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Weekly 2009 H1N1 Flu Media Briefing

October 06, 2009, 12:00 p.m.

Operator: Welcome, and thank you all for standing by. At this time I would like to remind parties that your lines are in a listen-only mode until the questions and answer session. To ask a question, please press star 1 on your touch-tone phone. Today's conference is being recorded. If you have any objections, you may disconnect at this time.I will now turn the meeting over to Glen Nowak. Thank you, sir.  You may begin.

Glen Nowak: Thank you, and thank you all for being here and for dialing in today for this update on H1N1, including H1N1 vaccine supply and distribution. Today's update will be conducted by Dr. Thomas Frieden, the Director of the Centers for Disease Control and Prevention. And I will turn the podium over to Dr. Frieden. Thank you.

Thomas Frieden: Thanks, Glen. And thanks for being here. What I would like to do is update you where with are with the virus, where we are with the vaccine, and what we're beginning to see in terms of both of them. Also to discuss some of the concerns that we have been hearing out in the field about the vaccine in particular. As of today, influenza is widespread in most of the United States. We're seeing it continuing to increase in some areas. We're seeing a slight decrease in some areas. We note that it's now present throughout the United States. It's still remains overwhelming H1N1 pandemic influenza and influenza is a tough enemy. It's unpredictable, and one of our biggest challenges is continuing to anticipate what it might do next.Although there has been a slight decrease nationally and in some areas, in other areas it's still on the upswing. We wish we could predict the future. But we can't. We do know that flu season generally lasts well into May. So, we've got many, many months ahead of us where we don't know what will happen and we need to take the best steps we can to protect ourselves.

Vaccine efforts are starting. All states in the U.S. have ordered vaccine. It is being delivered and each Friday, we'll provide information on the amount of vaccine available to each state and the amount of vaccine each state has ordered. That's a little complicated, because as I have explained before, what we have decided to do is make vaccine available as soon as it comes off the production line. That means, it's coming available in lots, and states learn each day, of additional vaccine available to them. It's a little bit of a messy process and we do expect it to be somewhat bumpy in the first few weeks. This is the best way to get the vaccine out and available as soon as it becomes available.This week, the flu vaccine became available in the internasal variety. Next week, it will become available in the injectable variety. The first flu vaccinations of the season were done yesterday in many states throughout the country, with a priority on health care workers and children as well as people who care for infants. Flu mist, being only able to be used for people age 2 to 49 and who do not have an underlying health problem.

With the production of this strain, we have cut no corners. This flu vaccine is made as flu vaccine is made each year. By the same companies. In the same production facilities. With the same procedures. With the same safety, safeguards. We have had literally hundreds of millions of people vaccinated against flu with flu vaccine made in this way. That enables us to have a high degree of confidence in the safety of the vaccine.It has an excellent safety record. We wished we had the vaccine earlier. It would have been great to have had it back in April or May. But the current science doesn't allow us to produce it really in much less than six months, and that's what it has taken to produce it at this time.

People have concerns about vaccination. People always have concerns about vaccinations and that's understandable. We would all rather if we didn’t have to take any shots or take any medicine and stay healthy. But vaccines are one of the truly great scientific inventions, really of science, for -- going back for hundreds of years to the first vaccination. And the flu vaccination, being tried and true, is very effective. What we're seeing still is an excellent match between the virus that's spreading throughout the U.S. and the strain that was chosen to make the vaccine against. So, we expect a very good match, a very good degree of efficacy of the vaccine. It will work to protect you if you get it in time. Three major concerns that people have, despite the clear message from all of us in public health and from doctors throughout the health care field that vaccine is our best tool to protect against the flu. Vaccine is the best tool to protect against the flu, because, not only does it prevent people from becoming severely ill, it also prevents the spread of flu. The first concern that we hear is, oh, flu is just a mild illness. Actually, on average, flu is not a mild illness. It can make you pretty sick, knock you out for a day or two or three. Make you miss school and work. And for too many people end up sending them to the hospital, to the intensive care unit and tragically some people may die from it. In fact, this year already, we have seen quite a few children who have died from flu. So, although it is not a disease that will send lots of people who get it – a large proportion of people who get it – to the hospital, it can be very serious and even for those for whom it's an average case, it's no picnic. You would rather avoid it for yourself and your kids. The best way to do that is with vaccine. The second concern we hear is that the vaccine may not be safe. That corners may be cut. That shortcuts may have taken. It's a new or different vaccine. In fact, none of that is the case. The vaccine is made in the same way it's made each year. Each year, we look at the strains that are circulating and we select the ones that likely to be in the population. We put those into the flu vaccine. That's exactly what has been done in this case. It is against specifically H1N1 influenza. It is made in the same production facilities with the same companies with the same methods as it is made each year. And it is the same type of vaccine of which hundreds of millions of doses have been given. My children will get it. Other public health and societal leaders and experts will get it, will have their families get it. It's something that we have a high degree of confidence in. Third concern, it is too late for the vaccine. Well, it's too soon to say it's too late. We don't know what the rest of the season will bring. Even in places where flu has been widespread it's affected 5% to 10%. That leads 90% to 95% of the population that's still susceptible. Flu vaccine is our best tool to protect against the flu.  And though we wish we had it earlier, we can't predict what the future will hold and we know that vaccination is our best tool to reduce the impact of flu.

Just to let you know where we stand now, all states have placed orders. More than 2 million doses have been ordered. Nearly all of the doses that are available. More doses are becoming available each day. When the states learn that vaccines becomes available, they place an order, which doesn’t just order one big supply, it orders it by the provider. So, the states at each state level, they identify a certain number of people who will receive or facilities which will receive the vaccine and how many doses they will receive. The state then allocates it out to different providers to receive vaccine. The different formulations of the vaccine. The flu mist or the shots. The shots can come in single dose vials or multiple dose vials. All of that has to be factored in when the ordering is done. It's then shipped from four different warehouses. Temperature-controlled -- It stays at the same temperature until it gets to the place where it will actually be given or further distributed to be given. If it's the shot, rather than flu mist, it travels together with, about the same time as, injectable materials, needles, syringes, alcohol swabs. It's a very big and complex undertaking. It will be different in different parts of the country. Some parts of the country will do lots of school-located vaccination. Some places won't do so much. Some places may be better prepared than others. Our goal is to help as many places as possible to prepare as well as possible. So they can start as soon as possible and vaccinate as large of a proportion of people who want to get vaccinated as soon as possible. And with that, I'll stop and take questions. We'll start with the room. Any questions here?

Reporter: Hello, I'm Rebecca from CBS Atlanta. There seems to be some confusion in the some of the states and local governments as to how to disperse the vaccine, given such a small amount in this initial distribution, have you all been giving them guidance to how to distribute the vaccine?

Thomas Frieden: These are early days for vaccination. We have only a small number of doses available. The injectable vaccine will become available next week. And, initially, for the flu mist, the groups that are best to vaccinate with that, are young, healthy people, like health care workers, as well as people who care for infants, as well as school children. It's really up to the state to figure out what will work best. There is not a prioritization within the priority groups. All of those groups are priority. When the shot's gone, we want the five key priority groups to be vaccinated first. Pregnant women, health care workers, individuals who have underlying health problems, people who care for infants under the age of 6 and school children and young adults up to the age of 24 years.

Joanne Silberner: One of the questions we have gotten from some of our listeners at NPR.If there's a problem, and it’s unlikely there’s a problem with the vaccine, how long before you knew it and how long they would know it?

Thomas Frieden: There have been initial studies from the clinical trials that have shown, nothing to be particularly concerned about in the trials that have been public so far. We look at that very carefully. We have a number of different systems in place. Using a variety of sources including health plans and others. The vaccine problems that could occur, would likely occur at a very low rate. 1 per 100,000. 1 per million.  It would take some time to know there was a problem. On the other hand, there's no reason to think there would be more problem with this vaccine than with the vaccine each year. We expect that there will be concerns for problems. For example, we know that many people, each week, develop health problems, whether it's a miscarriage, or a heart attack, a hospitalization for a heart problem, even tragically a sudden death, and that those problems will not be prevented by the flu vaccine. Some people who get the flu vaccine will experience some bad outcome and we will look at each report to see if it's related and if, in the overall group, there's any sign of an increased rate of adverse events, we’ll share that information publicly. We're committed to transparency. We'll go to the phone for the first call.

Operator: Thank you. At this time if you would like to ask a question, please press star 1 on your touchtone phone.  Our first question is from Betsy McKay, Wall Street Journal.  Your line is open.

Betsy McKay: My question was about distribution. I wondered if states are learning each week how much they can order only for the next week, or do they get any advanced notice of how much they'll be able to order later this month or in November. Is advance ordering something you're able to let them do, given the production schedule?

Thomas Frieden: We have the anticipated schedule for the next few months. Obviously, the further out it gets, less certainty we have. At least for the next few weeks, we have a pretty high degree of certainty that the vaccine will be available as per what the manufacturers have told us and we're hoping and advising states that they should be actively planning for vaccination programs and anticipating that the vaccine will be available in substantial quantity by the middle of October.

Mike Stobbe: Thank you.Mike Stobbe from the AP. Doctor, can you give us an updated number about how many doses will be available this week? I think you used the figure 2 million.  Also, is demand outstripping supply, or is supply outstripping demand at this point?

Thomas Frieden: This week, as of yesterday, about 2.4 million doses were available for ordering.About 2.2 million of them had been drawn down or ordered by this week. Each day, as more vaccine is cleared, more vaccine becomes available for ordering, each Friday we'll provide the totals.Some which would have become available that Thursday or Friday. We're trying to make sure that we cut as much time as possible off the cycles to get it out and available for providers to vaccinate.To do that, means a little bit of messiness with how it comes out. Each day each state checks for their allocation. If there's a problem – even a minor problem with any of the vaccine in any of the warehouses, we don't have it available for ordering.We need to make sure it's safe and temperature-controlled. Before we allow it to be released to the states. So there is some lack of certainty. We have a high degree of confidence by middle October, we'll have substantial amounts of flu vaccine available. Clearly at this point, we have only some vaccine and not everyone can receive that vaccine. Demand is outstripping supply.We expect that fairly soon, supply may well begin outstripping demand. The challenge will be to try to ensure that people who would benefit the most have every opportunity to be vaccinated. On the phone?

Operator: Our next question is from Alice Park, Time Magazine, your line is open.

Alice Park: A question about the supply issue. Looking ahead, did the calculations that the CDC made as far as the ordering include the potential that more and more individual entities would mandate the vaccine for their health care workers. For example, I understand that in New York, which has mandated it for the entire state that right now, they're having problems with getting the seasonal vaccine in enough supply? Can you just address whether those initial calculations took into account that there might be more entities mandating the vaccine, therefore you might have a higher rate of compliance or demand for the vaccine than you have had in previous seasons?

Thomas Frieden: We're very confident that there will be plenty of vaccine for everyone who wants to be vaccinated. Unfortunately, it won't be available when everyone would like to be vaccinated. We’re getting it out as rapidly as possible.  States are signing up providers. Providers will then receive it from directly from the manufacturer. The information should be available to the public through the state health department, either on the website or through call numbers to find out the details of where it will be available.But that's not ready quite yet because, there are not large quantity-- there is not a large quantity of vaccine available today out there to be given for H1N1. Seasonal flu vaccine, although there are some areas have had less, there are well over 50 million doses already distributed earlier than is distributed generally in each flu season. So we’re confident there will be plenty of both seasonal and H1N1 vaccine for those who people who want to be vaccinated. We're particularly prioritizing those key groups I spoke about earlier. On the phone?

Operator: Next is from Karen Denice, CNN. Your line is open.

Karen Denice: Thank you for taking my question, are you seeing any mutation in the virus at this point and are you concerned at some point, that the vaccine will not match the virus as we continue through the season and we get seasonal flu and H1N1 both out there?

Thomas Frieden: Our biggest concern is that the virus could change, could mutate to become more deadly. We have seen nothing to suggest that that would be the case. So far, in fact, the virus has been quite stable genetically.It hasn't changed much at all from when it first emerged back in April and May to the most recent samples that are available from laboratories around the country and around the world.The part of the virus that determines whether or not it's very deadly is a different part of the virus that determines whether or not you're going to be protected by the vaccine. That's good news. Because, it means that the vaccine that we have now, which is very effective, very highly, tightly matched with the virus that's spreading is likely to protect you even if this virus were to become more deadly. And the match is excellent right now of the more than 1,000 samples that have been looked at from around the world.The vaccine strain is right in the middle of that genetic variability and the variability is very small.That means that we do expect there will be a high level of match and a high level of effectiveness for this particular vaccine against this particular virus. Clearly the most concerning possibility is the possibility that it could mutate, either to become more deadly or to not match the vaccine. Right now, neither of those things have happened.On the phone? Another from the phone?

Operator: Robert Bazell from NBC News, your line is open.

Robert Bazell: Several local and state health departments have had to cancel seasonal vaccine influenza programs because of, they haven't gotten orders when they wanted to, and San Francisco and some other places have had to cancel novel vaccine programs that they had, because it becomes clear that even though they placed an order, promised an order on a certain date, the vaccine ends up not coming.Can we expect a lot of that in the days, weeks and months ahead?

Thomas Frieden: As we anticipate, the first couple of weeks are going to be bumpy.As we get the supply chain worked out, as the manufacturers deliver or don’t deliver on time, as there are problems identified or not identified with some of the initial shipments. But, I think what we're seeing now, is the tap beginning to flow. We're seeing substantial quantity of vaccine beginning to get out.In an average flu season, we get out about 25 million flu doses per month. And we’re going to have by the middle of this month, within the next two to three weeks, we're going to have tens of millions of doses available.So I think, although it won't be everywhere, it will be widely available in the next few weeks. From that point on, I think we’re going to be comfortable overall with supply, increasingly comfortable, as the season goes on.From the room?

Beth Galvin: Thank you.Beth Galvin with Fox 5. What would you say to people who are not in the priority group who are very eager and might become frustrated if they don't get vaccine soon, what your advice be for that group?

Thomas Frieden: One of the groups who can get vaccinated right now if there is vaccine available locally, are people who are healthy, age 25 to 49 who can get flu mist. That’s not one of the priority groups, and there is vaccine available.It will be a while before vaccine is widely available. We wish it was available for everyone now.Technology doesn't enable that to happen. Perhaps in a few years, we'll have new technologies which will allow that to happen, but that doesn't help us for this year.For this year, we ask people to remember there are simple things that you can do to protect yourself against the flu.  You can stay home if you're sick, very important.Cover your mouth when you cough and sneeze. And wash your hands often.

Those three simple things can make a really big difference in how widely flu spreads this year. On the phone?

Operator: The next is from Lauren Neergard, Associated Press. Your line is open.

Lauren Neergard: Kind of a technical question that has to do with ensuring that children under 10 get their two doses. I wonder what advice are you giving to some of these providers to make sure they actually have enough on hand to give the kids a second dose, are you telling them to plan ahead and partial out that much and keep it on hand for the three-week return visit?

Thomas Frieden: We do anticipate that children age 9 and below will need two doses. We don't have the final data on that yet. We ask that places ot hold vaccine back. More will be coming. Vaccinate as many people as you can now. That second dose, which is generally given three to four weeks after the first dose, there will be plenty more to provide then. On the phone?

Operator: Next is from Jon Cohen, Science Magazine. Your line is open

Jon Cohen: Hi, thanks. You said you had an anticipated schedule, can you tell us what it is or make it public.Also, you said that right now, supply isn't meeting demand. Yet, that conflicted with requests for the 2.4 million doses, only being 2.2 million.

Thomas Frieden: We can provide information and we will each Friday. It's information that changes day-to-day as manufacturers figure out how much is ready for shipping and to clarify, vaccine goes from the manufacturers to a central distributor, and from the central distributor, onward to providers or to health departments to actually vaccinate. I'm sorry, the second part of your question was about? Supply and demand. The 2.4 million available was the first 2.4 million doses. Some states were figuring out exactly where they wanted to spend or send those doses. So far nearly all of that 2.2 million has been called down. It will take some time to get the whole system from the manufacturer through the distributor, to the providers and to people who want to get vaccinated up and running. One of the things that this weekend and next, will provide is something of a dry run. Not enough vaccine around. Although we wish we had more, some can get vaccinated. It will get us ready to get a running start on vaccination come mid to late October.

Mike Stobbe: Thanks. Mike from the AP again. Doctor, you mentioned once or twice the possibility in such a situation that a problem was identified in the shipments, I guess at the production facility, has that happened yet? Have there been any problems identified with swine flu vaccine?

Thomas Frieden: There has been no vaccine that has been found to problematic in any way.But each year, each time we do vaccination programs, we're meticulous at tracking and tracing each of the lots of vaccine. That is particularly important not just to ensure that that's safe, but also, if there's a problem either with safety or with it seeming not to work, low efficacy, to know was there was any point in the chain, at which the cold chain was compromised in which it went too cold or two warm with a narrow band it’s supposed to be in. It's just a question of verifying that things are working well. We have not had any vaccine so far rejected because of any problem. Two more questions. On the phone.

Operator: Next is from Todd Neal, Medpage Today. Your line is open.

Todd Neal: I have a couple of nonvaccine questions. I was wondering how hospitals and emergency departments are faring during this outbreak?Are hospitals being overwhelmed or stretched to capacity in any parts of this country? Also, is CDC making any recommendations about restricting visitation to patients hospitalized suspected or confirmed H1N1?

Thomas Frieden: With we have seen, in places with lots of H1N1, are real stresses particularly on the emergency departments. Largely from people who are coming in because they're very worried about influenza, may have influenza, but probably don't need to be in a hospital emergency department. On the other hand if you have an underlying health condition, if you're pregnant, if you’ve got diabetes or heart disease or lung disease or a child with difficulty breathing, it's very important when you have the flu to get treated promptly. It's a complicated message and getting that understood and acted on effectively in communities throughout the U.S. is very challenging. We do see some stresses on emergency departments. We have not so far seen problems with intensive care units being overwhelmed with people who need respiratory support or ventilatory support or breathing machines. That's something that we're tracking closely. That would be a great concern. One of the things that hospitals can do to reduce the risk is to limit the number of visitors. But that's a balance between the emotional well being and recovery of the patient. That’s something that we can provide general information for health care facilities about, but really it's a facility by facility decision at this point. One more question on the phone.

Operator: Next is from Robert Lowes, Medscape.  Your line is open.

Robert Lowes: Yes, doctor, I have two questions, one is, there are recommendations to have patients who are, who have underlying conditions, receive a pneumonia vaccine?  Is there any concern in your agency there may not be enough pneumonia vaccine?

Thomas Frieden: Pneumonia vaccine is effective, it works, and it's underused.We need more people to get pneumonia vaccine, and if you get the flu, it protects you against one of the more serious complications of the flu. At this point, we haven't seen a shortage of pneumonia vaccine in the market and we hope, in contrast, we will see increased uptake in pneumonia vaccine. You had a second question.

Robert Lowes: Yes, there's one poll which, by Harvard Public School of Health, that showed that only about 50% of American adults plan to get vaccinated and only about 40% were absolutely certain they would, are you going to do anything special to respond to that, I guess, lack of motivation to get vaccinated, any special program, or outreach plan?

Thomas Frieden: There have been several different polls that are somewhat variable in their findings. Most of them find that most people want to and plan to get vaccinated. What will actually happen will depend on a lot of things. How easy it is to get vaccinated, people don’t like going out of their way to get vaccinated. And addressing the three concerns that I talked about earlier, understanding that flu isn't always mild, it can kill you, understanding that this vaccine is made in the same way that the seasonal flu vaccine is made, hundreds of millions of doses with an excellent safety record, and understanding that even though the flu may be here in your community and may even already be decreasing in your community, it's a great idea to get vaccinated because you don't know what the rest of this long flu season is going to hold. We have not had a flu season like this in at least 50 years. Unless there are any questions from the room, I think– Well, thank you very much for your interest. It's a real challenge to balance for the public, information about the vaccine, information about the virus, understanding whether it's in the cases of emergency departments, they need to get care promptly on the one hand if you're really sick or have an underlying health condition but not to go to the emergency department if you’ve got an average flu, and can see your doctor or, are able to care for yourself at home. And similarly with vaccine, to ups that people do have concerns about safety and about whether it's necessary. But in fact, the flu vaccine is our best weapon against the flu. We're fortunate to have the vaccine here. Would have been great to have it earlier. But it's starting to become available, but in the next few weeks will become widely available. Thank you very much.

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