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Press Briefing Transcript

Telebriefing on Flu Season and Vaccine Effectiveness

Friday, January 18, 2013 at 12:00 p.m. ET

OPERATOR:  Welcome and thank you for standing by. I'd like to say that your lines have been placed in the listen only mode until the question and answer session of today's conference. Today's conference is also being recorded. If you have any objections you may disconnect at this time. I would now like to turn the meeting over to Mr. Tom Skinner, senior public affairs officer for the CDC. Sir, you may begin.

TOM SKINNER:  Thank you, Calvin. Thank you all for joining us for this update on the 2012-2013 influenza season. With us today is the Director of the Centers for Disease Control and Prevention, Dr. Tom Frieden and the Commissioner of the Food and Drug Administration, Dr. Peggy Hamburg. Both will deliver some opening remarks and then we'll get to your question and answers. So without further ado, Dr. Frieden.

TOM FRIEDEN: Thank you. And thank you all for join us for the update on this year's flu season. The bottom line is that the flu season continues. We're in the middle of flu season. About halfway through. And it's shaping up to be a worse than average season and a bad season particularly for the elderly. There's still time to vaccinate and as we'll discuss early treatment is critically important. Today I’ll provide an update on flu activity. Then on vaccine supply and some information for providers about ordering vaccine and for people looking to get vaccinated. I’ll end with discussing what people can do to protect themselves and their families this season and then I’ll turn the call over to FDA Commissioner Dr. Hamburg who will discuss antiviral supplies and then we'll both be available to answer your questions. The FluView that we released this morning shows that as we said before we experienced an early start of the flu season this year. About a month earlier than usual. Many parts of the country are still seeing high and even in some parts of the country increasing levels of activity while overall activity is beginning to go down.

Now what we expect to see with this data is really a phased response. So first we see the cases increase. Then we see hospitalizations increase. Then we see deaths increase. That's what we see each year as the flu season progresses. Nationally, influenza-like illness is down slightly this week from last, from 4.8 percent to 4.3 percent, but some parts of the country, particularly in the West, are showing increases. Thirty states in New York City are now reporting high levels of influenza-like illness activity. Last week it was 24 states. Forty-eight states report widespread geographic flu activity. Last week, hospitalization rates increased sharply in people 65 and over and this week hospitalization rates for people 65 and older increased sharply again. Going up to a rate of 82 per 100,000, which is really quite a high rate. Seasonal influenza always takes the heaviest toll on seniors when it comes to deaths, particularly during seasons when H3N2 is the predominant strain- as it is this year. In general, we estimate that about 90 percent of flu-related deaths are in people 65 and older.

I'm also saddened to report there were another nine pediatric deaths reported this past week, bringing the total this season to 29. That's well below the 153 deaths reported in the 2003-2004 season which was another H3N2 season, but as I say we're only in the middle of our season and even a single death in a child is one too many. We expect to see both the number and the rates of both hospitalizations and deaths rise further in the next week or so. As the flu epidemic progresses and people have the complications of the illness that they developed in the past. I’ll talk about treatment more in a minute, but I do want to really highlight the importance of prompt treatment with a drug like Tamiflu.

First though, let me mention supply of vaccine. We continue to hear reports of spot shortages of vaccine. Some people haven't been able to find vaccine and I understand that they're frustrated. Some providers haven't been able to get vaccine for their patients and they're also frustrated and that's understandable. I'd like to give you an update about what we know about supply and what providers and patients can do to get vaccinated. Many had—the five companies that manufacture or provide vaccine in this country had originally projected that there would be about 135 million doses available for the U.S. for this flu season. We have checked with the manufacturers and recent reports indicate that they are able to produce additional doses of flu vaccine totaling about 145 million doses. As of this week, about 129 million doses had been distributed. That means that there is more vaccine out there for providers to order. There are some formulations of vaccine that may be out of stock while it gets into the system. Particularly for younger children. Providers who want to order more influenza vaccine can visit the influenza vaccine availability tracking system, that's IVATS, and you can find that at www.preventinfluenza.org/ivats. That allows providers to find the vaccine available for purchase. Providers who have exhausted their vaccine or patients who want to find vaccine can go on to flu.gov where there's an interactive. You can put in your zip code and find out where there's flu vaccine in your area. If you want to double check, you might call before going. But that's being kept up to date.

There are about a million doses of flu vaccine given every day during flu season. So keeping up to date with who has vaccine is something that may be necessary for people to check around. I want to close my remarks by reminding everyone that although the flu vaccine is far from perfect, it's by far the best tool we have to prevent influenza. You can still protect yourself through vaccination. Particularly for folks out west. You probably have most of the flu season still to come. We have talked today about the elderly being particularly vulnerable. And I really want to emphasize that the importance of our second line of defense against influenza, influenza antiviral drugs. We at CDC have looked very carefully at the use of influenza drugs in the clinical setting and our conclusion is quite clearly that when given promptly, they work. They can reduce symptoms, shorten the duration of illness and prevent serious complications, including hospitalization and death. In fact in studies of very sick patients we have seen death rate cut by 50 to 75 percent or even more through the prompt use of antiviral drugs. So for high/risk patients antiviral treatment really can mean the difference between a milder illness and a stay in the hospital or in the intensive care unit or even death. The drugs clearly work much better if they're started soon after onset of illness in the first 48 hours.

So if you have the symptoms of flu or you're worried about how severely ill you are, do see a doctor or other health care provider promptly. It's particularly important for patients at high risk including the elderly, young children and high risk groups such as people  with asthma, diabetes, heart disease, pregnant women or children with neurological or neurodevelopmental disorders to see a provider promptly if they become ill with flu-like symptoms and for providers- even if a rapid flu test is negative, if someone is either high risk or in one of those high risk groups, very young or very old, and has symptoms of flu, even if that rapid flu test is negative, they should be treated particularly in the first 48 hours because rapid flu test does have a number of false negatives. Finally for people who are at higher risk it's a sensible thing to do is to stay away from sick children. You might not want to have the grandparent babysit for a sick child at home. Not a good idea. And if you have symptoms, please stay home from work. Keep your children home from school if they're sick to keep from spreading flu to others. I’ll now turn the call over to Commissioner Hamburg who will speak on antivirals and then we'll both be available to answer your questions.

MARGARET HAMBURG: Okay, thank you very much, Dr. Frieden. I'm very happy to join with CDC on this call and appreciate your sensible advice. I would first like to begin by saying that the FDA has been working very closely with our colleagues at the CDC throughout this flu season and will continue to actually monitor and help address both the supply and distribution of vaccines and antiviral treatment. First a brief comment on the vaccine issues that Dr. Frieden was discussing. The FDA has now approved influenza vaccines from seven manufacturers and collectively as he mentioned they've produced about 145 million doses of this season's flu vaccine for the United States. It's worth noting that thanks in large part to the combined efforts of HHS, CDC and FDA, this is twice the supply that was available only several years ago and of course in many years some vaccine remains unused due to lesser demand. But this is a very high demand year.

As Dr. Frieden mentioned, we're also focused on the people who are already suffering from flu and the important role the antiviral treatment can play. And the FDA is working hard to make sure that medicine to treat the flu and its symptoms are available for all who need it. Some locations may experience intermittent, temporary shortages of the oral suspension form of the antiviral, Tamiflu, which is the liquid version often prescribed for children for the remainder of the flu season. But the FDA has been working with the manufacturer, Genentech, to increase supply and is reminding health care professionals that FDA-approved instructions on the label provide directions for pharmacists on how to make a liquid form of Tamiflu from the Tamiflu capsules if the oral suspension product is not available. I want to assure patients also that Tamiflu 30 milligram and 40 milligram capsules remain available and pediatric patients one year of age and older can be dosed correctly using the 30 milligram and 40 milligram capsules.

However, pediatric patients less than 1 year of age should be given Tamiflu oral suspension, preferably the commercial oral suspension product or if that isn't available, then the suspension prepared by the pharmacist according to the current label instructions. Tamiflu 75 milligram capsules are currently available, but supplies may run low if many pharmacies have to use the capsules to prepare an oral suspension for pediatric patients or use to fill large numbers of prescriptions for adult patients. So to help avoid a shortage, the FDA is now allowing Genentech to distribute two million units of Tamiflu at the 75 milligram capsule level that have an older version of the package insert. This additional supply is the same medicine that the product is currently in distribution, but does contain an older version of the package insert. So it's important to note that this medicine is fully approved. It is not outdated. Only some of the information on the package labeling is older. The main differences are that the older labeling doesn't have the new version of the instructions on making an oral suspension from the 75 milligram capsules and new dosing information for treatment of pediatric patients two weeks to less than 1 year of age.

But to assure that people have access to medication to treat the flu and its symptoms, we took the necessary steps to allow Genentech to distribute its reserve Tamiflu capsules without requiring them to repackage it as repackaging would take many weeks which is time we simply don't have this flu season. However, we're working with the company to notify pharmacists and health care providers of this information so they can properly dispense Tamiflu to patients and we're also posting this information on our website. With early notification from companies like Genentech and the communication about needs in the community, we are able to use our regulatory discretion to help avert a shortage situation and that's exactly what we have been trying to do with Tamiflu.  We'll continue to monitor this situation and we'll post information on our website, FDA.gov to update the public on this important issue. And with that, I’ll turn it back to Dr. Frieden and happy to answer any questions on these issues that may arise.

TOM SKINNER: Calvin, I believe we're ready for questions, please.

OPERATOR: Thank you, sir. At this time, if you would like to ask a question, please press star, one on your telephone keypad. Again, that is star one to ask the question. Our first question comes from Jonel Aleccia with NBC News. Your line is now open.

JONEL ALECCIA: Yes, hi. Thanks very much. Good morning. Thanks for taking our questions. So we have more hospitalizations and deaths we are seeing, but looking at this with FluView I also see it looks like the visits for ILI and the number of flu positive tests seem to be dropping sharply. So have we reached a peak of this season?  I know you said we're halfway through. But it looks like the graphs are going down.

TOM FRIEDEN: Absolutely. And, again, you can't predict the future with flu. But we do look like we're about in the middle of the season. We're about halfway through. Overall in the country. We're still seeing increases in California and some other locations. And what we expect to see is a lot of cases and then as people get complications of flu or become more ill after the cases peak, then comes the hospitalization and death peak. So we do see those coming in waves and that's why we're really emphasizing the importance of prompt treatment of flu. Remember, even when you're halfway through the season that means you've still got half of the season left. Doesn't mean the season's over. So when people have symptoms of flu for those who are older or for young children or people with underlying health problem, very important to get seen by a health provider promptly and what we're seeing is not as many people as we would like who are in those categories are getting treated with Tamiflu.

That's important because Tamiflu can reduce the likelihood of hospitalization, severe illness or death. But we have seen actually the rate of treatment come down a little bit from a few years ago when people were a little more attuned to this during the pandemic. And during the 2009 season, I think doctors got in the habit of knowing that important to treat promptly with Tamiflu. This year we're seeing a particularly severe season for the elderly. So very important, particularly for the elderly, as well as those with underlying conditions and children to be—infants to be treated promptly if they have symptoms of flu.

TOM SKINNER: Next question, Calvin? 

OPERATOR: Our next question comes from Lena Sun with The Washington Post. Your line is open.

LENA SUN: Thank you very much. Dr. Frieden, you in the last briefings you had mentioned that the manufacturers had planned or had produced about 135 million and because of the production process, you know, it's not something they can flip a switch and make more. So why all of a sudden now is it 145?  Is it a vaccine that they took out of reserve? Is it vaccine that they were originally going to distribute to overseas market?  Where did this extra 10 million come from? 

TOM FRIEDEN: So these are not—vaccine they just made.  And these are initial estimates. They also can adjust their production somewhat based on demand. So when they're seeing more demand, they will make more product. Sometimes the yield with the traditional means of making flu vaccine is somewhat unpredictable. So I think they would rather underestimate and over-deliver and that's probably what we have seen this year.

LENA SUN: Just to follow-up then, this is because the initial numbers that they gave you were not quite correct? 

TOM FRIEDEN: No. I wouldn't say that. I would say that they were committing to producing at least 135 million doses and that as they have seen additional demand, they have been able to continue production and continue to fill in finish process so that they would be enough vaccines on the market.

LENA SUN: Thank you.

TOM SKINNER: Next question, please.

OPERATOR: The next question comes from Miriam Falco with CNN Medical News. Your line is now open.

MIRIAM FALCO: Hi. Thanks for taking questions. Nine more pediatric deaths, that's—that's quite an increase. Do you have any information about the causes in terms of were these children vaccinated or not?  And also, I just want to make sure I got these numbers right. You said there was a drop from 4.8 percent to 4.3 percent over last week. Are you talking about the outpatient illness surveillance?  Because those aren't the same numbers I'm looking at.

TOM FRIEDEN: So first, on your question on mortality, what we generally find is that more than half of the children who die from flu haven't been vaccinated. And we do find that usually a large proportion of the children who die from flu have other health problems as well. In terms of the 4.3 percent, could you just repeat that question? 

MIRIAM FALCO: I just want to make sure I'm looking at the right numbers. I'm looking at the outpatient illness surveillance which the new report says was 4.6 percent and the January 5th data ending January 5th said 4.3. So to me that looks like an increase. I'm not sure if I'm talking about the same numbers as you were.

TOM FRIEDEN: Yes, we are. We generally update the previous week's data to correct or for late reported data.

MIRIAM FALCO: Okay.

TOM SKINNER: We can follow up with you to clarify after the call if you'd like.

MIRIAM FALCO: I appreciate it. Thank you.

TOM SKINNER: Next question, please.

OPERATOR: Our next question comes from Jennifer Corbett with the Wall Street Journal. Your line is open.

JENNIFER CORBETT: Hi, I have a couple questions. The first thing is Tamiflu the only antiviral out there?  Is there, you know, another option?  And then the other question I had on the hospitalization rate. To me, that looks like it may be is above the peak that was seen in the—you know, in the H1N1 and the 2009-2010 time period.

TOM FRIEDEN: Your question—your second question was about the hospitalization rate? 

JENNIFER CORBETT: Right. Not the rate but I'm looking at it—I think it was 8.3 percent?  This past week.

TOM FRIEDEN: The fatality rate then, pneumonia and influenza mortality for 122 U.S. Cities? 

JENNIFER CORBETT: maybe that's—

TOM FRIEDEN: In any case, what we saw with the pandemic in 2009-2010 was particularly hard-hitting—hitting children particularly hard. What we're seeing this year as we have seen with previous H3 predominant years is hitting the elderly particularly hard. Your first question, no, there's a second drug, Relenza. I’ll ask Dr. Joe Bresee to speak about it.

JOE BRESEE: There are two drugs that we recommend for treating flu. One is called oseltamivir, Tamiflu is the brand name, and one is called Zanamivir or Relenza is the brand name and both are available right now and I think as a doctor, they can choose to use either one.

TOM SKINNER: That was Joe Bresee. Next question, please.

OPERATOR: Our next question comes from Marilyn Marchione with the Associated Press. Your line is open.

MARILYN MARCHIONE: Hi, thanks very much. Dr. Frieden I was hoping you could clarify those numbers again too. The 82 per 100,000 which you said is really quite high. Is that hospitalizations, influenza-like illness, can you just clarify that please? 

TOM FRIEDEN: Sure. That is the influenza—laboratory confirmed influenza hospitalizations from one of our surveillance systems. This is in the FluView that we posted on our web as of January 12, 2013. And the graph is really quite striking in a really rapid rise of the rate of laboratory confirmed influenza hospitalization for people 65 and over.

MARILYNN MARCHIONE: Okay. That's what I wanted to clarify. Is it just 65 and older or are you speaking—when you say 82 per 100,000 is that overall or over 65 and over?  Thank you.

TOM SKINNER: That's in the 65 and over. We have seen increases in all age groups. The overall is 19 per 100,000, but the rate among those 65 and older is 82 per 100,000.

MARILYNN MARHCIONE: That's what I wanted. Thank you so much.

TOM FRIEDEN: Thank you.

TOM SKINNER: Next question, please.

TOM FRIEDEN: I would also comment on that—that these rates are undoubtedly an underestimate because influenza-related hospitalizations can be missed either because the testing isn't performed or because cases may be attributed to other causes of pneumonia or other things that may result from influenza. Next question, please.

OPERATOR:  Our next question comes from Shannon Pettypiece with Bloomberg News. Your line is open.

SHANNON PETTYPIECE:  Hi. I wanted to know do you have any information on among the deaths so far, like what rate of those are typically people who are unvaccinated?  I was wondering if you could just go over quick one of the questions earlier about the percentage of doctor visits that are flu related. I think there was some confusion on the numbers, the 4.3 percent versus 4.6 percent  These are just go over the percentage rates.

TOM FRIEDEN: Thank you. I’ll address your question on deaths and then I’ll ask Dr. Bresee to clarify on the percentage of influenza-like illness visits. There are three groups at particular risk for serious illness from flu. The elderly, infants and very young children. And people with underlying health conditions. And we see each year that in a bad flu year, each year there are thousands of deaths from flu. In a bad year, there are tens of thousands of death from flu and usually about 90 percent of those deaths are in people over the age of 65. Those can be prevented in a few key ways. First by vaccinating, both the elderly and people around them. Second by giving prompt antiretroviral—sorry, giving prompt antiviral treatment. Antiviral treatment works. It reduces the risk of serious illness and death. But it's most effective if given within 48 hours of onset of symptoms. So prompt treatment is really important and we're still seeing in preliminary analysis of this year's flu season that we're not doing as well as we should be doing with getting people treated promptly. That maybe as many as a third or a half of people who are hospitalized with flu aren't getting prompt treatment with antivirals. So the second line of defense after vaccination is prompt treatment and that can have a big impact on reducing serious illness and deaths. Dr. Bresee? 

JOSEPH BRESEE: Let me explain. You asked a question about the outpatient or the ILI data. Let me just explain how it works. What this means is the proportion of patients who go to one of the participating practices or emergency departments in the country, the proportion of all the patients that show up at those clinics that are attributable to what we call influenza-like illness which is a respiratory illness with fever, and so this week we found that 4.6 percent of all these visits to these personal clinics or emergency departments had ILI. We track that during the year. And what we know is that percentage tracks really well with influenza positive laboratory tests and what we have seen so far this year is a sharp increase as you have seen and we have been above what we call base line for the last several weeks. But more importantly what we have seen in the last two weeks is a declining rate of that. Not everywhere in the country, but nationwide it's declined two weeks in a row. But as Dr. Frieden says, some parts of the country are still increasing. So our message is not that flu season is over. Our message is that flu season may be declining in some of the places but still will be a risk even there, but some parts of the countries especially as we go westward in the country have increasing rates of flu, have increasing chances of getting the flu.

SHANNON PETTYPIECE:  And what were the—what was the rate in the week ended January 5th?  Because I thought it went up. I thought it was 4.3 percent.

JOSEPH BRESEE: Yeah. We should have explained that. I apologize. Yeah, the rate we published last week I think was 4.3 percent. This week, the rates were publishing for last week are slightly higher than that. What happens is Dr. Frieden says is that after we stop looking at the data to publish our report each Friday, people keep reporting things. So people that didn't get their data in for last week continue to report over the weekend and early this week, and so we adjust last week and the week before’s data. So it may change a little bit each week.

SHANNON PETTYPIECE:  Okay. Thanks.

TOM SKINNER: Next question, please.

OPERATOR: Our next question comes from Robert Lovitz with Medscape Medical News. Your line is open.

ROBERT LOVITZ: Thanks for taking my call. So what is the revised ILI rate for the first week of the year?  It's not 4.3 percent, so what is it? 

JOSEPH BRESEE: It was 4.8 percent this week.

TOM FRIEDEN: And 4.5 percent last week.

ROBERT LOVITZ: No, I’m saying for first week, ending January 5th —

JOSEPH BRESEE: That's what I mean. 4.8 percent is what we published. It was 4.3 percent last week.

ROBERT LOVITZ: Right.

JOSEPH BRESEE: We got more data over the weekend and early in the week. So that week now becomes 4.8 percent.

ROBERT LOVITZ: Oh, now becomes.

JOSEPH BRESEE: So the 4.6 percent we're seeing this week—

ROBERT LOVITZ: Would be a decrease.

JOSEPH BRESEE: Would be a decline over last week's data.

ROBERT LOVITZ: Then are there any other changes from—for last week in terms of the number—let’s say the number of states reporting widespread influenza activity?  We had that down as 47. The states reporting high levels of ILI. We had that as 24. Are those numbers—have they been revised as well? 

JOSEPH BRESEE: So. Those numbers don't change. The numbers that tend to change and usually only subtly are the ILI data and the laboratory data sometimes change. But again they don't change in a way that changes dramatically our message to be honest. They'll change subtly over the weeks and we'll back fill those in but actually the trends tend to stay the same.

ROBERT LOVITZ: I have another follow-up question. It has to do with the influenza associated pediatric deaths. You have a—on page 6 of the pdf, 2011 and 2012 it says number of deaths reported –34. Is that for the entire season or for deaths through the second week of 2012? 

JOSEPH BRESEE: That's a good question. Those numbers listed above the curves in the previous years are for the entire flu season.

ROBERT LOVITZ: So in other words 34 was the entire number of pediatric deaths in the 2011-2012 flu season? 

JOSEPH BRESEE: That's exactly right. As we said last year and we’ve said this year actually 2011-12 influenza season was an unusually mild season. So we saw 34 pediatric deaths last year, compared to 122 pediatric deaths the year before.

ROBERT LOVITZ: So would you venture to say that the pediatric deaths by the end of this flu season are going to exceed those for last year? 

TOM SKINNER: We'll answer your question, but we need to move to the next question, so close the line, we'll move to the next question after you answer, Joe.

JOSEPH BRESEE: I think the answer is we don't predict what will happen to flu as Dr. Frieden says. I think it's too early to tell how severe, how long this season will last. And so I wouldn’t speculate on how many deaths may occur.

TOM SKINNER: Next question, Calvin.

OPERATOR: Our next question comes from Anna Gordon with Los Angeles Times. Your line is open.  

ANNE GORDON: Thank you.  Can you talk about the role of vaccinating health care worker, doctors, nurses, and other staff in hospitals on reducing deaths from the flu? 

TOM FRIEDEN: Vaccinating health care workers particularly in hospitals and long term care facilities is quite important. And as we mentioned on one of these calls a few weeks ago we have more specific and refined data this year than we have ever had in the past on the different types of health care workers getting vaccinated. It is interesting and important. We found that for pharmacists, doctors and nurses, about 85 percent were vaccinated even relatively early in the season. But that for some of the allied health workers and in some settings including nursing homes, the vaccination rates were down around or below 50 percent. So vaccinating health care workers is a very important measure to both protect them and their families as well as the patients they care for. We have also seen that facilities that make it easy for patients to get for—I’m sorry, facilities that make it easy for the health care provider to get vaccinated do it on work time, at their work station, flexibly reaching out to the health care workers can routinely get rates of 90 percent or higher.

TOM SKINNER: Okay. Calvin, we'll take a couple more questions, please.

OPERATOR: Thank you. Our next question comes from Rebecca Adams with the Congressional Quarterly. Your line is now open.

REBECCA ADAMS: Great, thank you so much for taking the question. First, is there anything else that's in the works either to address the shortages of vaccine or Tamiflu?  Are you confident that 145 million doses of the vaccine and the efforts on Tamiflu will take care of the problem?  And I also wanted to talk a little bit about the future. This week we saw the approval of flu bot—the new seasonal vaccine that Barta helped develop. Dr. Hamburg, are there any more products on the horizon?  And Dr. Frieden last week you said you all are working on policies to improve the effectiveness of flu vaccine which this year is about 62 percent effective and last year was about 52 percent effective. So can you give us some more detail about that too? 

TOM FRIEDEN: Sure, I’ll speak briefly and then turn it over to Dr. Hamburg. It's necessary for people to check around. We do think that there will be spot shortages, but that by and large people who want to get vaccinated will be able to get vaccinated. There may be some specific areas of the country or some specific age groups for which it may particularly be difficult. We also may have a period of time in which a vaccine is not available in certain places or certain populations. And think that with the action of the FDA has taken, we do not have concerns about shortages of Tamiflu. But Dr. Hamburg? 

MARGARET HAMBURG: Well, you know, just to reinforce what Tom was saying, flu.gov really does work. I went on it myself this morning and so I encourage you to make that information available and use it yourself as needed to find where vaccine is. We cannot increase the actual production of vaccine for this current flu season because of the nature of flu vaccine manufacturing. But there's a lot of reason to believe that vaccine is out there and not getting to the people who need it. And that we need to really help people find vaccine in a timely way. There's good news on the overall vaccine front. I mean, one piece is what I mentioned earlier that we actually are seeing, you know, considerably more vaccine being routinely produced in this country than just a couple of years ago with more manufacturers and in just recent times in the last year time frame, FDA has approved four new vaccines. We have approved a new cell-based vaccine at the end of November. Which is an important advance in terms of not depending on cells and being able to really—I mean on eggs I’m sorry. And being able to— able to enable a faster start for production. We have approved two qadrivalent vaccines that have the benefit of having two influenza A strains and two influenza B strains instead of just one influenza B strain. And we also as you note just two days ago I guess approved the first recombinant influenza vaccine that does represent an important step forward in terms of the application of a new technology for flu vaccine but a vaccine technology that is well known and has been utilized for many years in other types of vaccines such as for Hepatitis B. So I think this means that that's going to be more manufacturers and more vaccine types available in future flu seasons.

TOM SKINNER: Okay. Calvin, we'll take one last question, please.

OPERATOR: Our last question comes from Rob Stein with National Public Radio. Your line is open.

ROB STEIN: Thanks for taking my question. You mentioned that the hospitalization rate for the elderly is unusually high this year, 82 per 100,000. I’m just wondering how that compares to previous years or an average year?  Just trying to get a sense of how much higher it is than usual. Thanks.

TOM FRIEDEN: Thanks very much. It's comparable—it's similar to a severe year with H3N2 like '07-‘08 or ’03-’04, those were both H3 years and we saw similar rates those years.

ROB STEIN: So—

JOSEPH BRESEE: That's exactly right. And i think the caution is clearly that the rates continue to go up and so we don't know where we'll end the year. But it's a reminder that in influenza season especially influenza seasons when this virus H3N2 virus circulates we often see lots of deaths especially among the elderly.

ROB STEIN: Is there any way you can tell me what it is in an average year as opposed to a severe year?

JOSEPH BRESEE: Thanks. Flu is so variable. We often report ranges because I think it's more informative than an average year and we published something a couple years ago which looked at 25 years of data and found that flu deaths varied from about 3,000 to about 45,000 to 49,000 deaths. So it's amazingly variable year to year.

TOM FRIEDEN: So thank you all very much. Thanks to Dr. Hamburg for joining. Just to recap in a word, it's a worse than average season, it's a bad year for the elderly. And there's still time to get vaccinated though you may have to look around. And check flu.gov and treatment with antivirals is important. Early treatment can save lives. Thank you all very much.

TOM SKINNER: Calvin, this concludes our call. Thank you all for join us. If you have follow-up questions please call 404-639-3286. A transcript of this call will be made available on the CDC Media Relations website. Thank you for joining us.

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