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CDC 2009 H1N1 Flu Media Briefing (unedited)

Friday December 22, 2009.

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 question and answer session, at which time you may press star 1 to ask a question.  Today's call 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 for joining us today for this update on H1N1, including H1N1 influenza and H1N1 vaccine.  Today's briefing will be conducted by Dr. Anne Schuchat who is the Director for the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. And I will turn the podium over to Dr. Schuchat. 

Anne Schuchat: Thanks Glen and good afternoon everyone.  I want to briefly today give an update on where we are with vaccine supply and where we are with vaccine use.  And give some helpful hints looking forward towards the holidays.  The H1N1 vaccine supply is getting better and better.  Surveys are showing that initial doses of vaccine were relatively quickly taken up and they were going to the people that they were targeted for.  We know from our survey, though, that many people are interested in being vaccinated and haven't yet had a chance to be and with the increase in supply and this window of opportunity that we have right now, it's a really good time to be vaccinated in the weeks ahead.  Vaccine is becoming available in more and more places and at more and more times.  And the states are working very hard to put vaccine in the path of people to make it easy for you to be vaccinated even over the holidays and going into the New Year. 

A brief update on the flu activity.  Disease is at a better state around the country than it had been.  Less viruses circulating, but still everything that we're seeing in terms of the flu strains is the H1N1 virus and so it's not gone at all.  None of us know what the weeks and months ahead will bring in terms of influenza activity, and it's very important not to be complaisant right now about the ongoing risk of H1N1 influenza.  As of today, about 111 million doses of H1N1 vaccine have become available for order by the states.  That's a lot of vaccine.  And that's really good news. 

I want to provide some information about a survey of vaccination uptake that the CDC has been carrying out and make some comments on the survey that Harvard carried out, a poll that they did more recently.  These two surveys suggest that the initial doses are being relatively quickly used and they're going to the people that they've been targeted for.  CDC carried out a national H1N1 survey and I’m going to report some results from the week of December 6 to 12.  So that's two weeks old, but I want to give you a snapshot of what things looked like at that point.  This is a survey that involved 1368 adults and 3243 children in terms of the telephone survey that was carried out.  Overall, that estimate for the week of December 6 to 12 was that about 46 million people had been vaccinated with the H1N1 vaccine by that time.  About 40% of the doses went to children.  Coverage was about twice as high in children as it was in adults, so much more vaccination of children than adults by that point in December.  That's really good news because usually with seasonal flu, that's a lot more vaccination of adults including seniors than of children, but we know that with the H1N1 vaccine, we were targeting children because they've been so hard hit by the virus.  More recently, Harvard carried out a poll of about 1600 adults and included about 400 parents in that group.  They carried out their poll December 16th and 17th and their data suggests that ten days later after our survey, about 56 million people in the country had been vaccinated with the H1N1 vaccine.  Like our earlier results, they also found that children were more likely to be vaccinated than were adults.  Taking those two data points together, we think right now probably at least 60 million people people have been vaccinated with the H1N1 vaccine.  We know from our survey, though, that about half of Americans want to be vaccinated with H1N1 vaccine and at the time of on our poll or our survey; only about one in three had been able to be vaccinated.  What we think that means is that many Americans who still want to be vaccinated have a great chance to in the days ahead.  More and more vaccine has become available and people will be seeing it really everywhere they go, I hope.  We know that vaccine is out in doctors' office, hospitals and health departments, but it’s also getting in to some of the retail settings, we know of some malls have it, retail pharmacies and other chain stores.  So I think that the goal will be to really get vaccine out in the path of people and make it easier day in and day out to find vaccine and take advantage of that. 

I want to make a couple other points because there have been things in the news that might have been confusing to people.  First I want to talk to parents.  If you have children who are under ten years of age and have gotten the H1N1 vaccine, it's important to know that your child needs a second dose.  We recommend two doses of H1N1 vaccine about one month apart, and so we know a lot of parents have gotten their children vaccinated but may not have gotten that second dose in yet.  It's really important to finish the series.  I also know a lot people want to vaccinated but they’ve been waiting, they’ve been wondering what is the experience with this vaccine. Do we know enough about it?  I want to give you a little more information about the vaccine safety.  At this point, we think probably 60 million people have received the H1N1 vaccine.  We've intensified our safety monitoring and we're not seeing any worrisome signs.  The information we have on the H1N1 vaccine to date is very reassuring from the safety front. 

So in closing, I think this is the time to act in the days and weeks ahead.  This is a very good time to be vaccinated.  Just because a lot of people are taking off for the holidays does not mean that this flu virus will.  This is a time to look for vaccine and make sure that you and everyone you love is protected.  So I’d like to answer questions that you may have.  Let's go to the phones. 

Operator: Our first question, if you would like to ask a question, press star 1.  The first is from Helen Branswell, the Canadian Press.  Your line is open. 

Helen Branswell: Hi, thanks very much for taking my question.  This isn't about vaccine.  It's about something that you said earlier Dr. Schuchat, about most or virtually all of the viruses being seen is H1N1.  I'm wondering what CDC is hearing from other parts of the world about circulating virus and whether the picture is becoming clearer or not whether this virus is going to replace both the seasonal viruses that we've had up until now.  Is that picture coming clearer at all? 

Anne Schuchat: You know, Helen, I wish I could answer that. I think it's too soon to say.  We do, of course, share information regularly with the other WHO Collaborating Centers and with our partners in other countries.  We have people stationed in a lot of countries and are getting thousands of isolates for testing.  We don't know yet what kind of seasonal flu strains will emerge and how frequent they'll be, but we're looking very closely, working with the states to try to test more and more strains and we want to hear about clusters of unusual disease so we can look into them.  No one knows how bad a time we'll have with seasonal strains this year, but we're looking for them.  And we also, of course, don't know just what we'll see with H1N1 virus after the holidays, will more and more cases occur or will by more and more being vaccinated we'll be able to blunt that and really protect a lot of folks.  Next question from the phone. 

Operator:  Stephen Smith, the Boston Globe, your line is open. 

Stephen Smith: Hi Dr. Schuchat, good afternoon and thanks for taking the question.  I'm wondering as more and more evidence comes in regarding patients who have been hospitalized with H1N1, what is being detected as the most significant underlying condition those patients have?  In other words, what seem to be the underlying conditions that most suggest a patient being at risk for hospitalization if the patient does contract H1N1? 

Anne Schuchat: Yes, thank you for the question.  We've been looking at information on hospitalizations from our Emerging Infections Program network and what we find is that asthma and chronic lung disease are very common.  In particular in children, those are -- asthma is a common condition that can complicate influenza.  We know that this virus is attacking the lungs and unfortunately in some people causing very severe respiratory failure.  And I think people who have chronic lung disease and don't have that margin of reserve have a harder time.  But we also see diabetes and chronic heart disease.  Of course pregnancy continues to be an important factor in hospitalizations.  We do think people are getting better and better at recognizing the importance of treating pregnant women with antivirals when they have respiratory symptoms, but of course that is still showing up.  Next question from the phone.

Operator:  Lisa Schnirring, CIDRAP News, your line is open. 

Lisa Schnirring: Hi, thanks so much for taking my questions.  A couple real quick ones.  Does the CDC or anyone else have any way of gauging how many kids under ten have already gotten their second dose?  And my other question -- I just blanked on it.  Sorry about that. 

Anne Schuchat: Let me try the first while you try to think of the second.  Of the -- we estimated in our survey carried out a couple weeks ago that about 46 million people have been vaccinated as of the week of December 6.  As of that week, about 2 million people had -- children had gotten a second dose.  So we do think there are a lot of children in need of second doses in the weeks ahead and of course some parents haven't yet had the chance to get their children vaccinated at all and for those who have children under ten who have only gotten one dose so far, remember that after a month you want to get the second dose in.  And it's okay if five or six weeks have passed.  It doesn't have to be exactly at four weeks.  But you do need to get that second dose in and we strongly recommend it.  Did you think of your second question? 

Lisa Schnirring: Are there going to be any more formal organized campaigns for a second push kind of like you do as a kick-in thing for the seasonal vaccine, kind of that late fall thing you've been doing in the past years?  Is there any new campaign starting out to kind of get that last push in for the H1N1 vaccine? 

Anne Schuchat: Yes, absolutely.  Right now there are a number of communication efforts being carried out, some public service announcements are going out around the country, and we know that many leaders are trying to help get the word out in their communities as well as nationally.  We also do intend to have National Influenza Vaccination Week.  You may be familiar with us holding that in early December.  This year we decided to hold it in January instead to really help with that additional push related to the H1N1 vaccination effort.  We think a lot of schools may be carrying out their second dose school campaigns in January and we really want to work together with our public health partners in the medical community in promoting influenza vaccination over the weeks ahead.  So, yes, I do think an important opportunity right now over the holidays for people to be vaccinated and continued opportunities in January and beyond.  Next question from the phones. 

Operator: David Brown from the Washington Post, your line is open. 

David Brown: Thanks a lot, Dr. Schuchat.  Two questions.  The Harvard poll found that less than one-quarter, specifically 22% of adults, prioritize to receive H1N1 flu vaccine have received it so far.  That seems pretty low and I’m wondering if your poll found similar numbers.  And my second question is, are cases going down in all parts of the country or does it seem that the epidemic is still on an upward curve in some regions? 

Anne Schuchat: Our survey data bears out the Harvard poll that children are more likely to be vaccinated including children compared to prioritized adults.  So we do think that there are lots of opportunities now for adults to be vaccinated and we know that early use of the vaccine in many states was really focusing on children especially states that were focusing on the sub priority populations, really which didn't focus above the age of 18 except for health care workers and parents or caretakers of newborns.  So I think that the time is now for adults with chronic health conditions to look for vaccine and for those they love, really people with lung disease, emphysema, diabetes, cancer, heart disease, and really for everyone else.  Because one thing you can do by being vaccinated is protect those around you including those with those chronic conditions.  Survey after survey suggests that people who have chronic conditions like diabetes or heart disease do not think of themselves as a person of high risk.  And so what we need is everybody to talk to each other and remind your loved ones really take care of your health and look for that vaccine.  The question about geographic spread is important.  Influenza is very local.  Right now five of ten regions around the country still have influenza activity that is above base line.  We have 11 states that still have widespread disease and many states still have regional disease.  So that influenza is still out there and as I said, it is still the H1N1 virus.  In areas where the disease has calmed substantially, we don't know what the future will hold, whether it will rise with a big peak, whether it will be a subtle increase in cases, or whether we will see outbreaks in certain communities and not others even within the same state.  But we're really intensifying our surveillance and reminding everyone there are a lot of unknowns, but the one thing we do know is that getting vaccinated will reduce the chance of you getting sick and reduce the chance of the country going through a third wave.  Next question from the phone. 

Operator: Mary Shedden from the Tampa Tribune, your line is open. 

Mary Shedden:  I wanted to touch base and find out, you mentioned the survey results, of how many adults said they wanted to get the vaccine.  I also wonder if the Christmas holidays will be a factor, as well as the fact that a lot of places with the vaccine now are retail clinics that are charging up to 20 bucks for vaccine.  Do you think that will be a problem? 

Anne Schuchat: Overall, about 50% of respondents said that they are interested in being vaccinated.  It varies a little bit by age and it's varied a little bit over time.  I think we might have had as many as 60% who wanted to be vaccinated many weeks ago and now it's around 50%.  The vaccine is becoming available at more and more places including the retail pharmacies that often do bill insurance or may charge for the administration of the vaccine.  Remember this vaccine is purchased by the government, so no one is allowed to charge for the vaccine itself, but private health care providers and the retail pharmacies can charge an administration fee.  We've encouraged people to make sure that that's reasonable and they're not allowed it to exceed the regional Medicare reimbursement fee.  We do know that the public health sector is continuing to make sure that vaccine is available without any administration fee either at local health departments or through mass clinics.  I know there were free vaccines at the zoo held in Virginia recently.  And there are all kinds of innovative efforts to get vaccine out to people and to really reduce costs being a barrier.  It's critical that people be able to protect themselves and their family without the financial hardships that we know so many people are going through.  I think those were your questions.  Did I get them all?  Okay.  I guess we're on to the next question from the phone. 

Operator: The next is from Marilynn Marchione, the Associated Press, your line is open. 

Marilynn Marchione: Good morning.  Thanks very much for taking my call.  We had a report this morning from the American Veterinary Medical Association that a dog in suburban New York was carrying the same strain of flu that is affecting humans.  We've had some rare reports in the past about some animals carrying the vaccine.  I wonder, Dr. Schuchat, if you could talk about this and what you'd say to the public who start thinking about pets and inter-species transmission.


Anne Schuchat: Yes, there have been reports of the H1N1 virus in a variety of species, including some household pets.  One important thing to say stepping back is that the human/animal interface is a very important place for influenza viruses. It’s a place where they sometimes emerge, you know, usually very far from here, but animals can carry influenza viruses and so can people and when they mix, that can sometimes make trouble.  In terms of people with pets, with cats and dogs, really this is not a reason to be concerned.  We think that the rare occurrences of this virus in other species is not a general problem, so enjoying your pets and your family through the holidays is the best advice.  Next question from the phone. 

Operator: The next is from Amy Burkholder, CBS News.  Your line is open. 

Amy Burkholder: Yes, hi, Dr. Schuchat.  Thank you so much.  Quick question.  It seems that CDC is pleased with the uptake in kids, but do you have any information about the uptake in pregnant women? 

Anne Schuchat: We don't have final data yet for the last bit of time on pregnant women.  There's a different survey we're doing to get at that.  Our preliminary look at pregnant women was very encouraging, but we'll have better data in January to report more formally on.  I would say to qualify, if I said I was encouraged about the uptake in children, I think the critical message is a lot more people need to be vaccinated to protect themselves.  We have had a good uptake at the beginning of the program with it going to the priority populations, but now that we have more and more supply, that's a chance for more people to protect themselves and their families.  So I hope more parents who have been waiting, watching, wondering what the safety data would show will now be reassured and will be able to take advantage of the vaccine for their children and themselves.  Next question from the phone. 

Operator: The next is from Denise Grady, New York Times, your line is open. 

Denise Grady: Thank you very much.  What is the status of the vaccine for the regular seasonal flu?  Is there any of it left, is it gone?  Is it available to anybody?  

Anne Schuchat: Yes.  And I can tell you my husband got his H1N1 and his seasonal flu vaccine a couple days ago at a pharmacy in the Georgia area.  So there is seasonal flu around.  Of course most of the seasonal flu vaccine has already been distributed, I believe it's all been distributed, it’s about 112 or 13million doses that the companies were able to produce.  There may be a little bit more coming that some of the companies are working on.  There's been an effort to really focus with the distributors that still have vaccine to assure that vaccine from distributors can get to the nursing homes that weren't yet able to fill their orders.  But we do think that there's a little bit of seasonal flu vaccine around.  It will be spotty place to place, but, again, checking with your doctor's office or your pharmacy and retail setting to see what's left.  The vast majority, we think, has already been used, but, as I said, we found it locally very recently.  Next question from the phone. 

Operator: Kelly Brewington, the Baltimore Sun, your line is open. 

Kelly Brewington: Hi, thank you for taking my question.  We're hearing reports that another vaccine recall is on the way.  We actually were under the impression that this would be discussed during the press call today.  Can you confirm this and what you can tell us about it? 

Anne Schuchat: I think that FDA would need to talk about that.  What I can say is that as part of the H1N1 vaccine program, there's a lot of quality assurance testing and certainly we're cutting no corners at all in terms of how the vaccines are being produced, released and followed after their release.  Many people heard about a recall last week.  Of course that was not related to safety or any kind of clinical problem.  And so I believe that FDA would need to answer questions about any pending decisions they're making.  Next question from the phone. 

Operator: The next is from Felice Freyer, the Providence Journal, your line is open. 

Felice Freyer: Hi, thanks very much.  I'm wondering if you have now or expect to have information on a state by state basis that would show what percentage of the target group are being vaccinated in each state.  For example, did North Dakota get 50% of pregnant women, that sort of thing, to help you decide what the best practices were. 

Anne Schuchat: That's a really important question.  We are a carrying out survey takes will involve every state through the Behavioral Risk Factor Surveillance System that many of the states use to track things like smoking prevalence and so forth.  So over the weeks ahead, we'll be gathering more and more data about what has been achieved so far in the immunization effort, whether some states were able to reach a lot more children or a lot more pregnant women or a lot more people with diabetes than other states were.  We're very interested in identifying best practices, what works in different contexts and sharing those.  We think the H1N1 pandemic has really improved our ability to deliver vaccine to children through the schools because probably 2/3 of the states have carried out school associated vaccination efforts.  But we don't know yet whether coverage was higher in the states that did those school based programs versus other states.  There’s going to be an enormous amount of learning to come that really can help us with seasonal flu prevention in the years ahead.  So we'll look forward to sharing those data when they're available.  Two more questions we have time for.  So the second to last question from the phone. 

Operator: The next is from Tom Corwin, Augusta Chronicle, your line is open. 

Tom Corwin: Hi, thanks for taking my call.  We're being told that CDC is redirecting vaccine from the states to the retail side about 10 million doses.  I'm wondering why that's happening and if that number is correct that it's 10 million. 
Anne Schuchat: There's no redirection of vaccine from the states going on.  CDC is working very closely with the state and local health departments throughout this H1N1 vaccination program.  We're working hard to make sure that we can get vaccine in the path of people who need and want it.  And so there's no redirection happening.  That's a misunderstanding.  Is there -- let's go to the next question, which is the last question from the phone. 

Operator: The next is from Karen Zietvogel, your line is open. 

Karen Zeitvogel: Hi, thank you for taking my call.  I was wondering about the study that was published online by JAMA where they say they found that a single dose, 15 micro grams, is enough to immunize children from 6 months to, I think, 18 and why are their findings so different from what was found earlier?  A different vaccine, do you have any insight into that? 

Anne Schuchat: The study that was reported from JAMA was one single study with one particular vaccine in one population at one point in time.  There are other studies that have been done of the H1N1 vaccine under the coordination of the NIH and it's through those NIH-organized studies that we strongly believe that two doses are needed for children under ten.  So I think there will be lots of scientific discussions about what happened with that study, what the particulars were that might have been unusual, but based on everything that I know right now, I think it's very important for parents for make sure that their children who are under ten get their second dose of the H1N1 vaccine.  So thanks, everybody, happy holiday and see you next year, I think. 

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