Press Briefing Transcripts
CDC Briefing on Public Health Investigation of Human Cases of H1N1 Flu (Swine Flu)
May 2, 2009, 12:00 p.m. EST
Dave Daigle: Good afternoon. I’m Dave Daigle, the deputy for media relations at CDC. Today Dr. Anne Schucat is here, director of the National Center for Immunization and Respiratory Diseases, will provide an update on this ongoing outbreak.
Anne Schuchat: It's nice to see all of you on a Saturday, joining us here today for the daily update. I think people in the media we've been hearing a little bit about we're out of the woods, it looks like this is ending. And I want to say that while reports from Mexico are-- appear to be encouraging, and some are cautiously optimistic, we can't afford to let down our vigilance. We have information that this novel virus continues to spread and with increasing cases, and increasing states affected and we are acting, as President Obama said this morning, actively and aggressively. Our highest priority is the safety and health of the American population. And we really want to make sure we're staying ahead of things.
Today's case counts, 160 confirmed U.S. cases. They occur in 21 states. The individual state case counts are on our website every day at 11:00 in the morning. You can check for the details there. Median age of cases remain fairly young at 17 years of age with a range of 1 to 81. The majority of the cases are younger than 20. The most recent known onset is April 28. So the case is continuing and the counts continue to go up. As we've all been saying we're focusing a lot less on the individual numbers and on the pattern. And what we see is continued illness in contacts of people who have been ill from clusters in schools that you've heard about. We've continued to ask the question about how severe this particular strain of H1N1 influenza virus is and will evolve to be here in the U.S. Those are important questions that we continue to look at. The response continues with the focus on making sure people who are sick stay home, that people don't fly or use public transit when they are ill but that it's totally fine to be out and about when you aren't ill with respiratory symptoms. We are thrilled people are washing their hands more, and we don't want people to lose their vigilance about that because that continues to be important. As we've said, we've been deploying our strategic national stockpiles to the state and private areas and we've got delivery in 30 of those states and the vast majority of the population is affected. And by the end of tomorrow we will have completed the deployment of the assets.
Because of the day, I want to keep my remarks fairly short and just focus on questions. I think as you know we've been thanking a lot of people over the days behind us. We've been thanking the media for your help in getting the story out, thanking the incredible workers helping to respond to this challenge at the front line helping respond to this challenge, thanking the CDC workforce for the night and days they're putting in. Today, we would like, on behalf of the CDC workforce, we would like to thank the families of the CDC workforce and those who are keeping their spirits up while we are here. With that, I'd like to answer questions that you have. Okay. Over here.
Cece Connolly: Cece Conley from the "Washington Post." I know that you've spoken in recent days about how there will be local decisions with respect to school closings. But along those same lines, do you have guidance for, say, businesses, government offices, that may have cases and is there any reason-- I notice schools are now talking about closing for 14 days. Is there thinking that children carry the virus longer? That seems like a long period of time.
Anne Schuchat: Yeah. Thank you. The guidance-- we have been updating our guidance regularly. And in addition to guidance for schools, we're trying to make sure there's information for other circumstances. So the situation with the business community or other workplaces is one that we're attuned to. We've been actually doing outreach calls to the business sector. I think we had several hundred business organizations on calls the other day reaching out to them about the questions their members had and how we could better reach their constituencies. We think the basics apply to those circumstances, keeping-- staying home when you're ill with respiratory symptoms. And I think even the president calls for permissive leave policies to help us manage this particular situation. The school guidance that was updated to suggest a 14-day period, that [inaudible] reflecting the information about the duration that a child might be-- continue to be infectious. The shedding of the influenza virus is longer in young children than it is in adults. Now, the information for high school-aged children may not be that complete. But with an abundance of caution, 14 days might be more prudent. I want to say that all of our guidance, particularly that for schools, school dismissals, we really want to respect the local jurisdictions, the local authorities who understand the circumstances on the ground and the challenges of these interventions. Our goal is for intervention to be evidence-based and to be no more harmful than the virus. We want to make sure we are having a net benefit. So issues such as the school dismissals are ones that we're actively reevaluating as we get more information. Okay. Yes? Mike?
Mike Stobbe: Good morning, Doctor. Mike Stobbe from the AP. Two days ago, when Dr. Besser was here he said there might be more information on a couple topics, one of them ER visits. Did you end up getting more information on that. And a follow-up?
Anne Schuchat: Sure. We have systems in the state and local systems have some systems and we do see an increase above baseline in visits to some emergency rooms for influenza-like illness through our biosense surveillance system. So we do see some of that. It's difficult to interpret whether that is illness or the so-called “worried well”. And that's something we're trying to look into a little bit more. With the help of the media, a lot of people know this is going on and are wondering is that cold or cough something I need to take seriously. Though we have seen a few-- not every emergency room that we're tracking, but we have seen a number of sites an increase over the baseline for this year in influenza-like illness visits. It's more that, you know, I would say many of our biosense sites, but not the majority of them, are seeing an increase. But I don't have numbers such as looking at main. But it's many individual sites.
Mike Stobbe: The new case count today.
Anne Schuchat: Right.
Mike Stobbe: What are the two new states and the hospitalization numbers? Also, do you have any more information on how many of the cases have been to Mexico?
Anne Schuchat: The two new states, I'm going to have to refer you to the website. It is on that. Maybe by the end of this we can check on that. The Mexico connection, for cases that we have good information on, which is a moving target, it's about a third of them. The majority of cases, the important point is the majority of cases don't have direct contact with Mexico. They didn't travel to Mexico. It is much more likely that people are getting this particular infection now from somebody who has no-- from somebody within their own communities. You know, we do think there is sustained transmission here in the U.S. I'm sorry. Can we go to the phone for the next question?
Operator: As a reminder of the phone, Star 1 to ask a question. The first question is from Jeffrey Weiss from "Dallas Morning News." Your line is open.
Jeffrey Weiss: Yeah. Here in north Texas we've had fairly different responses from the local health departments. In Dallas county, some events that were planned are going on. In Tarrant County, Fort Worth to our west, at the advice of the local health authorities, some events have been closed down. What can you say about what guidance you're giving to the local health officials and how people should interpret what at least appear to be inconsistencies from one location to another?
Anne Schuchat: The situation these days can be confusing for parents and for readers or viewers to see one thing in one community and another thing nearby. CDC has issued guidance around school dismissals aimed to provide information that could be used by local authorities, but we do respect the role of local authorities to understand what makes sense. Our guidance suggests that if there's a confirmed or probable case of the novel H1N1 influenza virus, that authorities consider dismissing students and that be for up to 14 days but with regular reevaluations of the circumstance. I think we're all optimistic that in the next several days we'll be able to understand a bit more about this and know whether that particular intervention is appropriate, if it's too much or too little in terms of an intervention. But we do think that other things may make sense. It's a balance. There are lots of benefits to the students and the community for students being in school. And certainly if you dismiss students and then they go congregate somewhere else, they're really not getting the benefit of the school or school lunches but all the risk of being around a lot of other kids. So the importance of the dismissal idea is to try to have very few contacts between children so we really don't get the virus spreading widely within the school. Local jurisdictions may consider things like how many students have already been sick. Are we seeing a problem at the end of local outbreaks or is it really the beginning. Is it a time where this intervention might have the most benefit or is it really too late for it to help. The goal of the social distancing efforts is to try to decrease the ongoing numbers of cases and to shift them to a later time by slowing transmission with the thought that if we can delay the onset of some of these illnesses we have more time to prepare a vaccine or for summer and perhaps relief from the warmer months when influenza is less likely to circulate. So another question from the phone?
Operator: Another question from Helen Branswell with the Canadian Press. Your line is open.
Helen Branswell: Thanks very much. I was wondering, Dr, Schuchat, if you know how often are anti-virals being used to test the cases in The United States? In the old days we heard that most people hadn't needed them and had recovered. Are they now being regularly given, or what's going on?
Anne Schuchat: Thank you for that question. I want to stress that the anti-viral medicines that we have in our Strategic National Stockpile that we've deployed to the states are primarily intended for treatment of influenza. And at this point mostly the focus is on treating severe symptoms, treating people who are ill with more severe presentation or people who have higher risk of complication from influenza, such as women, young children, people with underlying medical problems. There are some circumstances where preventive use of anti-viral medicines may be recommended, very special circumstances considered high risk with a high-risk patient or person. In terms of the use of anti-viral drugs, I can't tell you exactly what's going on. I can tell you we had one surveillance system that was designed to monitor early warning of whether there was influenza uptake by tracking the prescriptions that are filled for antibiotic viral drugs. And that system is no longer useful because we saw such a big increase in prescriptions really probably from concern rather than necessarily from use in actual treatment. So I should also stress that oseltamavir, Tamiflu and Relenza, zanamavir are both commercially available and they're also available through the Strategic National Stockpile. And we're told by the manufacturers that they are producing more and we should be able to have adequate supplies for treatment. As you know, yesterday I think we shared that the secretary of HHS had purchased -- moved ahead with the purchase of 13 million anti-viral drugs to replenish the stockpile. Another question. Let me do the room next. Okay.
Reporter: [inaudible] here in Atlanta. What is the latest on cases here in Georgia, confirmed cases? And the communities that have possible cases out there, what advice are you giving them right now even if they are not actually confirmed?
Anne Schuchat: Yeah. For the specifics of the Georgia cases, we suggest you contact the Georgia health department. They'll have the best information about where things are. As we mentioned a couple days ago, right now the states have the capacity to do that laboratory testing and finalize whether this is or isn't the new H1N1 strain. So they may know before we do what's going on and the circumstances. In communities where a confirmed or probable case has been reported, you know, my key message is the same as in communities where it hasn't been reported. If you have fever and respiratory symptoms, don't go to work or school. Don't infect others. If you're feeling fine, make sure you wash your hands regularly or use alcohol hand gels. That seems really basic, but it's a really effective way to reduce respiratory infection. And everybody has a role to play. The other thing that we think is important for community members is to stay informed because your own community may have issues and recommendations. Some places are changing guidance in and around schools or community gatherings, for instance, and it's really important to know what's going on where you live. At this point we don't have national guidance on those community gatherings and types of events but it's important to stay aware of what's happening in your own community. Let's go back to the phones.
Operator: Next question comes from Olivia Hampton with AFP. Your line is open.
Olivia Hampton: Hi. I just wanted you to confirm for the new cases, does that include the toddler who died?
Anne Schuchat: We had previously mentioned a toddler who died, unfortunately, from Texas. Yes, I believe that's part of this total of 160 that we're describing. We don't-- I'm not aware of any additional deaths that are laboratory confirmed due to this virus. We continue to look for them. And I will not be surprised if we find additional severe cases or additional deaths. Remember that seasonal influenza causes about 36,000 deaths every year, 200,000 hospitalizations, millions and millions of infections. So even if this virus behaves quite similarly to seasonal influenza, we would expect a range of mild to severe and even fatal cases. Next question back there at the camera.
Reporter: [inaudible] CBS Atlanta. You started off your comments with some of the public thoughts that were maybe out of the woods. Can you talk a little bit about why that concerns you and where the happy medium is between panic and being very blasé about the whole thing.
Anne Schuchat: Yeah. I think it's really challenging to find that right balance to stay alert and attentive and take those important steps personally or in your own communities. What I want to say is that we have a new influenza virus. It's spreading. We don't know as much as we'd like to about the way it's going to behave in our communities. And we're learning a little bit more each day about the way it behaved in Mexico. But the picture is still very incomplete. Here in the U.S. we're trying to act aggressively and quickly so that if it does turn out to be a moderate or severe influenza strain, that we're prepared, that we have the research and the trained people that can reduce the spread. So I think I don't want people to feel like they don't have to be aware of it because it may be that the common illness is going to come to the community soon. Also, severe symptoms and illness are such that you should seek medical care and make sure that you do get treated. We don't want people to be-- you know, it's very difficult tracking the media or tracking different messages to understand what level of concern to have. I just hope we can give you the facts as we find them out. Next question from the phone.
Operator: Next question, Joanne Silberner with NPR. Your line is open.
Joanne Silberner: Hi. Thanks. It seems like the local reactions are primarily to close schools but leave other institutions alone. But, epidemiologically, have schools shown to be [inaudible] of contagion?
Anne Schuchat: There has been modeling done the last several years. We have invested in preparing and understanding pandemic for influenza. One of the findings was that we know some things from seasonal influenza and some things from studying pandemics from the past century. Schools – well, children are very common reservoirs for infectious diseases, including infectious viruses like influenza. They tend to have lots of social contacts more than adults. And they-- somebody is laughing here because we know what kids are like. And they also shed the virus longer than adults do. So those circumstances, the frequent social contact, the close proximity in schools, and then the longer period of shedding often without even having symptoms are such that transmission can move quickly through a school and it may take a longer time to go through different kinds of institution or workplace or community. So some of the modeling about what we call community mitigation or that attempt to really slow spread within a community suggested that schools would be a valuable intervention point. This may not be the case for every influenza virus or every pandemic or potential influenza virus, but the modeling effort suggests this was a promising (Editor’s Note: This is a correction) area where we thought about social distancing. There are other parts of the armamentarium, closing mass gatherings, teleworking, this type of thing. But it was one of the interventions that although potentially very disruptive, could have a payoff. We're, in fact, working with infectious disease modelers on this response effort. We have brought some of the best infectious disease modelers to bear on this question, people who have really been looking at influenza transmission and trying to apply it to the current circumstance. And we're, you know, trying to use our real-time data and their models to understand where our interventions will be the most useful. The next question from the phone?
Operator: Next question Elizabeth Allen with "San Antonio Express-News." Your line is open.
Elizabeth Allen: Good morning. I had a clarification question. We've had reports that a special-- I know that CDC officials are already in Texas, but we had a report that a specialized team was sent to California and that San Antonio officials have requested one to be sent here. I was wondering about that, and also if that group deployed, if that would have any affect on the bottleneck of testing?
Anne Schuchat: Okay. I didn't hear all of that, but this is about teams being deployed to the field or the laboratory or general teams being deployed?
Elizabeth Allen: I think for the laboratory.
Anne Schuchat: Right. Okay. I can say that we've been working to make sure that we can reduce the bottlenecks on laboratory testing. One thing we did early on was send laboratory experts to Mexico to help there so they were able to establish the ability to test for this virus on site in Mexico. I think I'll need to get back to you whether we have laboratory staff in the field in San Antonio or California. I'm not remembering whether that's happened. But I think someone has told me about that possibility. The big thing we've done is to ship out these new kits for this new virus to the public health laboratories so they can do the testing beyond the probable stage, to the confirmed stage, and we hope that will reduce some of the bottleneck here in Atlanta. We're also trying to analyze the bottlenecks and understand where the issues are. I think we're in communication with the Association of Public Health Laboratories who are really, you know, terrific in networking and understanding the situation. And I hope we'll be able to address these bottlenecks. To me, however good our response is, we can do better. And I really want to make sure that we hear what the problems are and we fix them if we can. Is there a question from the phone?
Operator: Another question [inaudible] with "Miami Herald." Your line is open.
Reporter: Thank you. Could you, again, on the school closings, could you elaborate-- are you saying that the virus lasts longer in children and that's one reason that you recommend that they close for up to 14 days?
Anne Schuchat: The shedding of the virus is one way that it spreads. Certainly when you're actively infecting and coughing and sneezing, that's pretty much how you're going to spread the virus. But you can still have virus in your body without having any symptoms. And children are-- it turns out virologic studies suggest that children can shed the virus longer, probably because of their immune status, for instance. But we don't know for sure for this new virus if that's the case. The change from 7 to 10 days to 14 days was to recognize that if we are trying to wait for children to recongregate until after transmission likely to have ended we should go on the longer side. But I do want to say these are interim (Editor’s Note: This is a correction) guidance on the school dismissals, some of the modeling that had been done, the development of our community mitigation strategies included many different durations for school dismissals depending on the severity of a pandemic. If you have a severe pandemic like a Category 5 or the 1918 pandemic, schools could be dismissed for months. The 14-day idea was what we know about the influenza virus and making prudent recommendations. But I do want to say those are being evaluated. Okay another phone question.
Operator: Next question from Betsy McKay with "The Wall Street Journal." Your line is open.
Betsy McKay: Hi. Thank you, Dr. Schuchat. I wanted to follow up on something that I think you mentioned yesterday about testing samples which, if I understand it correctly, was about the fact that eventually, you know, the number of cases announced well may be already -- not every sample would be tested and confirmed as this strain of H1N1. So if I understood correctly, I wondered if you could talk about, you know, why it's not possible to do that and, for an individual, how important is it to know if the illness that they have or had is this particular strain. If they want to know if they had the antibodies and are immune to it going forward, is there any way for them to find out? I also wanted to ask-- I know Mike asked about hospitalizations-- and I may have missed the answer-- if you know the number of hospitalizations there have been thus far. Thanks.
Anne Schuchat: I believe that the number of hospitalizations now is 13. Is that right? Okay. 13. But I think it's-- we can double-check if that's confirmed or probable. That's confirmed only. Okay. We can double-check on that. We are seeing hospitalizations. We haven't talked that much about them, but we are seeing them. And, you know, it's important to remember that with seasonal flu we have 200,000 hospitalizations each year generally in people who are very young or very old with complications or other clinical illnesses. The value of knowing whether the respiratory infection that each individual has is caused by this new virus is different in different periods. At the beginning of our detection of this concern, it was important to know when the strain had arrived in the community, when did we see-- and certainly that's the case internationally. Countries that haven't detected it really need to know do we have anybody with this. But testing priorities change over time. The good thing right now is that the treatment recommendations for this particular influenza virus are actually a little easier than for seasonal flu. The virus that we've got is sensitive to oseltamavir, Tamiflu and Relenza. So for severe patients, patients presenting with severe illness or people presenting with respiratory symptoms with underlying risk factors, the treatment of this infection could be done without knowing specifically which influenza strain they have. So I think for an individual it's really of less relevance of treatment, for instance, than it would have been at the beginning when there was not yet confirmed disease in a particular case. We are pulling together our clinical experts and influenza experts with the diagnostic recommendations and different circumstances. When we had done our pandemic planning, we always intended to change the way the diagnostic tests are used at different periods. It tends to test at the beginning and a little bit less intense later on, trying to understand changes. We're using our-- one of our ongoing surveillance systems, the influenza-like illness sentinel providers to understand what's going on over time. There are physicians around the country that actively collect specimens for virus testing for people with influenza-like illness and report conditions to us. So we're using that network to understand are the illnesses going up or down and is the proportion of those illnesses that are caused by this virus changing. So that's the system that we'll probably in the next week or so want to tell you a little bit more about. Okay. So two more from the phone?
Operator: Next one is Andrew Quinn with Reuters. Your line is open.
Andrew Quinn: Hi. I'd like to return to the Mexico situation. Their health minister said today he believes their outbreak is stabilized. I was wondering if, looking at their numbers, if you would agree with that and, if so, what might that suggest about the course of infection in this country?
Anne Schuchat: You know, I am encouraged by what I have heard about the reports from Mexico, but I want to say that we are remaining vigilant and we have seen times where things appear to be getting better and get worse again. You may remember in 2003 in Canada, as they were dealing with the SARS outbreak, they thought it was really all clear and then found that they had a big second wave in terms of nursing homes that had cases and continual spread. So I think in Mexico we may be holding our breath for some time but remaining vigilant is the course. And I think the situation of SARS in Canada – we should be mindful of it -- It reminds us how important infection control is in the hospital settings around the world and remaining attentive to changes. In particular with the new virus like this we don't know exactly how it will behave over time or as it changes. Okay. So last question here in the room. Yes? Sorry.
Reporter: -- Conley. I wanted to follow up on Betsy's question a little bit. Because I think maybe what she was asking there was the notion that right now we don't have any underlying immunity to this new strain of virus. And so is it perhaps worthwhile to know if you've been exposed because perhaps that would mean in the future you might have a little bit of built-up immunity?
Anne Schuchat: Right. That is an important concept, and we've been talking about that as well, the idea of whether a certain percentage of our population is infected with this virus this year – will that mean we won't be at risk for it next fall. There are many different ways to get at that type of question, including population surveys, virologic surveys. I can say that one of our priorities is to try to develop a virologic assay (Editor’s Note: This is a correction) as to whether someone has been exposed to this virus and made antibodies. I'm told by experts that it might be pretty difficult to do that. So it's on our list of things we're working on, but we can't promise we'll have a tool that will help us predict the situation. Yes, I do think there are-- it can be valuable, especially when we're going forward and thinking about that, who might need it, who has already been exposed to understand exactly how much illness we've gone through in the country. So-- okay.
Dave Daigle: I want to thank everybody for coming out. We will do a briefing tomorrow as part of our daily briefing cycle. It is 13 hospitalizations among confirmed cases.
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