Press Briefing Transcripts

Weekly 2009 H1N1 Flu Media Briefing

November 3, 2009, 1 p.m.

• Audio recording (MPEG)

Operator: Good afternoon and thank you for holding.  Your lines have been placed on a listen only mode until the question and answer portion of today's conference.  I would like to remind all parties that 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 begin.

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 Dr. Frieden, the director of CDC, will update us on 2009 H1N1. 

Tom Frieden: Good afternoon.  And welcome to our routine briefing about H1N1 influenza.  The news today is essentially that the virus continues to be spreading and we're having a steady increase in the availability of vaccine but not nearly as rapidly as we would have liked.  Flu continues to be widespread and virtually all the flu that we're diagnosing is still H1N1.  So we’re seeing 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 a third of all of the people hospitalized with H1N1 influenza.  And we know that only half of those people with asthma when they got sick with flu, half 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 in the amount of vaccine that is available.  That's encouraging.  But 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 to us not to be able to give vaccines to our patients.  As public health professionals it's frustrating in part because we know many people who seek vaccine will not get vaccinated later.  They would have benefitted from it.  They would have wanted to be vaccinated but when the vaccine wasn't available they didn't get vaccinated and might not come back.  So we ask people to continue to be persistent.  We know that 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.  But people have understood that sometime it'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 attenuated intranasal only being able to be used for healthy people ages 2 to 49, the live vaccine has the nasal spray has primarily been used for health care workers and healthy children and the injectable vaccine being used for other priority groups. 

We're also continuing to see really unprecedented demand for seasonal flu vaccine.  This is something which 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 of people who are unable to get the seasonal flu vaccine and we recognize that this year looks like it will be the highest ever uptake of seasonal flu vaccine.  We anticipate there being around114 million doses of seasonal flu vaccine available through the market by the end of the year.  And It may well be that there is even greater demand than that by the end of this season. 

Antivirals are also very important.  Wherever we are in the vaccination program, before vaccine becomes available, as it’s available, whether it’s available, more or less, antivirals are effective at reducing the effect of severe illness.  And if you're severely ill 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 so that you can get treated because it does make a difference and it reduces the likelihood that you'll get severely ill or hospitalized or if patients are hospitalized increase the likelihood that they'll get out sooner and healthy.  And, of course, it’s always the case that you can protect others around you by staying home if you're sick.  And you can protect yourself and others by washing your hands frequently and covering your mouth when you cough and sneeze.  Flu season lasts until May.  And this flu season is unlike any other for at least 50 years. We don't know what will happen but we do know that we’ll 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.  Joanne Silberner from NPR.  You mentioned before this idea that half the people with asthma once they've gotten sick haven’t not come in.  Where does that number come from? How do you know that they’re not coming in if they’re not coming in?

Tom Frieden:  This is from telephone survey data that we have.  So 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 kind of widespread basis before.  We do know we would like for more people to seek care if they have an underlying condition and they have flulike illness.

Joanne Silberner: From the survey though you don't have a sense of what happened to them because they 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 in Atlanta.  You said most of the stuff going around is still H1N1.  Are you starting to see any signs of seasonal flu at all so far? 

Tom Frieden: There's almost no seasonal flu so far.  There are a few strands here and there. But overwhelmingly it's still H1N1, and it remains very tightly matched, the vaccine strain and with no changes that would suggest an increase in virulence.  Let's go to the phone for a couple questions.

Operator: Our first question today is from Marian Falco from 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 individuals with a body mass index that high also have other health problems such as diabetes or lung disease or heart disease that may increase their risk of getting severe complications of the flu.  So for those who are at an intermediate level of obesity with a body mass index in the 30 to 40 range the data is more mixed.  And it may be that people in that range are at increased risk of complications, but that's not entirely clear at this point. 

Miriam Falco: And 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.  But when you think about the fact that we’ve now had 30 million doses out there and there have really been only a few examples of improper handling that have led to vaccine having to be disregarded either if it's frozen because that inactivates the vaccine or out of temperature.  It's something that is important to monitor, track.  It’s one of the reasons why it's not easy to rapidly scale up vaccination programs because not all providers have the right types of refrigerators which can monitor the temperature over time and maintain it at a very stable temperature.  But this kind of thing is virtually inevitable to happen.  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 out 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 children around the country.  Children account, people under the age of 25 account for most hospitalizations.  And we continue to see very high rates of hospitalizations in places where there's more flu.  In terms of the 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 it was quoted in AFP that the health secretary was quoted saying that oh, uh, American risk groups will be vaccinated first.  I wonder, can you tell me when the U.S. will start sending vaccines to the WHO for developing countries? 

Tom Frieden:  The U.S. government has been in touch with the World Health Organization to explore ways of helping other countries get vaccines around the world.  There has been difficulty with vaccine growth and production so there are shortages and different countries are at different points of readiness in being able to vaccinate.  In terms of the specifics of when other donations will be available and when they'll be made, I think that has to be determined as the production schedule becomes more clear in the weeks to come.  Next question from the phone.

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 that’s being published in JAMA this afternoon.  Two questions about that. One, it comes up with a warning that even though, as you repeatedly said, this is a disease that strikes young people preferentially.  It also says that when it does strike older people they 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 providers or patients themselves.  And the second thing is, you just said you haven't taken a look at this data.  How can something come from the largest health department in the country of the largest state health department in the country and you haven't had a chance to thoroughly review it? 

Tom Frieden: The article that you’re talking about talks about the severity of illness in different age groups.  And 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, although much, much lower proportion of people over 65 get H1N1 compared to seasonal flu, 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.  Because still overwhelmingly, 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.  The JAMA paper seems to indicate that 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 folks who is have high BMI at greater risk? 

Tom Frieden: I think that would be very theoretical to consider what it might be and whether there is a difference 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 also in the midst of an epidemic of obesity.  Obesity has doubled in adults and tripled in children in the past couple of decades.  And we're still understanding what all the implications of that increase in obesity 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.  But this is something we need to learn more about and all of the evidence and information that's provided helps us to determine both what more we need to know and how we can better respond.  Next question on the phone.

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 just elaborate a little more on the contributions to WHO.  My understanding 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 while at the same time recognizing the responsibility that we have to the American people.  One reasons that we have a 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 here is with a scarce resource how do we try to ensure it's most equitably distributed.  Right now the maximum activity of the virus is in the temperate areas, I believe.  So right now the biggest need is generally in the places that are having the most virus circulation.  We still don't have the degree of predictability that we would want with vaccine production.  And until we have a better sense of where we are and where we’re going, I think it will be difficult to be able to say with certainty when and how much vaccine we'll be providing to other countries.  But this is a question that would 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 U.S. based 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 continuing to use the tried and true egg-based methods of vaccine production.  There are some newer methods.  We hope they will be ready within the next couple of years.  But they're not ready for prime time now.  We’re using only the tried and true methods, we're not cutting any corners.  The procedures that used for vaccine production are complex and frankly cumbersome.  They involve growth and testing mechanisms and are time consuming and take a long time to be done.  And we do hope and we need to have better vaccine production methods, but they're not ready yet.  So 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 that are circulating more promptly.  The challenge that we have is a challenge that’s 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.  And if the virus circulating changes between that 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: Yes, thanks very much.  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, then the harder question would be, do we have any 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.  It’s hard to do the surveillance because there are so many cases of flu.  And as you point out, when a health care worker gets flu whether they got it at home or in the workplace, and in the workplace whether they 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 with respect to seasonal flu vaccine we're seeing a bit of a higher uptake of influenza vaccination by health care providers this year so far than in previous years.  We’ll have to wait to see how high that goes and how extensive it is.  But at least we've seen a little bit of an uptake in health care workers getting vaccinated.  On the phone.

Operator: Our next question is from Maggie Fox from Reuters.

Maggie Fox: Hi, Dr. Frieden, can I go back to something you said, 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 CSL and Australia, where else has that happened?

Tom Frieden: That's been the primary example of that occurring.  Where there any other questions within the room?  Okay.  Well, thank you all very much.  Thank you for your interest. 

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES