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Weekly 2009 H1N1 Flu Media Briefing

November 6, 2009, 12:30 p.m.

Operator: Welcome and thank you for standing by.  I would like to remind parties your phones are in a listen only mode.  Press star 1 to ask a question.  Today’s call is being recorded. If you have any objections, you may disconnect. You may begin. 

Glen Nowak: Thank you all for coming or calling in for today for the press briefing on H1N1.  Today’s speaker is Dr. Anne Schuchat, the director of the National Center of Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.  She’ll give you an update on both the disease activity in the country as well as vaccine supply.  I turn the podium over to Dr. Anne Schuchat.

Anne Schuchat: Thanks, Glen.  Good afternoon.  The pace or our progress is picking up.  Today, we have twice as much vaccine available as we had two weeks ago.  I’m going to touch on three areas, an update on the flu itself, the disease and the vaccine supply situation and then talk in more about our vaccination efforts.  Flu is still widespread.  48 states have widespread influenza activity.  And virtually everything we are seeing is the 2009 H1N1 virus.  The rates of disease are higher than normal for this time of year.  We wouldn't expect this many states to have this widespread of a disease. And I want to remind people that flu can last until May.  We really don't know what we trajectory we will see with this virus in general.  Most of the illness that we’re seeing is in younger people.  More than half the hospitalizations are in people under 25.  90 percent of the deaths are in people under 65.  A flip-flop from what we see with seasonal flu.  The pediatric deaths unfortunately do continue to grow. This week we’re reporting a total of 129 children have died from H1N1 virus, there are other children who have died from flu where the typing wasn't done, but that's an increase from last week's number.  Two-thirds of the children who died from the H1N1 virus have underlying condition that increase their risk of this problem.  The leading underlying conditions in children who have died are severe neurologic problems like cerebral palsy and muscular dystrophy and the second category is asthma in terms of contributing to the severe outcomes. 

Fortunately, antivirals are very effective treatment against flu, including the flu complications.  We have updated information on our website for clinicians about some of the myths and misconceptions about antivirals.  We are seeing a better supply horizon out in the community and we think they ought to be used when there's a severe presentation of illness like anyone hospitalized and people with respiratory systems with underlying conditions like pregnancy or asthma.  Also if people are getting worse, they are not getting better, antivirals may be important.  The next thing I want to catch people up about is the vaccine effort.  As I said, today, we have about twice the vaccine available that we had two weeks ago.  Today, there are 38 million doses of H1N1 vaccine available for ordering by the states.  The majority of this is injectable doses.  About a third of it is the spray form that's recommended for people who are healthy between the ages of 2 and 49 years of age.  Today's number is up more than 11 million doses from last Friday's amount.  That is progress.  If all goes well, we are expecting about 8 million doses to be available in the week ahead- that's if everything goes well.  As vaccine supplies increase, we think things should go better.  We still don't have enough vaccine.  We know that communities are seeing lots of demand and the supply hasn't caught up with that.  Many places do need more.  We think we are toward a path of improvement at this point.  State and local health departments are going to be in the best position to determine how to effectively use and direct the vaccine doses that become available. 

The key now is focusing those vaccine doses on the priority groups, children and young adults up through age 24, pregnant women, parents or caretakers of babies under 6 months of age, adults 25 to 64 years of age with chronic health conditions and health care workers or emergency medical service personnel.  Those five groups are key and they’re really the focus area for the states and locals and for the providers who are offering vaccine around the country.  Our goal, really, is to put vaccine in the path of people who are in those priority groups to make it as easy as possible for these groups to be vaccinated and to really support the state and local health departments that are managing the effort.  We know that vaccine is being offered in a variety of venues with a variety of strategies and our goal, really, is to have vaccine accessible in these groups at this point.  I want to mention one really nice effort we have heard about in the Champaign-Urbana Public Health Department in Illinois.  They created a nice partnership between the public health department and private providers and the state special services program.  Children with special needs had an easier way to be vaccinated through the public health department clinic.  When parents bring the kids in with special needs, they don't have to get out of the car, a nurse comes out and the nurse is able to vaccinate them right in the car.  It’s been an innovative program that’s reaching these very high risk and vulnerable children.  I want to congratulate the Champaign-Urbana area for coming up with this partnership. 

In closing, I want to remind folks that progress is being made, but we need to extend that in the weeks ahead.  Priority groups are the focus of our activities in the next several weeks.  We are expecting variation state to state and community to community in finding the best ways to reach these high priority populations.  We know the state and local health departments and their partners in health care delivery are working hard to reach these groups.  It’s really important for every available dose to be used as quickly and effectively as possible.  As doses do increase, this will become more and more of a challenge.  We’re going to continue to have a challenges.  We aren't at the supply scenario that we’d like to be today, but we’re much better than we were a couple weeks ago. A reminder that there’s much you can do before you are able to be vaccinated.  Stay home when you are sick or keeping your children home when they’re sick.  Cover your cough and sneeze.  Wash your hands.  Stay informed.  Find out about the warning signs to watch for and when to call your health care provider.  There’s a lot of good information at flu.gov.  Let’s go to questions.  We’ll start in the room.  Maybe start over here.  Okay.  I’m looking for the microphone. 

Michelle Merrill: Thank you very much.  I’m Michelle Merrill with Hospital Employee Health Newsletter.  I spoke with someone at a major medical center who said they still had received zero H1N1 vaccine.  Many hospitals received a small portion of their order, maybe 10 percent.  We did have a report that corporations have been getting vaccine.  So, I’m wondering, why are hospitals not the absolute highest priority?  Obviously they have at-risk patients as well as health care workers. And does CDC have any plans to take more of an active role in determining who gets the first doses of the vaccine and as a secondary question, I understand many hospitals have not received their complete seasonal flu vaccine order.  I think that's not being produced right now because of the push to get H1N1.  Will they eventually be getting that vaccine? 

Anne Schuchat: Thanks.  The state and city health departments are doing an incredible job directing vaccine to places that can reach high priority populations.  In our survey of the states, what we understand is that hospitals were very highly prioritized by the majority of the states.  It doesn't mean they got everything ordered.  The initial amounts were relatively small.  Hospitals that were able to reach health care workers and some of the high priority groups in vulnerable adults and kids were heavily targeted.  We know there are a variety of places that you can reach people at risk.  We think doctors’ offices, health departments, schools, hospitals, employee clinic that can reach priority populations are reasonable places for it to go.  The key thing is to be able to vaccinate as many people in the groups as effectively as possible.  Sometimes, focusing on putting the vaccine in the path of where people will be is the strategy.  We work closely with the states in support of their efforts and have been emphasizing the importance of the priority population.  You asked about the seasonal flu.  I forgot to update you on that.  There are 91 million doses that have been shipped out so far.  This is a private sector enterprise.  The public health system is very minimally involved in seasonal flu.  But 91 million doses so far.  Manufactures have estimated that up to 114 million doses of seasonal flu vaccine may be produced this year.  Exactly the timetable for getting the additional doses, I don't know.  We have seen increased doses coming out each week.  91 million as of the latest update.  We are reminding people that the seasonal flu can occur and it's important to be vaccinated.  We think there's time.  Usually seasonal flu strains don't increase until December through May.  Now, everything we are seeing is the H1N1 virus.  Hopefully, there will be additional supplies.  They may not be ample, in terms of the seasonal flu vaccine, to reach the tremendous demand that we are seeing this year.  So, I think we can do another from the room. 

Jennifer Ashton: Dr. Jennifer Ashton.  There have been isolated reports of cases out of Pittsburgh of pediatric H1N1 with the complication of encephalitis.  I know CDC did report this as a complication in July as well.  What are you seeing in terms of encephalitis in pediatric H1N1 cases and is it an emerging trend? 

Anne Schuchat: Thanks for the question.  We did facilitate the report of neurologic problems last spring and are hearing the reports now.  I don't have the updated information about how widespread it is.  It’s recognized with seasonal flu, that some people can develop a neurologic problem like encephalitis.  Of course that’s a worrisome syndrome to get.  It’s something we can look into further.  Let’s do another from the room. 

Mike Stobbe: Thanks, doctor. Mike Stobbe from the AP.  Two questions.  You said swine flu is widespread in 48 states.  It’s the same number as last week.  Do you think it's leveling off or peaking?  I want to ask about the Harvard poll that came out this morning, specifically the finding that half the people surveyed didn't know where to go to get the swine flu vaccine.  Could you comment on that, too? 

Anne Schuchat: Sure.  We are seeing substantial disease, as I said widespread disease in 48 states.  Influenza-like illness that’s presenting to doctor’s offices is at about the same level this week as the week before its 7.7 percent of doctors’ visits that are for flu-like illnesses; it was about 8 percent last week.  It’s still way higher than we would see at this time of year, even though we had a slight downtick in that statistic.  I can't say exactly what's going to happen in the weeks ahead, certainly even at the point where there's a peak of disease in any one community.  Half the cases are still to come.  What we have seen in seasonal flu is that after the milder illness, the outpatient illness peaks, one has a delay before hospitalizations peak and a further delay before death's peak.  I don't think we are at peak at this point in the nation as a whole.  What I can say is that disease continues to occur at very high levels right now.  The other thing to mention is that in pandemics in the past, it's been tricky to predict too far ahead.  In 1957 there was a substantial amount of disease in the fall.  People thought, pretty much gave the all-clear sign, then after the first of the year, there was an increase in severe disease, so really another wave in '58.  We are very mindful that there's a long flu season ahead and we are going to be attentive to the needs of the population, the efforts to try to protect people going forward.  The second question you had was about the Harvard poll.  We have seen the data.  I think it's understandable that people were finding it difficult to find vaccine at the time of the poll because we were and still are at a point where the supply is relatively limited compared with the demand.  I think a really nice result of the poll was that we learned that nine out of ten people who had looked for vaccine and not been able to get it planned to try again.  They weren't giving up.  They weren’t so frustrated that they’d had it. They recognize the value of trying to protect themselves with vaccine and sticking with it through the next several weeks.  You know, I’m very mindful of the frustration people have had, whether it’s from information gaps or just the basic availability of the vaccine.  I think it should be getting better over the weeks ahead.  A question from the phone? 

Operator: If you would like to ask a question over the phone, press star 1.  Our first question is from Janelle Alecia, MSNBC.com. Your line is open. You may ask your question.

Janelle Alecia: Thanks for taking the call.  I have a question today about Peramivir and the IV antivirals.  I know that yesterday HHS authorized an increased purchase of these drugs.  Can you tell me, with Peramivir in particularly, what level of demand have you seen from doctors wanting this treatment for the most ill patients and whether you expect that demand to rise and whether you expect that there will be enough of the oral antiviral. 

Anne Schuchat: Peramivir is the first intravenous antiviral that has received the emergency use authorizations from the FDA.  We are providing that to clinicians who request it.  The indication is for a severely ill person who cannot tolerate other roots of administration where the intravenous route is preferred or necessary.  We do know there are other intravenous antiviral medicines under review.  Maybe we will get additional products in the foreseeable future.  At this point, demand for that product  from critical care personnel to care for their patients.  We have had more than 300 requests for Peramivir through our system, so far.  We believe that our supply will be fine, given the recent order of product and we will not have to have an interruption in supply based on the next amounts of product expected to be coming.  Okay.  Another from the phone. 

Operator: John Cohen, Science Magazine, your line is open. 

John Cohen: Thanks for taking my call.  The letter that Dr. Frieden sent out yesterday; Could you give us specifics about what triggered that?  If it indeed was the fact that corporations were receiving the vaccine, was there evidence they were using the vaccine in low-risk groups?  If so, which corporations and what happened? 

Anne Schuchat: We have no evidence that providers were giving vaccine outside the recommended priority populations.  But we were aware of concerns and reports and Dr. Frieden’s letter was sent out to the health officers as a reminder to emphasize how important it is, at this time, where supply is relatively limited, that we focus on the best ways to reach the populations that has been targeted for vaccine.  Next question from the phone. 

Operator: Miriam Falco from CNN medical news, your line is open. 

Miriam Falco: Thanks for taking the question.  It’s kind of a follow up to the corporation question.  Some folks think that the CDC may have been able to do a better job of communicating that corporations are also a place to get vaccinated and get the vaccine to high-risk groups.  Although, the guidelines you put out for businesses do say that.  Whose job is it- the state and local health departments- to more clearly tell their folks that this is what we decide or do you think looking forward that the CDC may need to do more to communicate that information better? 

Anne Schuchat: There are a variety of places where vaccination can reach high priority populations.  We think the state and local health departments are in the best position.  They know their communities and population and providers, they know the capacity of the care system.  What we are seeing state to state and city to city is a variation.  A lot of vaccine going to hospitals for health care workers, a lot of vaccine going to health care departments, some to managed care organizations and can reach them.  Vaccine in many states, going for school located clinics that are reaching a large number of young people who don't have that many doctor's visits and it may be difficult for parents to get them to the health department.  We’re also seeing vaccine going to employer based occupational clinics.  When you look at adults and where they get vaccinated with seasonal flu vaccine, it turns out that the workplace is a common place for adults to be vaccinated.  It’s convenient and accessible.  There’s nothing wrong with an employer based occupational health clinic getting vaccine to reach priority populations.  Our focus right now is helping the states and locals reach the priority populations.  Pregnant women are in the work force.  Adults with health conditions like asthma, diabetes, we recommend vaccine for that group.  Parents of children under 6 months or other care takers of children under 6 months.  I think there are many different ways where the priority adult populations can be reached and we want to support the states and locals in getting the vaccine as quickly and effectively out to them.  Next question from the home. 

Operator: Brian Hartman, ABC, your line is open. 

Brian Hartman: Could you go into detail on the status of production, whether there are new glitches, are the old ones still resolved and give me a best case, worst case scenario of when you think it's going to feel to the public like there's plenty of vaccine out there and they don't have to wait in line and searching around for it. 

Anne Schuchat: I’m not aware of new glitches in vaccine production.  People have heard by now, the vaccine strain has been slow-growing and the manufactures have had a challenge in getting a yield that were reliably producing batches week to week that met their earlier predictions.  There’s been intense outreach between the Department of Health and Human Services and the manufacturers really trying to get the best information.  I know that our secretary has reached out to the manufacturers to make sure we know what’s going on and to help where it's possible.  I’m not aware of new problems.  Looking forward, it's extremely difficult to predict when things are going to feel easier in any one community.  I want to go through a couple things with this because I have been asked that quite often recently.  The supply is increasing.  We have twice as much vaccine today as we had two weeks ago.  It might not feel like that wherever you are.  The demand for influenza vaccine, H1N1 vaccine and seasonal flu vaccine, is high now.  This could change area to area.  It can change week to week.  So, when we get to that sweet spot where there's ample vaccine and demand can be met easily, is hard to predict.  I’m expecting that in the next several weeks things will get better and better.  We have all been burned on prediction.  I’m not going to get more specific than that.  Next question from the room.  Is there one in the room?  Okay.  Sure. 

Mike Stobbe: I just want to follow up from the earlier question about the poll survey that half of Americans didn't know where to go.  What do we draw from that?  Are some health departments not being aggressive because of limited supplies to getting the word out on where to go? I have one more question.  Have we learned any lessons from Europe that say some have been more efficient and effective about finding the people who are prioritized and specifically getting them in for appointments.  Any lessons learned or things we can copy from Europe? 

Anne Schuchat: Right.  I think it's not surprising that many people didn't know where to get vaccine.  I think the first few weeks of the program; vaccine has been in very limited supply.  In some states, vaccine was being sent out to provider’s offices so patients could get it through their doctor.  But that wasn't being publicly advertised.  In many places, the health departments were directing the vaccine for school located clinics; they were really focusing on children.  There wasn't that much product that was actually being offered to the general population either to doctors and health care workers or to schools.  The other people who had priority conditions weren't necessarily able to find vaccine.  There are a number of states that have held mass clinics that were accessible to the community at large.  Many, many states have vaccine in the local health departments who are offering it through mass clinics or appointments.  The hospitals have gotten vaccine they can share.  I think the principle is that when you have limited supply, advertising is difficult because you don't have enough.  You don't want to frustrate the demand.  What I can say is we have all learned how important communication is.  Even if there aren't public clinics this week, they have been trying to get the planning going forward settled so that people would be able to look at the website at flu.gov and look at the flu locator and say OK, there’s nothing in my community this week, but in two or three weeks perhaps that pharmacy will have it.  It’s a challenging information environment. 

In terms of Europe, it sounds promising.  I’ll talk with you later about which countries you are talking about.  A number of states have done a great job working with their priority populations to find them.  Some states have immunization information registries and can figure out where things are with that.  I know the health plans are using their information systems to identify, okay, let's make sure we have a handle on our people with asthma or other conditions and we know how to reach them and let them know they should come in for vaccine.  I think information systems are a really, in the future, going to be a good way to make sure you reach priority groups and also innovative communication efforts.  We have been working with faith based organizations, community based groups and provider organizations to find best ways to reach people that might not be watching TV or reading the newspaper for the announcements.  Question from the phone. 

Operator: Steve Sternberg, USA Today, your line is open. 

Steve Sternberg: Thanks.  Two quick questions.  Do you have any idea about how many doses of vaccine have been delivered or actually administered up to this point?  And my second question is, there are a lot of folks who have gotten flu-like illness with high fevers, the characteristics of flu, but haven't been tested.  I get a lot of questions about whether they should be vaccinated anyway. 

Anne Schuchat: We don't have great estimates yet, about how many people have been vaccinated.  We are carrying out some coverage surveys done by telephone to track at a national level and then state by state, the percent of population that have received the H1N1 vaccine.  The information we have gotten is the baseline before there was much vaccine out there.  Very, very low levels.  What we are expecting in the weeks ahead is to be able to report to you the figures as we get them.  The second question was about people who believe they have had the H1N1 infection, fever and cough, but didn't get tested.  Should they get the vaccine?  We do recommend it.  The vast majority of people would not know, for sure, if they had the strain, the 2009 H1N1 virus.  There’s not that much testing capacity and we don't think there's any harm in getting vaccinated.  Many things that look like influenza or the H1N1 influenza are something else.  The recommendation, if you are in the priority group, when it's available in the community.  Another question from the phone. 

Operator: Jonathan Serrie, Fox news, your line is open. 

Jonathan Serrie: We know up to this point, the H1N1 virus has shown no signs of mutation.  Can you quantify the risk of this happening in the future?  It is unlikely scenario you have to prepare for or something you expect will eventually happen with this virus? 

Anne Schuchat: Well, influenza viruses change.  That’s pretty inevitable.  Mutations with occur.  The key part is will we see something in the near future that would make the clinical pattern of this progress change markedly to something more severe than what we are seeing or is there a change that would occur to leave the virus to escape the vaccine-induced protection?  Both of those changes are possible.  Fortunately, we haven't seen any of those, yet.  We have been testing a lot of viruses.  The virulence or the virus hasn't changed genetically and neither has the immune characteristics.  The vaccines that we are making available now are very good matches with the virus.  It is -- it has been seen with pandemics in the past that over the couple years after a new strain emerges, it starts to change a bit.  It starts to drift and become something that would need a change in vaccine formulation, so that's one of the reasons we make up new vaccines every year for seasonal flu.  Viruses may change from year to year and we may need to modify the vaccine.  Another question from the phone. 

Operator: Betsy McKay, Wall Street Journal, your line is open. 

Betsy McKay: Hi, thanks.  One of my questions was answered, but I wanted to ask you about the number of doses being delivered in the coming week.  I think you said 8 million are expected in the next week or weeks.  In the past two weeks, there were 10 million or more new doses.  I just wondered if, you know, you could talk about why the slowdown, if that is a slowdown and secondly, I wonder if you have more detail on formulations that are currently available.  I know you talked about injectable versus nasal spray.  How much injectable is in multi-dose vials, how many single-dose vials, how many pediatric formulations.  Do you have that available? 

Anne Schuchat: I don't have the specific details of the formulations.  As you’ve mentioned there’s several.  Pediatric single dose syringes, adult single dose syringes, a mist formulation, multidose vials, there are multiple companies. So I actually don’t have that.  I can say the majority is injectable now, not the mist anymore.  I believe the majority of the injectable is the multidose vials, but there are single-dose syringes for children and adults as well available.  The other question you asked was about whether we should read anything into expecting 8 million doses of vaccine this week and having gotten about 11 million and 10 million the weeks before.  I wouldn't read into it.  What basically is happening is batches of influenza vaccine are being prepared and produced.  The batches have to be ready.  It’s not something where week by week you can directly compare.  We are expecting, if everything goes well, we will have another 8 million doses this week and going forward, we'll get more information about what to expect.  I don't think there's anything to be read into an 8 million expectation for next week versus 11 million this past week.  Based on everything I know.  Another -- time for two more questions from the phone. 

Operator: Daniel DeNoon, Web MD, your line is open. 

Daniel DeNoon: Thank you very much.  I would like to follow up on Betsy’s questions.  We have seen 10 million this week and 8 million next week, can we see the flow is about 8 million to 10 million a week and is that the flow you are expecting or will it vary from week to week?  I’m not sure what the flow looks like. 

Anne Schuchat: I think we have been trying to stay away from getting too far ahead of the flow.  We were perhaps wrong in the past when we did that.  But, I think that I’m not actually aware of what happens after the 8 million that we are expecting this next week.  You know, that's what I can say.  Did you have a second question?  Or that was -- okay.  Next I guess the last question from the phone. 

Operator: Lorna Benson, Minnesota Public Radio, your line is open. 

Lorna Benson: Thank you for taking my call.  Some of the estimates we have heard suggest that the waves of illness can from last six to 12 weeks.  Here in Minnesota, we saw a jump in illness ten weeks ago.  What are your calculations in terms of how long this wave has been going on and is it similar to what they saw in the southern hemisphere in their flu season? 

Anne Schuchat:  That’s a great question.  We have been talking about that internally, trying to look community to community in how long things are lasting, whether we can predict a little further ahead.  What we are seeing is different in different communities.  You know, as we said, the southeastern states, some of the southeastern states had rises as early as august.  Quite a lot of disease in September and into October.  A number of those states are seeing drops.  They are not down to baseline, they are still very elevated.  About to say how long does it last is tricky.  We have seen parts of a city, then another part of the city.  I wish I could tell folks in your community what to expect, but it's difficult to.  Thanks everybody.  I think Tuesday we will be on, again or somebody will be out here Tuesday. 

 

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