as having flu. Thatís why the
most accurate, it's a little counter intuitive. The most accurate accounting
of deaths is an estimate, rather than an actual enumeration. And within the
next couple of weeks, we hope to give you the number on more of a real-time
basis. Weíve presented at a scientific meeting yesterday, some information
about what the ranges may have been through the summer. In terms of the
number of deaths and we want to move that forward, that we can get real-time
within a couple of weeks. On the phone?
Operator: Marilyn Serafini, "National Journal," your line is open.
Marilyn Serafini: Thanks for taking my question. I wanted to ask you, you
said that in some areas, that the trend is going down a little bit. That
perhaps, it sounds like what she's saying we may have reached the peak at
least of this particular wave? Is that what you're saying?
Thomas Frieden: No, nationally we're still seeing influenza-like illness
increase. So although there are some areas that have shown decreases,
including here in Georgia, overall there are many that are still seeing
increases. And as a country overall, the overall number is still increasing.
Mike Stobbe: Mike from the AP. Doctor, could you repeat how many courses of
pediatric Tamiflu have been released? What day were they released. And also
I wanted to ask you, you talked to the president recently. Is he conveyed to
you, his concerns about how the response is going or the has he asked for
any changes or new initiatives?
Thomas Frieden: We released on October 1, 300,000 courses of pediatric
liquid Tamiflu. And we are releasing in the coming days, the remainder of
the strategic national stockpile which is 234,000 additional doses. Weíre
talking with the states and localities today, they're available for calling.
Itís possible that not all states will call them down. But that's the number
that can be released, that's the number that exists in the stockpile. The
president is deeply concerned about strain strain. Heís directly involved.
Heís briefed regularly. He asks a series of important and relative questions
and wants to make sure that we're doing everything that we absolutely can to
respond as effectively as we can, and learn the lessons for the future, so
we can get our technology in better shape through a real focus on influenza
and other emerging diseases in the future. On the phone?
Operator: Robert Bazell, NBC news, your line is open.
Robert Bazell: Thank you. Do you recommend, Dr. Frieden, any special
precautions for Halloween? Weíve had enormous amounts of email and questions
from over the telephone about people wondering, should they send their
children out? Should they take any care with the candy they select? Should
they be aware of what homes they're going into, and gatherings and I just --
you want sick kids it stay home. But is there any advice beyond that?
Thomas Frieden: Have fun, stay safe and yes, if your kid is sick, please
keep them home. From all activity, school, for Halloween. We have time for
two more questions. On the phone?
Operator: Miriam Falco, CNN Medical News, your line is open.
Miriam Falco: Iíve got two questions. The first question is, do you have any
data on how the school vaccinations clinics are going? How many children are
taking advantage of these flu vaccine locations. and also, can you clarify,
especially in the confusion from the W.H.O. briefing this morning, how many
vaccines, a 6-month-old, for instance, would need, of H1N1. And also how
much of the seasonal flu.
Thomas Frieden: Weíre just beginning to get information in on school-located
vaccine clinics. We have distributed a best-practice document describing
some of the experience from Maine. Which has been very effective at getting
large-scale involvement in getting vaccinations done in schools with the
minimum of disruption. We are encouraged, if we see half or more of the kids
get vaccinated in the schools, we don't expect to see anything like 80% or
90% of kids getting vaccinated. Though if it happened, that would be great.
But even to get significant proportion vaccinated is a real accomplishment.
Itís hard to get the consent forms back. Itís hard to arrange the logistics;
kids are out sick sometimes, so they can't be vaccinated if they're not
there. In terms of number of doses under age ten. Two doses of H1N1. And for
seasonal flu, it's a little more complicated. The first year you have
seasonal flu vaccine, two doses. In subsequent years, if you got your two
doses, then one dose. Last question on the phone? Weíll take one more from
Operator: Donald McNeal, "New York Times," your line is open.
Donald McNeil: Youíve given away the last of the pediatric Tamiflu pediatric
stockpile now. What are the chances of replenishing that stockpile? And are
you willing to start importing generic Tamiflu, if necessary if there's a
shortage from the brand manufacturer?
Thomas Frieden: We have ordered additional Tamiflu from the manufacturer.
And we are looking forward to delivery early next year, if that stays on
schedule. In any case, because of the availability to make liquid Tamiflu
from adult capsules, we think that the pharmacies will be able to provide
that as a service, going forward. We didn't see a reason to keep it in
reserve when we have so much illness in children out now. And since it is
widespread throughout the country, there was a reason to I think, provide it
everywhere now. In terms of generic, we're certainly open to all possible
considerations. Everything would have to be FDA-approved. We would not want
to have non FDA-approved medications here and we'd have to look at what the
legal and other issues are, if there is a lack of availability. Tom, last
Tom Regan: Yeah, Tom Regan, WSB TV. Weíve heard stories of schools closing
as a result of mass illnesses related to flu. Are you aware or is the CDC
aware of any public facilities building throughout the country that have
taken that kind of action as a result of mass illness or sickness?
Thomas Frieden: We haven't heard of other facilities closing. We have seen
some schools closures, generally because they've had such a high degree of
absenteeism. We reiterate for schools you really can stay open, even with
high degrees of absenteeism, if you have the administrative wherewithal to
continue operating and if you don't have kids, a large proportion of kids
who have serious health problems like muscular dystrophy or schools for kids
that are medically quite frail. Weíve heard about schools that have had to
close for very understandable reasons if they don't have the staff to open
or operative effectually. But the key, I think with school closures and
general community approach is we want to minimize the disruption. We want to
protect the public's health while minimizing disruption. So people can go
about their lives, go about their work, and go about their schools without
undue difficulty. Thank you all very much.
CDC H1N1 Flu Media Briefing
1029 Atlanta GA
Tamiflu supply concerns
for pediatric cases
Operator: Welcome and thank you all
for standing by. At this time I'd 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 to ask a question. Today's
call is being recorded if you have any objections, disconnect at
this time. Thank you, sir, you may begin.
Dave Daigle: Hi, I'm Dave Daigle from CDC Media Relations. Today the
director of the national center for immunization and respiratory
diseases will give us an update on the H1N1 virus.
Anne Schuchat: Good afternoon, everyone. Weíve been carrying out
full press briefings. A lot of people are asking about a few issues
about vaccines. So I'll just briefly catch folks off that. The
vaccine distribution and a little bit about anti-viral use. We're
expecting a more full briefing tomorrow with new epidemiologic data
as well. I want to let you know that as of today, there are 24.8
million doses of the H1N1 vaccine that are available for the states
to order. That's 1.6 million more than yesterday. And as we've been
saying, although we aren't where we want to be with vaccine
availability, we are seeing forward progress with more and more
doses becoming available regularly. I know that it's hard to find in
many places. And a lot of people do want to be vaccinated which is
great. I appreciate the frustration people are seeing as they are
unable to find vaccine. And over the next several weeks it should
become more easily available. And as I've been saying each day we
are seeing forward progress. We're expecting a lot of vaccination
effort this is weekend in a number of places. I want to express my
appreciation for the incredible work that the state and local health
departments are doing in what is a challenging circumstance. We all
had hoped to have more vaccine by now than we have. And so states
and locals have had to adapt their plans about how many doses will
be coming in the days ahead. And where to have them delivered, about
how to run those clinics. Around the country, more and more states
have been finding that they have sufficient doses to initiate school
located clinics and some other mass clinics. As well, many doctor's
offices are beginning to get doses. So hopefully things will be
getting better. As I said, we're not where we had hoped to have been
at this point. I want to mention a few things about antivirals.
There are concerns about people having trouble finding antivirals. A
few weeks ago the secretary ordered 300,000 courses of the liquid
Tamiflu for children to be shipped out to the states. And that's all
going out to the state through the strategic national stockpile. We
know there are also capsules of the anti-viral medicine. There are
many different size capsules. Many of those are fine for children.
In addition, we're working closely with the manufacturers to really
understand the supply horizon and understand what is out there in
the commercial sector. We're working closely with the states who are
managing their stockpiles of these antivirals to get them to the
places that don't have them. What we think is going on is really
much more of a spot shortage that here and there, you know, there's
a pharmacy that doesn't have usually the liquid formulation. There
is quite bit of the capsule formulations. Pharmacists can use the
capsules to adapt dosing that is appropriate for children. And we've
worked with the FDA and the pharmacists and pharmacies to get
information about how no use those capsules, something called
compounding where you basically break up the capsules and mix it
with a liquid syrup and can have an appropriate dose for kids. So we
know that a number of chain pharmacies are doing compounding now.
And this should be much more accessible to parents. There's also
information for parents. If your doctor prescribed capsules for your
kids but your kids are just not going to take a capsule, there's a
way for you to at home break up the capsule, mix it with a liquid
syrup like chocolate syrup or unsweetened chocolate syrup and have
something that your child can tolerate. I want to remind people
about antivirals. They are very important part of our response to
the H1N1 virus. Fortunately, most people who get infected with the
H1N1 will do fine just with a few days of bed rest and care and, you
know, not going to work or school and infecting other people. But
don't need to seek care. But some people do need to seek care and do
really need to receive the anti-viral medicines. And there are
really great tips for parents on flu.gov about warning signs to look
for in your child, whether it's important to seek care or not, or
whether things are looking okay but start to look worse and you
really need to get back in touch with your provider. So when
antivirals are prescribed, we want to let people know that there is
more out there in the supply system. The formulation that you
thought you were going to get may not be the one you were expecting.
But that kids can take the capsules mixed in with the syrup and that
should be just fine. We're working very closely with the states to
understand their needs and be able to fill the gaps that are there.
So with that I want to move to questions that people may have. We
can start with something in the room if there's a question here.
Betsy McKay: Betsy McKay with Wall Street Journal, a couple
questions. I wondered if you'd be able to tell us how many doses
have been shipped and also how many -- do you have how many doses
have actually been administered? And the second thing is do you have
an update on pediatric deaths?
Anne Schuchat: tomorrow we'll be updating on the pediatric deaths.
We do know that a number -- the number of children who have died has
increased since our last report. But the full summary will be
available tomorrow. And we expect there to be more, unfortunately.
The issue with the doses shipped, last spring we sent out about 11
courses of antivirals including a number of courses for children.
October 1st there was an order for an additional 300,000 bottles of
the liquid Tamiflu to go out to states to supplement what was
already there. The commercial sector is increasing production of the
Tamiflu and, of course, there is also Ralenza available. Important
to say that capsule production is what is -- has really been
increased. There are more and more capsules being made or shipped
out. And what we want parents to know is that capsules are fine for
kids, even kids that can't swallow pills because there's a way for
the pharmacist or for you at home to convert that capsule into a
liquid. The -- I think those were your questions. Did i miss one?
I'm sorry. Okay. Right. So that number I don't have. It will come
tomorrow. What we're trying to do, just to say we realize that
people want information. We want to get you more information, more
readily than we have. And i believe pretty soon we'll start to
really just post something every day so you can keep track of it.
But the shipping information comes in a little bit later than the
doses allocated. So hopefully fairly soon you'll be able to follow
the progress without us having to call you in for a press briefing.
Okay, another one from the room?
Beth Galvin: Thank you. I'm with Fox 5. I'm just wondering, talking
to the flu vaccine manufacturers, what are you hearing from them?
What about the delay? Is that going to be something that's going to
be on going into the future?
Anne Schuchat: there's very active communication with the
manufacturers. Of course, we have been talking about this delay in
production. And a couple of the factors that led to that are the
slow growing virus, the virus just not cooperating in the eggs. And
really working closely with the manufacturers to understand what's
coming out of manufacturing and what we can expect week to week.
Very important to get accurate information so that we can pass that
along to the states who are really planning how to use very quickly
the doses that get to them. So I know that there's active dialogue.
I don't have an update on projections. We had announced that, you
know, we were not expected to make the targets by the end of this
month. Of course, we won't be making them. But as I said, we are at,
as of today, 24.8 million that is allocated to the states for order.
So going forward, I think, you know, there is some of the challenges
that they have which we believe they've been able to improve. You
know, changing the strength so the virus is growing better and some
of those lines that need to be cleared are now cleared. So we're
really trying to avoid estimating exactly how much we're going to
have from week to week other than working closely with the states so
that they can use the doses as they come out to them. Question from
Operator: Elizabeth Weise, USA Today your line is open.
Elizabeth Weise: Thank you for taking my call. I wanted to find out,
you were talking about the pediatric death rates. Do we have overall
death and hospitalization rates for the first wave in the spring and
then now the full ever since the flu began?
Anne Schuchat: Right. I can call people's attention to a paper that
just came out online in emerging infectious diseases. Carrie Reed is
the author of that paper. She and her colleagues here at CDC
estimated the burden of disease in the spring really going from
April when this virus first emerged to I think it's July 23rd,
really using a modelling approach to take cases that were reported
or hospitalization that's were reported and estimating how much
really happened? We have been saying that we were just finding the
tip of the iceberg with our laboratory confirmed reporting. And, of
course, in July we switched away from an individual case counting to
other methods. In that paper, although there have been about 44,000
lab confirmed cases reported during that time period, the estimate
was between 1.8 and 5.7 million total cases. So a lot more cases
than were actually reported through that lab individual case system.
Now when you have common conditions like this, it's just not that
efficient to use resources to individually count every one of them.
And what we do is move to modelling approaches. They also estimated
that there were between 9,000 and 21,000 hospitalization cases
during that same time period. Again, more than what we got reports
of from the lab confirmed system. And just to think it through, not
every case that occurs will result in a person seeking medical care,
not every person who seeks medical care will be tested for flu. Not
every person who is tested for flu will have a result that is
positive. Not every positive result will get reported. And so forth.
And so you can imagine how what we count, whether it's cases or
hospitalizations or deaths will be underestimates of the full
burden. And more and more epidemiologists are looking towards
modelling. We don't have an update since the July 24th with this
modelling approach. But as Dr. Frieden said, we believe many
millions of people have already contracted this virus here in the
U.S. and that we have had, you know, probably by now well more than
20,000 hospitalizations. This model suggests that even by July we
had 20,000 hospitalizations possibly. So, you know, the important
thing to say is we're working actively on understanding what's going
on and looking forward. And really the priority is to minimize the
continuing serious illness and death that we're seeing through these
interventions like prompt use of antiviral medicines and vaccination
as soon as it becomes available. Another question from the phones?
Operator: Mike Stobbe from Associated Press, your line is open.
Mike Stobbe: Hi. Doctor, thank you for taking the call. Hey, the
Tamiflu shortage for children, that was first reported a month ago.
Can you tell me has it been getting worse or better or have the
shortages been moving to different parts of the country? What's been
going on in that last month?
Anne Schuchat: you know, we've seen an increased use of the Tamiflu
from the surveillance tracking systems. We're seeing increased use.
We believe a higher use among those with underlying conditions who
are, you know, when they get flulike illness we recommend they be
treated. We are not aware that things are worse. When he done supply
projections last month that led to that shipment. October 1st we
shipped out the liquid Tamiflu projected on projections. We were
looking at how much is out there and how much is in the system and
if things continue with children and children get ill will we have
enough of the different formulations? So we tried to ship that out
before there was a problem. We're not aware of a widespread problem.
We are aware from media reports of anecdotal concerns where people
are having to call around a lot to find a pharmacy that has the
medicines. And so we take that kind of concern seriously and want to
let people know that the capsules should be an ample supply and the
adult capsules in very ample supply and you can convert the adult
capsules into medicines for kids. And then, of course, the pediatric
capsules can be mixed up at home with the syrup. So we're not aware
that it's getting worse. We're just aware that, you know, we're
seeing a lot of people with flu illness seeking -- who are being
prescribed medicine. We want to help with the shortage that's have
been reported. So another call -- question from the phones?
Operator: the next is from Daniel DeNoon, WebMD.
Daniel DeNoon: Doctor, going back to the EID paper. There is a
multiplier that has been used to estimate the cases of 79 cases for
each report that you received. Do those -- and a similar is for
three per hospitalizations. Do the multipliers still apply? Could we
use those kinds of modelling to guess how many people, how many
cases there have been and how many hospitalizations there have been
as of now?
Anne Schuchat: I think that paper is very helpful in providing a
method, a methodology. I think the multipliers need to be taken for
a grain of salt. If we think back to April and May, early cases, of
course, there was a keen interest in finding out whether this virus
had arrived in a place. And a lot more people with milder symptoms
were being tested. We don't actually get reports anymore of the
individual cases. We only get summary reports of hospitalizations.
So the case multiplier would be a challenging thing to track. The
hospitalization multiplier might also need to be taken with a grain
of salt at this time because we do also have a possibility that some
people were being hospitalized early in this outbreak for different
reasons than they would be now when this was a new -- newly
recognized virus. There were probably some precautionary
hospitalizations. So i think that it's an instructive and very
helpful analysis. But taking it sort of exactly as is with those
multipliers might lead to problems. Next question from the phone?
Operator: The next is from Robert Bazell, NBC news.
Robert Bazell: Hi, doctor. Thank you for taking my call. Two
questions if I may. The first is speaking to practitioners,
especially pediatricians and internists who are not infectious
diseases specialists, they say they're confused by the
recommendations about whether to use antivirals. I know you've
changed them over time and that the perception of whether there's
going to be a shortage and the perception of whether there is a risk
of creating resistance has changed over time. And I don't know that
you could clear this up in a second. But do you understand why
that's the case? And I do have a second question if you'll stay with
Anne Schuchat: Sure. Clinical judgment is always important. And i
really value the hard work that private -- either the frontline
practitioners are doing to care for people and to determine whether
their patients should come in to see them or just talking with them
over the phone. What we recommend right now for anti-viral medicines
is that focus be on treatment, not on preventative use of the
medicines. And that the focus be on treatment of people who have
severe presentations, anyone who is hospitalized with suspect or
likely flu, whatever kind of flu, should be treated. And you
shouldn't wait for the results of a test because that test results
even a negative may not be right and it may take some time. So
prompt treatment of people with severe illness like those who are
hospitalized is important. People with respiratory symptoms and
fever, influenza like illness who have chronic conditions like
asthma who are pregnant, who have diabetes, who are very young like
children under 2, those are groups where we do recommend anti-viral
use be the general approach. And then for people who are older --
healthy, otherwise healthy without the chronic conditions who are
not pregnant. If they have severe presentations or warning signs,
they may not be hospitalized, but they may be actually showing some
warning signs in terms of difficulty breathing and so forth that
medicines could be important in those circumstances. But for the
vast majority of people who have an illness that isn't severe and
who don't have the underlying factors like very young age pregnancy
or chronic health conditions, probably just bed rest, fluids and a
little TLC is the right way to go. You know, in all of our guidance
we really stress that that provider-patient relationship is very
important. We think doctors probably do know their patients well and
can sense whether things just aren't right. For parents, at flu.gov,
there is really helpful information about warning signs to watch for
for your children. I encourage you to take a look at. That if your
child is ill and things changing a little bit, look that up again
and see how they're doing or give your doctor another call if you're
worried. We know that parents have pretty good intuition of
something not being right with their children. You have a followup?
Robert Bazell: Yes, can still understand why parents and providers
is going to be wanting to have antivirals because of just fear and
this is the drug that's out there, it's available and it can be
used. And you say the patient-doctor relationship is important. Of
course this is something that is fairly new to a lot of people. They
haven't seen so much illness in young adults. This is one thing. The
second thing is that I want you -- would like you to answer is that
-- we talked to pharmacists who say they will not formulate Tamiflu
because they don't know how to do it. Yet, you're saying that
parents should do this at home. Isn't there a danger of parents
mixing up drugs at home with chocolate syrup or something else that
could end up giving the child the wrong dose?
Anne Schuchat: Thanks for those two questions. I definitely
understand that the challenges of our anti-viral -- of our antiviral
messages. This is not a black and white situation. Unfortunately, a
lot of clinical medicine is like that that evaluation, careful
evaluation, talking to the parent really understanding what's going
on is very important. What we've tried to do at CDC and with health
care community in general is to put out put algorithms that can be
helpful or for general guidance that can be benchmark for people
knowing that that clinical judgment is just as important.
Unfortunately we donít have a perfect black and white test that will
tell you that this personal absolutely needs medicine, this person
definitely doesnít. But we can say that the vast majority of people
get better without medicines. And that some people need medicines
very promptly. So it's tricky message. I hope it's one we can work
together in getting out more clearly. Your second question is about
the pharmacists and parents. It's just apples and oranges. We are
asking pharmacists to do something called compounding. They're
taking capsules and looking at body weights and dosing and sort of
mixing up a couple capsules, maybe more than one capsule with a
certain amount of liquid and doing something really under
pharmacistís attention that is with a prescription sort of guidance.
We know that some pharmacists don't want to do. That but a lot more
and more are saying that they will be part of the solution. A number
of the chains, I think I mentioned Walmart and Walgreens and CVS and
many states are saying the pharmacist will do this compounding.
Very, very different what we're telling parents. Parents should not
compound. At flu.gov, there is information for patients. If you come
home if the pharmacy with a prescription from your doctor that is
pills and says one pill a day or whatever and you can't get your
child to take that pill, there is -- there is a way for you to break
up open that pill, mix it with a little syrup and have your child
take the full spoonful of the syrup. Very, very different than what
we're asking the pharmacist to do. We don't want parents to become
pharmacists. You have a full-time job being a parent. Next question
from the phones?
Operator: Dr. Jon LaPook, medical correspondent, your line is open.
Jon LaPook: Hi. Public health officials believe that vaccination
will make a big difference in the survival of people with H1N1. In
parts of the world that don't have these resources right now, is
there evidence of increased mortality compared to that seen in the
Anne Schuchat: Iím not aware of information about that yet. But
that's a really good question. We work closely with the world health
organization and partners around the world to understand what's
going on and try to help with the situation. We do think that each
country has their own challenges and so I don't actually have data
to speak to that. I can say, though, that way that we track illness
is a bit different in different countries. You know, some are
focusing on illness that's in the hospital. Some are focusing on
community surveys of what's going on. So even just comparing what
the mortality is country to country is relatively complex. And I
think we have time for one more question from the phone.
Operator: The next is from Brian Hartman, ABC. Your line is open.
Brian Hartman: I wonder how tightly do you control the throttle and
production of the vaccine? I know that, you know, once the initial
you are rush of doctors who really want this vaccine get their shots
and get the nasal spray. How do you then calibrate the supply so you
don't just end up with a warehouse full of doses that nobody's ever
going to get?
Anne Schuchat: we are working very closely with the manufacturers
and the states and the private sector to make vaccine available as
quickly as it's produced. You know, it's going from manufacturers to
a central distributor and then out to the states. And they have a
population based formula for how much they get. They are using it as
quickly as they you know, ordering it as it becomes available and
sending it out to many places. I think over the weeks ahead we'll
get an idea of where supply is and possibly changing demand. One
thing I do want to say, though, is over the weeks and months ahead,
we may see fluctuations in disease. Disease may go up further. It
may start to come down. Even if disease comes down, I think we need
to be mindful of the lessons of the past. In 1957 disease went up
and then came down towards the end of the fall. And people thought,
you know, we don't need to bother to vaccinate. It turned out there
was a big, big wave after the first of the year in February and
March. And so I think that we'll need to be keeping our eye on
demand and the increasing supply and understand the best way to
prevent disease as much as we can. So thanks everybody for this and
there will be something more detailed tomorrow.
CDC H1N1 Flu Media Briefing
1027 Atlanta GA
We wish we had more
vaccine available now
We wish we had better
We wish we had a
technology that could produce a vaccine in weeks or months rather than the 6
to 9 months it takes given the current tried and true technology
NOTE: This is a rough, unedited transcript
and transcription errors may appear.
Operator: Welcome and thank you all for standing by. At this time, I would
like to remind parties are in a listen-only mode until the question and
answer session at which time you may press star 1 to ask a question. Today's
call is being recorded. If you have any objection, you may disconnect at
this time. I'll turn the call over to Glen Nowak.
Glen Nowak: Thank you for joining us. This briefing again, focuses on H1N1,
both the disease and the vaccine supply. The briefing will be conducted by
Dr. Thomas Frieden, the Director of the Center for Disease Control and
Prevention. I'll turn the podium over to Dr. Frieden to make some opening
remarks and answer your questions. Dr. Frieden?
Tom Frieden: Good afternoon, everyone. Today, H1N1 influenza remains
widespread throughout the United States and although we have seen some areas
have decreases in disease, we are also seeing increases continuing in other
areas. We continue to track the pattern of illness and there's been no
change in the pattern of what age groups are affected or what people are
most seriously affected by H1N1, there's also been no change in the
laboratory testing of the virus. So there's been no difference in the
likelihood that the virus strains are that are in the community will respond
to the vaccine that's bees produced and distributed and there's been no
change in the virus that would suggest it would be more deadly at this time.
While it's still too hard to get the vaccine, vaccine is becoming
difficultly more widely available.
This week, as of today, we have 22.4 million doses available for shipment
out directly to providers and we're getting to the level where it will
become significantly easier to find and receive vaccine. We're working
closely with the states to ensure that vaccine, once it becomes available is
order, delivery is overnight directly to the provider. And eventually, there
will be enough vaccine for all who want to get vaccinated to get vaccinated.
We wish we had more vaccine available now. We wish it had been available
weeks or even months earlier but we're beginning to get to a significant
increase in the availability. If you just look from last week to this, we
went from about 14 million doses last Wednesday available to today, 22.4
million, that's an increase in 8 million doses in about a week or less than
a week. That allows enough vaccine to be available in states and localities
that it can be increasingly widespread. That's good news, not as soon as we
would have liked it, but it does represent a significant advance. We're also
working with states and localities to identify best practices because having
the vaccine out even though it's not as large quantities as we would have
wanted, does mean that we have to work hard to ensure that what is available
is given and to the priority groups as conveniently as possible.
One of the key areas is school located clinics. Some jurisdictions have done
things such as have community forums, have community leaders coordinate
this, sent consent forms home by regular mail as well as e-mail. Conducted
vaccination programs during school hours when it's more convenient for
people to get vaccinated. All of these are important and in general, trying
to make vaccine as easy for people as possible whether it's in their
doctor's offices or as more becomes available in pharmacies or in schools or
for health care workers in particular in workplace, these are all important
are opportunities, also it does seem that people are getting more used to
the nasal mist that's available. In past years there had been some
reluctance to use it, it's recommend for people between the ages of 2 and 49
who do not have underlying health problems.
We wish we had better technology. We wish he had a technology that could
produce a vaccine in weeks or months rather than the 6 to 9 months it takes
given the current tried and true technology. Notice supply chain is working
hard. Manufacture, government, distributors, health departments, providers
and the public and I think all of us are frustrated that we haven't had more
vaccine that we don't have more vaccine now. When the season is over it will
be a good time to look back and think of what could have been done
differently or better. Clearly, the vaccine production technologies need to
continue to improve. We're still using eggs. We're still using technologies
that have been around for a long time, that's good news in terms of safety.
We're not cutting any corners, we're not trying anything new or experimental
in this season, but we wish we had vaccine technologies that could be
quicker. We also are struggling with complex vaccine manufacturing process
and the procurement and distribution process and figuring out how that can
work best is also something that's worth looking at specifically. But
there's a lot that the also gone quite well. Six months after the virus
emerged, we have a vaccine available increasingly. We have high degree of
confidence in its safety. It's an excellent match with the strains of virus
that are circulating. We did not cut any corners in terms of vaccine safety.
All of the safeguards are being used, we're using the same production
method, the same factories, the same safeguards to make a vaccine that's
been used for hundreds of millions of doses with excellent safety record.
And while we know that there will inevitably be events that occur after
vaccination we'll have a system in lace to determine are whether those
events are by chance or whether they may reflect any problem with the
vaccine. So we take vaccine safety very seriously.
Two final -- or three final points. First, that this is a collaborative
effort. Many parts of the federal government are involved, manufacturers are
involved, the health care providers, the health departments who have been
central in ordering, identifying providers and distributing the vaccine and
the public in identifying and prioritizing people at high risk to get
vaccinated as soon as vaccine is available, even when vaccine is available
and particularly in places where it's not as widely available as we would
like, it's very important to remember that treatment can be highly
effective. And if you are severely ill, having trouble breathing after
having flu or if you have an underlying condition like heart disease,
asthma, then you should be treated promptly and see your provider right away
if you have fever and flu-like illness. And of course, very effective,
always in preventing the spread of flu and protecting yourself and others is
to stay home if you're sick, to cover your cough and sneeze and to wash your
hands frequently. So while we still have many people who want to get
vaccinated and don't yet have ready access to the vaccine, we will be seeing
in the coming weeks, significant increase in vaccine availability and
predictably there will be challenges in ensuring that the vaccine that is
available gets to the people who want to get vaccinated and I expect that
will be a challenge in areas more than others. This is something that is
never easy. And particularly when there is the level of concern are and
interest in vaccination that there is now and so we're very grateful that
the excellent work is being done at all levels by states, by providers and
that people understand that this will likely take more time than we would
all have liked. Thank you, we'll take some questions starting in the room.
Diana Davis: Thank you. Diana Davis from WSB in Atlanta. You've mentioned
several times about the outdated production tech knowledge. Rather than
eggs, what would be an improvement? Would it be genetic engineering,
synthetic? And do other countries use this?
Tom Frieden: There are several other potential vaccine manufacturing
mechanisms, cell-based is one, DNA technologies are others, protein-based
are others. They're all still experimental, we're not using any of them in
this and I'm not aware of any other country that's using the new
technologies there. Is some use of adjuvant in other parts of the world,
we've opted not to use it here.
Mike Stobbe: Hi, Dr. Mike Stobbe from the AP. You said swine flu illnesses
are increasing in some parts of the country and decreasing in others. Could
you be more specific, where is it increasing and decreasing? Could you put
us in context? Are we in, would you call this the second wave right now or
is the second wave still in the future?
Tom Frieden: You could say that we've had one flu season that's been
continuous from April to now. But there was a lull over the summer with
fewer kids in schools and now that summer has ended and kids are back in
school, more cases. We're decreases in Georgia as was reported in the press.
It's quite focal, so it's not one region or one part of the state. But parts
of state, different parts of the city are seeing the spread at different
times. This consistent with influenza, it tends tour patchy. That's
important because it means that although many people have had H1N1 influenza
and we wish there had been vaccine for them earlier, there are still many
people at risk and it certainly not too late to get vaccinated when vaccine
becomes available. In terms of the detailed information, we make that
available each Friday on Fluview.
Betsy McKay: Hi, Dr. Frieden, Betsy McKay from the Wall Street Journal. I'm
just wondering if you have thoughts on what can or should be done to make
more vaccine available more quickly right now or if you think that needs to
be done? Thinking of expanding who can get nasal mist or different
formulations. And then the other question just logistically, do you know how
long it takes from the time a manufacturer ships vaccine to the point that
you're able to say that you have it available for states to order?
Tom Frieden: So the shipping goes directly to a set of warehouses. They're
logged in at the warehouse and becomes available for ordering for within
about a day. This then shipped overnight once the order is received. We've
cut as much cycle time out of that process as possible. Every single
shipment is checked to ensure that the temperature has been maintained at
every step of the way so hasn't gone out of temperature and in terms of the
just trying to get the vaccine out as rapidly as possible, the challenge is
work at the state and local and provider level to ensure that when vaccine
is available it becomes known to those for whom it's a every or the to get
vaccinated, that information is increasingly available at flu.gov through a
threw locater. There are other states and localities that have other
information. Different states have chosen different routes to try to get
vaccine out widely. Many have used providers. So it's a question of
providers signing up and receiving their allocation of vaccine. We
anticipate in the next week or so, will be a significant increase in the
perceive and real availability of vaccine as we go from the 10 to 15 million
range to the 25 million range in terms of doses in the community. That
should provide a significant difference. Remembering that in a normal flu
season, we vaccine about 100 million people over about four months. So
roughly speaking that's 20 million to 30 million doses per month. So having
more than 20 million doses out, we think, will provide some greater
availability of vaccine for a lot of people. On the phone?
Operator: First question is from Helen Branswell, the Canadian Press, your
line is open.
Helen Branswell: Hi, thanks for taking my question. I would ask a question
and follow-up if I could, please. You know the people who don't want vaccine
are quite vocal about their concern about the vaccines, but the lineups
you're seeing in the United States also speak quite loudly. I'm wondering if
CDC has any kind of current data from polling that you've done that gives
you a sense of how willing Americans are to get this vaccine, where things
stand at this point?
Tom Frieden: We do have steady polling information. And the results are
interesting. First there's still widespread in getting vaccine. There are
some people, as you note, who really dent want to get the vaccine. They've
made that clear. That's their choice. Interestingly, if you compare
attitudes towards seasonal vaccine versus H1N1 vaccine, there's some things
that are puzzling in the public perception. That I think that I mean that
all of us need to continue to emphasize certain messages. One is that there
is a difference in the confidence in the effectiveness of seasonal versus
H1N1 vaccine and we have every reason to believe that the H1N1 vaccine is an
excellent match with the virus that's circulating and that it will be highly
effective as effective as a highly effective flu seasonal flu vaccine.
Second, there are more concerns about safety, with H1N1 vaccine than there
are with the seasonal flu vaccine. Again, we've said it, I don't know how
else we could say it but it's the same manufacturing process, it's the same
factory, it's the same safeguards and if we had had H1N1 earlier in the
season, we would have most like included it in the seasonal flu vaccine so
it would have just been part of the regular seasonal flu vaccination program
as it will be for the southern hemisphere in the coming flu season. There's
also the perception that seasonal flu is riskier or more likely to be a
problem than H1N1, where we really don't know what the future will hold. We
do know that H1N1 is very widely circulating now, the rest of the flu
season, we'll only know what will happen later on in the year. But
certainly, H1N1 is the dominant strain circulating now and there's every
reason to be vaccinated if you're in a priority group as soon as the vaccine
becomes available. Did you have a follow-up question to that?
Helen Branswell: I do have a follow-up question. Earlier, you talked about
the production technologies and challenging they are under these
circumstances. And last week, when you had your press conference, you also
said the technology we are using although tried and true is not well suited
for pandemics. Once this is over, do you think it's time to decide that
egg-based vaccine production really cannot answer the needs of a pandemic?
Tom Frieden: That's not a question of deciding. It's a question of investing
in the research and the technology development to come up with new vaccines
and try to get those into our seasonal flu production process. We need to
get comfortable with a new vaccine process. I don't think any of us would
want in an ideal situation to try a new vaccine during a pandemic. What it
tells us is that there's an important need for ongoing significant
investment in new vaccine technologies. Next question from the phone.
Operator: The next is from Maggie Fox from Reuters. Your line is open.
Maggie Fox: Thanks very much. I want to follow up on this question about the
perceptions about the vaccines, is it frustrating to you that people on the
one hand are saying, hey, we can't get this vaccine but then there's plenty
of people saying don't get the vaccine it's dangerous. I know the last time
that there was a shortage of vaccine, you ended up throwing doses away. Is
there a risk of that happening here?
Tom Frieden: I think the likelihood is that we are currently in a situation
where we too little vaccine in the community. It's quite likely that that
too little vaccine is one of the things that's making people more interested
in getting vaccinated, frankly. Were we have shortages we see an increase in
demand. It is likely also as we produce more vaccine and as both people are
given the opportunity to get vaccinated, and as disease maybe wanes in the
future, we will have significant amounts of vaccine that can't be used. The
challenge at this point is to get what vaccine we have out now available to
people, provide it to doctors offices, school, health care facilities and
others as rapidly as possible so that as much as is available can be used.
One of the messages for states, localities and health providers is not to
reserve vaccine that they have available, to give it out as soon as it comes
in, because more is on the way. And the production is now in a scaled up
mode, so more being produced, not as much as we would like, but more is
being produced and made available as soon as it can be. Another from the
Operator: The next is from Miriam Falco of CNN Medical News.
Miriam Falco: Hi, Dr. Frieden, thanks for your taking the question. CNN
opinion poll only had 49% thinking the vaccine was safe. My question is do
you think you'll meet the downsized goal of 28 to 30 million doses by the
end of next week which is the end of the month?
Tom Frieden: We're at 22.4 million as of the end of today. We'll let you
know what is achieved by Friday. Is there a question in the room?
Beth Galvin: Beth Galvin Fox 5 News. Thank you for doing this briefing. I'm
wondering for Americans who are trying to get the vaccine and feeling
frustrated, when do you think it will be widely available for people who
don't fit into a high-risk group but really do want this vaccine?
Tom Frieden: Our focus is really is the high-risk group, the groups most
likely to bet severe illness, most likely in the case of illness to spread
severe illness. That's the focus now, while others I understand want to get
vaccinated, I think all of us can respect that the vaccine should be used
first for those who will benefit most, those who are most at risk. Those
children who are between six months of age and young adults 24 years, anyone
with an underlying health condition, health care providers who provide care
for those who are ill, those who provide care for people under the age,
infants under the age of 6 months. Those are the groups at the highest risk
of severe illness and highest priority for vaccine.
Beth Galvin: Can I just follow up and ask about widespread availability. Do
you have any idea when we'll have a potential stay mount for people?
Tom Frieden: Significantly more vaccine is becoming available. I do
anticipate that in most states within the next couple of weeks, it will seem
to be much more widespread and much easier than it is now to get vaccinated.
The big increase from last week to this week in availability translates into
more vaccine availability in the community from this week to next week and
increasing spread availability after that. On the phone?
Operator: The next is from Elizabeth Wiese from USA Today. Your line is
Elizabeth Weise: Thank you for taking my call. I want to check on the nuns
you were are giving for vaccine is that cumulative or just new out this
month or this week?
Tom Frieden: Cumulative. So as of today, 22.4 million doses are available
for ordering or basically can be shipped -- the weight process works is that
the manufacturers ship it to the central distribution place, they log it in,
ensure that the cold chain has been maintained every step of the way, make
it available for ordering, the orders are placed by the states, then the
orders go directly from the manufacturer in most cases, directly to the
provider, whether it's a hospital or a clinic or a private doctor's office,
or a health department. On the phone? And then in the room.
Operator: Amy Berkholder from CBS News, your line is open.
Amy Burkholder: Yes, hello, thank you, Dr. Frieden. Quickly, the CDC's
algorithm for distributing the vaccine, is that based on population only and
not where the illness is most acute and is that effective?
Tom Frieden: Our decision was to provide it on a per capita basis so each
state and each state has an equal likelihood of being able to get the
vaccine. One of the characteristics of using the distribution system that we
are using is that it's not reliant on the market, so it's not that if you're
a provider or a drugstore or a hospital has a better relationship with the
distributor or manufacturer, they'll be at the front of the line, everyone
has the same chance of getting the vaccine that's available. I'm sorry, the
other part of that question was?
Amy Burkholder: The second question and that do people who say they're
frustrated by either a lack of updated on the flu.gov link or some
unreliable information on where to get the vaccine, you would respond?
Tom Frieden: It's challenging with a limited amount of vaccine for a lot of
people who want to get vaccinated. And this means that asking your provider,
checking with your health department, checking on flu.gov may be necessary
whereas we wish it would be easier for people to find out where they could
easily get vaccinated. In the room?
Mike Stobbe: Mike from the AP again. Doctor, you just told us some stuff
that suggests maybe good news on the horizon, there's more vaccine becoming
available, reduction in cases in some parts of the country, but over the
weekend, we had the emergency declaration from President Obama which
suggests the anticipation that things are going to get worse. Can you tell
me what triggered that declaration? Where are we? What are we anticipating
in the next month or two?
Tom Frieden: It's really a preemptive move that gives the government and
providers another tool they can use to respond if they need to deal with a
large influx of patients coming in. So there are some hospitals that are
challenged and this is preemptive or preparatory step, it's not a response
to anything that worse and over the past few days or weeks. It's the
ability, it strengthens the hand of the government to respond as we go
forward in the season. One more question from the phone?
Operator: Stephen Smith, the Boston Globe, your line is open.
Stephen Smith: Good afternoon, thanks for taking the call. The Roman
Catholic archdiocese of Boston this afternoon is going to announce that it
is recommending to parishes that they stop providing communion holy wine
through the chalice and also recommending that parishioners not extend
physical greeting of peace that typically happens during the mass. I was
hoping to get your sense of the necessity of adopting such measures? And I'm
also curious as to whether you're hearing in other arch diocese and other
denominations whether similar measures are being undertaken in an effort to
curtail the spread of the H1N1 virus?
Tom Frieden: A variety of things are being done in different communities and
by different groups to reduce the potential risk of getting influenza or
other infectious diseases. I wouldn't want to comment on any particular
denomination or group's decision. Only to say that sensible means are
important and effective. Stay home when you're sick. Cover your cough and
sneeze. And wash your hands frequently. This is a challenging time. We wish
we had more vaccine available. As you know, we had anticipated having
significantly more available by now than we do. And that's been frustrating
to all of us. We are, though, beginning to see significant increases in
vaccine production, distribution and we think it will get easier to find
vaccine in the weeks that come. So thank you all very much for your interest
and we look forward to continuing to provide you information as soon as we
have it available. Thank you very much.