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Telebriefing on the Current Influenza Season and Seasonal Influenza Vaccine Distribution and Availability

Centers for Disease Control and Prevention
November 9, 2007

OPERATOR: Good morning or good afternoon, and thank you all for holding. At this time, your lines have been placed on listen-only until we open up for questions-and-answers. Please be advised today′s conference is being recorded. If you have any objections, you may disconnect at this time.

I would now like to turn the conference over to Ms. Curtis Allen. Please go ahead, sir.

CURTIS ALLEN: Yes, thank you for joining us today. This is a telebriefing about the current influenza season as well as the distribution and availability of influenza vaccine. We have two speakers today. First will be Dr. Jeanne Santoli. That is Jeanne Santoli. She is the Deputy Director for CDC′s Immunization Services Division. Then we also have Dr. Joe Bresee, that is BRESEE. Dr. Bresee is Branch Chief of Epidemiology and Prevention in CDC′s Influenza Division. We will start with short remarks with questions-and-answers to follow.

Dr. Santoli.

DR. JEANNE SANTOLI, DEPUTY DIRECTOR, CDC IMMUNIZATION SERVICES DIVISION: I want to thank everyone for being on the line today. As always, we really appreciate your interest in influenza disease and vaccination.

I′m really happy to be able to report that as of November 2nd, more than 103 million doses of influenza vaccine have been distributed by vaccine manufacturers and distributors. This is more doses than have ever before been distributed in the United States in a single season. And we anticipate as many as 132 million doses could be available by the end of the season according to manufacturers. That would be about 10 million more doses than have ever before been produced in the United States.

This is really good news. The amount of vaccine that′s been distributed so far means that almost all influenza vaccine providers should have vaccine in their offices to begin vaccination of their patients against influenza. And from what we can tell, those efforts are certainly well underway.

Now we do know that some healthcare providers may not have received their complete order of vaccine yet. As many of you know, CDC has encouraged vaccine manufacturers and distributors to use partial vaccine shipments so that they can get influenza vaccine doses to as many providers as possible at the earliest opportunity. We encourage those who provide influenza vaccine to their patients to continue to take steps to ensure that they have good supply of influenza vaccine in their offices, such as placing additional orders so they′ll have flu vaccine on hand in December and later.

This season′s vaccine supply gives us the opportunity to protect more Americans than ever before. Vaccination is recommended for anyone who wants to decrease their risk of getting the flu. And while anyone can get sick with influenza, the flu is especially serious for certain groups of people who are at high risk of complications from influenza, including infants and young children, pregnant women, children and adults with chronic medical conditions like asthma, heart disease and diabetes, and adults age 50 and older.

In addition, the close contacts of these persons such as their household members, their caregivers and healthcare providers should get vaccinated in order to protect their loved ones or those they care for. Vaccination of persons who live with or care for young infants is especially important because children less than six months of age are too young to be vaccinated.

To help raise awareness about the importance of influenza vaccination for people at high risk, for their close contacts, and for all those who want to be protected against influenza, we′ll be celebrating the second annual National Influenza Vaccination Week November 26th through December 2, 2007. That′s the week after Thanksgiving.

National Influenza Vaccination Week is a joint effort of the United States Department of Health and Human Services, the CDC, the National Influenza Vaccine Summit and many other immunization partners. And the primary goal is to remind people who have not yet been vaccinated that the time to get a flu vaccine continues into December, and January, and beyond when the influenza season typically peaks.

We hope that you will stay tune for more information from us about this year′s National Influenza Vaccination Week and we hope that during that week and the remainder of the season, you′ll help us get the message to the public that the time to get a flu vaccine is now.

ALLEN: And now Dr. Bresee will bring you up to date on the current influenza season.

DR. JOE BRESEE, EPIDEMIOLOGY AND PREVENTION BRANCH CHIEF, CDC INFLUENZA DIVISION: Thanks very much and welcome everybody.

I′m just going to give you a quick update on how CDC monitors influenza activity and viruses in the United States and what the current activity is. As you′ll recall, CDC monitors flu activity and the viruses that cause it in the U.S. through an integrated multi-part surveillance system.

The surveillance system is design to do three main things. First to find out when and where influenza activity is occurring, to monitor the severity of influenza seasons, and to determine which viruses are circulating and to detect changes in those viruses that are circulating should they occur.

Let me start with the usual caveat about influenza, which is that it′s not possible to predict with certainty which influenza viruses will predominate during any given season ahead of the season nor what timing severity or duration will be with certainty.

So far, we′ve seen a very low level of influenza activity in the United States this season. This is quite similar actually to low levels of activity seen at this point in time during most influenza seasons where peak activity usually occurs in January or February.

The components of the laboratory system – let me go through some of the systems now. First, laboratory surveillance, this week of the 2,015 specimens that were tested for influenza with partner surveillance laboratories only 50, about two-and-a-half percent were positive for influenza during the latest week we have information for. Greater than 90 percent of those reported were influenza A viruses.

The proportion of outpatient visits for influenza-like illness or acute respiratory illness this week also was below national baseline levels except for the mountain region which reported slightly higher influenza-like illness rates, slightly above its regional specific baseline.

No states are currently reporting widespread or regional influenza activity. Only two states were reporting local activity this week and 17 states were reporting sporadic activity. Reports in deaths attributed to pneumonia and influenza this week remain consistent with low levels of influenza activity. CDC also monitors, as you may know, influenza deaths among children and thus far, during this season, no deaths among children have been reported attributable to influenza.

The take home message from our surveillance information at this point is that the activity remains low and the people who have not yet been vaccinated this year should get vaccinated as soon as possible. The influenza vaccine provides the best way to prevent influenza and provides the most benefit when administered before influenza activity increases. Remember that the influenza vaccine protects against three different strains of influenza and vaccination is particularly important for people at high risk for some serious influenza related complications and those that have close contact with people at risk for complications.

So, as Dr. Santoli mentioned, there is an all-time high supply of influenza vaccine this season, it will be available and we should really make the most of this opportunity to protect as many U.S. residents as we can against this most serious disease. Thank you.

ALLEN: And we′ll open up for questions now.

OPERATOR: Thank you.

At this time if you would like to ask a question, please press star, followed by one on your touch-tone phone. Once again, star, one to ask a question. One moment for the first question.

Our first question comes from Daniel Danun with Web MD. Please go ahead.

DANIEL DANUN (ph), WEB MD: Thank you very much. Dr. Santoli and perhaps Dr. Bresee, we′ve heard a lot of talk about a possible mismatch this season between the H3 component of the vaccine and possibly even the B component. Could you comment on that and tell us what your thinking on this is right now?

DR. BRESEE: That′s a very good question. Thanks for asking it.

The first point is it′s not possible, as I said, to precisely forecast the strains that will circulate during this season, and therefore, it′s not possible to precisely forecast whether the vaccine is going to be a good match for circulating strains. So far this season, we haven′t seen enough influenza viruses isolates to characterize whether we′re likely to see a good match during the season or not. There are some data that you – that you imply that have been presented both from last season in the northern hemisphere and from the southern hemisphere over our summer time that indicate that it′s possible that an H3N2 component might be circulating. Remember there are three influenza types that circulate and three types in the vaccine. H3N2 is one of the A types that both circulate and are included in the vaccine.

It′s possible that the H3N2 component could be a sub-optimal match with some of the circulating strains if the strains that are circulated in the southern hemisphere also circulate in this hemisphere this season. We currently have seen 82 percent of the H3N2 viruses that have been characterized with CDC from late May through September, and have been slightly drifted from the virus contained in the vaccine. We now call this virus as Brisbon-like (ph) viruses.

The Brisbon-like (ph) viruses have predominated over the course of the flu season in the southern hemisphere this year, but again, we really don′t know what this will mean for influenza activity in the U.S. And I′ll highlight the fact that even in the event of a less optimal match to one of the components of the influenza vaccine, CDC will continue to recommend that a flu vaccine be given since it′s still the best way to prevent against serious flu complications for a couple of reasons.

First, vaccination with one strain of influenza virus often protects against other drifted strains. We see evidence of that with this particular strain in other parts of the world. Also, with a less than ideal match can reduce effectiveness, it can still protect enough to make the illness milder and prevent flu-related complications. This is especially true of those that are at high risk for complications.

So, in summary, let me just remind you guys, there′s always a chance that the vaccine doesn′t perfectly match the circulating strains each year. But each year vaccine remains the most promising and the best method, the best tool we have to prevent against serious influenza complications and this year should be no exception to that.

ALLEN: Next question, please.

OPERATOR: Thank you. Our next question comes from Victoria Elliott (ph) with the American Medical News. Please go ahead.

VICTORIA ELLIOTT (ph), AMERICAN MEDICAL NEWS: Hi, this is a question for Dr. Santoli, I was wondering since we′re now, I believe in our second year of really plentiful vaccine, if there was increased interest in simplifying the recommendations of who supposed to get it or even moving to a universal recommendation.

DR. SANTOLI: That′s a really good question. There′s been a lot of discussion about what is the best strategy to protect Americans against influenza. There′s certainly been a lot of discussion about broader recommendations among young children. And so I think it is being discussed and people are reviewing the evidence. CDC′s advisory committee on immunization practices is interested in this and has been talking about it. There was some discussion at the ACIP meeting that we had in Atlanta in October and there will be continued discussion, and I think we′ll hear more about that in February of 2008 when the ACIP meets again.

ALLEN: Next question, please.

OPERATOR: Thank you. Our next question comes from Jonathan Borwith (ph), Baltimore Sun. Please go ahead.

JONATHAN BORWITH (ph), BALTIMORE SUN: Yes, thank you. Can one of you walk us through the reasons why the supply is at such a high level this year? And then I′m going to have a very brief follow up question.

DR. SANTOLI: I′ll take a stab at that. I think there′s a – there′s a couple of things that have led to a more robust supply this year. One is that we now have some additional manufacturers in the market. This year a new manufacturer was licensed and one other manufacturer who was already licensed had a product that′s now able to be used in even younger children. So there are more folks making vaccines for the U.S. market, and I think that partly has to do with the fact that there is a very strong recommendation here for the use of the vaccine and wanting to be able to meet the demand that providers have to get vaccine to care for their patients.

Another thing that I think that′s led to increased capacity for influenza vaccine production in the U.S. has been a number of efforts around pandemic preparedness. The Department of Heath and Human Services has made a number of investments in manufacturers to increase their capacity to produce pandemic influenza vaccine. That also spills over into their capacity to produce seasonal influenza vaccine so it′s actually a benefit to us every year.

So I think those are probably the two primary reasons that we′re seeing such a robust supply, you know, increasing over the past couple of years.

BORWITH (ph): OK. Thank you. And just real briefly, could you refresh my memory as to when the last year was that we had a really severe flu season?

DR. SANTOLI: In fact, I can. Oh – I thought you meant a severe supply. I′m going to turn that over to Dr. Bresee to answer that question. He′s better positioned than I am.

DR. BRESEE: Actually, I think the best answer to that question is the ′03, ′04 season was associated with greater mortality both in elderly people, but particularly in kids. And so we look back that season since the ′03, ′04 year has been milder relative to the ′03, ′04 year, which was also an H3N2.

ALLEN: Next question, please.

OPERATOR: Thank you. Again, as a reminder, if you would like to ask a question, please press star, followed by one.

Our next question comes from Miriam Franco (ph) with CNN Medical News. Please go ahead.

MIRIAM FALCO (ph), CNN MEDICAL NEWS: Hi, it′s Miriam Falco (ph). Thanks for taking the question. I have one quick question, at the very beginning, Dr. Santoli, you said that we had 103 million doses distributed, which is more distributed than ever, and then you anticipate 132 million to be produced by the end of the season, 10 million more than ever produced. So, are – in this second year of massive production, are manufactures still enthusiastic about producing that many? Are they getting monetary reimbursements for those that aren′t used?

DR. SANTOLI: That′s a really good question. In fact, I talked about investments in capacity, but there are not actually subsidies for vaccine production. I think what′s happening is that we′ve expanded our recommendations for the usage of vaccine in the past number of years. Young children in 2004, 2005 season, we recommended children between the ages six and 23 months of age. Then in the ′06, ′07 season, we recommended vaccination for 24 to 59 month old children. So we′ve expanded the recommendations.

At this time, almost 75 percent of the U.S. population is recommended for vaccination. You know, we′re not as successful at reaching all of those groups as we would like to be and we are continuing closely working with partners to try to improve our vaccination rates. But there are a large number of Americans even without universal vaccination who are already recommended for vaccination each and every year in the U.S.

ALLEN: A follow up? Next question, please.

OPERATOR: At this time we have no further questions, sir.

ALLAN (ph): OK. If there are no further questions, we will wind this up. There′s a couple of things I′d like to remind you of. First of all, the American Lung Association, on Monday, November 12th, will be partnering with CDC with a press briefing in New York City, Gotham Hall, 1356 Broadway, with actors Jennifer Garner and Dean Cain. Dr. Ann Shuchet (ph) from CDC will also be participating in that briefing.

This is part of the Faces of Influenza Campaign from the American Lung Association. I understand we may have a couple more questions?

OPERATOR: Thank you, sir. Our next question comes from Jari Chung (ph) with the Los Angeles Times. Please go ahead.

JARI CHUNG (ph), LOS ANGELES TIMES: Hi, I′m sorry. I just had a question about what we′re counting in the flu vaccine count that we have here. I mean does this – are we just talking about shots or are also including like nasal mist and things like that?

DR. SANTOLI: That′s a great question. Actually the numbers we′re talking about are all vaccines, all products, all manufacturers, shots and nasal vaccine. So that′s the total number.

OPERATOR: Thank you. And we have a follow up from Miriam Falco (ph) with CNN Medical News. Please go ahead.

FALCO (ph): Hi, this is for Dr. Bresee, since you said it′s too early to really tell if we have a mismatch of sorts. Can you explain once again which you think so far is matching well, which are the strains and which aren′t, because you were saying it very quickly and I didn′t get it all?

DR. BRESEE: Say that one more time.

FALCO (ph): Which strains seem to be working – which are the three strains are you getting a good response to and which of the strains are you not so sure about yet?

DR. BRESEE: Well, let me explain a little bit because I may have been unclear. So you′re right. It′s a little too early to tell whether this year′s vaccine will match this year′s strains. That′s absolutely true. The strain that we are most concerned about is the H3N2, mainly because the strains of those types that are circulating in the Latin America over our summer time seem to be slightly different than the vaccine strain. And so it may set up for a mismatch.

But again, two points for that. So, even if that circulates in the United States, the current year′s vaccine here is by far the best prevention method for a couple of reasons. Number one, each year in the United States, each of the three types of influenza circulate, at least they have for the last several years. And so, a person may be exposed to any of the three types. So even if there′s a strain mismatch against one of the types, you′re protected very well against the other two types.

The other point to make is even if you′re infected or exposed to one of the strains that the vaccine is not matched well against, suboptimal match against. There will be some protection against it. As we′ve seen in the Department of Defense data from Europe last year, those who were exposed to this sort drifted H3 strain or slightly different H3 strain, but we′re vaccinated against the name H3 strain that are included in our vaccine this year, had about a 52 percent protection rate against influenza illness.

So even if it′s a drifted strain this year, the vaccine should offer some protection. And again, this is most important among those people who are at risk for complications or death attributable to flu.

FALCO (ph): OK, so it′s just one out of the three? Because I′m afraid that some people might hear, oh, there′s a mismatch in the vaccine at this point …

DR. BRESEE: No, I think the message should be that we don′t know whether there will be a mismatch or not. I think the message is that it′s too early to tell, but that vaccine remains the best preventive strategy no matter what happens.

FALCO (ph): Thank you.

OPERATOR: Thank you. At this time, we have no further questions.

ALLEN: OK. Thank you very much for joining us today. There will be a transcript of this teleconference on the Web site at www.CDC.gov/media. The transcript should be up within a couple of hours. If you have further questions, please contact the Division of Media Relations at CDC at 404-639-3286. That′s 404-639-3286.

Thank you very much for joining us and have a good weekend.

OPERATOR: Thank you. That does conclude today′s conference call. We thank you for your participation and you may now disconnect your lines.

END

####

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