Check out the FAQ,Terms of Service & Disclaimers by clicking the
link. Please register
to be able to post. By viewing this site you are agreeing to our Terms of Service and Acknowledge our Disclaimers.
FluTrackers.com Inc. does not provide medical advice. Information on this web site is collected from various internet resources, and the FluTrackers board of directors makes no warranty to the safety, efficacy, correctness or completeness of the information posted on this site by any author or poster.
The information collated here is for instructional and/or discussion purposes only and is NOT intended to diagnose or treat any disease, illness, or other medical condition. Every individual reader or poster should seek advice from their personal physician/healthcare practitioner before considering or using any interventions that are discussed on this website.
By continuing to access this website you agree to consult your personal physican before using any interventions posted on this website, and you agree to hold harmless FluTrackers.com Inc., the board of directors, the members, and all authors and posters for any effects from use of any medication, supplement, vitamin or other substance, device, intervention, etc. mentioned in posts on this website, or other internet venues referenced in posts on this website.
We are not asking for any donations. Do not donate to any entity who says they are raising funds for us.
Announcement
Collapse
No announcement yet.
CDC & White House Media Briefings on Swine Flu Epidemic
CDC Telebriefing on Investigation of Human Cases of H1N1 Flu
May 21, 2009, 12 noon ET
Operator: Welcome and thank you for standing by. During the question and answer session today you can press star 1to ask a question. Today's conference is being recorded. At this time MR. Glen Nowak, you may begin, sir.
Glen Nowak: Thank you. Thank you all for coming in this morning for the update on the novel H1N1 virus. I am joined by Dr. Anne Schuchat director of immunizations and respiratory diseases and Dr. Schuchat will provide brief opening remarks and she will take your questions and I will turn the phone over to Dr. Anne Schuchat.
Anne Schuchat: This afternoon what I would like to do is to continue to put what we're seeing into perspective for you and give you a little bit of an update for a report that's in the Morbidity and Mortality Weekly Report about some interesting laboratory studies that have just been completed.
The novel H1N1 virus continues to circulate in the U.S. This is a new virus so far it's behaving similarly with the seasonal flu viruses, but it's new and we're still making sure that we understand it going forward. We know that seasonal flu viruses cause a lot of illness each year in the U.S. and that even with seasonal influenza things can be unpredictable. So we do think that the H1N1 new strain is very likely to be unpredictable and we're keeping an open mind to what would happen as things go forward. We are seeing activity decline in some areas, but we're seeing increased or localized outbreaks in other areas and so we should expect to see more cases, more hospitalizations and potentially more deaths as we move into the weeks and months ahead.
The study that CDC is reporting today in our MMWR suggests that older adults might have some pre-existing antibody against this new H1N1 strain, but we don't know yet what that will mean in terms of actual immunity or clinical protection. It's interesting that the laboratory findings we're reporting seem to correlate with the epidemiologic data that we have so far that suggests most of the illnesses we're seeing have occurred in younger people and have spared the elderly who are at great risk for seasonal influenza.
As I mentioned, there are localized outbreaks going on in several states, and I think there's been substantial attention to New York City and surrounding areas where there have been increased levels of this novel H1N1 influenza or increased levels of influenza-like illness. There have been some school dismissals in the New York City area and in other parts of the country and those are being carried out in general consistent with our national guidance that when there's high absentee rates or high illness in students or staff and the school can't really function, it's appropriate to dismiss students.
I want to talk for a couple of minutes about the MMWR article which is entitled ?Serum Cross-Reactive Antibody Response to a Novel Influenza A (H1N1) Virus After Vaccination with Seasonal Influenza Vaccine.? This is a report of studies that were carried out here at the CDC laboratory and we had great cooperation from NIH and from academic researchers and others, the manufacturing companies in providing serum that had been studied in vaccine trials so that our laboratory scientists could learn as much as we can about how this new virus might behave when it's exposed to antibodies to the seasonal flu vaccine. So this is a laboratory study, not a clinical or epidemiologic study, and it came about across a great partnership in academia. Our MMWR report provides details of a serology study of samples from children, younger adults and older adults who were vaccinated with the recent seasonal influenza vaccine to try to understand whether those seasonal vaccines offered any immune benefits against this novel H1N1 flu. Serology means we're studying blood or serum to identify antibodies in the actual serum. The presence of the antibodies can indicate immune protection, but it's an indirect measure. So these studies are just interesting and not definitive.
The results presented in the study found that the seasonal influenza vaccine provides little or no immune benefit against this novel H1N1 flu virus. The bottom line of the study is that adults might have some degree of preexisting cross-reactive antibody to the novel H1N1flu virus, especially older adults, over 60 or over 65 depending on the samples that we had. However, we don't know if those antibodies that we saw provide any protection against the novel influenza A in actual people. The presence of preexisting antibody may be due to previous exposure through infection or vaccination to an Influenza A H1N1 virus that more closely related to this novel H1N1 virus than the contemporary seasonal H1N1 strains that we had. CDC does not believe that seasonal influenza vaccine would provide any meaningful protection against this novel H1N1 strain. On the other hand, we do believe that seasonal flu vaccine is important and can help protect people from the regular flu viruses that circulate each year. So this is a fairly complex study and we'll be happy to answer questions when I finish the formal opening here.
I want to remind you that vaccines are a very important part of our response to flu, including novel influenza that may become pandemic. CDC has the novel H1N1 virus and we're working to provide a vaccine provided to industry so manufacturers can scale out for production if necessary. We remain hopeful that we will have vaccine viruses to send to manufacturers at the end of May, and that's still within the original timelines that we have been describing. Remember there are many steps involved with producing a vaccine. We're committed to work across the government with NIH, FDA, BARTA and the manufacturers of flu vaccine to see further about developing full-scale vaccine production. But remember, this is all unpredictable, just like the seasonal flu vaccine production, the steps involved are subject to variation of the strains, of the manufacturing process, et cetera. If things go well and we do move forward with full-scale production it would still be several months before a vaccine against this new virus would be available. The seasonal flu vaccine production efforts are ongoing. They remain on track according to what we heard from the manufacturers and we are expecting to have a full and aggressive seasonal flu vaccine campaign next fall. Remember that seasonal flu does cause about 36,000 deaths each year and 200,000 flu-related hospitalizations in the U.S. this year. So while we have a lot of uncertainty about this new H1N1 virus and the steps involved with vaccine production, we continue to be certain that seasonal flu vaccine in the fall would be a good idea for people to lower their risk of regular flu.
In closing, I really want to make sure that we think continued vigilance is important. As we are seeing in our state reports and in trends and certain communities this, outbreak is far from over here in the United States. Because infections have occurred mainly in younger people so far, we think that older adults might possibly have protection that might help ward off this infection from the novel H1N1 virus. The study we're reporting today provides a little clue consistent with that clinical observation we've made. We still recommend vaccination with seasonal flu vaccine and we are looking aggressively at the steps involved with vaccine development. Remember that it's still too early to predict how severe this particular H1N1 outbreak will turn out to be in terms of illness or death or spread, but we're aggressively responding with public health partners here and working together with our international colleagues. Our extensive efforts on the monitoring and science front are continuing with our goal being to learn as much as possible, as fast as possible so that we can use it in our control efforts. This is an ongoing public health threat and we're continuing to be aggressive. So I would welcome the questions that you have.
Glen Nowak: Operator, we'll take the first question.
Operator: Thank you. Our first question comes from Shahreen Adedin from CNN. You may ask your question.
Shahreen Abedin: Yes, Hi. Thank you for taking my call. I'm wondering, can you give us a further breakdown of the younger versus older cases, older people, the ages and as far as the cases that you've seen of this new virus? And you said there's a downturn only in some areas and not in others and could you tell us where that downturn is. My second question is about --would you -- are you expecting very soon, are there certain front-runners of people who are sending you useful forms of vaccines that you think that are coming out there. I understand Dr. Boucher may be sending you one today. Do you have any news on that front?
Anne Schuchat: Okay. Let me take the first one or two questions to make sure I get the train of thought.
Shahreen Abedin: Sure.
Anne Schuchat: Of the cases that we have reported to us which have gone under some type of laboratory testing, 64% of those are occurring in people between 5 and 24 years of age. Just about 1% of our cases are in people over 65 so the vast majority are in younger persons and the biggest proportion of those are people in the 5 to 24-year-old age group. Your second question was about what we're seeing geographically. At the national level we're seeing that the percent of visits for influenza-like illness is starting to turn down. This is an aggregate of the whole country, but that's a good sign. It is consistent with the idea that on average, the worst may be over. On the other hand, in our New England region, we're still seeing an upsurge in influenza-like illness in the New Jersey-New York area we're still seeing an upsurge. The mid Atlantic area is seeing a decline. The southeast area is somewhat seeing a decline, but it may be too soon to say about that and the Midwest and southwest are also starting to see declines. This is one of those issues where we really need to keep our eyes out. You know in New York City things looked like they were getting a little better and then it looked like they were getting worse. With the new virus, it may take some time to pass through communities, but in terms of the way that we're trying to track this at the national level, we think that it's an ongoing concern. We also, on our website have a map. You can find it under the spotlight for H1N1 disease, and each of the states rates the condition of who going on in their state and that's a really good thing for you to look at, particularly if you're reporting locally. States that are having widespread disease are defined as ones where more than half of the regions in the state are seeing increases in the influenza-like illness and even in some of the states that aren't seeing that kind of widespread disease. They have localized outbreaks that are quite important. So this is the long answer to the geographic question, and I think the most important thing for people to realize is that the virus is spreading in many areas and it's variable. Your public health support at the local and state area are working very hard to know what's going on and to issue local guidance. We're supporting them from the national level, but just league weather, this is a local occurrence and people need to stay in tune with what's going on with their own communities and the local health authorities will have the best information. Can we go to the next question?
Operator: The next question is from Maggie Fox of Reuters. You may ask your question.
Maggie Fox: Dr. Schuchat, can you update us on the epidemiology? Do you have any estimates on total cases? We've been using the 100,000 that Dr. Besser gave us last week, and can you -- well, no, that's my main question. Thanks.
Anne Schuchat: Yeah. Let me give you the cases that we're counting and what our estimate is on that. Here in the U.S. we now have 5,764 probable and confirmed cases. As we've been saying, we think that's a vast underestimate and that 100,000 figure that you heard about a few days ago that came from an estimate that perhaps one in 20 of the total cases that were occurring might be the ones that we know about from these lab testings. It's just an approximation. I think if you heard 100,000 a couple of days ago, we're at a higher number now, but really what we're trying to do is follow these local trends. With seasonal influenza we don't count every single case. We use modeling at the end of season to do some estimates based on hospitalizations and deaths and influenza-like illness and it's with some sort of quick math, looking at our seasonal flu patterns and then trying to assess what's going on here that some of our scientists came up with the 100,000 estimate. It's not the kind of estimate that we'll be updating on a daily basis. Next question, operator.
Operator: Our next question comes from Mike Stobbe from AP. You may ask your question.
Mike Stobbe: Hi, thanks for taking the call. Doctor, first you said there was regional variation and you talked about it in terms of visits. Visits to what? Did you mean emergency rooms and doctor's offices? Also, I wanted to ask in MMWR. That's based on 80 children and 280 adults, is that right? Are those all U.S. people and lastly, I'd like to ask if you can describe in plainer terms than you d the antibodies that were found in that and what they do or don't mean. I'd just like a little more information to be clear.
Anne Schuchat: Yes. Let me give you some answers and then we might have Dr. Jackie Katz provide a little bit more. The first thing to say is that these samples came from the manufacturers, from NIH researchers and from others and they're actually mostly --they're not just Americans they include Europeans where some of these vaccine studies were made. In terms of the numbers, it varies by age group. I guess I can go through all of the numbers, but there were 33 children. It's probably too many for me to go through. The MMWR is on the Web site right now so you'll be able to get the numbers together. So it's 79 children.
Is that all you were asking about was the concern? Basically it's just based on 79 children. A larger number of adults were based on the study. I think the important thing to say is that these are interesting results. They tend to be consistent which we're seeing on the epidemiologic front, but the laboratory tests that we use to measure the antibody is not a traditional one that we can easily correlate with clinical protection. We had to use a different essay and so we make some assumptions about what that might mean, but we need to be very cautious. We were not using the traditional way of measuring antibody against influenza virus for this particular asset. But I think the important feature is that we saw a difference in pre-existing antibody levels in seniors which seems to correlate with what we're seeing with the epidemiology of this infection. Whether it will pan out over time, the seniors really don't get this infection. We can't say whether this particular essay will pan out over time as predictive of clinical protection, we can't say, but we thought it was important to get this information out into the community of researchers and others quickly. This was a cross reactive microneutralization antibody, not our typical essay and it needs to be taken with caution.
Glen Nowak: Mike, did that answer your question?
Operator: One moment, please. Mike, your line is open.
Mike Stobbe: Thanks. I guess -- could you also clarify the visit that you talked about? Was that to hospital emergency rooms or --
Anne Schuchat: Yes, thank you. That other question I'll give you an easier answer for. We have systems to monitor office visits through our influenza-like illness surveillance or ILInet and we're also looking at emergency department visits through BioSense and both of those systems are showing regional variation - things on the upswing and things on the downswing in different communities. We have also seen data that's been collected by some of the bigger cities that have emergency department or other syndrome and surveillance systems and similar to the systems that we're tracking nationally, those specific cities are also finding variability. So I think that we have been tracking this disease through the virologic surveillance, through the ILInet and emergency department visits and we're looking at pneumonia and influenza mortality from the 122 cities and the good news is that we haven't seen an increase in that metric yet. For that we're grateful that there don't seem to be large scale increases in deaths in the United States comparing it with the seasonal baseline. We'll be looking at hospitalization data soon, but we don't have that yet.
Glen Nowak: Next question, operator.
Operator: Thank you. Our next question comes from Helen Branswell with the Canadian Press. You may ask your question.
Helen Branswell: Thank you very much for taking my question. I was wondering if we could sort of drill into the data in terms of the seniors. It isn't actually ? I mean looking at the numbers unless I'm reading them wrong. You're not seeing cross-reactive in seniors and I'm wondering if there's any explanation as to why that is and if you're seeing hat mainly in the U.S. versus the European Serra and also I would wonder if you could sort of explain how it is if you're seeing it in 43% in seniors, why are only 1% of the cases in seniors? Is it a combination of maybe some cross-protection and maybe patterns of exposure?
Anne Schuchat: About a third of the adults 60 years of age and older had some level of cross-reactive antibody against the novel H1N1 virus before they were vaccinated in this study. Important to remember is we're not talking about thousands of specimens. We're talking about a relatively small number of specimens. The seniors that we studied were from the United States and not from Europe. The issue of -- you know, there are so many steps removed here. We have clinical findings on this novel H1N1 virus at one point in time. Today less than 1% of all of the cases we have laboratory results on are coming from people 65 and over. Well, that increase over time, we've been saying in these briefings over the past several Days, we think virus is initially amplifying among teenagers in schools or college students coming back from spring break and mixing and more seniors might get infected over time as the strain circulates deeper and deeper into our community. The next thing that's a step remove side that this is a laboratory test that's not even the standard test that we use against influenza viruses. So we have to make inferences. A third issue is the size of the sample that is not enormous and the uncertainty around that would be great. I don't think it's at all surprising that we have one-third in the lab study and 1% at one time in the epidemiologic data and it's just one of the frustrating features of the influenza that we don't know as much as we want to know today and hopefully over the time to come we'll learn more and more.
Glen Nowak: Next question, operator?
Operator: Next question comes from Daniel DeNoon from WebMD. You may ask your question.
Dan DeNoon: Thank you very much. Another frustrating feature of influenza I hear from clinicians seems to be that the rapid flu test is not as sensitive as it's cracked up to be. The label suggests 70% sensitivity. It seems that experience is less than that. Can you talk about the sensitivity of the rapid test for both the seasonal and for the novel H1N1 and what getting a flu test means on the level of someone with a level of influenza who goes to see a doctor?
Anne Schuchat: We wish we had better tests for influenza. Much of the preparedness that we have had has been focused on diagnostic test development to get better tests against new strains and technologies that would be even better against the regular flu strains. It's through some of that research that we found the first case of the United States of this virus. There are rapid tests out there and their label sensitivity is sometimes described as overestimating what clinicians see in real practice and of course, that is frustrating for providers. There are many things that can lead to variation in the sensitivity of a test against influenza. One possible variation is the strains that are circulating. When the tests are licensed they tested against a lot of influenza strains, but as years change, things drift a bit and the sensitivity may vary depending on which particular seasonal flu strains are circulating. The sensitivity of the test also can vary with the age of the patient. The tests seem to be more sensitive in younger children than in adults, perhaps because of the amount of virus that young children are shedding. A third variable is the swabber. It turns out that some people are better at collecting a specimen than others and for other laboratory test, the specimen collection is just as important as the actual laboratory reagents or the way the test is performed in the lab.
Interestingly enough, we believe in some of the early results that we have right now that some of the rapid tests we have out there might perform a little bit better against this novel H1N1 strain, than against the seasonal A strains that are circulating. This isn't something that we have great numbers behind, but an observation that has been coming in. If it's true, when we are actually able to confirm that observation it could have something to do with a higher viral load or a higher amount of virus that's present with this novelH1N1 strain than the seasonal strain that's circulating. Of course, even if it's more sensitive for the novel H1N1 strain, the sensitivity is 90% to 100%. We are suggesting when it is important, additional test be performed. A positive is important, but a negative doesn't necessarily rule out influenza. The way diagnostic tests are being used, though, right now at this point in our seasonal influenza is different than might happen at other stages. We don't think it's as important to confirm every single patient with the H1N1 novel strain. We are trying to make sure we get test results on a sample of patients so that we can understand the trends over time. Are things getting better or worse and certainly, when there's anew infection in a new state that doesn't even know if they have the H1N1 virus, we're trying to make sure they understand the presence in the community there.
Glen Nowak: Operator, next question?
Operator: Thank you. The next question is from David Brown from the Washington Post, you may ask your question.
David Brown: Yes, thanks very much. There seems to be a booster effect in the 18 to 64 age group where 9% are what appears to be a protected antibody before being vaccinated with seasonal flu and after being vaccinated it goes up to 25%, and I just --if you could comment about whether and why not or why that isn't viewed as a sort of useful observation and, you know, in terms of clinical application and my other question is since the virus that reappeared, the H1N1 that reappeared in 77 was the same one that disappeared in '57, how do you explain this greater protection the older you get? Do you have any sense of which viruses, which years might have been the ones that were most important in terms of provide anything protection to the novel strain?
Anne Schuchat: You know, I think just to correct something. I think you said something about the protective level. We need to be very cautious in concluding that this microneutralization antibody is protected. We really don't know that. So there was, as you said, a bump in the 18 to 64-year-olds, 90%with the 160 post-vaccination. We really don't know whether that is correlated with protection. We look at the post-vaccination to pre-vaccination ratio with a factor of two. That's pretty wimpy. If you look at what happens with the seasonal flu vaccine, you can see that we're seeing ratios of 12, but when you have small numbers and you're looking at tigers you can see the variability, but we don't consider that pre-vaccination to post-vaccination ratio even if it were with a protective laboratory assets to be impressive and here we have the additional qualification if this is a surrogate essay. So that's really why we aren't pushing that finding. Wouldn't it be great if there was boosting, but we don't think we have sufficient evidence of that at this point to conclude that. You know, I would say that there will be lots more studies going on with the seasonal flu vaccine because it was used this year and we have a lot of serum that's been collected over the course of our investigation. So these are the first results we were able to produce with the vaccine studies that were done with the seasonal flu vaccine, you know, that would basically -- with the serum in freezers around the world, we could get some quick results, but I think in the weeks or months ahead, we hope to have a lot more direct information that would help answer that question.
Glen Nowak: Next question, operator?
Operator: The next question comes from Richard Martin with the St. Petersburg Times.
Richard Martin: Thanks for taking my call, doctor. Can you talk a little bit more about how effective the seasonal flu vaccine is and can you speak to some of the popular arguments against getting one such as the dangers and the ingredients such as mercury, other risks and the strains and vaccine not matching the strains that are circulating?
Anne Schuchat: Thank you. Every year a new -- we've --okay. Every year influenza vaccines are produced so every year the vaccine is different. So when we look at the literature for influenza vaccine, an important feature is that different strains circulate and the vaccine is different. What we know about seasonal influenza vaccine is that it works best in people with the strongest immune system and it doesn't work quite as well with the elderly and people with weaker immune systems. That some years it works very well and some years it doesn't work as well. The years that it doesn't work as well, we believe they're related to less than optimal matches between the strains that are circulating and the strains that the vaccines were made against. Most years the vaccine is significantly protected and can reduce illness, hospitalization and death. There have been controversial articles written about whether the vaccine is beneficial or want and our sense at the CDC and certainly the advisory committee for immunization practices that looks at vaccine recommendations every year, strongly recommend this vaccine for reducing the risk of influenza. It's particularly important in people who have higher risk of complications of influenza and we've also recently expanded the recommendations for children all of the way up to age 18 to try to reduce illness in children and keep them healthy and in school.
There have been questions about whether influenza vaccine is safe. There have been questions about their ingredients, you mentioned thimerosal. Thumerosal is made with multiple-dose vials in order to keep them from being contaminated with bacteria. Because of a multiple dose, you can go in and out with a needle. There was a question as to whether it might be unsafe. There have been quite a few studies now that suggest no increased risk of long-term problems associated with thimerosal, and we believe this is a safe ingredient of vaccines. Last question you asked was about matches, and this is the real challenge with influenza vaccine. Every year we do this intensive surveillance to figure out which strains are circulating and to predict which strains should be included in the vaccine that's produced each year and every year we keep our fingers crossed to see how well the prediction will work. Unfortunately, not every year does the prediction work perfectly and so we always need to be mindful that one or more of the three influenza virus strains that are in the vaccine may not be an optimal match. So I think that is a challenge. I know the media has been reporting this, but some of the government's investments over the past few years have been in novel influenza vaccine production. We would love to have an influenza vaccine that didn't need to be updated this year. So far, we still are required for the perfect approach. Optimizing production against the case before it's selected.
Glen Nowak: Operator, we have time for two more questions.
Operator: This question is from Richard Knox with National Public Radio. You may ask your question.
Richard Knox: Thank you very much, Dr. Schuchat. Do you think at this point that the presence of some preexisting antibodies in some people might be likely that they need two doses of the vaccine and thereby conserving supplies. I realize that the pre and post-vaccine was with vaccination of the seasonal vaccine. Is there any reason to think that there's a specific vaccine against it and it might be hemogenic and I have a second one.
Anne Schuchat: The question on whether two doses will be need side a critical question. If some or all people don't actually need two doses, vaccines could go a lot further. Part of the role of the NIH in clinical evaluation of vaccines is to look at the number of doses that are required. You may recall it was done with the H1N1 vaccine studies in the past. So it would be wonderful if some parts of the population or many parts of the population don't actually need two doses. Our working hypothesis is that everyone who gets this vaccine is likely to need two doses, but perhaps there will be some people where pre-existing immunity will be there and one dose would lead to a primed response. So that is definitely a great question and something we're interested in. The best way to answer that question will be in clinical studies of a vaccine targeted against this strain in different age populations looking at response after one dose and response after two doses and those are the types of studies better planned. You had a follow-up question.
Richard Knox: I think you just began to answer it. I was wondering what your current thoughts about the pandemic flu vaccine. What are areas you're thinking about and what studies would need to be done?
Anne Schuchat: You know, there are two activities that are vital to that question. One is the epidemiologic studies that are ongoing here in the U.S. and that will be going on in the southern hemisphere to understand who is at higher risk of this disease? Does it affect all age groups? Does it affect people with and without underlying diseases? Where is the disease burden? And that's one way that we can do our targeting. A second factor is how does a vaccine that's produced against this virus work? Will it work as well in different age groups with one or more dose. So we'll be looking at a pattern of disease that we see and then at the value that a vaccine has. If we had a high-risk group that was clearly at risk, but really no response of the vaccine in that population, we may not want to target that population. So those are the types of studies that we'll try to put together in this very complicated decision about whether anyone and everyone ought to get the vaccine that is being considered.
Glen Nowak: Last question, operator?
Operator: Thank you. The last question comes from Beth Galvin with Fox. You may ask your question.
Beth Galvin: Hi, Dr. Schuchat, thank you for taking my call. I was wondering if you could talk about the hypothesis that older adults might have been exposed to the strain of flu, is this the 77 flu? The 57 flu? What are you thinking?
Anne Schuchat: I think one possibility is that older people might have been exposed to H1N1 strains a long time ago that might have some relation to the strain we're seeing now. Our virologists have compared it to all these other strains and this is really different. This is not a close, genetic relative of any of the H1N1s that have been a problem in people, but the immunologic characteristics might be different than the genetic characteristics and so it would be very great if older people had been exposed to some H1N1 a long time ago that had some relationship with this one immunologically and that might lead to that pre-existing immune they we hope is there, but we're not sure is there. So we don't have a particular virus that we're thinking about because the genetic characteristics are so different, but we are wondering about whether there were some viruses around back in the '30s, '40s or '50s that might be immunologically similar to the one we're seeing now.
Glen Nowak: Thank you all for your interesting participation this afternoon. We'll be posting the transcripts on this some time later this afternoon. If you have additional questions don't forget to call CDC's Office of Media Relations. Thank you.
Operator: This does conclude today's conference. We thank you for your participation. That the time you may disconnect your lines.
Update on the Novel Influenza A H1N1 Virus and New Findings Published Today
May 22, 2009, 1 p.m. ET
Audio recording (MP3)
Operator: Welcome, and thank you all for standing by. At this time, I would like to remind parties that your lines are in a listen-only mode until the question-and-answer session, at which time you may press star 1 to ask a question. Today's call is being recorded. If you have any objections, you may disconnect at this time. I'll turn it over to Glen Nowak. You may begin.
Glen Nowak: Thank you, and my apologies to all the reporters who tried to call in, and ran into a dead line, as I understand it. We've been working with our phone services to fix that problem, and I think we have managed to get it solved, so, again, I apologize for that inconvenience in getting this call started today. Today's update, we're going to focus on two things. Dr. Anne Schuchat, director of CDC's national center for immunization and respiratory diseases is going to give an update on the novel H1N1 in the United States, and we are also joined today by Nancy Cox, Dr. Nancy Cox, that's C-O-X, who is director of CDC's influenza division, and she'll be talking about a paper that's been published today in "Science" that looks at the origins of this novel H1N1 swine influenza virus. So, I will turn it over first to Dr. Anne Schuchat for an update.
Anne Schuchat: Good afternoon, everyone. You know, this is -- we're heading into Memorial Day weekend now, and it's a time to reflect on sacrifice and service, and of course, observance of this holiday often also involves travel and other outdoor activities that involve crowds. I hope people will remember to be safe this weekend and to think about personal protection and personal responsibility in the context of the current outbreak of Novel H1N1 virus. This is no time for us to relax on the important reminders people have been taking to wash their hands, cover their coughs and to avoid traveling if they're sick or their children are sick. But we do hope people will be able to enjoy the weekend. The new virus continues to circulate in the U.S., and while it still is a very new virus, it appears to be behaving a lot like seasonal flu, except, of course, it's circulating so late in the spring. We also know that even the seasonal flu viruses cause much illness and harm each year in the U.S., and we are continuing to take this new virus very seriously. While we're seeing activity decline in some areas, we should expect to see more cases, more hospitalizations, and perhaps, more deaths over the weeks ahead and possibly into the summer. Today, the situation in the New York City area and a few other parts of the country have led to more school closings. We believe that there are 60 schools around the country that have dismissed students and that about 42,000 students are out of school because of this virus. Local authorities are dismissing students from school when school has been disrupted from excess absenteeism of students or staff and when it's just not feasible to keep the school open. Of course, some schools and universities are finishing up for the year, and so, I want to say happy graduation to my niece, Dora. Today's update, for those who are actually following the call, we have officially 6,552 probable and confirmed cases here in the U.S., but we remind you, these are just the tip of the iceberg. We're estimating more than 100,000 people probably have this virus now in the United States. The U.S. count for fatalities is at 9 and there are over 300 known hospitalizations. There are, as I mentioned, some outbreaks of influenza-like illness in schools that are leading to those dismissals, consistent with our guidance on this of having the local authorities decide about those matters. I want to say a few words about vaccine before I turn things over to Dr. Cox. Today's CDC received from one institution a candidate vaccine virus. This was created by combining the genes of the novel H1N1 virus that are responsible for eliciting protection to influenza with other parts from other viruses that are needed for high growth in eggs. That process is called reassortment. Also, CDC and FDA have created a candidate virus using reverse genetics. Here at CDC, we're performing analysis of the egg-derived and reverse genetics-derived candidate vaccine viruses to make sure that they are able to stimulate optimal immune responses or that their ability to do that remains intact. And after that work is done, suitable viruses will be sent out to manufacturers. We expect by the end of May that will happen so that they can begin work on developing candidate vaccine seed for production of pilot loss of vaccine. You may have heard that today Secretary Sebelius announced that she's directing about $1 billion for clinical studies of vaccine pilot laws and for commercial production of potential ingredients for a pre-pandemic influenza stockpile. So, these are pretty big developments, but I think today's big news is really a report in the journal "Science" that I think represents a big breakthrough from global scientific collaboration, and Nancy Cox, who's the director of our influenza division, is going to describe that briefly.
Nancy Cox: Thanks very much, Anne, and good afternoon, everyone. I'm very pleased to have this opportunity to discuss some of the key findings published today in the article in "Science." The publication is entitled "Antigenic and Genetic Characteristics of the Early Isolates of Swine Origin Development H1N1 Virus Circulating in Humans," a fairly complex title, and I'll try to explain the analyses that we did in a simple way. This publication really represents an excellent collaboration within public health partners in the United States, with our Mexican counterparts, and with our long-term collaborators at Cambridge University. This work could not have been done without rapid sharing of specimens and information about the emergence and spread of the 2009 H1N1 viruses, both with our Mexican colleagues and with our public health partners in the United States. And without this collaboration, our understanding of these H1N1 viruses, their epidemiology and other aspects of the disease and so on would not have been possible. When any new pathogen emerges in humans and begins to spread globally, it is critically important to try to understand the origin of the pathogen to potentially stop its re-emergence. We also need to determine the most important characteristics of the emerging pathogen and concentrate here at CDC specifically on those properties of the pathogen that have relevance for prevention and control efforts. To do this, we and our colleagues collected specimens from ill people, diagnosed the disease and then sequenced the genomes of more than 70 samples of the novel influenza H1N1 viruses that were first identified in April 2009 in the United States and Mexico. Our paper describes for the first time in detail the antigenic and genetic characteristics of these H1N1 viruses and explains the history and evolution of human and swine influenza viruses in North America and other areas of the world. From our analysis, we have confirmed that the novel H1N1 virus likely originated from pigs based on data that each of the genetic components of this virus are most closely related to corresponding influenza virus genes identified from swine influenza viruses. We found that the new H1N1 viruses are antigenically similar to each other, that is, they react to antibodies in a similar way. They're rather homogenous. However, they're antigenically very different from human influenza H1N1 viruses. As you know, this indicates that seasonal influenza H1 vaccines may not protect people from infection with this novel virus. This study reinforces the fact that swine are an important reservoir of influenza viruses with the potential to cause significant respiratory outbreaks or even a possible pandemic in humans, and the results of the study show the global need for more systemic surveillance of influenza viruses in pigs. So, I'll talk just little bit more now about, give you little bit more detailed remarks about the genetic and antigenic analysis of these viruses. So, we had full or partial genome sequences from more than 70 novel H1 viruses, including 17 viruses isolated in Mexico and 59 viruses from 12 states in the United States. As stated in previous press briefings, our analysis showed that the novel virus contains a combination of gene segments that previously had not been reported among swine or human influenza viruses in the United States or elsewhere. And the novel aspect was that two of the genes, a matrix protein gene, and the nerve gene segments appear to be derived from Eurasian swine viruses previously not detected outside Eurasia. Now, if we go back in time, we can actually determine where each of the genes of the H1N1 viruses originated. And I think that what I would like to do rather than to have very, very extensive comments, just to hit on some of the highlights. So, we have this unique gene combination within the 2009 H1N1 viruses, and while our analysis shows that all gene segments are derived from swine influenza viruses, at this time, we do not know if the virus entered the human population directly from swine or via an intermediate host, nor do we know for certain the exact host that the viruses might previously have circulated in to obtain its current properties. We do know that our veterinary colleagues at USDA and elsewhere in the world are now looking very carefully to see if they have in their freezers samples from pigs or other animals that might provide the missing links and information about intermediate viruses that could help narrow down the times and place of emergence of this novel influenza virus. Now, to really focus in on the public health aspects of our analysis, we wanted to look very carefully to see if these viruses were homogenous and if it might be easy to derive a vaccine candidate virus that would cover all of the novel H1 viruses that are circulating in different countries around the world. And so, we did what is called antigenic analysis, and what we found is that these viruses are very homogenous in their antigenic properties, that is, the way they interact with antibodies, as well as in their genetic properties that we can see from sequenced data. This makes our job of coming up with a reference candidate vaccine virus much, much easier. We see much less variation among these new H1N1 viruses than we do for typical, seasonal influenza viruses. In addition, we have been monitoring these viruses, these H1N1 viruses, very, very closely for their resistance patterns to the antiviral drugs that are licensed for use in many countries around the world. And I want to just reiterate that the novel viruses that have been tested up to this point are sensitive to the neuraminidase inhibitors, but resistant to the M2 blockers or rimantidine and amantadine. So, these findings from this paper, out lined in this paper and mentioned on earlier press briefings are really critically important for our global public health response. So, I think I'll close now with my comments and we will both be available for questions. Thank you.
Glen Nowak: Operator, this is Glen. We'll take the first question.
Operator: The first is from Steve Sternberg from "USA Today." Your line is open.
Steve Sternberg: Hi, thank you for this explanation. I wonder if -- you did a very good job of boiling this down, but I wonder if you could try and take it to one greater step of simplicity. Is the goal here primarily to figure out where the virus emerged or is that the primary goal? Is the primary goal to determine, you know, our capability to combat it with a vaccine?
Anne Schuchat: Our primary goal is really to respond to the emergence of this novel virus. And so, our primary responsibility is to respond. And so, our analysis attempts to do two things, two inform our public health response, that is by helping us understand how we can make a vaccine and make the most effective vaccine possible, to inform our recommendations on use of antivirals for treatment and prophylaxis, but it's very important also to understand the origin of these viruses, because if we can determine the origin, we also then can take measures to make sure that the virus doesn't re-emerge in a slightly different form, and so, our first goal is to prepare for response, but understanding the origin is a part of that response, but it's a secondary part.
You can also think about the new tools that we have at our disposal in the scientific community. With the type of genetic and antigenic characterization that the scientists did, they can look backwards in history and try to understand where these parts of the virus emerged from, and that can help us really try to prevent those types of reassortments or emergences in the future. And so, this is little bit like medical or sort of scientific detective work, understanding the sources of this virus through the genetic characterization but also looking forward, preventive, so that the more we understand how these new strains come into human populations, the easier it will be for us to counter them in the future.
Glen Nowak: Thank you. Operator, we'll take the next question.
Operator: The next is from Donald McNeil, "The New York Times." Your line is open.
Donald McNeil: Hi, thank you. This is in part a call for more surveillance of swine influenza. I know that the chicken industry stepped forward very quickly a couple of years ago when there was a need for more surveillance of Avian influenza. Does this mean that the pork industry needs to step forward and pig farmers around the world need to, or submit more samples, or what needs to be done now that this problem has emerged?
Anne Schuchat: Yeah, you know, I think that this really hits home how important it is for animal and human health to cooperate and collaborate. We're pleased with the improved collaboration of the two disciplines, but for many infectious diseases that have emerged over the past few decades, we see that what happens is that the animal-human interface is very important. And so, part of our strategies now involve joint investigations and shared information. And I think this does point to the need for that going forward.
Glen Nowak: Next question, operator?
Operator: Thank you. Again, if you'd like to ask a question, please press Star 1. The next is from David Brown, "Washington Post." Your line is open.
David Brown: Yes, thanks a lot. Dr. Cox, I just -- I'm trying to make sure that I understand the possible sequence of events. There was a triple reassortment that occurred, you know, a number of years ago, and this new emergent strain, my understanding, is a triple reassortment that took place on top of that might have occurred in one event but is more likely to have occurred in two events, and you're now looking for the intermediate, you know, the product of the first event, because we have the product of the second event, which is the new strain. Is that correct? And my sort of related question is, can you talk a little bit about the survey -- surveys that have been done in North America and maybe elsewhere of existing swine herds to see, do we have anything that looks like this that has been actually out in pigs any time recently? How thorough has that canvas been and where has it occurred?
Nancy Cox: Okay, David, those are very good questions, and I hope I can simplify my answer as much as possible to the first question. As you know, a triple reassortment virus that contained genes that had originated in -- of course, let me preface this remark by saying that all influenza viruses are present in the Avian reservoir. And so, the ultimate origin of all influenza viruses is from birds. And so, what had happened was in swine, there had been introduction of the 1918 virus, and that virus evolved and continued to circulate in pigs without interruption, as far as we can tell, between 1918 and the current time.In addition, human influenza viruses have been introduced into pigs because pigs are susceptible to human influenza viruses. In addition, another Avian influenza virus was introduced into pigs in North America. These viruses interacted in such a way as to reassort, essentially, swap genes, and thus, we had a triple reassortment virus that's been circulating fairly widely in pigs in the United States and occasionally causing human infections. So, we were very well aware of this triple reassortment, both because it caused infections in pigs and because it caused occasional sporadic infections in humans. This triple reassortant virus, which had originated in North America, was then later detected in pigs in Europe and Asia. And this triple reassortant virus that originated in North America co-circulated with Eurasian swine viruses. Now, those Eurasian swine viruses, as I mentioned, originated in birds, the ultimate source of all influenza viruses.But once they enter a new host, they evolve in a way that you can distinguish the genes from those from the original Avian source. So, the reassortant event that occurred was between this triple reassortant and the Eurasian swine influenza virus. Now, if you look very closely at the gene sequences that are present in the databases that exist, such as GenBank, you will see that reassortants between the North American viruses that have been very well described in the literature and the Eurasian swine lineage viruses have been detected in people and in pigs. However, the exact gene combination that we've seen for the viruses that are spreading in humans had not been detected previously either in North America or in Asia. So, we know that the reassortment had occurred and there were reassortants, but they didn't have exactly the same gene constellation. In the United States, surveillance in pigs for influenza viruses does occur when there is an outbreak that causes disease and it comes to the attention of veterinary authorities, but the surveillance is not very systemic. Sometimes farmers don't report that they have outbreaks in pigs. Often these outbreaks don't cause serious disease and so on. And while we have some surveillance in the United States, the surveillance in other parts of the world is much more limited than that that we have in the United States. And I think that's where we can see the greatest gaps in surveillance in pigs. I hope that's answered part of your question.
Glen Nowak: Operator, we'll take another question.
Operator: The next is from Maggie Fox, Reuters. Your line is now open.
Maggie Fox: Hi. I want to ask about the homogeneity of the antigens and what that says to you. I also want to ask what the intermediate host might be if it's not pigs. And thirdly, I want to ask if there's any elements that you saw genetically that were different from what we had seen before in the triple reassortant virus and the Eurasian swine virus that combined to make this one.
Glen Nowak: I will start by turning it over to Dr. Cox.
Nancy Cox: Okay, so, the homogeneity that we're seeing in these viruses, both with respect to the genetic characteristics and the antigenic characteristics indicate that this virus may have been introduced into humans in sort of a single event, or possibly an alternative hypothesis is that there were multiple events where this virus was introduced into humans, but the introductions were of very similar viruses infecting humans. So, it really looks like a very, almost a clonal introduction of this virus into humans, if you will. Once the virus begins to circulate in humans, then there's a bit more genetic diversity that occurs. Now, in terms of alternative hosts, we really don't have a hypothesis for an alternative host based on what we know today. And I must say that we don't know a lot about circulation of influenza viruses in other hosts. You know, we found out that H5N1 viruses could infect feline species, including tigers, leopards and cats, and we didn't know this before. So, for each different combination of genes in an influenza virus, you might have slightly different host species that can be infected. So, there's a lot that we don't know, but what we can say is that the closest gene for each of the eight segments were circulating in swine.
Glen Nowak: Next question, operator?
Operator: Karen Kaplan, "L.A. Times," your line is open.
Karen Kaplan: Hi. Before this paper, when I was talking to scientists, they all would say that this strain was the first time that they had seen the North American and Eurasian swine viruses mixed together, but you referenced this lineage from Thailand in 2005, and I want to make sure I'm understanding this correctly. So, we have previously seen cases of North American swine and Eurasian swine viruses getting together?
Nancy Cox: That's correct, but not in North America. And this particular gene constellation has never been described anywhere in the world. So, just to be very clear, if you look at the gene sequences in GenBank, you can see that reassortment had occurred in the past between the two different lineages and that viruses representing reassortment between these two lineages had been detected in Asia, but those viruses did not have this particular gene constellation.
Glen Nowak: Next question, please?
Operator: The next is from Jennifer Peifer, CNN. Your line is open.
Jennifer Peifer: Hi. Thanks for taking my call. Just clarification on a couple points. At one point, you said it's estimated we may have more than 100,000 cases in the United States. Can you -- I just want to make sure I got that number right, because I was --
Glen Nowak: Dr. Schuchat can answer that.
Anne Schuchat: We know that many people with influenza-like illness are not tested for a laboratory diagnosis, and in fact, don't think that everyone who has that condition right now needs to get a diagnostic test. We do some estimation around what we have confirmed in the laboratory and what we're seeing in terms of the monitoring of influenza-like illness, and we are currently estimating that, perhaps, 1 in 20 of the reported cases -- or that the reported cases may represent about 1 in 20 of the actual illness due to this. We think, perhaps, the hospitalization reporting is a little bit more complete than the total reports, but we know that most years, influenza circulates very widely, and it's the minority of cases that we actually count individually. So, what we're trying to convey is that the numbers are going up each day by a couple hundred, for instance, but that the actual infections out there are a lot more common. What's important, though, is to say that nationally, influenza-like illness seems to be falling. In a couple areas, it's continuing to rise or is still causing a lot of illness. And so, we do know that there are several states that have widespread disease, and there are a few parts of the country that are having outbreaks of influenza-like illness in schools and they're dismissing students because of the high level of absentee rates. So, while on the national level, the picture is looking better, there's some places where it's still very, very active, and we don't want people to think that they're out of the woods yet. We also need people to remember that this is a new virus, and it could keep circulating during the summer, even though usual seasonal influenza viruses become very rare in the summer. It's also a new virus that could come back in a worse way in the fall. So, those are important cautions about what's going on today and what may be coming in the next weeks or months.
Glen Nowak: Thank you. Operator, next question?
Operator: The next is from Richard Knox, National Public Radio. Your line is now open.
Richard Knox: Hi, thanks very much again. I wonder if the picture you're presenting in the "Science" paper, a lot of stability over a long time of the swine H1N1 compared to the higher immunability, you know, greater among human H1N1 during the time period, number one. And second, the stability so far you're seeing in the 2001 H1N1 circulating in humans, does that imply to you at all that this new virus is likely to be more stable, less variable in the future than the seasonal virus? And I have a second question, if I may.
Glen Nowak: Turn it over to Dr. Cox.
Nancy Cox: That's a very good question. What we've learned over time by looking at swine influenza viruses and human influenza viruses is that influenza viruses in swine just inherently mutate at a slower rate. We believe this may be because there's less antibody pressure because the animals simply don't live so long and have subsequent infections. We do expect that now that these viruses have been introduced into humans that they will evolve at about the same rate that other human influenza viruses, seasonal influenza viruses mutate. We'll be looking at that very carefully over the coming months and years.
Glen Nowak: You had a second question?
Richard Knox: Yes, please. How much concern do you currently have as the new H1N1 gets established throughout the world, and maybe especially in Asia and perhaps in places like Egypt, where H5N1 is still circulating that there could be another reassortment event between H1N1, the new H1N1 and H5N1, and how good do you think we'll be picking that up?
Nancy Cox: That's another very good question. Influenza viruses, because of their ability to reassort, do pose a particular challenge to us. And so, we're concerned first and foremost about reassortment between seasonal influenza viruses and the currently circulating seasonal influenza viruses and this new H1N1 virus. And we feel that this is a much more likely reassortment event to occur simply because there's so many more human infections with seasonal influenza viruses.Nevertheless, we are somewhat concerned about the possibility that the new H1N1 virus could reassort with H5N1 viruses if they co-infected humans. But the frequency of infection of humans by H5N1 virus is just very low. It's a relatively rare infection. And so, that's not where our biggest concern is for reassortment. Thank you.
Glen Nowak: Operator, time for two more questions. Take the next question.
Operator: The next is from Mike Stobbe, "Associated Press." Your line is open.
Mike Stobbe: Hi. Thanks for taking the call. Two questions. First, following up David Brown's question about surveillance in pigs. We've seen numbers for surveillance in humans, but could you give us some numbers for surveillance in pigs, a little more detail about how many pigs in the United States and the other countries have been tested? And then I have a second question.
Glen Nowak: I'll have Anne answer that first one.
Anne Schuchat: We don't actually have that kind of information, but the USDA would be a good source for you to follow up with.
Glen Nowak: Your next question?
Mike Stobbe: Okay. It appears that there's a little difference between what the W.H.O. is saying and what the CDC is saying in terms of whether the new swine flu virus is more infectious than the seasonal flu. Could you help clarify that? Is it or is it not more infectious than seasonal flu?
Anne Schuchat: Right now, we're learning all that we can about the behavior of this virus, and we are working with infectious disease modelers to estimate the transmissibility of the virus. We have studies going on with households and in some other settings, and we think some of the parameters of this virus look similar to seasonal influenza and some of them look a little bit different. So, I think it's one of those things where we're going to have to just hold our breath a while until we really have solid numbers. Some of the estimates so far are based on relatively small numbers, but we're trying to really update those models and get more solid estimates for people.
Glen Nowak: Next question, operator?
Operator: Next is from Denise Grady, "The New York Times." Your line is open.
Denise Grady: Thank you very much. When you talk about learning about the origins of these viruses and hoping to prevent their re-emergence, could you give us some idea what you mean when you talk about preventing a re-emergence? How could -- what would that entail? What would you have to do? What does that mean?
Anne Schuchat: You know, I think when you think about infections in animal populations, there are controls like good agricultural and good farming practices that can lead to recognition when there are ill animals, and of course, taking care of the animals in ways that reduce the chances that viruses will persist or swap around. There are also ways that people and animals can interface that are safer than others. You know, we can think back to the SARS situation and those wet markets where many different species were in close quarters together, and that was just a recipe for disaster in terms of emerging infections. So, we really think that there's a lot that can be done in the animal arena. In addition, there are animal vaccines that are often developed to try to control infectious diseases in the animal population and prevent their spread across the animal populations and then, perhaps, into humans.
Glen Nowak: Thank you all for your interest and attendance, and if you have additional questions, please contact CDC's Division of Media Relations. So, thank you and have a good weekend.
CDC Telebriefing on Investigation of Human Cases of H1N1 Flu
May 26, 2009, 1 pm ET
Audio recording (MP3)
Operator: Good afternoon. Thank you all for standing by. All lines have been placed on a listen-only mode. Today's call is being recorded. If you have any objection, you may disconnect at this time. I would like to turn this call over to Dave Daigle.
Dave Daigle: Today, we'll update the emergency response of the novel H1N1 flu outbreak with our director of the National Center of Immunization and Respiratory Diseases. She will provide a short update and then take questions.
Anne Schuchat: Good afternoon. We're roughly a month into our emergency response to this new virus, and I think it's a good time to stop and take stock. Confirmed cases continue to rise here in the U.S. and around the world, and we've had this initial focus on cases and responding to illness and understanding this very new virus and how it behaves in our population. I think we're at a transition point where we're entering an area of new focus and new priorities. We really are on a fast track over the next eight to ten weeks to learn as much as we can as this virus heads to the southern hemisphere and to strengthen our planning for this surge of illness that we expect to experience here in the fall. Today, the World Health Organization is announcing that the global case count is 12,954 cases in 46 countries. And, of course, here in the United States, we are contributing very much to that world case count. Our count today is 6,764 probable and confirmed cases in 48 states and the District of Columbia. There have been more than 300 hospitalizations, and we have ten deaths reported on our website although you may have heard some reports from additional sites that have not made our system. In this period of transition, we continue to update guidance to make sure that information is available. Over the weekend, we've posted updated guidance on safe masks and respirator use and guidance on this virus for institutions. It's based on what we know now and the best science available as well as the situation on the ground. There are many areas where we wish you had more science available and we're continuing to really try to fill some of those gaps. In terms of the weeks ahead, there are a couple of areas that will be under intense pressure. Understanding what this virus does in populations that are just entering the influenza season, the winter months in the southern hemisphere will be very important, our different populations at risk of illness, will the virus change and become more resistant or more severe or transmissible. What will be experienced in populations that don't have a strong health infrastructure as we do here in the United States. A second area of focus is preparing for the fall. Based on what we've learned from our surveillance experience, the lab testing and surge that the health care system and public health system has gone through, how can we best prepare to handle an influenza season that's normal and a potential for this new virus to cause illness or problems on top of the regular seasonal flu problems. We'll also be working across government in the early steps of development of a vaccine, and as you heard on Friday, Secretary Sebelius announced a commitment for a vaccine and pandemic stockpile of that vaccine. Quite a bit of planning will be around the potential development of a vaccine for use and if it were to be used, what sorts of steps would be needed to actually manage an immunization campaign. Those are the kinds of things we'll be turning our attention to while we continue to support the state and local areas around the countries for whom this problem has not yet ended. In the country as a whole, the influenza-like illness patterns are starting to decrease. There are until focal areas where ongoing cases and new hospital consolidations are a daily problem but in many parts of the country influenza-like illness is returning back down to the levels that we would expect for this time of year. We need to stay ready. There may be new clusters or new communities that haven't seen the virus yet this spring, which may have problems, but much of our attention is focusing on your hemisphere and the preparations for very intense experience in the fall. So with that, I would be happy to answer questions.
Dave Daigle: Thank you, doctor.
Operator: Thank you. David Brown of "The Washington Post", your line is open.
David Brown: Yes. Thank you very much. Doctor, I'm wondering what, if any, studies are being done on the half of the people who are hospitalized, most of them young adults, who have no underlying illness, predisposing them for a serious case of influenza, because it seems to me it's kinds of a half glass half full/half empty, pretty shocking in some sense that there are people who are in their teens and 20s who end up on ventilators with no obvious reason why they should, you know, have such a severe case. So are your all doing things to try to see if they have certain genetic characteristics that might predispose them for a serious illness?
Anne Schuchat: There are definitely projects ongoing to look at hospitalized patients, to better characterize what, if any, underlying illnesses they have, to understand their clinical patterns and to really identify risk factors that may not be evident. I think it's important to note that even seasonal influenza can cause severe complications in otherwise healthy people. We have been carrying out active reporting of pediatric deaths around the country and every year between 50 and 100 or so children die from influenza. Many of whom don't have underlying diseases. The very vast majority of deaths that occur in influenza are in seniors and majority of hospitalizations are in people with underlying diseases. Even totally healthy young children and teens can die from this infection, just the seasonal flu. The genetic of risk is an interesting concern. I'm not certain whether we have studies ongoing. That's been an issue that's been of interest even with seasonal influenza. So I can't really speak to that in particular.
Dave Daigle: Thank you, David. Next question, please.
Operator: Thank you. As a reminder, if you would like to ask a question, please press star 1. Betsy McKay, ?The Wall Street Journal,? your line is open.
Betsy McKay: Doctor, a couple of questions. You were mentioning that influenza-like illness levels are returning back to levels we expect to see for this time of year. So does that mean that -- is that regular seasonal influenza or does that mean that levels of novel H1N1 are starting to decrease, because the numbers we're seeing every day would suggest the opposite. I think my ultimate question is what do you expect to happen as the warmer weather comes across the country? Is this going to peter out for awhile or do you think it's going to continue to build, the number of cases over the summer?
Anne Schuchat: When we overlay our surveillance on influenza-like illness, what we see is the vast majority of influenza-like illness that has a viral isolate associated with it. Right now that's the H1N1. A few weeks ago, it was the seasonal flu still circulating. Almost all the positives we have is this novel H1N1 virus. When we look more broadly at the influenza-like illness trends, while almost all of the influenza-like illnesses this new virus, the actual percent of visits that are influenza-like visit are going down in most regions of the country. So we can see that overall we're below -- you know, we were over baseline for this time of year, which is really extraordinary for the past several weeks. And now we're down below the baseline again. With our nine regions of the country, I think there's only one that is still at an elevated level. Actually two levels, region one and two are still a bit higher than you would expect for this time of year. The others are all on the downswing. So that your question gets to of the viruses that are circulating, is this novel H1N1 the major culprit? Yes. But how much disease is circulating? Probably less now than a week ago.
Dave Daigle: Thank you. Next question, please.
Steve Sternberg: Thank you. Steve Sternberg of "USA Today," your line is open.
Steve Sternberg: Thank you very much. I wanted to ask about how you would track flu in the southern hemisphere this winter.
Anne Schuchat: Thank you. You know, there are several important aspects of tracking influenza in the southern hemisphere. Probably the most important aspect is to understand the virus. This requires laboratory testing of people with influenza symptoms or respiratory conditions and it requires an infrastructure that can do that testing and the special test kits that we have developed and distributed. There's a number of places in the southern hemisphere that regularly carry out influenza surveillance and we want to make sure those laboratories can test for this new virus on top of their regular viruses. We also were interested in the epidemiologic disease. Is there a second bacteria pneumonia occurring or viral type picture? Which populations are at higher risk? Women with or without underlying diseases? What are the circumstances? Are there outbreaks in schools or institutions like we saw here with the school outbreaks, or is this more of a transmitted affection or strictly in the community? Those are the kind of issues we'll work on. CDC works together with the world health organization and many ministries of health around the world to strengthen infectious disease surveillance, laboratory capacity and field investigation, and we're in the process partnering with Pan-American Health Organization and a number of partners in developing active plans for the southern hemisphere.
Dave Daigle: Thank you, Steve.
Operator: John Cohen from "Science" magazine.
John Cohen: I have two quick ones. You're suggesting that the outbreak may have peaked in the United States. And the second one, the decision for purchase of ingredients for 20 million people to receive vaccine, when do you plan to make a decision for the rest of the U.S. population?
Anne Schuchat: The question about has the virus peaked is a complex one. I like to use the analogy of weather and while most of the country may be entering the warmer months or even summer, cold fronts could happen in any particular location. So, we know that diseases are still very active in New York City and a few other parts of the country and they may not feel that this condition has peaked. We don't know whether the warming up in a lot of areas is permanent or they might have some more disease to come. Our national statistics and most of our regional statistic suggest that we may have passed the peak here for this time of year. We're also thinking that the later we go, the more of the warm summer months ahead may give us a little bit of respite. The question about the decision to vaccinate is important. Further steps that might involve a decision to vaccinate some or all of the population. We don't intend to make a decision about immunization until, as late as possible. The idea would be to learn all that we can from the southern hemisphere experience about the ongoing severity and problem associated with this virus. And to learn all we can from the clinical pilot lots that are developed against this virus, to understand whether a vane that is tested is even safe and beneficial and to take the information of that potential risk, potential benefits and the potential value of an immunization program for the Summer for all of the country we'll make that decision in late summer early Fall.
Dave Daigle: Thank you, John. Next question.
Operator: Steven from "Health Day."
Steven Reinberg: Did I hear you correctly you expect the virus to surge in the Fall? And if that's so, do you expect to it be worse than it has been?
Steven Reinberg: Let me clarify. We do expect seasonal influenza to return next fall or winter. Every year we see many strains of influenza circulate and the timing of the beginning of illness can very from early to late fall to winter, depending on the part of the country. So that is a given. We're certain we'll continue to have a seasonal problem with influenza. It is very possible that this virus will continue to circulate and cause illness again next fall or winter. Whether it will cause more illness than it's been causing recently, whether it will dominate among the seasonal flu viruses or whether it will disappear is not predictable right now. We're mindful of the past that pandemics of influenza have sometimes come in waves and the very severe 1918 pandemic had a moderate or mild herald wave in the spring and a much more severe second wave in the fall. So that really terrible experience of 1918 is in our minds. But I can't tell you whether this virus will cause a lot of disease, some disease or no disease here in the northern hemisphere next season. It's really being prepared for the possibility that it will, that we're focusing on right now.
Dave Daigle: Thank you very much. Next question, please.
Operator: Helen from "Canadian Press," your line is open.
Helen Branswell: Doctor, I was wonder if you could tell us about the susceptibility testing. Are they susceptible to Tamiver or reduced susceptibility to those drugs?
Anne Schuchat: The drugs we've tested are susceptible. I'm not aware of other labs that have found differences. I checked with people today about whether there were any hints of problems and was told no. So my latest information is that we have not detected any problems with the Tamiver or other drugs in this novel H1N1 virus. We are very aware that resistance has emerged in the seasonal H1N1 viruses to the point where virtually all of them are now resistant to Tamiver. So we feel it's very important to keep tracking viruses and not assume this novel H1N1 virus will always be sensitive. But for the time being, we continue to have good news on that front from our laboratory.
Dave Daigle: Thank you, Helen. Next question, operator.
Operator: Mike Stobbe from the "Associated Press," your line is open.
Mike Stobbe: Similar I guess to Steve's question. I was wondering about surveillance in the southern hemisphere. You mentioned you're working with a season that's upon us. Do you have any more detail you can give us in which countries surveillance will be taking place? Also, we've talked about a vaccine against the novel swine flu virus for the United States, but what about some of the southern hemispheres? Is that season just too close and we could, you all could never pull that off?
Anne Schuchat: Let me take the questions in reverse. The steps involved with developing a vaccine are numerous, and there isn't enough time to develop and produce a vaccine before the southern hemisphere flu season is upon us. So, unfortunately, the timing of the new virus' emergence and detection is such that we don't think we can get vaccine available before the flu season peaks in the south. On the other hand, the world health organization is working with manufacturers and developing countries and such to try to address the eventual need of their global community with vaccine development. Your other question was more detailed about how we will be working with the southern hemisphere, and for instance which countries. I want to say that the CDC is part of the W.H.O.'s global influenza surveillance network and of course we also developed these reagents that permit texting against the new virus and so we have shifted our test kits out to more than 100 countries, I believe. I'm looking for the numbers, but I can't find them. We really widely ship kits out so other countries will be able to identify this virus and with technical assistance we hope that the laboratory testing can be added to the influenza laboratories in most countries where they exist. So that will be a primary way that we try to support southern hemisphere work in both provision of these important reagents and the technical assistance to make sure that the testing can go forward. In addition to that, we do expect some active efforts to look at clinical disease and this is really building on some efforts that the CDC has had for several years where we've been focusing on respiratory illness in a number of countries. The actual details of which countries will be major focus of our effort, I don't have yet. That's the kind of information we would like to share with you in a future briefing.
Dave Daigle: Thank you, Mike. Next question, please.
Operator: Thank you. Your line is open.
Kafi Drexel: A couple part to this question. First of all, you mentioned that there's some regions of the country that are still seeing higher increased amounts of activity. Am I correct to say obviously New York is one of those areas. And can you comment on what other regions? Also, more specifically for New York, in your surveillance, how do you guys have been doing on some things more specifically on the ground looking at the borough of Queens which seems to be an epicenter this was activity to figure out why that is, and also since it does seem to be an epicenter of activity why it hasn't trickled out more into the larger community and in an area where people commute by buses, subways, there's a lot of foot contact, et cetera. So, there's that part of the question. The other part is just more on how much longer given the way that flu seasons behave you expect for this to act and we are getting into the warmer months here already, so what kind of impact that can have on activity here as well.
Anne Schuchat: Thank you. New York is part of region two, which has New Jersey and New York in it, and that is one of the two regions that still has influenza-like illness that's at a higher level than earlier weeks. The second region that still has influenza-like illness at the higher level is region one, which is essentially New England, it's Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. So the New York/New Jersey and New England areas are still above that baseline whereas the other regions are on the downswing. Your second question was whether we're on the ground in New York in a need to emphasize that the New York City health department has a terrific team that's very actively in the lead and responding to the situation there. CDC has provided some assistance to the New York City health department in looking further into the situation across the city. So, I will leave it to the New York authorities to report on what they are learning in that very active investigation. Your third question was about how much longer do we expect this virus to circulate and cause illness here in the U.S. or perhaps in the New York City area, and I think this is one of those very challenging questions. Sometimes influenza continues to cause illness in the Summer. There can be outbreaks in summer camps with regular seasonal influenza. It's the function of the survivability of the virus in certain circumstances, the population characteristics, and really how probably some things we don't know, measure. So I can tell you that New York will not see ongoing cases over the weeks and months ahead. In general, we don't see much influenza in the Summer months, and we are all hoping that that will be the case. But that's one of the reasons we're turning our attention to southern hemisphere and also to preparing for the Fall, but as you know, right there in New York, it's a very active investigation and response with you had hospitalizations that are challenging and so we know things are not finished up for the season yet in New York.
Dave Daigle: Thank you. Angie, we have time for one last question, please.
Operator: Thank you, Lisa from "Greenwich Times," your line is open.
Lisa Chamoff: Thanks for speaking with us today. My question focuses on school closures, and I know many schools have been applying, the most CDC recommendations not to close school unless there's a magnitude of absenteeism that interferes with activities. I'm wondering given the research you've done recently and especially in region one and two there's a lot of emerging new case. Any updated guidelines or advice on whether schools should close if they are seeing an uptick in cases and is there a point when closing the school would, you know, stop any, any increased transmission?
Anne Schuchat: The school guidance that CDC has issued has not been updated since, I believe, May 5th or so, and that guidance, either that interim guidance really tried to incorporate what we had learned about this virus, it's severity, and transmissibility in contrast to some of the more severe pandemic strains that we studied from the past like the 1918 strain. And that guidance continues to be that school dismissal for the purposes of slowing transmission was not recommended for this virus. We had initially recommended it at the beginning of the response. Instead, we suggested that local authorities make these decisions and then a factor for dismissals might be when the absentee rate was such among students or staff that the school couldn't really function well. The issues that local authority will take into account in addition to the severity of the virus which is what we were trying to help with, would be multiple, you know, the size and staffing at the school, what services the students will have if they aren't there in class, where you are in the school calendar, what are the competing needs and balance the value of being in school with the potential protection that might be afford by not being in school. The focus of our guidance and most of the local authority's guidance has been that if you are in school we think it's important that those who are ill stay home and that, you know, people recover from their illnesses at home. That children who are found to be ill at school be scene home so that they can be taken care of and not, you know, have to beat the school environment. So we, our current guidance continues to be school dismissals aren't recommended for the purpose of slowing transmission but may be needed based on local decision making because of the functioning of the school.
Dave Daigle: I think we can take one more.
Operator: Thank you. Thank you. Jennifer Corbett of "Dow Jones."
Jennifer Corbett: I had a question on the timing of the decrease that you're seeing in most regions outside of New England. I mean most recent figures I have are for the week ending May16th, but I didn't know if you were looking a little bit into last week also.
Anne Schuchat: Yeah. We have a little bit more than the week of May 16th. In our reporting, you know, going through the May 26th reports I'm looking at have some updates on that. But I think an important point I neglected to say in my opening statement was, you know, we've just had a three-day weekend. Most of the public health departments and laboratories were not operating, and the CDC as well. We're not operating on a 24/7 way that we've been operating for the past month and it may be that we see a surge in case count from the states or from our own lab here in the days ahead. So important to recognize that while we had moved from weekly reporting to daily reporting for our influenza-like illness and our laboratory result, some people might have gotten their first day off in a month this weekend, so I think we'll need to see what happens over the next couple of days in terms of some of the predictions I was making.
Dave Daigle: So, thank you very much. This will conclude our briefing. Thanks all for joining us.
Operator: Thank you. That concludes today's conference. You may disconnect from the audio portion and thank you for your participation.
Operator: Good morning and thank you all for holding, your lines have been placed on a listen-only mode until the conclusion of today's conference. If you would like to ask a question, please press star one. I would like to remind all parties that today's conference is being recorded. I would now like to turn the call over to Mr. Dave Daigle. Thank you, sir, you may begin.
Dave Daigle: Hi, this is Dave Daigle from CDC Media Relations. Today Dr. Anne Schuchat, our Interim Deputy Director for Science and Public Health Program, will update us on the novel H1N1 influenza outbreak. She'll begin with a short statement and then take questions from reporters.
Anne Schuchat: Good afternoon, I'm going to just briefly go through some case counts and I want to talk in more detail about three things today ? what we've learned so far about the virus and some clinical warnings, our educational and prevention efforts that are ongoing and just a few words about vaccine development.
We do continue to see more cases in more places. Though we're not seeing dramatic large increases, the numbers I'll share with you today will look like a big bump from the last media briefing we've done. And that's really because of no reporting over the long weekend. Internationally, the W.H.O. is reporting 13,398 confirmed cases in 48 countries with Singapore and Bahrain being most recently added to the list. Here in the U.S. our official count today is 8,585 probable and confirmed cases. We're aware of 12 fatalities and 507 hospitalizations. Most of the people that are getting sick are continuing to be in that 5 to 24-year age group. That's 62% of all the cases that we're counting. And that it still appears relatively rare for people 65 and over to come down with the infection. There's only about 1% of our confirmed or probable cases in that age group. I want to let you know that beginning next week, we're going to shift to a different schedule. We'll be updating our case count information less frequently. And every Friday we'll be doing updates of what we call FluView, a more extensive report on many ways that we track influenza. Weekly reporting through FluView is what we do during the annual influenza season, including the peak of the season. And we hope that sharing information on that basis will keep people informed.
Next I want to talk a little about what we've learned about the virus so far. There are some respects in which this virus is behaving like the seasonal H1N1 influenza viruses. Remember that for seasonal influenza, we usually see H1N1, H3N2 and B strains of influenza. And when we look at this novel H1N1, there's some similarities between this and the seasonal H1N1. Seasonal H1N1 often causes more disease in younger people compared with the other strains that can be more common in older people. The seasonal H1N1 typically doesn't cause as many deaths as the H3N2 seasonal viruses do. In years when H3N2 predominates, we have a higher death toll than in years when the H1N1 predominates. So during the annual flu seasons, we've often found that H3N2 influenza viruses are most strongly associated with severe illness and more deaths. Back to the novel H1N1 virus, currently the attack rates that we're seeing, that's the percentage of contacts of an infected person who becomes ill, are fairly consistent with what we see with seasonal flu. In a typical influenza season, about 7% to 10% of the people in a community may become infected with an influenza virus. And about 20% of the people in households that have infected people contract influenza. And based on the studies that are ongoing, the field work and such, those ballpark figures are about what we're seeing so far in many of the communities where we're looking. Now, there's lots ongoing and the numbers can shift around a little bit. But those attack rates are secondary attack rates in the households and are in the right range for the seasonal flu studies that are reported from the literature.
But there are some aspects of what we're seeing that are very different from seasonal patterns. And of course, there's much that does remain of concern. This virus is circulating much later than the annual flu viruses. We're really not seeing much of any other seasonal flu viruses any more. But we are continuing to see this strain circulate, even though of course we're almost at June. This is a novel virus. And much of the population, we don't think, has immunity to it. So that's again different from the seasonal strain. The current seasonal flu vaccine that people got earlier this past year does not provide protection against the strain so far as we know. And of course, there are areas of country, New York City and several other communities, where we believe active transmission and increased illness, including hospitalizations and deaths, are ongoing. So there are aspects where this is different from seasonal flu. And there's some aspects where the seasonal H1N1 looks a little bit similar to this novel H1N1. I want to stress again the idea of weather and local variation. So while we're regionally -- I'm sorry, nationally we're seeing influenza-like illness, the low, returning back downwards. There are areas where the influenza-like illness patterns are still increasing. The New York-New Jersey area is one of them. And in today's report, we see an increase in the influenza-like illness in region 10, which is Alaska, Idaho, Oregon and Washington. Now that regional data might be obscure because a lot is going on in one or two communities, and not that much in the rest of the region. But in that region 10, we're seeing an uptick that we didn't see last week.
Next I want to go through a little bit of information about some clinical observations. And you've heard us talking about the hospitalizations and the idea that the majority of hospitalizations that we're seeing are occurring in people who have underlying health conditions, pregnancy or various underlying medical problems. This is what we see in hospitalizations with seasonal flu. And so we are seeing that hospitalizations are more often occurring among people with these underlying conditions. When we look at our deaths, we have information on 11 of the 12 deaths that have been reported to us so far. And it appears that 10 of those fatalities occurred in people who had an underlying condition that put them at greater risk for severe complications of influenza. Some conditions like asthma can make it harder for a person to fight off an influenza infection. And we're seeing that kind of pattern, that the more severe complications, hospitalizations or deaths, tend to be disproportionately in people with underlying conditions. Whereas the actual cases out there in the community are often in people with no underlying conditions at all. So we think these patterns suggest to us that it's important for people who have chronic health conditions, or people who are pregnant, to have special attention to warning signs to regarding when to seek care or receive medical treatment for a respiratory illness like influenza. These are the types of warning signs that we look, look to for regular respiratory infections. And they're certainly of concern for an influenza-like illness. And I'm just going to go through them. Because I don't think we've talked about them on one of these briefings before. In children, signs that need urgent medical attention include fast breathing or trouble breathing; blueish or gray skin color; not drinking enough fluids; severe, persistent vomiting; not waking up or not interacting.; being so irritable that the child doesn't want to be held; and flu-like symptoms improve, but then return later with a fever and a worse cough. Those are warning signs we physicians think about all the time, with respiratory infections. And they're good to have in mind with this new influenza-like illness caused by the novel H1N1 strain. Just good things for parents to have in the back of their mind.
In adults, we look at another set of warning signs that suggest the need for urgent medical attention: difficulty breathing or shortness of breath; pain or pressure in the chest or abdomen; sudden dizziness, confusion, persistent or severe vomiting that doesn't go away; and flu-like symptoms that improve, but then come back again with a fever or worsening of cough. Other conditions can bring on new challenges. They can create the potential for more severe illness, that is not a certainty, but it's a possibility. And it's for that reason that we want to make sure that people who have these underlying conditions, or family member who care for such people, remain vigilant about these warning signs emerging. It's often best to consult or at least initially by phone or email, with a health care provider. That's probably a better strategy than going to an emergency room, but we do think that these warning signs can help people differentiate a cough or cold or respiratory symptoms without warning signs, from the type of signs that might lead you to want to attempt medical, to seek help from a medical provider.
I next want to turn to some comments about the education and prevention efforts that we have going on in partnership with state and local health department and the health care professionals, as well as other parts of the U.S. government. From the outset, I think we've been very aggressive with our efforts to reach the public with information that can be useful as people try to protect their health and the health of their families and communities. As you know, we've developed and updated and issued a number of guidelines, interim guidelines for a number of concerns. And we've been stressing the importance of hand-washing, coughing and sneezing into tissues and staying home when people are ill. We've appreciated the help of the media in getting those messages out broadly to communities all over the country. Over the coming months, we plan to continue and expand our efforts to increase awareness of our recommendation and the symptoms associated with the H1N1 influenza. Some of our efforts will target everyone, others of these efforts will target people at higher risk for medical complications. And some of our efforts will target the traveling public, attempting to reach people who plan to be traveling to let them know how to protect themselves, as well as other people from this H1N1 virus. We're expecting that our efforts will use a wide array of media. We'll be working on radio and television, public service announcements, materials for distribution at clinics and health departments, posters in airports and other public places. Numerous materials on our CDC website and continued use of social media, like the twitter efforts that we've been making. So we appreciate the tremendous media attention that has helped us reach information-sharing around the world. We realize that the media isn't paying as minute-to-minute attention any more, so we're taking on some other educational health promotion avenues that we hope will prepare people for the summer months and for the fall.
Lastly, I want to make a few more comments about the vaccine arena. Several days ago, CDC shipped candidate virus strains to several different manufacturers. Manufacturers involved in developing and producing the novel H1N1 vaccine, will start the process by producing candidate lots in the coming weeks. The strains that CDC has provided have been produced using both traditional methods, by growing the virus up in eggs, and new technologies, so-called reverse genetics. In addition to the U.S. manufacturers that we shipped the virus, the candidate virus strains out to, CDC will be providing candidate strains to manufacturers in other countries. And that will be happening in the coming days. We're pleased that we met the timelines we proposed for distributing the candidate virus strains, but I need everyone to remember that there is a lot that is unpredictable in making influenza vaccine for clinical test development or large-scale production. We know every year with the seasonal influenza vaccine preparation, we all have to be prepared for some unpredictability. And although we have met this first initial milestone, we need to stay tuned over the next weeks and months because manufacturing and development and clinical studies can be unpredictable. At this point, I'd like to thank you for the interest you've had in this over the weeks. And go to the questions.
Dave Daigle: Thank you, Dr. Schuchat. Operator, first question, please?
Operator: The first question is from Helen Branswell from the Canadian Press.
Helen Branswell: I was just wondering, I will ask the manufacturer, but I thought you would know, the reverse genetic seats that you made, do you know if MedImmune is agreeing to waive its patent position for any vaccine that's made using a reverse genetic seed string?
Anne Schuchat: You know, think that would be best asked to MedImmune directly.
Dave Daigle: Thank you, Helen. Next question, please, operator?
Operator: Our next question is from Tina Saey, from Science News magazine.
Tina Saey: I also have a question about the vaccine. Can you tell us a little bit about the testing that was done and when we are likely to see the first vaccine come off the production line? And who might be eligible to get this vaccine?
Anne Schuchat: You know, the steps going forward are that manufacturers will be developing lots of vaccines for use in clinical studies. And those clinical studies will be happening over the summer months. The ones that are coordinated here in the U.S. are really overseen by the FDA, working with manufacturers. And by the National Institutes of Health. That runs a big clinical testing evaluation effort. So those two government agencies, FDA and NIH will be in the best position to update on the studies going on this summer. And the development of ingredients for bulk ingredients. Bulk antigens and bulk adjuvant. So in addition to production of vaccines that can go into people to study things like what dose is needed to get an immune response. Whether one or two injections will be needed to get a good persistent immune response. Whether vaccination of different age groups gives different results. Whether adjuvant is needed to give a good response or not. Those are the kinds of questions that clinical studies will do. At the same time, manufacturers will be producing larger amounts of bulk antigen and bulk adjuvant should there be a request to actually produce a vaccine, to fill and finish a vaccine.
The actual making of the final vaccine doses that would go into people in a real program, need to wait for the clinical studies to be finished. Because you need to know how to make the vaccine. How much of each ingredient to put in it and so forth. So there will be a lot going on in the summer, to study test lots of vaccine and look at their performance. As well as manufacturing of the ingredients that can be more rapidly assembled for use. There will be decisions later in the summer, or early fall, about whether to actually do that, fill finish step and how large-scale the production might be. And whether or not an immunization program here in the U.S. is going to be recommended for some or much of the population. So this first steps are very important ones. The handoff of the candidate virus strains to manufacturers so they can go do what they do very well. But we have a very long way to go before we are at the point of making decisions about vaccinations and potentially implementing them. If everything went really well in terms of the production, the testing, the answering all of those questions, and the manufacturing steps, and the decision to actually vaccinate was made it would not be until the fall, when this kind of vaccine would become available. We're saying at this point, you know, not before October would you get doses that might be given to people, besides these clinical research settings. And so we will have a lot to think about over the months ahead. Planning to be ready to immunize should we need to, but also learning as much as we can about how easy it is to make a vaccine and about the circumstances in the southern hemisphere.
Dave Daigle: Thank you very much, Tina. Next question, please, operator?
Operator: Our next question is from David Brown from the Washington Post.
David Brown: Yes, thanks very much. Dr. Schuchat, you mentioned that there continues to be community spread in various places, New York, New Jersey, region 10. Other places despite the fact that it's a, increasingly inhospitable season. My question is, is it conceivable to you that there could be community spread in this continent and not community spread in Europe, which is roughly in terms of weather, and everything, the same, same season, same hemisphere. Does that make sense to you?
Anne Schuchat: Well I think there's, I would like to give two responses to that very good question. The virus properties in terms of its transmissibility and ability to survive in certain kinds of weather, is probably the same here as in Europe. But the one thing that's different, I believe in some of the European countries, is the point at which introduction occurred. I think that we had our first introductions quite a bit earlier than some of the European countries. And we also are likely to have had a bit more widespread disease by the time we were responding here in the U.S. And so it's conceivable to me that in a country in Europe where they really pounced on the first traveler who came back from elsewhere with this virus, with an aggressive containment strategy, they may have had a different experience. But I, I do agree with the idea that this appears to be a very transmissible virus. And that in our populations, with New York City as the poster child, it's being transmitted quite widely. So I think that with the right circumstances, with enough introductions of virus, it's hard for me to believe that the virus wouldn't spread easily, the way it seems to be doing here.
Dave Daigle: Thank you, David. Next question, please, operator?
Operator: Our next question is from Daniel DeNoon, from WebMD.
Dan DeNoon: Thank you very much for taking my question, Dr. Schuchat, my question is about the flu view information. During regular flu season I'm always a little frustrated by getting the results a week or even the Monday after the week, so that the information seems to be a couple of weeks old. Is there anything that's in the works to move this up a little more quickly? So far example on Friday we'll be getting the data through the 23rd of May. It still seems like a reporting what happened a week or so ago. Is there any way to get more updated data? And can you talk to me a little bit about how this is going to go out and when the flu views will be available. And what we should be making of that information that comes from a week before the period we're reporting it? Thank you.
Anne Schuchat: Sure. There are many aspects of our reporting during seasonal flu, that were used during this active response period. And there's some aspects of our regular reporting that we enhanced substantially. So things like many of the reporting systems that would be weekly, we changed to daily. You know, the states were reporting to us every day. And the sentinel providers, who tell us about influenza-like illnesses were telling us what was going on every day. This was a huge, huge collaboration. And we're very grateful for the parts of the system that really stepped up for that. We are trying to gauge the intensity of reporting to the information needs. And some of the delay that happens is because we are testing isolates and trying to get results so between the time a person gets an illness, seeks care, gets a specimen, a specimen is forwarded to a state or public health lab, the specimen is typed there, which can happen right now. Or is typed here, which used to happen before the kits were sent out. You know, there's a natural delay there. We all wish we had data from everywhere available all the time. And I think this is one reason why I've been stressing how valuable the local health authorities are. You know, I think in New York City, people are getting information about what's going on in New York City. In a very timely way. Based on their active outreach to hospitals, and clinic sites and so forth. So I think, unfortunately here at the national level, as we try to put the story together from many communities, there are these lags. Some of our systems are more timely than others, and we are really looking hard at what are the information needs we're going to have when we go into the fall, regular increase in seasonal flu with this new strain potentially on top of it. So, yes, you're right, that many of the data points you're looking at will have a delay built into them.
Dave Daigle: Thank you, Daniel. Next question, please, operator?
Operator: Thank you, our next question is from Richard Knox, from National Public Radio.
Richard Knox: Hi, thanks again for doing this. A couple of somewhat related questions. In the months ahead, if the swine flu virulence increases incrementally, as measured by deaths and hospitalizations, will we be able to pick that up? I'm not talking about a sudden obvious surge in deaths, but something that may be more incremental. And secondly, what are the criteria under discussion that would come into play to trigger the decision to use the swine flu vaccine?
Anne Schuchat: Great, okay. The question of incremental changes in virulence severity is important. We are in planning stages with partners in other countries, with national, I'm sorry, international networks like the Pan-American Health Organization and World Health Organization, in ways to try to improve information availability from countries that will just be going into their flu season shortly or have already started. To understand whether the patterns that they see are different from what we have been seeing here. Severity has been extremely challenging to measure. because of the wide spectrum of illness that influenza can cause. And even with the most severe pandemic we know about, the 1918 pandemic, the mortality for that was about, at the 2% range. It's hard to be very precise in these ranges that we're seeing right now of .15%, or .2% of all cases resulting in death. So whether we'll be able to pick up an incremental increase in virulence, I can't promise. I think we think it's the kind of thing that's important to look for. And it's an emphasis area for us, but we may not be able to answer those information needs precisely. There are a number of criteria that will be part of the decision-making, regarding use of vaccine in the fall. And I think one of the issues here is that I think many leaders are keen to get public input into these types of decisions, to understand where our communities and citizens are thinking. But in terms of the typical criteria, issues like how severe disease is. How disruptive disease is. Who is getting the disease? Is it possible to prevent disease? You know, we certainly make a great effort to prevent seasonal influenza, with production of vaccine and use of more than 100 million doses of vaccine every year. So the opportunity we have right now, because this disease emerged in the spring here, for actual vaccine development to go forward, we have an opportunity to potentially have a prevention tool for something in the fall. That wouldn't have been the case, had disease first emerged in September or October. On the other hand, the, the clinical studies that will be done are going to be vital. Because if these clinical tests suggest in a we cannot make a vaccine that is protective, or is that there is just unacceptable safety properties of a vaccine that appears to have a good immune response, we'll need to really weigh that heavily into a recommendation for vaccination. So there will be both practical criteria, like the results of these clinical studies, and information about the clinical disease we've had so far. And disease that may be forthcoming in the southern hemisphere. And where it occurs, and what age groups and what populations. is it really feasible to prevent a lot of disease with a campaign. So those are some criteria that will go into that thinking.
Dave Daigle: Thank you, Dick. Next question, please, operator?
Operator: Our next question is from Denise Grady from The New York Times.
Denise Grady: Thank you. I'd like to ask you two things. One is if you could tell us something about when, where and how the clinical testing is done. And then the next question I'm wondering is in the southern hemisphere, is there any particular area, place within the southern hemisphere, where we generally look to make our judgments about what to expect? That's it, thanks.
Anne Schuchat: Sure. The question about the when, where and how of the vaccine studies, I'd like to refer you to BARDA for that. And then additionally, the National Institutes of Health will have a lot of information. BARDA is part of the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services and they have the lead for the health questions for emergency types of questions like pandemic or prepandemic. And they will be coordinating these issues. The FDA regulates vaccines and is overseeing manufacturers' plans for studies. And companies may or may not share with us all the studies they're doing. But the FDA would be a good source of what's going on from their perspective, and then the NIH will be overseeing clinical trials carried on their vaccine testing and evaluation units, which their websites have lots of information about those vaccine evaluation units. That, but the specifics of the studies of which places will be doing what studies, I'm not sure of those decisions have already been made. But certainly one of those other organizations will be a better source than I am. In terms of the southern hemisphere, what I'd like to say is is that there is, the World Health Organization oversees a global influenza surveillance network, that characterizes strains of influenza and every year is involved with the decision-making about the dominant strains that go into selection, which strains will go into a vaccine for the northern hemisphere. And which strains will go into the vaccine for the southern hemisphere. And there are many investigators and influenza experts in the southern hemisphere involved in that process. One of the international collaborating centers under the W.H.O. framework is in Australia. That's one of the four international collaborating centers. And they will certainly be influential in helping us understand what's going on with influenza strains in their country. We in the U.S. are one of the, at CDC, we have one of those four W.H.O. collaborating centers. And we receive strains to test from that from many countries in the Americas, as well as other parts of the world. So there is an influenza network that really shares strains and information about strains all the time through the W.H.O. framework. There are also a number of investigators in countries in the southern hemisphere and partnerships that the U.S. government has with a number of these countries. So we're at the stage of really needing to be ready for a disease to emerge or be a big problem in a number of places and need a flexible strategy where partners or we will be participating in evaluation efforts.
Dave Daigle: Thank you, Denise, next question, please, operator?
Operator: Our next question is from Betsy McKay from the Wall Street Journal.
Betsy McKay: Hi, thanks very much, Dr. Schuchat. A couple of questions. One may be one of the million-dollar questions. But I'm wondering, given what you know, are you able to give any predictions about the spread of the virus in the southern hemisphere? Is there any reason to believe it wouldn't spread widely as it has in Mexico and the U.S.? And the second question I had was just to clarify. I'm interested in the attack rates that you mentioned and I'm wondering if we have, if the population has less immunity to this particular virus, how can the attack rates be similar to seasonal flu? Which we presumably have more immunity? Or is that something that you've already factored in? Thanks.
Anne Schuchat: Yeah. The prediction question I wish I could answer that question. It would be a lot simpler if I could answer that question, because our planning could go forth with a much greater certainty. At this point, we really need to plan for multiple contingencies, for severe disease in the southern hemisphere, for no disease in the southern hemisphere, and for something in between. So I really don't know what's going to happen. Certainly, from what I've been seeing here in the U.S., the virus can spread easily and cause disease in people. So it would surprise me if we didn't see it anywhere in the southern hemisphere. But whether we see it in the sustained transmission, hospitalizations and deaths and so forth that we've heard reported from Mexico or that we've been experiencing, I just don't know. In terms of -- second question? The attack rate, thank you. The attack rate information we have so far is partial. Some of the attack rate that we have hasn't yet been adjusted for whether family members were on anti-viral medicines, which would likely lower the attack rate. But the range we're seeing is pretty similar to what we see in seasonal influenza, with a higher attack rate in younger kids than adults in terms of the households that have been looked at. I think that in, in terms of attack rates, even with pandemics, attack rates don't get to be 100%, really, symptomatic attack rates are lower than that. We haven't yet measured asymptomatic infection in terms of serologic conversion or antibody, production of the antibody in people that are exposed to the virus. So it's possible that with additional testing and studies, these attack rates will be adjusted upwards, from what we've seen, once we understand who is exposed and infected, but not ill. What we call the asymptomatic attack rate. So I think it's too soon for us to say that, to say too much about the attack rates although we did want to share what we had learned so far.
Dave Daigle: Thank you, Betsy. Next question, please, operator?
Operator: Thank you. Our next question is from Mike Stobbe from the Associated Press.
Mike Stobbe: Hi, thanks for taking the question. Actually two. First one tailing on to Betsy's -- could you remind us what were the attack rates for the pandemics in 1918, 1957, and the one in the late '60s? And my second question had to do with probably New England Journal of Medicine released two pieces of news yesterday. A group of three Columbia researchers, if I understand it correctly, ended by saying that the immediate ancestors of the novel swine flu virus have been around unnoticed for about two decades. Could you help me understand, is that consistent with what you all at the CDC have been saying? Or is that a little different?
Anne Schuchat: The, let me say something about attack rates and the pandemics of the past. When we did our pandemic preparedness planning, we had certain assumptions about attack rates that were on the range of 30% or so. But what's important to say is that the pandemic, the big difference in a pandemic is less the attack rate than the, in our planning assumptions, was the severity. That you know, quite a few people get influenza, even with seasonal influenza. But that expected deaths would be quite different in the 1918 scenario, versus a 1957 or '68 scenario. So some of our assumptions were that a lot of people would get sick, but what would be the proportion that needed medical care, hospitalization, or that might die. We are right now seeing this sort of 7% to 10% range of community attack rates, which is lower than that pandemic 30% situation. But of course, there are reports that there are some places in Mexico for instance that did have a petty high attack rate, as the virus passed through the community. And remember in some of those places that we're measuring things, it's not over, there are still cases. So these would be snapshots in time. The second question that you asked was not about attack rates.
Dave Daigle: It was the New England Journal of Medicine.
Anne Schuchat: You know, I actually haven't read that yet, so I'm not going to be able to comment, I'm sorry.
Dave Daigle: Thank you, Mike. Operator, we have time for one more question.
Operator: Helen Branswell from the Canadian Press.
Helen Branswell: Thank you very much for taking a second question from me. I was wondering, Dr. Schuchat, if you could tell me, you described at the beginning that this virus seems to be behaving in many ways like the seasonal H1N1 virus. And I'm wondering if the scientists at the CDC are debating giving any additional thought to whether or not this is more like antigenic drift, that this is not perhaps a pandemic virus?
Anne Schuchat: You know, I don't think people are thinking that yet, but I think what is striking people is that you know, H1N1 years, of seasonal H1N1 years, seem to be, or years where there's who disease in kids than we see in the H3N2 years. That the elderly don't have as much disease when there's H1N1-dominant years. So you know it is quite similar in that way. In terms of the -- you know, the novelty of this virus, people are pretty convinced it's quite novel for humans. There is this issue with whether adults over a certain age have preexisting immunity, which would get to similarity with strains that were seeing quite a long time ago. But I think that you know, at this point, the genetics of the virus are very different from the things that circulate. The immune properties of course are questioned, because of this possible preexisting immunity in adults, in older adults.
Dave Daigle: Thank you, Helen. And operator, this concludes our briefing. Thanks to all for joining us.
Operator: Thank you and this concludes today's conference, you may disconnect at this time.
CDC continues to take aggressive action to respond to the outbreak. CDC’s response goals are to reduce the spread and severity of illness, and to provide information to help health care providers, public health officials and the public address the challenges posed by this new public health threat.
Learn more >>
U.S. Human Cases of H1N1 Flu Infection
As of 11:00 AM ET on May 29, 2009, CDC is reporting 8,975 confirmed or probable cases and 15 deaths in 49 states (including the District of Columbia):
CDC PRESS CONFERENCE: June 11, 2009 at 12:45 p.m. ET
CDC Media Advisory
For Immediate Release
June 11, 2009
Contact: CDC Media Relations
(404) 639-3286
CDC Press Conference on Investigation of Human Cases of Novel Influenza
A H1N1
WHAT: CDC will host a press conference to discuss an update in the
investigation of cases of novel influenza A H1N1.
WHO: Thomas R. Frieden, M.D., Director, CDC
Anne Schuchat, M.D., Director, National Center for Immunization and
Respiratory Disease (NCIRD)
WHEN: Thursday June 11, 2009 at 12:45 p.m. ET
WHERE: Centers for Disease Control and Prevention
1600 Clifton Road NE
Atlanta, GA 30329
Tom Harkin Global Communications Center (Building 19), Press Room
For directions to CDC, please visit http://www.cdc.gov/about/resources/v....htm#direction.
Parking is available in the Building 19 parking deck located on CDC
Parkway. Media should arrive at the CDC by 12:15 p.m. Media must present
photo ID for access.
Media who cannot attend in person can listen and ask questions by
toll-free conference line. The briefing will begin promptly; media
should dial in a few minutes before the start of the conference.
Important Instructions: If you would like to ask a question during the
call, press *1 on your touchtone phone. Press *2 to withdraw your
question. You may queue up at any time. You will hear a tone to indicate
your question is pending.
BROADCAST ACCESS
Call Crawford Communications Bookings at 1-800-243-1995 to make
arrangements for broadcast feed.
LISTEN-ONLY AUDIO WEBCAST
This press briefing media will also be available via listen-only audio
web site at www.cdc.gov/media. We strongly encourage non-media
participants to use the webcast.
TRANSCRIPT
A transcript of this media availability will be available following the
briefing at the CDC web site at www.cdc.gov/media.
###
U.S. Department of Health and Human Services
Kristen Nordlund
Press Assistant
Division of Media Relations
Centers for Disease Control and Prevention
Re: CDC PRESS CONFERENCE: June 11, 2009 at 12:45 p.m. ET
I listen to these press briefings everytime. I get much more out of it than reading the transcript. It's easy to sign on and listen to the audio. If you can't get to it right away, sign on anyway. The leave the audio available for quite some time. The transcript can take hours to a day to be published.
Use this link: http://www.cdc.gov/media/
Look for the green box in the right center of the page, and click on the audio only button.
CDC Press Conference on Investigation of Human Cases of Novel Influenza A H1N1June 11, 2009, 12:45 noon ET
Operator:
Good afternoon, everyone. Thank you all for standing by and welcome to today's conference call. At this time your place lines have been placed on listen-only for today's conference. During the question/answer portion, please be sure to press star 1 and record your name at the prompt so that you may be introduced to ask your question. The conference is also being recorded and if you have any objections, you may disconnect at this time. I will now turn our conference over today to Mr. Glen Nowak. Sir, you may proceed.
Glen Nowak:
Thank you for coming here and dialing in for this update on the H1N1. This will be directed by Dr. Anne Schuchat, Dr. Frieden who will make opening remarks, then turning the podium over to Dr. Schuchat. We'll then turn it over to questions and answers. I'll now turn it over to Dr. Frieden.
Tom Frieden:
Thanks very much, Glen, and thank you all for being here. I want to welcome the media and also our partners on the telephone including health departments from around the country. It is wonderful to be back at CDC. I worked for CDC for 12 years and this Monday began my term as director. It is just great to be part of such a wonderful organization. Since the beginning of H1N1, I was health commissioner in New York City and was able to interact on a daily basis with the experts at CDC and have just tremendous respect and admiration for the great work that has been done here. I also want to recognize the leadership of Dr. Rich Besser, Anne Schuchat and Steve Redd through this period. They will continue to be part of CDC's leadership team in this response. I'm honored to be leading the nation's experts in this response to the Novel H1N1 virus. As you know, W.H.O. has officially declared us to be in a pandemic, phase 6 of the global pandemic description. This is not a surprise. It was expected based on the data. W.H.O. waited until they were certain that they had documentation that on multiple continents it was person-to-person sustained transmission and this basically meets our definition of a pandemic. If a strain of the flu virus to which most of us don't have immunity, which is spreading from person to person in many parts of the world. This does not mean that there is any difference in the level of severity of the flu.
This is not at this point a flu that's anywhere near as severe as the 1918 pandemic, for example.
The declaration of a pandemic does not suggest that there's been any change in the behavior of the virus, only that it is spreading in more parts of the world. And really for all intents and purposes, the U.S. government has been in phase 6 of the pandemic for some time now. This, however, is important because it does send the strong message that the virus is here, it's in all likelihood here to stay, and it's important that we continue our aggressive efforts to prepare and respond. Our key goals are to determine where the virus is spreading and to reduce its impact, particularly on those who are most vulnerable - people with underlying health conditions and infants as well in this case. I'd now like to turn the podium over to Dr. Anne Schuchat who will provide you with an update on cases around some of the action that's been taken.
Anne Schuchat:
Good afternoon, everyone. I'd also like to welcome Dr. Frieden to the Centers for Disease Control and Prevention and this press conference. I'm going to give you a quick update on the situation, talk a little bit more about the W.H.O. declaration today, some clinical information, and then summarize some of the actions we're taking here at the Centers for Disease Control and Prevention with partners around the world.
Our U.S. situation, we are continuing to see ongoing transmission of this novel virus. The virus has reached every state in the country.
Many of the states are seeing decreases in illness but there are a couple of areas where influenza-like illness is still above the baseline for this time of year. Our case counts, we've been increasing them every week at this point and we're trying not to focus on them but I can give you the situation.
There are over 13,000 cases reported to us here in the U.S. There are over 1,000 people who have been hospitalized that have been reported to us. And our last update on the counts of death are 27, but we'll be updating that soon and I do, unfortunately, expect that number to rise. The regional trends that we've been seeing on our website, we're showing that information, we're tracking the influenza-like illness from our 4,800 sentinel providers around the country.
What we're seeing is that region 1 and region 2 still see increases above what they'd expect. Region 1 is New England, and in particular Massachusetts is having some challenges. And region 2 is the New York/New Jersey area, and they're also above baseline but plateauing above baseline. I think it's important to recognize that we have to keep our eye out for this, that people think that it's over, flu season is over. But you know, we do expect that there may be continuing transmission over the weeks ahead and we need to remain vigilant. We're looking for that and we know that a number of health departments are still working very intensively.
Let me mention a few things about the pandemic alert level or the pandemic phases. As you know, Dr. Chan, the Director General of the World Health Organization, declared phase 6, announcing that it is a pandemic now. I want to go a little bit into detail about what that means for individuals and what does that mean for countries and our global community.
This phase 6 means a pandemic is under way. We've been talking about this for years, we've been planning for it, and of course here in the United States we've been reacting as though we were in a pandemic already in terms of our intensive efforts to prepare individuals and respond as a nation. This means, just as we've been talking with Americans, it is important to remember the personal steps you can take to reduce spread of infection and to keep yourself and your family healthy and safe. Important to cover your cough or sneeze, important to stay home if you're ill, not traveling when you're ill, and to really be prepared for greater amounts of illness in your community or your school.
What does this mean actually for others? It means that for countries that weren't already seeing the kind of community transmission that we have here in the United States, they really do need to dust off those pandemic plans, make sure they know how they're going to react as illness increases in their own communities, and take aggressive steps to follow what's going on. We say that influenza is unpredictable, and I know it is really frustrating because we wish we could tell you exactly what's going to happen, but we can't. So we have to be prepare for changes in the amount of illness, the severity of illness, the characteristics of the virus, and the reactions of our communities. And what this really means, this spread to multiple regions that is what defines a pandemic, an actual pandemic, what it means is that the virus is spreading, not as Dr. Frieden said, not that it has changed in the apparent severity.
Now severity's been something a lot of people have been talking about. We can think about the severity to the individual and we already know that this virus can cause very mild self-limited disease that gets better without treatment, but it is also able to cause very severe illness for an individual, hospitalization, intensive care unit, or even death. And we try to look at the spectrum of how much of that severe to mild illness is there.
Right now the world health organization is characterizing this as a moderately severe pandemic.
They're not saying it is the same thing as that 1918 devastating pandemic, but it's something we have to take seriously and we need the countries to be paying attention to. Of course, the same virus can cause very different patterns in different countries. We know some countries have limited health structures and health services, and some communities have more people who are vulnerable to life threatening infections with the same kind of virus that would cause a mild illness in others. So I think we really need to work together. We're really all in this together around the world. Here in the U.S., the phase 6 declaration isn't going to change our day-to-day activities. We continue to take this seriously, continue to work with state and local health departments and the provider community, and continue to want Americans to be aware of this and be thinking ahead. You know, taking those safe precautions of covering your cough or sneeze, but also thinking about if things got worse in my community, how would I cope with that.
We're not restricting travel outside -- to particular countries. We're not changing those types of things. This is not what the meaning of the declaration is. It's just really important to remember that a pandemic is a global thing. It means that the whole world is united around this condition now. For a while there it looked like it was just the Americas.
A couple points about the clinical picture. We continue to see a disproportionate amount of illness in hospitalizations. Younger people compared with the elderly. With seasonal influenza, in a typical year we see a lot more disease in the elderly. But in some ways this Novel H1N1 virus is behaving somewhat like the seasonal H1N1 viruses which tend to affect younger people and not the elderly so much. The H3 viruses, the influenza H3 viruses tend to affect the elderly and often are quite severe there. In other respects, of course, this virus isn't like the seasonal H1N1 because we don't think there's general population protection. It is a very new virus.
57% of the cases that we're having reported to us occur in people 5 to 24 years of age, and 41% of the hospitalizations are in that same age group -- the older children and young adults. But I also want to tell you about the rates, the cases per 100,000 population, and let you know that the highest rates of hospitalization are actually in children under 5. And the next highest rates are in those people 5 to 24. So it looks like this is a virus that's disproportionately affecting younger people but there are still lots of infections and hospitalizations in older persons.
According to the U.S. statistics, 71% of the hospitalized patients have occurred in people who have an underlying condition -- respiratory illness like asthma or conic obstructive pulmonary disease, immune deficiencies, and so forth. As we have noted, there's been a disproportionate amount of pregnant women among those who have had infection.
Let me turn last to the actions that we're taking. There are two categories I want to cover. One is understanding the problem and the other is preparing for prevention. To understand this problem we're now intensively focused on the southern hemisphere. We still have spread here in the U.S. but we're looking to the southern hemisphere which is just beginning their influenza season. We of course at CDC have people stationed around the world working on a number of conditions and they're helping us know what's going on with influenza. We also have deployed staff to selected countries in the southern hemisphere to get a little more of the ground truth. We are hearing reports officially from several southern hemisphere countries about increases in disease and those have also been in the media. Australia's going into their flu season. They've reported a lot of cases so far. Chile has also reported a lot of cases. They've been very open and transparent about their circumstances and congratulate them for that.
The second area of actions is about vaccines. As we've been talking over the weeks, vaccines are a very important potential prevention opportunity for a pandemic of influenza. It is important to separate a couple things. We think about vaccines in terms of vaccine development, vaccine manufacturing, and vaccine administration or delivery. At this point the government has launched an effort to develop a vaccine against this strain and we are in the early stages of manufacturing. There has not been a decision to actually vaccinate people, and that's a very separate decision that will be made later on, quite a bit later once we have more information. At this point what I'd like to do is turn things back over to Dr. Frieden. I think he and I will take questions.
Tom Frieden:
Thank you, Dr. Schuchat. In summary, we know that the virus is circulating widely now, not only in the U.S. and neighboring countries, but also in many parts of the globe. The unfortunate news is that it seems to spread faster, at least in schools-aged children than we've been accustomed to seeing. The good news is that so far, we've not seen lots of disease among the elderly who tend to be the more severely affected by seasonal influenza. Given the continued transmission and the uncertainty about the course that had will take, our role will be to continue intensive preparations and planning for the coming months. We can expect to see continued and increased urgency and visibility of planning efforts. We can expect to see continued efforts to develop a vaccine and we hope and anticipate that that may be in place by the fall. Again, a decision of whether or not to use the vaccine is a separate decision from whether or not to make the vaccine. But obviously we need to make it in order to make the decision of whether or not to recommend it and use it.
There's been excellent cooperation with the World Health Organization and with countries around the world. This is one of the many conditions that reminds us that we are all connected, and many of our decisions in the U.S. will rely on good information from countries in Latin America, in Africa, in Asia, Australia and elsewhere. So very important that we confront this jointly. Of course, state and local health departments are at the forefront of responding to H1N1 and facing many very difficult and daily decisions. We're faced with a situation of uncertainty. We wish we could foresee the future. We wish we could know what course it will take. But what we're doing now is getting information as effectively as we can so that we can take the steps that are most sensible now to reduce the number of people severely ill or tragically, who may die from H1N1 influenza.
One of the key steps is that for anyone who does have a fever, a measured fever, take your temperature, over 100, along with either cough or sore throat an also has an underlying condition, whether you have asthma, diabetes, or are pregnant, or an infant under the age of 2, see your doctor right away to see if you should be treated for influenza with antiviral medication.
There will be increased discussion and planning with school officials, faith organizations, community organizations, the business community, on how to address flu when it comes back in the fall and winter. Moving forward, we'll have to address two different challenges -- seasonal flu, as we have each year, and Novel H1N1 influenza. We'll be looking at those separately and how they relate to each other. This is a shared responsibility -- government, health care providers, the private sector and the public. All of us are in this together to respond to what can be a challenging situation. Up until now we have been fortunate that we have not seen a level of severity that's greater than seasonal flu, and the fact that it has not, until now, affected seniors heavily is fortunate and we'll be tracking to see if that remains the case. At this point I want it thank everyone for being here and we'll turn to questions.
Mike Stobbe:
Hi, doctor, Mike Stobbe from the AP. Regarding the W.H.O. announcement, there was speculation or even expectation that might happen for weeks and weeks and weeks. Now that it's finally happened, was that delay in some way beneficial in terms of the public understanding that it wasn't as severe as it might have been at the beginning? Can you comment on that?
Tom Frieden:
I think for some time maybe if we had it to do over again a few years back when we set the six phases of influenza activity, we might have had a different way of doing that that also would incorporate the level of severity. This is at this point nowhere near the level of severity of the 1918 pandemic which many of us think of when we think of a pandemic. I think what's W.H.O. wanted to do was make sure, verify, get set so that we could understand it. But really the practical implications are not significant. We have been acting as if it's a pandemic for some time, and of course in the U.S. and in the Americas, we have already had wisely continued transmission for some time. So this doesn't change any of our actions.
Mike Stobbe:
Could we avoid some hysteria as a result of the delay?
Tom Frieden:
Well, I think as time goes by we better understand the particular strain. At the same time, we're concerned that people not become complacent because this is a Novel strain of influenza, it has spread rapidly. So we have to balance our response. We have to be prepared, we have to ensure that when people are sick they stay home, encourage people to cover their cough when they cough and cover their sneeze when they sneeze, take medications if they have an underlying condition and have fever with cough or sore throat. And at the same time, recognize that this isn't a situation that is such that we would take broader actions at this time.
Operator:
Our first question comes from David Brown with the Washington Post.
David Brow:
Thank you very much. I have two unrelated questions. One is, Dr. Frieden, could you just repeat the advice to consumers about the age and clinical symptoms that warrant going to see the doctor? And my second question is, how many doses or what is the current size of an order that HHS has put in to various flu vaccine makers for production of vaccine?
Tom Frieden:
In terms of recommendations to the public, if you have symptoms of flu -- and by "symptoms of flu," we mean a fever that you measure and that's at least 100 Fahrenheit, along with either cough or sore throat, and you also have an underlying condition, such as asthma, which has been the most common underlying condition we've seen, or you are pregnant, or for an infant under the age of 2, see your doctor to see about treatment. In terms of vaccine order, I'll turn that over to Dr. Schuchat.
Anne Schuchat:
Our HHS Secretary Sebelius announced May 22nd that nearly $1 billion was going towards vaccine development and manufacturing. That included resources for the clinical trials that are being carried out through NIH and through the manufacturers in collaboration, of course, with the FDA and with the part of HHS that works on these pandemic matters. It also included resources to assure manufacturing capacity for both antigen, the component of the vaccine that gives you that immuno response, and the additional chemical that can sometimes increase the immune response that's more specific to the antigen. So the actual amounts -- or I can give you dollar figures rather than not ghost information -- there are five different manufacturers that the HHS has contracted with and there's been a procurement order for a total of $650 million worth of antigen, and $287 million worth of adjuvant. It is posh to say there are a lot of steps important in the clinical development of a vaccine and the testing and we can't predict today how much antigen would be needed. For the H1N1 vaccine we need a lot of antigen to get the response but with adjuvant you could get a different response. We need to be able to manufacture vaccine in case there is decision to use vaccine we have it on hand. Even if the decision to use vaccine is not made, these orders permit the chemicals to be stored in bulk where they could later be formulated if they needed to be. We've done this in a way that's giving us a lot of options for the future.
Glen Nowak:
Thank you, Anne.
Operator:
Our next question comes from Alice Park with Time Magazine. Ma'am, your line is open.
Alice Park:
Yes, this is also a question about vaccines for either Dr. Schuchat or Dr. Frieden. At this point do we have any better information for how well this vaccine is going to be matched to whatever strain we might be in the fall, and how quickly would we be able to adjust this vaccine if we were to see a slightly different variant of this H1N1 become more prevalent in the fall?
Glen Nowak:
I'll have Dr. Schuchat answer that question.
Anne Schuchat:
The good news so far is we have tested a number of isolates from around the world, including different countries and many different states here in the U.S. Characteristics of the virus are the same, suggesting that the strains that are being used for vaccine development are matching the strains that are continuing to circulate. But with influenza, we need to keep looking. So we'll be testing strains through the course of the weeks and months ahead and learn more from that about whether whatever may circulate here in the fall or winter is still the same as what has been circulating so far. So at this point we have no reason to think that the strains that are being used to develop vaccines have any kind of diversion from what's circulating. Now, of course you've asked the question about how well will this work. That's the million dollar question because we don't know yet. We're going to need to do those clinical studies to see whether a vaccine that's developed gives a good immune reaction in different people, whether vaccine with or without adjuvant and whether there are different doses people need to get a good response. Those are studies we'll carry out over the next several months and we'll look forward to seeing results from them.
Glen Nowak:
Is there a question in the room? Okay, operator?
Operator:
Helen Branswell with the Canadian Press.
Helen Branswell:
Thank you, very much. I would ask two unrelated ones, as well, if I could. The first is about the fact that authorities, both the U.S., internationally, everywhere, seem to be often saying that most of the people who get sick or require hospitalization are people who have underlying health conditions. Thing is though that many of the conditions creates a very, very broad umbrella. And I think that many of the people who are standing under that umbrella may see themselves as healthy individuals, you know, people with asthma may not sort of see themselves as inherently unwell. I'm wondering if you have some concerns that there may be people who don't think they're at risk because they don't view themselves as having co-more bid conditions. That's the first question.
Glen Nowak:
Let me address that first question. I'll have Dr. Frieden answer that first question.
Tom Frieden:
This is a valid concern. We want to make sure that what we're trying to do at this point in the U.S. we don't have a vaccine. So the most effective thing we can do to reduce the impact of H1N1 in the U.S. in communities where it's continuing to spread, first, stay home if you're sick. You're not doing yourself or the community any favor by going out and possibly infecting other people and not feeling as well yourself. Second, of course, cover your mouth when you cough. And then, for those who become sick, if you have an underlying condition, seek care promptly, because quick treatment does make a difference. And it is important to recognize that if you have asthma, that means you may have a lot more trouble breathing if you have an infection like flu. That's an important time to consider going to the doctor to get evaluated. If you're having trouble breathing, go to the hospital very promptly. So it is important that people recognize they are in a group that may be at higher risk so if they do develop a measured fever that's high, along with flu-like symptoms, they can promptly receive care. You don't even necessarily have to go to your doctor. In most jurisdictions you can call your doctor and he or she may be able to provide a prescription over the phone or if you're very ill, direct you to go in to get seen immediately in a place that can provide more intensive care.
Helen Branswell:
Thank you, could I ask a second question?
Glen Nowak:
Sure, go ahead.
Helen Branswell:
Thanks very much. Early evidence in the southern hemisphere points to this new virus potentially crowding out the seasonal flu viruses which is something that's been seen in previous pandemics. I'm wondering if anybody is giving any consideration to the notion that, come fall, you're not going to want to be using up resources administering seasonal flu shots.
Glen Nowak:
I will have Dr. Schuchat respond to that question. Anne?
Anne Schuchat:
The pattern of illness of the inch influenza strains in the southern hemisphere is an important issue that we're tracking. And of the information we have so far, in some places they're seeing this Novel H1N1 virus earlier than your usual flu season and it is the main thing circulating. And in other countries we've heard reports that it's the minority strain, the other usual seasonal flu strains are more common. We'll be looking at that over time. Seasonal flu vaccine production is well under way and we're expecting as much as we can ever predict, we're expecting a good supply of seasonal influenza vaccine to be available. And we are continuing to expect to be administering the seasonal influenza vaccine and making sure people get it. Now there's a couple things to remember. Seasonal influenza can be a bad thing. About 36,000 people die from that every year, and it's disproportionately a problem in the elderly and the vaccines that are available can really reduce illness as well as some of the complications. We are expecting to be using that seasonal flu in the fall. Another thing to consider is that, when you have circulation of the seasonal flu strains in this new Novel H1N1 virus, we're concerned about the possibility of the mixing of the strains. Seasonal H1N1 virus that we've had this past year is resistant to Tamiflu. And we really don't want this Novel H1N1 virus to become resistant to Tamiflu as well so there can be some benefit from trying to reduce these other infections even in the circumstance of a Novel strain. I think it's really premature for us to make any definitive conclusions about the seasonal influenza vaccine, but based on what I know today, I'm not expecting us to change our recommendations about that.
Glen Nowak:
Operator, I'll take another call from the phone.
Operator:
Our next call comes from Stephen Smith with the Boston Globe. Your line is open, sir.
Stephen Smith:
Hello, good afternoon. I, too, would like to pose two unrelated questions. The first is, I'm hoping that you might be able to explore -- certainly Dr. Frieden, from your previous perch in New York, you have a particular insight on this point -- why we are seeing continuing elevated activity in New England and the New York/New Jersey areas and what's being done to better understand that. And my second question is, from what has been reviewed to this juncture, what in your estimation are some of the supply chain issues going forward that need to be addressed and refined?
Glen Nowak:
I'll let Dr. Frieden ask the first question and Dr. Schuchat the second question.
Tom Frieden:
Influenza is one of, if not the most, unpredictable of all infectious diseases. And why it acts the way it does, why it goes away in the summer, usually, why it has been more intense in some areas than others is very hard to predict or very hard to explain. What at least we can do is to track it carefully. We do know that there are parts of the country where we still see lots of influenza-like illness. Some of that may have to do with people being more sensitized. Going in for care more commonly. But some of it clearly reflects increased community activity of influenza and the reasons for that are very hard to determine. We'll be looking at that. We're working with groups of researchers who can try to understand that better, but the implications really aren't any different. There's flu around, so take it serious I had, particularly if you have an underlying condition.
Anne Schuchat:
Could you just repeat that second part of the question?
Stephen Smith:
Certainly. What's been experienced vis-a-vis these supply chain issues whether it has to do with antivirals, whether it has to do with getting masks out -- because there have been shortages across the country, transient shortages. I'm just wondering what sort of lessons have been learned about -- it's often discussed we live in a just-in-time economy. I'm wondering, as you now have seven or eight weeks experience with H1N1, the sorts of lessons that have been learned from that and how that might lead to some tinkering with supply chains as we move into the fall and the prospect of having two strains in circulation.
Anne Schuchat:
Thank you. Those are terrific questions. Before this Novel H1N1 virus was recognized, of course the U.S. government and our partners at state and local levels were actively working on preparedness plans for just such an eventuality and they did involve things like procurement and stockpiling through our strategic national stockpile of antivirals and personal protective equipment like masks, and exercises where we would practice how would we move them around and state and local exercises to figure out how would we further distribute them, and we really tried to get as ready as we could. This past several weeks has been an opportunity to test those plans in action, and there have been some challenges. What's going on right now is an intense effort working with state and local governments to try to gather those lessons learn and to understand what worked well, what didn't work well, how can we take those lessons and really get more ready for the fall. So the association of state and territorial health officials is hosting a series of regional meetings that's really going to try to pull together that kind of lessons learned, not just about supply chain issues but really about all of the components of our response. I think this will be vital information for us to reaction better in the fall an potential information to share with our colleagues in the southern hemisphere who are just facing this concern right now.
Glen Nowak:
We have time for two more questions.
Operator:
Our next question comes from Craig Schneider with the Atlanta Journal Constitution.
Craig Schneider:
Hello. I just wanted to ask if this new level of -- for the pandemic is expected to create any kind of changes for state or local governments?
Glen Nowak:
I will have Dr. Frieden answer that question.
Tom Frieden:
The new W.H.O. level really makes no practical difference for state and local governments around the U.S. We've already been in a situation where there is widespread person-to-person spread of a virus to which most of the population does not have immunity. So there are no practical implications for most state and local health departments in the U.S.
Glen Nowak:
Operator, one final question.
Operator:
Our final question comes from Shannon Pettypiece with Bloomberg news.
Shannon Pettypiece:
I was wondering, based off the information you have so far from the statistics, is there any way to say this flu strain right now appears to be less severe than the seasonal flu as far as fatalities and hospitalizations. I was also wondering just on the vaccine question, I know we talked about it a lot, but is it still a question of concern about whether we're even going to have a vaccine available and through all the testing and clinical trials by the time flu season comes around?
Glen Nowak:
I'll let Dr. Schuchat answer those questions.
Anne Schuchat:
The first question was about the severity of this virus compared to seasonal influenza. And at this point I think it's premature to conclude that it is less severe than seasonal influenza. We're certainly seeing pretty severe illness in individuals who are young, including some people who are young and otherwise healthy, unfortunately. So from that perspective, we're seeing this range, this spectrum where the vast majority of people have an illness that gets better on its own and this much smaller proportion of people have quite severe illness. So I think we're really looking to larger numbers and to understanding more detail the potential severity over large population. The second question was about whether we have a vaccine. That's a really good question. You know, we have mechanisms in place to develop a vaccine and to test it and to study it, and we're going to need to look at the results. We're going to need to study the results. We cannot assume that everything is going to go perfectly. There may be some bumps in the roads, there may be some really big bumps in the road. I think we need to be prepared for the possibility that a good vaccine may not be created or that we may not have it in sufficient time before we have a lot of disease. And that's why it's so important for individuals and communities and governments to continue to prepare. Vaccines aren't the only tool that we have in the tool box. We have other efforts like appropriate use of the antiviral drugs, mitigation efforts like social distancing or school dismissals as appropriate. There's a lot we can do individually and in our communities and I think we have to be ready for the idea that we may not get a vaccine as soon as we'd like it, or we may not get a vaccine that works as well as we would like it, or we might not even get a vaccine. We're really taking all the steps we can to make sure that we have one if we need it. But I think there is uncertainty in that just like there is uncertainty in the nature of the influenza virus.
Glen Nowak:
Thank you all for coming here and participating in this press briefing. The transcripts will be up in the next few hours. If you have any additional questions, please contact CDC's division of media relations. Thank you.
Operator:
That does conclude today's conference call. We thank you all for participating. You may all now disconnect and have a great day.
Tweet
Comment