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Press Briefing Transcript

CDC Telebriefing on infectious disease threats and global health security

Thursday, January 30, 2014 at 12:00 E.T.

OPERATOR: Welcome and thank you for standing by.  I'd like to make sure you put your phone in the listen and answer mode.  This call is also recorded.  If you have any objections, you may hang up now.  I will now turn the meeting over to Mr. Tom Skinner. 

TOM SKINNER: Thank you, Calvin, and thank you all for joining us today for this telebriefing, strengthening global health capacity, which is focused or highlighted in today's MMWR.  With us is the director of the CDC, Dr. Tom Frieden, who will provide some opening remarks and then we will get to your questions.  Dr. Frieden? 

TOM FRIEDEN: Thank you very much and thank you for joining us.  Greetings, everyone, from a snowy and icy Atlanta.  Thanks for joining us.  This, I think, is important.  This is exciting news about some projects overseas that are making us safer here in the U.S.  These are projects that had to do with what we referred to as global health security.  That means keeping both the U.S.  and the world safe and secure from infectious disease threats by three key measures of detecting, responding to, and preventing outbreaks as early and effectively as possible.  Because of three important trends, we're actually at great and perhaps even greater risk from some diseases than we have been in the past.  These three trends are, first, new and re-emerging pathogens, things like H7N9, plague.  Second, dug-resistant organisms, whether that's drug-resistant tuberculosis or drug resistant infections like carbapenem-resistant Enterobacteriaceae spreading in our hospitals and, third, sadly intentionally created bioweapons which, since the anthrax attack a decade ago, has become easier unfortunately for isolated groups to potentially build.  Emerging infections such as H7N9 in Asia and MERS coronavirus in the Middle East are two examples of infectious disease threats.  The upcoming season, which will include the Lunar New Year starting in a few hours, the winter Olympics and later this year the World Cup brings millions of families and fans together across long distances and they also are another example of why it is so important that we address the ability to find and stop outbreaks where they occur before they spread. 

We are all connected by the food we eat, the air we breathe, and the water we drink and, therefore, really a threat anywhere is a threat to health everywhere.  The two articles in today's MMWR are on Uganda and Vietnam.  Exactly a year ago, when we saw this confluence of factors and the need to accelerate progress, we decided to do pilots in two countries to see if we could make really rapid progress in these core areas of health protection.  And we were pleasantly surprised and impressed by the amount of progress that was possible in less than a year.  These are models of health security that can make the countries that they operate in as well as ourselves in the U.S. and the whole world safer.  During about six months of intensive collaboration, as CDC specialists worked with the ministries of health in both Uganda and Vietnam to do several core things.  The first was to modernize diagnostic testing for high-risk pathogens.  The second was to develop real-time information systems to track outbreaks faster.  And the third was to improve emergency operations procedures so that these countries could respond to urgent situations faster and more effectively.  Some of the improvements included improving clinicians' ability to report and track the suspected dangerous cases by text message.  That allowed us to immediately find out when there were suspected problems so that there could be rapid investigation. 

Also, we were able to expand specimen referral and transportation systems.  I was able to see this system in action in Uganda last year and it was really quite impressive.  There are clinical facilities operating all over the country which had previously been shipping specimens to the capital for the testing of infants born to mothers who are HIV positive for what’s called early infant diagnosis and that's a blood spot, heel-stick specimen.  They were able to use that infrastructure, which consists of doctors and other health care workers taking the specimen, motorcycle carriers traveling through very remote rural areas to pick up the specimens regularly and overnight mail service to the capital, a high-quality standardized laboratory in the capital, and then results reported through what's called a GSM printer, something that was donated by Hewlett-Packard, so that the results were printed in the rural remote areas as soon as they came off the test equipment in the capital city within a day or two of collection.  A terrific technology and cooperation and is now being used not just for HIV but also for cholera, for ebola, for other viral hemorrhagic fevers, for drug-resistant tuberculosis and for series of other infections that are endemic and potentially epidemic in Uganda, including Zika virus, Crimean-Congo hemorrhagic fever virus, hepatitis E, meningitis, yellow fever and others.  They have also been able to improve the speed of response so that there's a single case, the emergency operations center can activate and they can track and improve the response locally.

 Similarly, in Vietnam, procedures for emergency response were strengthened.  While progress is being made in places like Uganda and Vietnam, overall we are woefully behind.  The World Health Organization International Health Regulations required all countries in the world to be able to effectively find the port, stop and prevent infectious disease threats.  But as of the initial deadline of 2012, fewer than one in five countries in the world have even self-reported that they've met that level of preparedness.  Today is the eve of Lunar New Year which brings in the world's largest annual migration.  There will be more than 3 billion transit trips in China, including some travels who may bring family meals during the celebration.  This peak coincides with the surge of H7N9 avian influenza virus.  The H7N9 strain jumped from birds to people the first time last year and China has reported more than 100 H7N9 infections this season.  If it mutates and spreads between two people -- and there's no evidence that it has done that yet.  But if were to do that, that might bring in the world’s next deadly pandemic.  China has closed several poultry markets and is monitoring new reports of H7N9 and I’ll say that we've worked very closely with the China public health authorities and they have been completely transparent through this process. As soon as the organism was isolated they sequenced the genome and shared that internationally, that allowed us to do diagnostic tests and develop a vaccine and that kind of collaboration is exactly what we need to build on through global health security.  Because of these kinds of collaborations, we are safer as of the countries where the enhancements are taking place. 

At CDC we're working with the state department and others to ensure that in the upcoming mass gathers whether it be the Olympic games or otherwise travelers and others are able to get up-to-date health information and track what is going on.  We actually also work to establish a way of connecting different experts to those who may need input in real-time on a variety of areas and we're also collaborating with a way to find out things very quickly by using mobile applications on smartphones and that's being considered for development during some of the upcoming events. 
To sum up, today's reports outline very encouraging progress in two countries in making those countries and, therefore, their neighboring countries and the world safer against infectious disease threats.  Keeping the U.S. and the world safe and secure from infectious disease threats is achieved by preventing, detecting, and responding to outbreaks as early and as effectively as possible.  What we need to do in the coming months and years is to build on these achievements, both in Uganda and Vietnam and in other countries so that countries have more stable, more productive, more vibrant societies, protected from infectious disease threats and we in the U.S. also are better protected.  I'll be happy to answer any questions and thank you very much. 

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

OPERATOR: Thank you, sir.  At this time, if you would like to ask a question, please press star 1 on your telephone keypad.  That's star 1 to ask a question.  If you'd like to withdraw your question, press star 2.  One moment for our first question.  Our first question comes from Michael Smith with MedPage Today.  Your line is open. 

MICHAEL SMITH: Yeah, good morning, Dr.  Frieden.  Thank you for taking this question.  I actually have a couple of questions that don't bear directly on the demonstration projects that you're talking about.  They do cover some of the issues that you raised.  If I can just -- the first one is, you talked about using text messaging in Uganda and smart mobile phone -- mobile smartphone application.  In general, how widely do you see the future use of these kinds of applications starting with mobile phones and that sort of thing for first identifying and tracking outbreaks? 

TOM FRIEDEN: I think this is -- mobile applications are going to be and already are very important.  They are an early warning system.  They are obviously not a way of confirming.  It's important to always keep in mind that they can sound the alarm, kind of like a smoke alarm or a fire alarm going off but they can't investigate to see if it is truly an outbreak nor can they control the outbreak but it's very encouraging that we've seen the ability, for example, we had a very successful pilot a few years ago in Africa looking at malaria cases reported by text message and we've been using text messaging for a variety of disease reporting.  I think it's been very helpful.  One of the technologies that is quite exciting in Africa is the use of these GSM printers where, instead of having to courier the results of a laboratory test, you can actually send it over the internet and it prints locally, securely.  So there are a lot of ways in which the new technologies are making it easier, faster, more efficient for us to track and find and facilitate the investigation and control of outbreaks.  It's important not to over promise with technology.  You still need a laboratory to be able to determine what the condition is and you still need doctors and public health experts to go out there and control it.  That's not going to be done by clicking or pushing a few buttons.  But it's a tremendously powerful tool, a series of tools and we're very encouraged that this is one of the things that makes global health security even closer to our reach, really, and similarly we've been able to use some of the newer technology systems to ensure that information flows rapidly, the information collection can be done with PDA’s and you're doing it as you're collecting the data rather than in the old-fashion ways and picking up a questionnaire.  Similarly, just as many countries in Africa have leap- frogged over the telecommunication advances and have a proportion of the population of 80% or higher with cell phones, there are -- some of the health facilities in Africa, including many supported by PEPFAR, the presidents emergency plan for AIDS relief, that have electronic health records that can be used to provide and extract information. 

MICHEAL SMITH: Okay.  Thank you very much, Dr.  Frieden.  The other question I have, you mentioned the Olympics as one of these mass events.  I'm interested in what sorts of things you are looking -- worried about in Sochi.  In particular, the Russian Federation in the region has rates of TB incidents along the lines of 90 to 100,000 population.  At least they did in 2012.  What's the -- is TB a risk?  What are the infectious disease risks?  What are the disease risks in general in Sochi? 

TOM FRIEDEN: Thanks.  I'll answer this question and then I think we'll have to go on to the next questioner.  There are things that travelers can do.  Make sure immunizations are up to date.  Pack smart, including a travel health kit, see about travel health insurance.  One of the things that we always are concerned about is crowd safety and safe transportation and doing simple healthy personal habits, like wearing seat belts and having good hand hygiene.  There are a variety of health information specific to the Olympics on our website and this is one of the things that we do in collaboration with any mass gathering.  In terms of your question specifically about tuberculosis, many countries have high rates of tuberculosis and we've seen lots of drug resistance as well.  It generally requires long prolonged contact with someone who has not been effectively treated.  It's not one of the things that we generally see as high up on the risk level but certainly if people have contact with someone for a prolonged period of time with someone with untreated tuberculosis, it's something that we would investigate. 

MICHAEL SMITH: Great.  Thank you. 

TOM FRIEDEN: Thank you. 

OPERATOR: As a reminder, please press star 1 if you would like to ask the question.  Our next question comes from Michelle Castillo with CBS news.  Your line is open. 

MICHELLE CASTILLO: Hi.  I was wondering if it you could speak more about the H7N9 threats in China and whether or not there are fears if it would cross to the U.S.? 

TOM FRIEDEN: So we know that we've already had our first case and death from H5 in Canada earlier this year in a resident from Beijing.  We also know that H7N9 has many concerning characteristics.  The fact that it doesn't make birds sick so we can't cull the flocks.  The case -- the fact -- just one moment, please.  The fact that it has a high case fatality rate, the fact that it spreads readily from poultry to people as well adapted to that.  What's reassuring is that although it's continuing to mutate, it has not mutated in ways that would allow it to spread from person to person and until and unless it does that, it does not, we believe, present a risk of a pandemic of widespread transmission.  While we might see an isolated case in a traveler, we would be unlikely to see widespread transmission unless it develops that mutation.  And we don't have a crystal ball.  I can't say whether that mutation will occur tomorrow, in ten years, or never.  What we can do and what we are doing is make sure that we are tracking it intensively and how we would limit in any way possible the harm that it would do. 

MICHELLE CASTILLO: Thank you. 

CALVIN: And I’m showing no further questions at this time. 

TOM FRIEDEN: Great.  So I just want to reiterate that global health security is about keeping the U.S. and the world safe and secure from infectious disease threats, about preventing, detecting and responding to outbreaks as early and effectively as possible because we are all actually connected by the food we eat, the air we breathe, and the water we drink.  And that's why a health threat anywhere is a threat to health everywhere.  We're making a lot of progress and the reports in today's MMWR from Uganda in particular and also Vietnam show how much progress can be made using new technology and training and a focused approach in just a few months.  But there are still many countries and many parts of many countries that are not adequately protected and we look forward to making much more progress in the months and years to come and we thank you all for joining us. 

TOM SKINNER: Calvin, this concludes our telebriefing.  I encourage reporters who have follow-up questions since the CDC's press office is closed, you won't be able to call our office but you can e-mail the CDC press office if you have follow-up questions and the e-mail address is media@cdc.gov.  And we'll be happy to help you -- assist you with further information.  Thanks again for joining us.  This concludes our call.  

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