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Press Briefing Transcript

Telebriefing on U.S. Influenza Activity and Vaccination Rates for Current Season

Thursday, December 3, 2012 at Noon. ET

OPERATOR: Welcome.  And thank you for standing by.  At this time the participants are listen only mode until the question and answer session.  At that time you can play star one to ask a question.  I would like to inform all participants that today's conference is being recorded.  If you have any objection, you may disconnect at this time. I would now like to turn the conference over to Tom Skinner, Senior Public Affairs Officer for the CDC.  Sir, you may begin. 

TOM SKINNER: Thank you, Jennifer and thank you all for joining us today as we quick off National Influenza Vaccination week with this telebriefing.  Today we have with us the Director of the Centers for Disease Control and Prevention, Dr.  Thomas Frieden and we have also with us the acting Director for the National Center for Immunization and Respiratory Diseases Dr.  Melinda Wharton.  Both will provide remarks concerning some information we want to release today on how the season is going.  How many people have gotten vaccinated as well, and then we'll get to your questions and answers.  So, with that, I’ll turn it over to Dr.  Frieden. 

THOMAS FRIEDEN: Hello, everyone, the news from today is that flu is increasing.  This year's strains look to be a great match with this year's vaccine and it's time to get vaccinated if you haven't been already gotten vaccinated.  We've seen an increase in flu that's over the threshold that suggests that the flu season has started.  So about 2.2 percent of all of the visits variable in different parts of the country are for illnesses that are like the flu.  A significant prportion of which will end up being flu.  That's higher in five states that have high level activity, and have as many as 4 percent  or more of their visits, flu-related symptoms.  This is the earliest regular flu season we've had in nearly a decade, since the 2003-2004 flu season.  That was an early and severe flu year, and while flu is always unpredictable, the early nature of the cases as well as the specific strains we're seeing suggest that this could be a bad flu year. 

Of the doctors who are submitting specimens that we look at to see which strains of flu are spreading, about 90 percent are very well matched with this year's flu vaccine.  That means that we did about as good as we could have done to put the right three strains of flu into the flu vaccines that are available on the market.  Influenza is a serious disease.  It causes a couple hundred thousand hospitalizations a year and thousands of deaths.  Every flu season is different and we expect different patterns in different flu seasons but vaccination is, by far, the best tool we have to protect ourselves against flu.  One of the things that the CDC does during each flu season is to track how the vaccination campaign is going and we get an early indication of that, and we're releasing information on that early indication today.  Overall, what we've seen over the past several years is an increase in flu vaccination rates, including among children, among pregnant women and among health care workers, three key groups that we look at, because they are so important to spread of flu, and they're so vulnerable to severe disease in the case of pregnant women. What that data shows is that we’re holding the gains from past years, but we need to make further gains moving forward.  There's very interesting information about pregnant women that's available.  We're finding that while nearly half of all pregnant women have been vaccinated already, the biggest predictor of whether a pregnant woman is vaccinated is whether her Obstetrician will offer a vaccine in the office.  Nearly three-quarters of pregnant women who are offered a vaccine in the office get vaccinated.

There's also interesting information on health care workers, where we've looked at the different types of health care workers.  What we found is that 80 to 90 percent of pharmacists, doctors and nurses are getting vaccinated.  Have already been vaccinated this season but we need to do much better among allied health workers, aids and other health care systems as well as in nursing homes.  And we're seeing that work sites and pharmacies are major sources of vaccination for adults with more than a third of the vaccines being given either at work sites or pharmacies.  So, in summary, flu activity is up, vaccine is the best tool to protect against flu.  The vaccine is widely available.  There are already over 120 million doses out there to be had.  While it's important to wash your hands, cover your mouth and remain home if you're sick, the vaccine remains the best tool that we have. So, we encourage people particularly as flu season is likely to pick up in the coming weeks and as the holiday season approaches, when you get together with your friends and family, be sure you spread good cheer, and give presents and that you don't share infections and spread the flu. 

TOM SKINNER:  Jennifer, I think we're ready for questions. 

OPERATOR:  If you would like to ask a question, please press star 1 and record your name clearly.  To withdraw your request, you may press star 2.  Once again, to ask a question, please press star 1.  Just one moment for our first question.  Our first question comes from Mike Stobbe of “The Associated Press”. 

MIKE STOBBE:  Hi, thank you for doing this and for taking my question.  Two questions, actually.  Dr.  Frieden, can you clarify?  You said that the strains circulating seem to be very well matched to what's in the vaccine.  But did you say this is shaping up to be potentially a bad flu year?  Why would that be if there's a good match if you can clarify.  And my second question is the early start to this season, is that in any way related to the weather? 

THOMAS FRIEDEN:  The strains that we're seeing in the community are influenza "a," H3N2 predominant.  And what we've seen in past years is that H3 predominant years tend to be the worst years.  And at least in 2003, also an earlier year.  So maybe Dr.  Melinda Wharton would like to say more. 

MELINDA WHARTON:  Thanks Dr. Frieden. In years, when H3N2 strains have been dominant; we have tended to do more in other instances.  Because of that, I think we are particularly encouraging people, having gotten vaccinated yet, do it, but to have the good match the vaccine, there's an expectation that this could be a more severe season than it would be if it weren't H3N2.  As far as the weather is concerned, I think that the relationship between weather and influenza is something that people always are interested and curious about, but I don't think we've got evidence that that's a factor. 

TOM SKINNER:  Mike, do you have a follow-up? 

MIKE STOBBE:  No, I don't think so.  Thank you. 

TOM SKINNER:  Okay.  Next question, Jennifer. 

OPERATOR: Our next question comes from Lauren Browne of “ABC News”.  Your line is now open. 

LAUREN BROWNE: Hi. Yes, this is Lauren.  Thank you for holding this news conference.  You had mentioned that there are five states that are showing high levels of activities of the flu, I was just wondering if you could specific which states those were and why those particular states were implicated more so than others? 

TOM SKINNER:  We’re going to let Dr. Wharton answer that question. 

MELINDA WHARTON:  Thanks.  What we're seeing is a high level of influenza-like illness activity in a number of states in the southeastern and south central region of the United States.  The five states that have reported high level activity through the influenza-like illness surveillance system are Tennessee, Mississippi, Alabama, Louisiana and Texas.  There also is moderate illness -- moderate level of illness being reported in Missouri and Georgia.  But, I think it's just a matter of time before we'll have higher level of activities in other parts of the country but this is where it has shown up first this year. 

TOM SKINNER:  This is Tom Skinner.  I want to remind the reporters on the line that the latest edition of the flu view which contains some of the maps with activity level readings and what not are available on the CDC website.  So you can go to the CDC website to get the latest edition of the flu view map and report.  Do you have a follow-up? 

LAUREN BROWNE: No, I think that's it. 

TOM SKINNER:   Jennifer, next question please. 

OPERATOR: Our next question comes from Elizabeth Weiss of “USA Today". 

ELIZABETH WEISS: Hi, thanks. Can you hear me? 

TOM SKINNER:  Yes, we can hear you. 

ELIZABETH WEISS: Thanks so much for taking my call.  A terminology question, I'm look at the flu view, and I’m trying to find a way to explain the activity level, and when I get to the number of standard deviations below or above the mean for the current week, do you guys have a layman's explanation for that? 

MELINDA WHARTON:  I think of it, it’s the threshold of illness where it's almost certainly due to influenza.  That there always is illness in the community where people can suffer respiratory illness that's similar to flu, but it's only when it's more common that it's like -- it's much more likely to be influenza than something else.  So I would describe it as the threshold at which it's more likely to be influenza in the community. 

ELIZABETH WEISS:  So a high state on that list is not necessarily a state that has an absolute higher percentage of flu in sessions, but just the state where the people who come in and say they're sick, actually a higher percentage of them in fact have flu. Is that correct? 

MELINDA WHARTON:  In the influenza like illness, it's based on the proportion of doctor visits that are for influenza-like illness. 

 ELIZABETH WEISS:  So that is actually -- that's a measure of absolute numbers of people who probably have the flu in the country? 

MELINDA WHARTON:  Well, it's a measure of the proportion of doctor visits.  So it's going to be influenced by how many people go to the doctor, health care utilization, patterns and so forth. Yeah.  I think if there's specific issues about this that you -- that we need to talk about some more, we can get back to you on that. 

TOM SKINNER:  If that didn't answer your question, call back and we'll put you in touch with someone who knows the ins and outs and very familiar with the nuances of flu view.  Okay? 

ELIZABETH WEISS: Thanks so much. 

TOM SKINNER:  Okay.  Next question, Jennifer. 

OPERATOR:  The next question comes from Erika Edwards of “NBC News Channel”.

ERIKA EDWARDS: Hey, there.  I was wondering how you would describe how early this season is, compared to recent years.  Several weeks or months, something like that? 

THOMAS FRIEDEN: This is Tom Frieden.  There's a graph in flu view that kind of gives you a sense of that.  Generally, its peaks a month or two late, Dr. Wharton. 

MELINDA WHARTON:   Often influenza actually peaks after the new year, in January, February or even later.  And last year, we had of course a very late season.  The point Dr.  Frieden made earlier, excluding the pandemic, this is the earliest year since 2003, I think is the point I would make. 

ERIKA EDWARDS: Thank you. 

TOM SKINNER:  Next question, Jennifer. 

OPERATOR: Our next question comes from Helen Branswell of “Canadian Press.” 

HELEN BRANSWELL: Hi, thanks very much for taking my question.  Dr. Frieden mentioned that there are 120 million doses of vaccine available in the United States for use this year.  Can you—there's a universal recommendation for universal vaccination in the United States.  Can you give us an idea how many doses have been used in the last few years?  So, not purchased but actually put into arms? 

TOM SKINNER: This is Tom Skinner.  Just to clarify, the manufacturers had projected that they were going to produce around 135 million doses this year.  That may go up, that may go down.  And as of—the latest estimate as to how much vaccine has gone out is about 123 million doses or so, so I just wanted to clarify that. 

MELINDA WHARTON: But if we apply the coverage estimates that we're releasing in the survey today to the U.S. Population.  We end up with an estimate of about 112 million Americans will have been vaccinated so far.  Now some of the people need two doses, many of the children, but based on our coverage estimates, we're estimating around 112 people will have been vaccinated based on these coverage estimates. 

HELEN BRANSWELL: So far this year? 

MELINDA WHARTON: Yes. 

THOMAS FREIDEN: So far this year, 123 million doses have been sent out to providers. 

MELINDA WHARTON: But that -- we're estimating 112 million people have been vaccinated based on the coverage estimates we're releasing today.

TOM SKINNER: Next question, Jennifer. 

OPERATOR: As a reminder, if you would like to ask a question, please press star one and record your name. Our next question comes from Becky Kellogg from “Weather.com.” 

 BECKY KELLOGG: Actually the last person asked my question, I want to get a little more information about the early start to the season.  I think you guys clarified that.  Thank you. 

TOM SKINNER: Great.  Next question, Jennifer. 

OPERATOR: Our next question comes from Prentiss Findlay of the “Charleston South Carolina Post and Courier.”

PRENTISS FINDLAY: Hi. Thanks for taking my question. I actually have two questions. There's a lot of talk about the early start to the flu season. What is generally considered the flu season?  I know there's a lot of variabilities here, but is it typically just the fall and winter or is there more precise definition of the flu season? 

MELINDA WHARTON: Well, we monitor influenza throughout the fall, winter and then into the spring.  And of course during the influenza pandemic, we monitored it year-round, but generally it's fall, winter and spring.  It’s when we run our surveillance to track where we are.  And usually, the season -- and the season often peaks as late as February.  And so—but when it starts, it varies.  Influenza is a disease which is not very predictable year to year, and we can't know when it's going to start without doing the kind of monitoring that we do. 

PRENTISS FINDLAY: Right.  And you mentioned 123 million doses and then 112 million people vaccinated.  Does that mean that there are now what about 11 million doses available for those who have not been vaccinated, or --

MELINDA WHARTON:  The estimate of 112 million people vaccinated is an extrapolation from the coverage rates that we're releasing today.  So and it may well be an overestimate given that the coverage estimate is based on reported vaccination -- on self-reported vaccination coverage tend to be a little on the high side.  The 123 million doses available are data from the manufacturers on how far they are along in the production process and what has actually been released and distributed.  And, again, these are estimates.  And our expectation, based on what the manufacturers have told us, as they were expecting to be produced around 135 million doses total this year. 

TOM SKINNER: This is Tom Skinner. I think the key point to understand is we're not hearing of any issues or problems of people not being able to get their vaccine.  There's still vaccines out there for those who want to get vaccinated.  That's the bottom line.  Next question, Jennifer. 

OPERATOR: Next question from Timothy Martin of “The Wall Street Journal.” 

TIMOTHY MARTIN: Hi, thanks for taking my call.  Two questions—first off, what factors or variables are looked at to make the assessment or projection that this could be the worst year -- flu season since 2003-2004?  Is it the outpatient visits?  And if so, how does that compare with, say, all of the other years before '03-'04, and the second question deals with this 112 million flu shots administered, what does that rank versus the last flu season or last several flu seasons?  Is it more or less or about the same?  Thank you. 

THOMAS FRIEDEN: Thank you.  This is Tom Frieden.  Just to clarify, flu is unpredictable. That’s probably the most predictable thing about it. We haven't said this is going be the worst season in a decade, we've not said that.  What we have said, it's the earliest season that we've seen since 2003-2004 in a regular flu season, and that within influenza, there are many different sub types.  The sub type that we're seeing in most of the people with flu this year, is the same sub type as 2003-2004 and it's a sub type called H3N2 that's generally associated with more severe flu seasons.  So it does look like it may be shaping up to be a worse flu season—or I should say, it looks like it's shaping up to be a bad flu season, but only time will tell.  The only thing we know for certain, besides unpredictability is that getting vaccinated is the best way to protect yourself.  We're at a very similar level of vaccination to last year.  We did not see shortages of vaccine last year.  We're not hearing about shortages this year. 

TIMOTHY MARTIN: And then just one quick follow-up to that.  Can you characterize it's shaping up to be the earliest season we’ve seen since ’03-‘04, and you said it's generally associated with more severe flu season. So, just a two-parter:  Can you explain what is—the earliness? What is this year, this season versus previous, that make it one of the earliest in a decade?  And can you explain H3N2 versus the other type of flu strains that were seen in previous years that might tend to a more severe flu season? Thank you.

THOMAS FRIEDEN: This is just a month earlier than we generally see a peak, we generally would see a peak in January.  We're seeing a peak in late November, early December.  Not a peak, I should say a general uptick.  ‘Cause we don't know when the peak will happen until we begin to see it beginning to fall.  But we're beginning to see the uptick start at least a month before we generally see it.  The last time we saw it like this was in 2003-2004.  The issue of the type is somewhat complex, so we divide flu into "A" and "B" of the "A" flu, we divide them based on two proteins that are on the surface of the flu molecule the hemagglutinin and neuraminidase, and there are different types of those, and the influenza virus evolves year to year, and cycles sometimes for different types of those proteins.  We can give you more information on that offline if you would like us to explain that further, but the symptoms and signs of flu are the same whichever sub type you get.  And we do find that certain strains tend to hit the elderly or hit young kids or vulnerable people harder than other strains but any one individual, any strain of flu can be life threatening. 

TOM SKINNER: Next question, Jennifer. 

OPERATOR: Our next question comes from Carrie Feibel of “Houston Public Radio.” 

CARRIE FEIBEL: Can you hear me? 

TOM SKINNER: Yes, we can hear you. 

CARRIE FEIBEL: Terrific. Going back to the states of higher levels of activity, including Texas, is that typical, or can sort of the higher regions move around the country and does there that have any relationship to these being more southern, more warmer states later in the winter, so forth? 

MELINDA WHARTON:  Where influenza starts is going to vary from year to year.  Our surveillance experts tell me they do sometimes see it start in the Southeast but it's not something that happens every year and I don't think I would put a lot of – although it obviously affects those communities where it's starting sooner.  It's going to end up, you know, our expectation would be that it would spread throughout the country as the season progresses. 

CARRIE FEIBEL: Thank you. 

TOM SKINNER: Next question, Jennifer. 

OPERATOR: The next question comes from Stephanie Innes of the “Arizona Daily Star.” 

STEPHANIE INNES: Yeah.  Thank you for taking my question. I was wondering what percentage of the overall population currently gets a flu vaccine, and is that percentage going up?  I know you mentioned health care workers and pregnant women, but I was looking for a population as a whole.  Hello? 

TOM SKINNER: Yeah, we're here.  Hold on just a sec.  

STEPHANIE INNES:  Sorry.  I wanted to make sure you heard me. 

MELINDA WHARTON:  Our coverage estimates that we're releasing today, for the entire population, is about 37 percent, for people six months of age and older.  It's a little higher among children with an estimate of 40 percent, and 35 percent in adults.  Now, we are still in the season.  Influenza vaccination is continuing and our expectation is that as the season progresses, that coverage will rise. And last year, it went from -- it was 48 percent by end of the influenza season for the general population, six months of age and older.  Coverage is higher among older people.  We’ve always had the highest amount of coverage by age group among people 65 years of age and older.  But we're doing a much better job of vaccinating children, and we also have a focus on health care workers, pregnant women and people with high-risk conditions. 

THOMAS FREIDEN: I would just reiterate that what we're seeing in health care workers is encouraging, we’ve got 80 percent to 90 percent of health care workers, pharmacists, and doctors have already gotten vaccinated this season and it really shows the importance and we’ve found in obstetricians offices, another high-risk group: pregnant women, that if the vaccines are offered, three-quarters of the women have been vaccinated. 

TOM SKINNER: Next question, Jennifer? 

OPERATOR: Our last question comes from (reporter at) KSL in Salt Lake City.  

KSL SALT LAKE CITY: Thank you for taking my call.  I think somebody already asked this about the significance of the H3, basically characterizing why that's so significant on that protein, without getting too technical, too scientific. And second question, would be, I think I missed the new part about children and their vulnerability with the H3N2 or H3 strain.  If you would please address that.  Thank you. 

THOMAS FREIDEN: Well, when there's a bad flu year, and there are lots of cases, then there are more people who may have severe illness from that influenza.  It's not necessarily that that strain is more dangerous for them.  So in 2003, 2004, we saw severe illness in both children and the elderly.  Just to wrap this up, I want to thank everyone for joining the call.  If there are follow-up questions, our media office can address them.  The information here that we're seeing an uptick in flu.  It’s the earliest uptick we've seen in nearly a decade.  We've seen high levels of activity in southern states as we often see at the start of the flu season, the predominant organism is H3N2 which can be associated with more severe flu season, the match of this year's flu vaccine, because every year we decide which viruses to vaccinate against, which sub types of flu is an excellent match with the flu circulating.  And influenza vaccination remains the best thing you can do to protect yourself and your family from serious illness.  I've been vaccinated.  My family has been vaccinated and I encourage everyone over the age of 6 months to get vaccinated. 

TOM SKINNER: Thank you for joining us. And this concludes our call.  If you do have follow-up questions, feel free to call the CDC press office at 404-639-3286.  Thank you. 

OPERATOR:  That concludes today’s conference.  Thank you for your participation.  You may disconnect at this time.  

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