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CDC Briefing Information on Investigation of Human Cases of H1N1 Flu

May 8, 2009, 1 p.m. ET

>> OPERATOR: You can press Star 1 to ask a question.  Today's conference is being recorded.  At this time I will turn the call over to Mr. Glen Nowak. You may begin, sir. 

>> GLEN NOWAK: Thank you.  And thank you all for joining us for today's update on H1N1.  Before I turn the podium over to Dr. Besser, I do want to spend a minute giving the media out there an update on our plans in terms of press briefings.  We -- we are planning to do a press briefing tomorrow, a telebriefing, at 11:00 a.m. with Dr. Ann Shucket.  We are currently not planning to do a briefing by either by phone or here at CDC on Sunday.  And hopefully, we will able to do that.  And on Monday, we will be implementing more telebriefings, so we'll switch formats from these formal briefings to a telebriefing format.  Obviously, as events warrant and things unfold, we will be back in this room should we need to do that with Dr. Besser or other people at the CDC.  But I want the media to know the plan is for a telebriefing tomorrow at 11:00, no briefing on Sunday, and then we’ll be back on Monday with a telebriefing probably sometime around noon.  With that, we will start this press briefing.  Along with Dr. Besser, we will be joined very briefly in this press briefing by Dr. Robert Blendon of the Harvard School of Public Health. The Harvard School of Public Health has been doing some public opinion polling and has some new results from a poll that they’ve been doing this week.  And so, Dr. Besser will be introduce to Dr. Blendon as part of his opening statement.  So, I'll turn it over to Dr. Besser. 

>> DR. BESSER: Thanks very much, Glen, and thank you all for joining today's briefing.  You know, I want to start first and address an issue that's been concerning me and that has to do with a sense of having dodged a bullet, a sense that this is over.  And while we've seen a lot of encouraging news in terms of severity, we continue to see hundreds and hundreds of new cases each day.  And at CDC we are still going full on to try and insure that we're providing guidance and information to limit the impact on people's health. 

Let me give you an update on some of our laboratory work and some of our laboratory testing.  Currently, CDC's receiving on average about 300 to 400 specimens per day.  And we're able to turn around those results in about 24 hours.  I know that there's some frustrations in states given the volume of specimens that they're trying to handle, and we're working to address that.  One of the principal ways we're working to address that is by putting out to states a test kit and helping them validate, insure that their testing is the same as if the testing were done here.  And currently ten states are now able to perform their own confirmatory testing.  At some point, we're going to see -- we're going to reach a point where there are too many samples for states to test, and the value of doing that testing is not as great. What you want to see during a large outbreak is where is their activity, what states are seeing a lot of cases of disease and where is it starting to tail off.  And we have in place a number of reporting systems for influenza that we will be transitioning to that we're looking at now, and those will be able to take up the reporting role that we're doing now with case-based reporting.

But I do want to give you the case numbers for today.  As of 11:00 a.m. today, there are approximately 2,500 probable and confirmed cases in 43 states and the District of Columbia.  There are 1,639 confirmed cases in 42 states and D.C.  That's an increase of 743 from yesterday.  We're -- we have approximately 850 probable cases reported nationwide.  The median age is -- has not changed from yesterday.  It's 14 with a range of 1 to 87 years.  23 of these cases are under age 1.  The most recent case that is confirmed is from May 3rd with a probable case from May 4th.  3.5 percent of these cases, 57, have been hospitalized.  And this is different from what we reported yesterday and really reflects on how unstable some of these numbers are.  As we do more and more testing, and in particular, as we catch up with the backlog on some of the milder cases, we expect that these numbers will continue to change.  Yesterday I reported on 26 hospitalized cases -- 13 hospitalized cases.  Today I have some information on 26 hospitalized cases.  And of those 26 hospitalized cases, 58 percent had an underlying condition.  7 of those 26 individuals had asthma, and this just points to a couple things -- one, many people in our country have asthma, and respiratory infections can be a trigger for asthma attacks, and so it's very important that people who have asthma know that respiratory infections can be a problem and that they're in touch with their doctors so that they're properly cared for when they do get the flu or other respiratory infections. 

The World Health Organization today has reported 2,371 confirmed cases in 24 countries.  The largest number of cases outside of the U.S. and Mexico are in Canada, Spain, and the United Kingdom.  They have not yet documented evidence of sustained person-to-person transmission outside of North America.  And so, they are holding at a level five. 

In Mexico, there are now 1,123 confirmed cases and 42 deaths.  As I mentioned yesterday, the outbreak is in different stages in different parts of the country, very similar to what we see here.  And Mexico yesterday announced the lifting of the number of their control measures in terms of people going back to school and businesses reopening and those sorts of things.  And it will be very important as this goes forward to see what the impact of the lifting of those measures is on transmission. 

So, what are we seeing here?  We're seeing continued transmission around the country.  We're seeing more and more people becoming ill.  Yesterday, we published a report in the "New England Journal of Medicine" looking at the first 642 confirmed cases, and we have here in the audience the lead authors from that paper that reports on the work from CDC as well as many states around the country.  And it's a very important piece of work that really provides detailed information that people can use to understand the outbreak and understand control measures.  What they found is that most people are recovering; most are experiencing illness that's similar to that caused by seasonal flu, and most, however, are young, most are under 18 years of age.  Most illnesses appear to be lasting less than a week.  But one thing we're seeing is that, unlike seasonal flu, a higher percentage seem to be having vomiting and diarrhea.  We need more data to say for sure whether this is a difference from other strains of flu, but it is something that we want to keep our eye on.  And what it says is that if you have vomiting and diarrhea with respiratory symptoms, don't think that just because you have the symptoms of the stomach flu that you may not have influenza. 

Very good.  I wanted to switch to the discussion of the data that's coming out of Harvard that Glen mentioned before.  CDC has a very close relationship with Dr. Robert Blendon and his program at Harvard, and what they're able to do is during a public health emergency, during a crisis, they can do on-the-spot polling of the public, and this can give us information in terms of what messages are people receiving, where there are issues that need to be clarified and it can be very helpful in guiding our communication messages.  We've used its services during other outbreaks and during other emergencies, and in a moment I'm going to ask him to give some of the key findings.  A couple things that I wanted to note that are very encouraging -- 67 percent of Americans are washing their hands or using hand sanitizers more often.  And this is an increase from 59 percent just a week ago.  And 55 percent have made preparations to stay at home if they or a family member is sick.  And many people are quickly learning that the name of this flu that we're using is H1N1 disease.  So, Dr. Blendon, are you on the line? 

>> DR. BLENDON: Absolutely.  Thank you, Dr. Besser.  Quickly, for people listening in, at 1:30 p.m., the second in our series of tracking polls will be available in the Harvard School of Public Health website.  The complete results are there.  It's a national randomized sample using telephones with also a subsample of those using cell phones only.  I just want to highlight four points that sort of wrap around what Dr. Besser was just talking about.  What you'll see on the charts is that this outbreak has permeated a lot of American life and the list of things that substantial numbers of people have been trying to do to avoid situations where they might be exposed to the H1N1 flu.  So, this has really gotten into their lives.  This is not something people are watching but not doing anything about.  It's quite incredible when you see the list of just things that people are trying to do to avoid the situation.  The second and we think is the most important point that relates to Dr. Besser's remarks is that we found something unusual in the polling world.  That is, we find 77 percent of people say that they're continuing to follow news stories about the outbreak.  But at the moment, 61 percent of them report they're not concerned that they or a family member would get sick from H1N1 in the next 12 months.  That's usually quite unusual.  People stop following the news when they decide they're not going to get something.  This figure is up from 53 percent who were not concerned last week. 

Now, we think this means something and has important implications for the media.  We think what people are saying is that they are following the news closely because they're both interested and uncertain about the risk for themselves and their families over the next year.  So, even though they're not immediately worried at this point, they are uncertain.  And so, they're going to pay a lot of attention to whatever comes out as the days and weeks go by.  Just two other quick points, and then we'll take any questions.  We found that parents with youngsters in school are substantially more concerned than the rest of the population that doesn't have kids in school that they or a family member could get sick.  And the reason why we want to highlight this for our media audience is that half the parents report not knowing what their schools are doing in response to the outbreak.  And so, there have been changing advisories on what schools and parents should do, and they're uncertain and there's quite a high level of concern here.  So, this is really something that needs to be addressed.  And lastly, just something that we thought was worth everybody knowing and tracking from so many other threats that we've been trying to deal with in the public sector. 

That is the public sense of how well federal, state, and local public health officials have been managing this outbreak.  And at least the current ratings are incredibly positive.  83 percent were satisfied the way the response was being managed, 88 percent with the information they're getting, and it shows the combination of the public health response plus the media has led people feeling relatively good at this point about something where there has been a lot to uncertainty.  Again, this is kind of unusual because when there is uncertainty, many people may be worried about the information they're getting, and it's very positive that they are reassured about where this is going and the management of it.  Let me stop and take questions there.  All the data is available.  There are a number of PowerPoints on the site.  There are some trends from the prior week.  But I think the critical issues have just been covered. 

>> DR. BESSER: Thank you, Bob.  We'll take those questions at the end.  I just have a few more comments that I wanted to make.  But thank you, Dr. Blendon, for that report.  A couple things in the survey that come to mind for me, and one is the increasing number of people who are not concerned.  And what I would like to encourage is an appropriate level of concern.  And we've learned a lot over the past two weeks.  We've learned a lot about severity, that this virus is not as severe as we had initially anticipated.  One of the messages we've tried to convey is that the seasonal flu, and this virus is acting much more like a seasonal flu strain, the seasonal flu has tremendous impact on the health of people in this country, and that there are things that people can do to reduce their risk.  The messages around hand washing, the use of alcohol hand gels, covering your cough appropriately, and staying home if you're sick and keeping your children home if they're sick can do a lot to reduce your own risk and to reduce spread in the communities.  So, that appropriate level of concern is really very important. 

The other piece, in addition to the things that you need to do now and that you can do now to protect your own health, is looking towards the future.  And that's what we're doing here at CDC, and that's what we're doing at all levels of government.  While we're responding to this current outbreak, we're thinking about what could be coming in the fall.  And we're thinking about what do we need to do now to be ready for the fall.  And there are a number of things that we can do and there's a number of things that the public can do.  The first is what we're doing is we're going to be monitoring very closely what happens as this virus goes into flu season in the southern hemisphere.  What that can tell us is whether this virus is likely to return here in the fall in a form that could cause problems to people's health.  We'll be monitoring this virus over the next few months to make sure that it doesn't develop resistance to any of the drugs that we've been using to treat it.  And we'll be also tracking the virus to see whether it picks up any factors that have been associated with severe infection in the past.  We're also going to be planning, doing a lot of planning, because you don't want to play catch-up should any of those things take place. 

So, what we're going to be doing is looking to see, okay, if this were to come back in a more severe form, what do we need to be ready to do in our communities, what do we need to be ready to do at the federal level.  And we're going to be ready- so that we are not taken by surprise.  As an individual, those are things you can do, as well -- making sure that you have a communication plan for your family, making sure that you have been thinking about what you might do if in the fall your school were to be closed for a period of time.  Those things we've been talking about over the past two weeks; now is the time to be thinking and looking forward, how do I make sure that if I want to do that in the fall I'm ready and I have the support that I need to make that happen?  And so, we're encouraging people to visit pandemicflu.gov.  There's a lot of information there for individuals, for schools, for community groups, for businesses that can help people prepare for next fall season. While at the same time, we don't want people to take their guard off those things they can do right now, because we are spread across the states and we're hearing from states of increased flu activity.  So, with that, I want to stop and open it up for questions either for us here at CDC or for Dr. Blendon at Harvard.  And we'll take the first question from the phone. 

>> OPERATOR: Thank you.  And if you have a question on phone lines, please press Star 1.  Our first question comes from the "Detroit Free Press."  You may ask your question. 

>> CALLER: Hi.  Thanks for taking my question.  I'm wondering if there's a sense within these polls if people would get a vaccine for H1N1 if it was available, if it was decided to be made? 

>> DR. BESSER: We did not test this at this stage.  I think the important issue is that when it's available people will learn about risks, tradeoffs, everything, and so it is too early until there actually is a vaccine on the table to really ask people if they would take this because there is a variation in public response, as everyone knows, to vaccinations in general.  So, when it's there and the CDC has really briefed people about the tradeoff implications, that's the time we would like to go and ask people, but we're too early for that. 

>> DR. BLENDON: We're undertaking discussions around what type of public engagement should we be undertaking over the next few months and issues around vaccines, vaccine safety, who should receive vaccines.  Those are questions that it's very important to engage the public on.  In the event that we do want to implement a vaccination program in the fall, the public will have had time to get used to that idea and understand what's involved.  Question here in the room? 

>> MS. MCKAY:  Thanks, Betsy McKay from the Wall Street Journal. Two questions, if I might.  One is what plans does the CDC have or what would you like to do going forward to keep this in people's minds?  Do you have funding for a media campaign or anything of that sort?  Because we will forget to wash our hands, and this is a seasonal flu without a vaccine.  Secondly, I just wanted to ask in terms of the studies, the exposure -- and exposure question, which is just the -- you know, most of the cases have been under 18.  Is there evidence yet of exposure to older communities?  In other words, are we seeing anything that would suggest that older populations are exposed but just not getting sick, or is it that, you know, the exposure has really only been in the younger people and that's why the younger people are getting sick? 

>> DR. BESSER: Thanks for those questions.  You know, every year we have activities that are under way in terms of educating the public about the risk of flu and other respiratory infections.  And, you know, right now, we have a teachable moment.  People are very concerned about this and are paying attention.  And the activities that people do now, if they can make hand washing something that's routine, if they can make covering their cough appropriately something that's routine, that will protect them not just from influenza but from so many respiratory infections that are spread the same way.  We'll be talking about what other activities we need to do in terms of communication.  But the goal is not to keep people on the edge of their chair during those months.  What you want to do is empower people, give people concrete things that they can do moving forward, concrete activities in terms of planning.  Schools are a wonderful way to educate children but also to reach out to their families around issues like this.  And so, we're very hopeful that the messages that we've been sharing and so many people have been sharing will continue during this period.  In terms of the epidemiology, we continue to track this across the country.  And as we get more information about hospitalization, we'll see more about severity.  And as we get more from these transmission studies -- we have transmission studies that are under going -- that are going on in a number of states, we'll be able to say more about have people been exposed and then just not getting sick.  The kind of etiologic studies that you want to enter that question, we don't have the information on those yet.  But that's coming, and those are really important questions because they will help inform who is at greatest risk, and if we go forward with a vaccine, where you may want to put those doses of vaccinations.  Next question from the phone? 

>> OPERATOR: Thanks. John Lauerman with Bloomberg News.  You may ask your question. 

>> MR. LAUERMAN: Hi.  Thanks for taking my question.  So, today in Mexico a study from a Pavo researcher said that the measures in Mexico that included closing schools avoided more than 8,000 deaths and 30,000 hospitalizations.  I was wondering if you'd like to comment on that. 

>> DR. BESSER: You know, I haven't seen that study or those results, but I look forward to reviewing that.  One of the things that is critically important, especially early on in an outbreak or a potential pandemic, is to do studies to look at what control measures work and what measures don't work.  One of our overarching strategies in this was to put our resources into things that were most likely to have impact on people's health.  And so, you know, in terms of why we didn't have a border strategy, because that fits into an activity that clearly we did not feel would have an impact on people's health.  Why we initially went forward with school closure with a severe, very severe infections.  That was an activity that we felt would have an impact on people's health.  Mexico provides another setting to try and understand what worked, what didn't work, and what might we want to do going forward should this recur in the fall or for future pandemics since we know that over history, over time, pandemics will recur.  Next question from the phone? 

>> OPERATOR: We do have a question from Bob Roos, with CIDRAP News.  You may ask your question. 

>> MR. ROOS: Thank you.  Actually, I have two questions, one for Dr. Blendon.  I'm wondering if your poll asked people what they were concerned about eating pork or catching the virus from eating pork or having it.  And also a question for Dr. Besser.  I'm wondering how far along the vaccine manufacturers are in making the flu vaccine for the U.S. market and just as a recommendation to switch to making an H1N1 vaccine.  Just wondered how far along they are with the seasonal vaccine. 

>> DR. BLENDON: Dr. Besser, you want me to go first or --

>> DR. BESSER: Why don't you go, Bob. 

>> DR. BLENDON: Briefly, we've been tracking Americans' beliefs about whether or not you can get the flu from eating pork.  This week we have 10 percent of Americans reporting that was the case.  It's statistically lower.  It was 13 percent last week.  We've also been asking about coming in contact with pigs.  It was 34 percent last week.  It's 26 percent this week.  So, there is on the pork side about 1 in 10 that believe that this is a risk. 

>> DR. BESSER: So, it sounds like we're making progress and getting the message out that the H1N1 disease is not transmitted through eating pork, which is -- which is important, because we want people to put their control efforts into those things that can protect their health, and those are the respiratory precautions.  In terms of vaccine manufacture, we are in contact -- or the department is in contact with manufacturers and in discussions around schedules, where are they in current production schedules, what would need to be done to insure that if we decide to produce a vaccine that we're able to do that.  So, those discussions are under way.  There's a lot of activity across the department in looking at the schedules for doing initial clinical studies for a vaccine as we continue to move forward with the efforts to select a virus and grow a seed, a seed virus for vaccine production.  Next question from the phone. 

>> OPERATOR: That comes from Brian Thompson with Kansas public radio.  You may ask your question. 

>> MR. THOMPSON: Thank you very much.  Dr. Besser, you mentioned that severity has been less than expected and is apparently due to the virus not being as virulent as feared.  Is it so much that the virus is less virulent or that there has been a lot of success in catching it early and treating it with antivirals? 

>> DR. BESSER: Thanks for that question.  You know, I don't think that we can definitively say why this virus is causing less severe disease.  Some of the factors we're looking at is who is at risk, if there's a possibility that older individuals have some level of protection because they've been exposed to flu viruses over a longer period of their life.  That could explain some of the age distribution and could explain why we're seeing less in the way of severity.  We're going to be looking to see issues around treatment and when was treatment started and does that impact.  That's one of the key questions from Mexico.  When we were initially hearing of high rates of hospitalization and high rates of death, the question came up: was there a difference in treatment practices? Were people coming in for treatment later than we would like to see?  So, that's a factor, as well.  But these are important questions for us to look at, and we are undertaking studies in different parts of the country and world to look at those questions.  Next question from the phone? 

>> OPERATOR: Thank you. That comes from Maggie Fox with Reuters.  You may ask your question. 

>> MS. FOX: Hey, I have two questions, actually.  I'm wondering if there's any way of tracking whether this resurgence in hand hygiene will affect other respiratory and infectious diseases including gastrointestinal viruses.  And second, in Mexico, it seems that a lot of the people who died had diabetes, and I was surprised to learn that diabetes is, in fact, a bigger cause of death in Mexico than heart disease.  I'm wondering if that could help explain some of the disparities that we're seeing. 

>> DR. BESSER: Thanks, Maggie.  You know, I think you ask a great question about the hand hygiene, and it's one that we're going to need to look at.  We know that hand hygiene is an important prevention step for a number of infectious diseases, and it would be absolutely wonderful if a spin-off from people taking more precautions to prevent flu would be a decrease in gastrointestinal disease.  So, we have a number of surveillance systems that allow us to look at that.  I think that it's probably a little early to be seeing any change in the data there.  You know, we are not in the prime season for gastrointestinal disease, but that's something we'll look at.  I would be very surprised if there weren't other payoffs from people washing their hands.  In terms of diabetes, you know, I think it's premature to say too much about risk factors for Mexico.  Those studies are under way.  We'll look to see what the differences are in terms of risk factors.  Here in the U.S., we're still looking at a very small number of hospitalized patients, 26, and it's impossible to generalize from a group that's that small.  But those are very important questions, and if there was a different -- rates of diabetes in the United States are quite high, as well, and so, you know, we'll be able to look across the two countries and see if there's a difference.  But we have major issues with diabetes here, especially as the issues around the obesity epidemic continue.  Last question from the phone? 

>> OPERATOR: Thank you.  That comes from Craig Snyder with "The Atlanta Journal Constitution."  You may ask your question. 

>> MR. SNYDER: Dr. Besser, I understand that the one hospitalized case in Georgia has been moved from La Grange hospital to Emory in Atlanta.  And she's been in there for two weeks now.  And I just wanted to -- I understand CDC is playing a role in this.  I wanted to get a sense as to your thoughts, your concerns about this particular case, what, if anything, you're learning from it, so forth. 

>> DR. BESSER: Yeah.  You know, I would refer you to the state health department.  We don't comment on an individual case.  That would be something that the state or local health department might be able to provide you information on.  But in general, there's a major attempt to protect the privacy of an individual patient.  Thank you very much for your questions and your time.  Appreciate it. 

>> OPERATOR: Thank you.  That concludes today's conference.  We thank you for your participation.  At this time, you may disconnect your line. 

End

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