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Flu Telebriefing with Dr. Keiji Fukuda
October 31, 2001
CDC MODERATOR: Hello, and welcome to the Influenza Telebriefing Update.
Our speaker today is Dr. Keiji Fukuda. Let me spell his name for you. His
first name is K-e-i-j-i, last name F-u-k-u-d-a. He's a medical
epidemiologist in our Influenza Branch here at CDC.
Dr. Fukuda is going to discuss our current flu recommendations for this
year's season, give an update on the influenza vaccine and also give a
report on the latest influenza surveillance data.
DR. FUKUDA: Thanks, KD.
Good morning, everyone. Let me say a few words about influenza and some of
the current recommendations for this year, and then we'll just throw it open
Influenza, I think as all of you know, is viral disease, and it's an
infection that anybody can get, but there are certain groups of people who
are at higher risk than other people for developing severe complications,
and these are things such as pneumonia. And these complications can lead to
things like people getting hospitalized, and in certain cases they can lead
to people dying.
On average, in the United States, we see over 20,000 people die from
influenza every year, and we see approximately 114,000 people get
hospitalized from influenza. So it's a major, major public health problem in
the United States every year.
Now influenza vaccine is the major way that we have to reduce the
complications from influenza, and so every year the Advisory Committee on
Immunization Practices and CDC give out recommendations on how influenza
vaccine should be used.
And this year, as in every year, the focus of vaccinating people against
influenza really focuses on those groups of people who are at highest risk
from developing severe complications and health care workers. The groups of
people that are at highest risk from serious complications include the
elderly, that is, people who are 65 years and above, and then those people
who have certain chronic medical conditions, particularly heart and lung
conditions, but also things like immunodeficiency diseases and other
conditions such as pregnant women who will be in the second or third
trimester of pregnancy. So we recommend and focus our vaccination efforts on
that group of people because they're the ones that are most likely to get
We also are recommending health care workers get vaccinated first because
these are the people who have close and frequent contact with the high-risk
people, particularly when they're very vulnerable, and health care workers
can transmit infections to these high-risk people. So we also recommend
vaccinating health care workers.
So the message has been this year to focus on vaccinating those groups of
people, especially through October. Now, as we go into November, it is also
recommended that we vaccinate other people, and particularly healthy people
who are between the ages of 50 and 64 years of age, and then other people
who are in close contact with high-risk people. Again, this is to help to
decrease transmission of viruses to the high-risk people.
Now to other important--there are a couple of important things about
influenza vaccine this year. One of them is that we are going to have more
vaccine available than we've ever had before. We're going to have
approximately 85 million doses of vaccine available, and these will be
available through sometime in December, probably about mid December. But the
vaccine, as you know, the distribution this year has been somewhat delayed
compared in previous years.
Now through the end of October, we will have gotten out a little bit over
half of the vaccine supply. So that means that substantial amounts of
vaccine will be coming out in November and in December.
Now another thing that I want to emphasize is that the optimal time to get
vaccinated is usually October and November. However, it's clear that every
year after November there really are substantial numbers of people who ought
to get vaccine who remain unvaccinated. And so we're really, really trying
to get the word out that physicians ought to continue their vaccination
efforts through November, through December, as long as vaccine is available.
I think this is a very important message to get out to people.
Now so far we are pretty early in the influenza season. The activity that we
have seen in the country has been pretty low and pretty much limited to
sporadic cases. The mortality levels and the influenza-like illness levels
associated with influenza have all been at baseline or lower levels.
There have been some viruses that have been isolated this year, and so far
they predominantly appear to be influenza A viruses. We have limited
information, but based on that limited information, so far it looks like the
vaccine match with the circulating viruses is good.
So I think that I will stop at that point and throw it open to questions.
AT&T MODERATOR: Ladies and gentlemen, if you do have any questions, please
press the one on your touch tone phone. You will hear a tone indicating
you've been pleased in queue and may remove yourself from queue by pressing
the pound key. If you're using a speaker phone, we do ask that you please
pick up your handset before pressing the number.
First, we will go to the line of Maggie Fox with Reuters. Please go ahead.
MS. FOX: Hi, thanks. Boy, I'm surprised to be able to ask my question. It's
hard to get in on these CDC conferences. Anyway, thanks for taking our
You just answered my question, actually, by saying that there hasn't been
much. I wanted to ask you how much flu has been seen this year. And also, on
a kind of lighter note, I'm told everybody in the world is washing their
hands a lot more than they normally would because they're scared of anthrax,
and I'm wondering if you think this might have an effect on the flu rates
DR. FUKUDA: Maggie, in terms of the levels of flu, it's pretty much what I
told you. There have been 12 states in the U.S. that have reported sporadic
levels of flu activity. Otherwise, the other states have reported no levels
of flu activity. And so, again, we're pretty early in the season.
As for washing your hands, I'm not quite sure it's going to affect levels of
influenza activity, but I think the improvement in general hygiene will be
good for everything else.
MS. : Could I follow up on that?
DR. FUKUDA: Sure.
MS. : Everything I've heard from infectious diseases people is that if you
want to prevent transmission of the flu that you should wash your hands,
that hand washing is one of the primary ways to prevent it. Am I wrong on
DR. FUKUDA: No. You know, washing your hands is one of the major things that
we can do for any infectious diseases. It's one of the major things that we
can do for any infectious diseases. It's one of the major ways that we
transmit influenza virus--or transmit many infections. But influenza viruses
are transmitted primarily through the air, so when somebody gets sick and
they're infectious and they cough or they sneeze, they send viruses into the
air and people breathe them in, and they get infected.
It's also possible to transmit influenza viruses directly on your hands, by
touching other people and so on. But, really, the major way that we transmit
influenza viruses is through the air.
MS. : Thanks.
AT&T MODERATOR: And for our next question we go to the line. Helen
Chickering (ph) with NBC News Channel. Go ahead, please.
MS. CHICKERING: Yes, we've heard a lot of differing opinions from various
health officials about why we should get the flu shot in light of the
anthrax scare and that symptoms of the flu can mimic or are similar to
anthrax. Is there a recommendation? I've just, you know, heard a call for
more flu vaccines in light of the anthrax scare. What are your thoughts
about that? And what's the message to the public?
DR. FUKUDA: Helen, thanks for asking this question. This has really been one
of the more confusing things for everybody this year.
I think that in terms of flu vaccine, I think the message is pretty clear.
You know, the reason you get vaccinated against influenza is to either
prevent your chances of getting influenza or, if you get influenza, it's to
decrease the severity of the disease. The vaccine is protective against
influenza. It is not protective against other viruses. It is not protective
So there are amply--ample good reasons to get vaccinated with the flu
vaccine, but it's to prevent influenza, and it's not to prevent anthrax.
MS. CHICKERING: I think, though, to follow up on that, that people are
not--know that it's not to prevent anthrax, but it's to prevent the symptoms
that mimic anthrax. And to follow up on that, are you concerned as we get
into flu season and people are coming down with the flu and the similar
symptoms, especially in areas like Washington and New York, that they will
be rushing to their emergency rooms worried that they have anthrax? And are
we prepared--are emergency rooms prepared to handle that?
DR. FUKUDA: Yeah, again, this is a sort of complicated series of issues and
questions, but let me try to tease them out.
I think that it's really important to understand that, you know, every year
there are tens of millions, if not more people, who develop so-called
flu-like illness. You know, these are the things that we think of commonly,
you know, like fever, muscle aches, headaches and so on. And those flu-like
illnesses are caused by a whole variety of different agents, and some of
those agents are influenza viruses, other agents are common cold viruses,
and then many other viruses, such as adenoviruses and so on. So the--you
know, so the flu vaccine is going to reduce the people--the number of people
who develop influenza, but there is still going to be lots and lots of
people who develop these flu-like illnesses from these other viruses.
And even people who get vaccinated against influenza still stand the
possibility of developing flu-like illness either from getting infected by
these other viruses or because the influenza vaccine is not a hundred
percent protective against influenza itself. And so I think that we really
don't want to sell the idea that if you get vaccinated against the flu that
it's going to either decrease your chances of getting anthrax, or that if
you get vaccinated against the flu, we don't want to have the implication
that, you know, if you do develop a flu-like illness then you ought to be
more worried about anthrax.
And so this has been very confusing to people, but I think that the bottom
line is that, you know, we want to--we want people to get influenza vaccine
to prevent influenza. But even after we get that vaccine out there, there
are going to be lots of people who develop flu-like illnesses for other
reasons, and that this--developing those flu-like illnesses doesn't need to
increase your worry about anthrax.
MS. CHICKERING: Are health systems or hospitals prepared to handle people
who may be coming in panicked, anyway?
DR. FUKUDA: Well, you know, I think that we all recognize that there is a
high level of concern about anthrax throughout the country, and then
typically we recognize that throughout the year, but particularly in the
fall and in the winter months, that lots of people go to hospitals, anyways,
for influenza-like illnesses. And so, you know, every year for the past many
years we recognize that some hospitals in some cities frequently, you know,
just get inundated with people coming in for respiratory illnesses. And I
expect that that will be the same this year as it has been in other years.
There are things that hospitals can do, however, and you know, to give you
an example, a couple of years ago in Los Angeles, there was a season, the
1997-98 season when a lot of hospitals in Los Angles became overrun by
people with respiratory illnesses. And one of the organizations down there,
the Health Care Association of California, which is a health care industry,
really came up with some common-sense recommendations for hospitals which I
think would be useful for other hospitals to consider this year.
And some of those suggestions were that hospitals during these periods when
they get inundated with respiratory patients is that they consider doing
things like reducing or eliminating elective surgery. They can consider
relaxing the staff-to-patient ratios, you know, within the limits of their
state licensing agencies. They can develop ways to identify and bring in
extra staff to help out with the patients. They can set up walk-in flu
clinics to try to triage the patients. They can take extra care to immunize
their staff so that they have more staff available.
And so I think that those kinds of steps this year can really help some of
the clinics and hospitals out there to handle the--the seasonal rush of
patients that we always see.
CDC MODERATOR: Thank you. Can we have our next caller, please?
AT&T MODERATOR: That will be from the line of Lara Meckler from Associated
Press. Go ahead, please.
MS. MECKLER: Following up on that same line of thinking concerning the
anthrax scare, it seems like there are a lot of doctors out there who
are--forget about the issue of flu, that's always there, there will always
be people who get the flu, we'll always have to deal with that. But there is
a unique situation this year, which is that people are coming into their
doctors' offices scared that they actually have anthrax. And doctors--I
heard from doctors who are frustrated because they don't know what to do.
They don't want to tell someone they're going to be fine when in fact we
don't really fully understand who does and does not get anthrax. At the same
time they don't want to bow to the pressure to just give everyone
antibiotics who wants them.
Could you speak specifically to the unique issues that doctors are facing
this year due to the anthrax scare and the fact that the symptoms do
resemble flu sometimes?
DR. FUKUDA: Sure. And this can be a very difficult issue. I mean I think
that in the first place I think we all have to recognize that in some
instances it can be difficult to tell the difference between early
inhalational anthrax cases and then flu-like illness cases from other
But I think that if physicians out there evaluate all of the relevant
epidemiologic and clinical information which is available, they really have
a very good chance of coming up with the accurate diagnosis. And here are
some specific points.
First, in terms of the epidemiologic information which can be considered, I
think the first thing to remember is that again every year we see tens of
millions of people develop flu-like illness from, you know, a variety of
causes, including common cold viruses and flu viruses and so on. This
happens every year, we expect to see it. There are lots of people who
develop these things.
By contrast, I think that we have to remember that very few people have
developed anthrax. There has been an awful lot of attention on the cases,
but the bottom line is that there have been few cases, and these cases
generally have occurred in a limited number of communities within a limited
number of groups. And so the message for the epidemiologic information is
that anthrax really has not been diagnosed in most parts of the country,
whereas we expect to see millions and millions and millions of flu cases all
over the place.
MS. MECKLER: But let's assume that you have a doctor in New York or
Washington. Right now we have somebody who died this morning from it
[inaudible] somebody who wasn't a postal worker and, you know, she had
anthrax. I mean how do you--what do you tell a doctor to tell a patient who
thinks they are the next person just like that person?
DR. FUKUDA: Well, I think when you get the individuals and get sort of like
the clinical cases, I think that one of the more helpful things to remember
is that among the cases that--of anthrax that have been seen so far, you
know, these cases have not presented with rhinitis or a runny nose. And
whereas when people develop the common cold, having a runny nose is really
is a very common symptom. And so again, one of the things for physicians to
look out for and to tell their patients when they talk with them on the
phone or see them, you know, if you're developing something which feels like
a cold and you have a runny nose, you know, this is very likely to be the
MS. MECKLER: Have you heard from doctors who are facing this dilemma? I mean
is that something that you guys hear from?
DR. FUKUDA: Sure. We hear from lots of people all over the country, both
physicians and state health departments, and --
MS. MECKLER: What are they telling you? What are they saying?
DR. FUKUDA: Everyone is wrestling with this issue, and people are looking
for ways, you know, how do we tell the differences between these cases? And
there are a couple of other things which are helpful.
You know, there are--are some tests, rapid tests which can be done to
distinguish influenza cases in some instances. These are tests which can
give you an answer in about 15 to 30 minutes, so they can be useful in
doctors' offices. These tests are commercially available.
But in pointing that out, I also want to point out that these tests are not
appropriate for every patient. Sometimes they overdiagnose infections,
sometimes they underdiagnose infections, and they generally have to be used
within a few days of when people get sick.
And so I think like any other medical test out there, you know, there are
some patients for whom the tests are appropriate and many other patients for
whom they are not appropriate.
The bottom line is that it's a difficult--difficult issue to sort of wrestle
through but, you know, we sort of have to use common sense in this kind of
problem. The common-sense things tell us that for most people in most places
in the country, the vast likelihood is that we are going to be dealing with
colds or influenza.
It is true, though, that in certain situations--you know, for example, if
you were a physician in New York City, you have a patient who is a postal
worker, then we have to think about that person differently. You know, we
take them in the epidemiologic context, and we might treat that patient
differently and be more aggressive about the work-ups and think about the
And I so think--
MS. MECKLER: Although isn't that changing? I mean aren't we less confident
to rely on that, given the most recent case?
DR. FUKUDA: Well, you know, I think that right now we are pretty early on,
we are learning about the epidemiologic information, and I think that as we
get more epidemiologic information and we understand the sort of spectrum of
how the anthrax cases can appear, then understanding of how to approach
patients will change.
You know, we did that with the HIV epidemic, for example. And I think that
our understanding of things will evolve. But this is where we are right now.
MS. MECKLER: The last thing, do you think that given the anthrax scare, it's
even more important for people to get the flu shot this year so that it
reduces the pool of potential really scared people about anthrax?
DR. FUKUDA: Again, I think that--
MS. MECKLER: I mean I know it's important every year, but is it particularly
DR. FUKUDA: Again, I want to very clearly make--get across the message that
we're trying to point out that--the first group of people that we're most
concerned to get vaccine into are those people who are at high risk of
serious complications for influenza. And then there are other people who
should be getting--
MS. : [inaudible].
DR. SAKUDA: You know, these are people who are in the 50 to 64-year-old age
group, the groups of people who are in contact with high-risk people. But
we're not telling people to just indiscriminately go out and get vaccinated.
CDC MODERATOR: I'm gonna have to move on.
MS. : Okay.
CDC MODERATOR: We have several callers. Thank you.
AT&T MODERATOR: We next will go to the line of Shankar Vendatum [ph] of
Washington Post. Go ahead.
MR. : Dr. Sakuda, thanks for doing this press conference; appreciate it.
I have another question that's sort of related to the concern over anthrax.
You'd mentioned a little while ago that the flu shot does not protect people
a 100 percent from the flu and that there are a number of other viruses that
produce flu-like symptoms, that are not the flu.
Would you be able to tell us what proportion of flu-like symptoms are
because of the flu and what proportion of flu victims are likely not to get
the flu because of taking a vaccine, and, in other words, would this
subgroup of people then be reassured about anthrax concerns because of
getting a flu shot? And I have a second question after that.
DR. SAKUDA: Okay. The flu vaccine can be up to about 70 or 90 percent
protective against influenza and so that means that in a good year, when
there's a good match between a vaccine and the circulating viruses, if the
person has a pretty good immune system, vaccine can be very protective, but
not a 100 percent protective, and so some people who have gotten vaccines
still can go on to get influenza infection.
Now the second thing is that if we look at all influenza-like illnesses
during the year, flu-like illnesses that happen, less than half of those
will be due to influenza viruses themselves.
A minority will be due to influenza viruses and a majority of those
influenza-like illnesses will be due to other viruses.
Now I think that when people get vaccinated against influenza, they have
decreased their chances for getting flu, but they can also still get
infected by these other viruses.
You know, they can get infected by cold viruses, and so, you know, I think
that we want to separate the idea that getting vaccinated increases or
decreases your chances or your worries about getting anthrax. These are just
two separate issues and we really don't want to mix them up. I think that
would be unhelpful to people out there.
MR. : Just to follow up on that issue, Dr. Sakuda. You did say that the flu
vaccine is gonna protect against some proportion of people with flu-like
symptoms, in other words, the people who actually influenza. Wouldn't that
subgroup then be reassured about not having anthrax?
DR. SAKUDA: No. What they will have done is they will have decreased their
chances for getting influenza but it won't have affected any of their
chances either for getting anthrax or not getting anthrax. They're just two
completely separate issues.
MR. : Okay. You had talked about seeing, a doctor in New York City seeing a
patient who's a postal worker, somewhat differently than the doctor who's
seeing some, another kind of patient.
Wouldn't that same concern sort of be applicable, you know, perhaps to
everyone in New York or everyone in Washington where anthrax spores have
been found in dozens of places.
I mean, isn't that, from an epidemiological perspective, isn't that concern
DR. SAKUDA: Yeah. I used the example of a doctor seeing a postal worker. New
York City is I think a good example of someone that we would agree, would
look at different. But, again, I agree with you that we should take the
epidemiologic information into consideration, and in places where anthrax
cases have appeared, then I think the physicians will be looking at their
patients somewhat--and I think that's entirely appropriate; makes sense.
CDC MODERATOR: Thank you, sir. The next caller, please.
AT&T MODERATOR: That'll be from the line of Gina Collata [ph] with New York
Times. Go ahead, please.
MS. : Hi. Thank you very much for taking my questions.
I was wondering about the flu vaccine. You had said that there's a delay
this year compared to previous years. Why is there a delay, and then I was
wondering if you could also tell us how many companies are making it and how
does that compare to previously? And you said there's more this year than
ever but I was wondering how much more.
DR. SAKUDA: Okay, Gina, good question. This year we're gonna be having about
85 million doses of vaccine distributed by about mid December, and so in
last year, we had about 70 million doses of vaccine, and in the year before
that, we had almost 77 million doses of vaccine come out, and if you look at
the amount of vaccine that's been distributed in the U.S. over the past two
decades, you know, there's sort of been an increasing curve of vaccine and
85 million doses is clearly the most that we've had distributed before.
MS. : Why is there a delay in getting it going this year? Why are you--for
example, you mentioned that until November, which I guess starts tomorrow,
you wanted to have--you would like to see the vaccine distribution
restricted [inaudible] very highest risk.
Why don't we have it earlier?
DR. SAKUDA: You know, compared with last year we're down one manufacturer.
MS. : Which one is that?
DR. SAKUDA: Parkdale is no longer producing influenza vaccine for
distribution in the U.S. and so that means that we're left with three
manufacturers, and one of--
MS. : And who are the three?
DR. SAKUDA: The three that are left are Wyeth Lederle, Aventis Pasteur, and
MS. : Okay.
DR. SAKUDA: And basically these companies are really having to ratchet up
production, increase production, sort of change their vaccine manufacturing
capacity to try to make up for the vaccine, and in doing so, they're
actually able to go and produce more vaccine than they have in the past but
it's taken a fair amount a time and effort to ratchet up the vaccine
production, and so, you know, that's really been the major reason for the
delay in getting the vaccine out this year, but it also is--you know, that
effort is what's leading us to have more vaccine than we've had available in
MS. : But it sounds like the message you've been giving out is that people
who are not in these high-risk groups should not have the vaccine, at least
DR. SAKUDA: Well, the message that's gone out is that because we're having a
delay, should take that early vaccine and get it to the people who need it
the most, the high-risk people, and now as we're entering into November and
December and there's been vaccination efforts focused on the high-risk
people, we're saying that, you know, vaccine is now--you know, much more
vaccine is gonna be available for other people. So continue your efforts to
vaccinate the high-risk people, but it can, you know, the efforts can be
broadened to include these other groups.
CDC MODERATOR: Thank you, Gina. Next caller, please.
AT&T MODERATOR: That'll be from the line of Tom Corwin [ph] with the Augusta
Chronicle. Go ahead, please.
MR. CORWIN: Thank you, Dr. Sakuda. Have you offered a prediction on what
sort of flu season we can expect and also is the delay due to the problems
with Wyeth-Ayerst in their Marietta, Pennsylvania plant?
DR. SAKUDA: Boy, Tom, every year I get asked about making a prediction and I
always give the same answer which is no. I mean, it's just--flu is one of
those really unpredictable diseases, where, if you make a prediction you've
just got such a good chance for being wrong. So no, we're not predicting
what kind of year it's going to be.
The basis for the vaccine distribution delay again has been, you know, due
to the efforts of the industry to ramp up their production capacity. I
really can't speak to individual plants. I really don't know about the
issues at individual plants.
AT&T MODERATOR: Next we go to the line of Jonathan Bore with Baltimore Sun.
Go ahead, please.
MR. BORE: Hi, thanks for taking my call. I'm going to do this in two parts,
so if you can come back to me, I would appreciate it.
In spelling out the various tiers of people who should get vaccinated, you
don't seem to be mentioning young healthy people, and as you look around us,
employers and even grocery stores are offering vaccine to all comers. Are
you specifically not recommending that young health people get vaccinated?
DR. FUKUDA: No. We're not--we're not specifically recommending against that
group to get vaccinated, but the--you know, the philosophy that the Advisory
Committee on Immunization Practices and the CDC has had for a long time is
that again there are certain groups of people who are at high risk for
complications, and they're that people who are most likely to get seriously
ill if they get infected by flu viruses, and so let's protect that group of
people. I mean, that's been the overriding philosophy for many, many years,
and that continues.
However, it's--you know, there is also a quite permissive element to the CDC
and ACIP recommendations, and, you know, many people who do not fit into
those categories also wish to avoid getting influenza, and so, you know, I
think that for anybody who wants to avoid getting flu, including healthy
young people, then, you know, we think that you should consider getting
vaccinated against the flu, but I want to make the distinction that, you
know, we really focus on those people who are most likely to get sick, and
then we are not specifically recommending that anybody else avoid getting
MR. BORE: Okay, thank you. The other question, actually, has a major anthrax
tie in. A lot of us are wondering what--in the anthrax arena--why some
people might be getting anthrax, whereas others don't, whether there are
differences in susceptibility that have to do with genetics or biology or
ongoing health conditions. I'm wondering if there's anything about flu
susceptibility that might shed light on the anthrax question?
DR. FUKUDA: Those are pretty difficult questions, and I'll really have to
defer on the anthrax side. You know, I'm not an anthrax specialist and I
can't really answer those things, and I think that--but just speaking
generally again, you know, we have a limited amount of experience with the
anthrax cases, and so I think that it's very difficult right now to say to
what extent the experience with other infectious diseases applies directly
to the anthrax cases right now.
AT&T MODERATOR: Next we go to the line of Robert Cook with Newsday. Please
MR. COOK: Every year or every few years it seems we get a new flu coming out
of Asia. Is there any hint of anything on the horizon we're going to get a
new bug coming through?
DR. FUKUDA: Well, we watch pretty carefully for new viruses coming out.
There's an extensive global network of laboratories maintained by the World
Health Organization. There are probably about 140 laboratories in the United
States that participate in that effort in addition to CDC, and so lots of
laboratories looking for those new viruses.
So far we have just a limited number of viruses on the scene in the United
States, and we don't have--we don't have any new viruses yet that are
looming as the next new big virus, but we're certainly keeping an eye out
MR. COOK: The Asia A has been around for, what, 5 or 10 years or something
DR. FUKUDA: Well, I'm not sure what you mean by the Asia A. There are
Influenza-AH3N2 virus. There are Influenza-AH1N1 viruses. And, you know,
these viruses continually evolve. They mutate and form into new strains, and
every once in a while one of the new strains tends to become one of the
dominant viruses circulating in the world.
MR. COOK: Well, the woman that gave me my flu shot yesterday said that this
was a 5-year-old vaccine or 5-year-old strain is why I raised that. It's a
well-known strain that we're combatting this year then?
DR. FUKUDA: Yeah. Again, as I mentioned early in the program, we only have a
limited number of viruses that have been identified so far in the U.S., but
of the ones that have been identified and looked at carefully, you know, the
match with the viruses and the vaccine is pretty good.
The vaccine for the United States is formulated every year, so there's a
selection process where, you know, there's a decision made as to what goes
into the vaccine, and that's done every year in the United States.
MR. COOK: All right, thank you.
AT&T MODERATOR: And next we will go to the line of Mary Ellen Butler with
U.S. Medicine. Go ahead, please.
MS. BUTLER: I just had a quick question just about whether or not demand for
flu vaccine is rising and doctors around the country are having to tell
maybe younger healthier people to come back in later weeks. Is that part of
why you're stressing these recommendations now?
DR. FUKUDA: Well, I think that, Mary, if you look over the long run,
influenza vaccine demand in the country has clearly risen, and this is
particularly true over the last decade or so, and I think that demand for
vaccine will probably continue to increase, and this is true both among
people who--the groups of people who have high-risk conditions, and also
among healthy people, that population.
But, you know, again, the recommendations that we're stressing, you know, to
really focus on high-risk people, that's really driven by the fact that
they're the ones who are most vulnerable, and the strategy for focusing on
that group of people first, and then widening the group of people for whom
vaccine is recommended as we head into November and December, is driven by
the fact that we had a vaccine delay to deal with this year. And so it's
really to deal both with that delay and also to make sure that we cover the
most vulnerable population.
MS. BUTLER: Okay, thanks.
AT&T MODERATOR: We have a question in queue from the line of A.J. Hostettler
with Richmond Times Dispatch. Go ahead, please.
MS. HOSTETTLER: Hi, Dr. Fukuda. Last year we saw a lot--got reports of
doctors all over the country who couldn't get flu vaccine at all, even for
high-risk patients, and there were a lot of reports about price gouging.
This year there are already reports of physicians who are unable, and
telling their patients that they're not going to get any vaccine at all.
What is the CDC doing to try to match physicians with available supply, and
is the CDC going to use its influence to try to prevent the price gouging
that we saw last year?
DR. FUKUDA: Well, there's been a tremendous amount of work done over the
past year, I can really say actually over the past two years now, you know,
because of the delay last year and the delay this year, and so again, a huge
amount of work has gone on behind the scenes with CDC and other federal
agencies working with the manufacturers, distributors, various medical
organizations, physicians, state health departments and so on to come up
with ways to deal with the vaccine delays to get the message out there that,
you know, we really need to focus on vaccinating these high-risk people.
So I think this year we have a delay situation which is moderate. You know,
certainly less severe than the delay situation that we had last year. And I
think that it's clear that there are still physicians and vaccine providers
who are having difficulty getting vaccine, or vaccine has not gotten to them
yet. But I think that the message, and what we're hearing is that the delay
is less severe than last year, and that--you know, the message we want to
get out to people again is that there's a lot more vaccine coming out in
November, and there's a lot more vaccine coming out in December, and so
that, you know, physicians--you know, we should have plenty of vaccine for
Again, we're going to have a lot more vaccine available in previous years,
and more vaccine is coming out this month and next month, and so I think
that everyone's working pretty hard. I can certainly say that on the federal
side, and we're working with the manufacturers closely this year. I know
that they've been very cognizant of the problems caused by the delays and
that they've also been working very hard to try to get at least some vaccine
out to all of the docs out there.
MS. : What about the issue of price gouging from the distribution--
DR. FUKUDA: There have been reports of price gouging. You know, it's--it's a
complicated distribution system. You know, the vaccine manufacturers
some--sell some of their vaccine directly to physicians, but they also sell
some of the vaccine to distributors and then distributors sell it to other
distributors. It's a complicated system, and it's clear that there have been
reports of price gouging that have occurred this year. And, clearly, some
people are having to buy vaccine at inflated prices. And this is--this is a
practice that all of us have worked pretty hard to discouraged. But, again,
it's a private market system out there, and CDC doesn't have any direct
control over how much the vaccine costs or what people can sell prices at.
We have worked very hard, again, behind the scenes, to get the word out to
people that we would strongly discourage that kind of practice. But it is a
free market system.
MS. : Thank you.
AT&T MODERATOR: Next we go to the line, Anita Manning with USA Today. Go
MS. MANNING: Thank you very much for taking the call. Keiji, is the CDC
going to do anything to help clinics and physicians who may have smaller
practices afford some of the rapid flu diagnostic kits that you mentioned?
And the second part of my question, which is sort of an entirely different
question, is: How is this flu season--I know you won't predict how this flu
season will be, but can you say how it's comparing with the previous seasons
in terms of the amount of disease at this point in time compared to last
DR. FUKUDA: You know, Anita, I--I'd have to go back and look at previous
seasons. But, you know, as you know, the influenza seasons are so widely
variable. And this is--this is very early. This is October. And typically we
don't see activity begin to pick up until November or December. But, again,
in some years, activity can not pick up until we get in January or February.
And it's just so unpredictable.
So I think at this point it's very hard to say whether this season looks
late or early compared to other years. It's simply so early that we wouldn't
in most years expect to see appreciable flu activity now.
In terms of the first question that you asked, I don't know of any--of any
plans for federal purchase of these kinds of kits for--for physicians'
offices. And I think that one thing that we will try to do is provide as
good information as possible about these kits and their use. But no plans to
purchase kits for private offices.
MS. MANNING: How extensive are they? Can you characterize that for us?
DR. FUKUDA: Again, generally, the kits are priced so that a test costs about
$15 to $20, and most of these kits are set up so that they have about 20
tests per kit. But, again, you know, the prices vary by manufacturer, and a
person would have to call the individual companies to find out the exact
MS. MANNING: Thank you.
AT&T MODERATOR: And next we go to the line, Robert Hagar from NBC News. Go
MR. HAGAR: Dr. Fukuda, is there any concern that the demand could be
exacerbated by the thing that you've been talking about, we all have the
issue that--that you're kind of keeping in check that people have the notion
that it might be important to get a flu shot to avoid confusion if they
present with signs and they've got anthrax. So is there any worry on your
part that that could make demand worse?
DR. FUKUDA: Sure. I mean, you know, I think that, again, I recognize by
reading the various newspaper reports and listening to the radio and so on
that there have been mixed messages going out, and--and people are quite
confused about--about the issues. And when people become confused, you know,
they can, you know, go to--go to clinics to find out from their doctors
about what's going on, and that this can increase the number of visits and
put a lot of pressure on--on physicians and health care systems. And so I
think that, you know, we want to work really closely with--with the various
news agencies to make sure that--you know, we get out a
reasonable--reasonable message out there that--that people, you know, really
need to use common sense when thinking about these flu-like illnesses, and,
you know, hopefully we can calm some of the fears out there.
MR. HAGAR: A second question. You've chosen your words very carefully that
you want people to take the flu shots to avoid the flu. I'm wondering about
the high-risk groups. I heard the Postmaster General get asked at the
hearing yesterday, as Senators were saying, well, shouldn't all postal
people get flu shots. And he said, well, he was asking the CDC for guidance,
that maybe they should, and my own organization, NBC, because of our risk,
personnel people are saying get the flu shot. But do you discourage that
sort of thing? I mean, it surely sounds like what you're trying to do.
DR. FUKUDA: No. Let me clarify that to--again, you know, the longstanding
recommendation and push for vaccinating people by CDC has really focused on
those people who are at high risk for complications. I mean, I've said this
several times, and I've said it because it's such an important message to
get out there. But, you know, one of the other things that CDC and the
Advisory Committee on Immunization Practices has pointed out and said in its
recommendations for many years, that for people who wish to avoid influenza,
and also for those groups of people that perform essential community
services, that if those people wish to avoid influenza and its disruption,
then, you know, flu vaccine ought to be considered.
So I think that when we look at the postal workers, for example, you know,
this is a group of people who has, you know, really suffered from--from the
whole anthrax episode. They clearly perform essential services for the
country. So I think that if the Postal Service wants to go ahead and
recommend influenza vaccine for its staff and workers, then, you know, this
is an action that CDC would support.
MR. HAGAR: Okay. Thanks very much.
DR. FUKUDA: Sure.
AT&T MODERATOR: Our next question comes on the line, Victoria Elliott from
American Medical News. Go ahead, please.
MS. ELLIOTT: Yes, hi. I was wondering if you had any concern about
physicians not being able to prioritize their patients, because there have
been some surveys done by the AMA where physicians said that they really
didn't know how to prioritize their patients, you know, to get the flu
DR. FUKUDA: Well, I think that, you know, the--the failure to be able to
prioritize, you know, reflects a couple different things. I think one of
them is that, you know, patient offices or physician offices are just so
busy and they have to deal with so many patients. But the other thing is
that I think that, you know, we just need to get the--high risk and who
ought to get vaccinated, and I think that we can do a better job of getting
that message out there. But I think that, you know, the groups of people
that are at high risk, these are reasonably easy people to identify. These
are people who have chronic medical conditions. These are people who are
elderly, but the role that we have is to try to get that message out there.
MS. : Do you have any tips on how to target the high-risk people?
DR. FUKUDA: Within physicians' offices or you mean more broadly?
MS. : Yes, within physicians' offices and then more broadly.
DR. FUKUDA: Well, I think more broadly, one, I think that, you know, the
media is an invaluable group of people for getting that message out there. I
think that if you can help to identify in your articles, you know, who is at
high risk, and again I'll clarify that. These are elderly people, 65 years
and above. These are people who have certain chronic medical conditions,
particularly heart and lung conditions. These are people who have other
conditions like diabetes, immunodeficiency diseases, pregnant woman who are
going to be in the second and third trimester of pregnancy. These are
younger people such as children who have conditions such as asthma, you
know, that this is the group of people who ought to be getting vaccine under
I think you guys can do a really invaluable service by getting that
information out there. I think that within physicians' offices, you know,
there are a variety of ways, and they can contact CDC for help on some of
those ways. For example, the National Immunization Program has done a good
job of identifying ways in which high-risk patients can be identified. But I
think that by using, you know, computerized medical records and so on,
offices can set themselves up so that they can identify high-risk patients
within their practices.
CDC MODERATOR: We have time for one more question.
AT&T MODERATOR: Thank you, and that will be from the line of Frank James of
the Chicago Tribune. Go ahead, please.
MR. JAMES: Yes, hi there. I know that it's still fairly early in the flu
season, but I wanted to ask if there have been any deaths, you've had any
deaths that have come in that have been related to flu.
And, also, we can expect that there will be thousands of deaths this year,
if this year is like past years when it comes to the flu, but I'm wondering
what is the CDC going to do to make sure that the deaths that we see, the
thousands of deaths definitively from flu and that there aren't anthrax
deaths that were in those numbers?
DR. FUKUDA: Well, let me talk about the first part of your question first,
in terms of deaths. We don't monitor individual deaths. What we do is look
at sort of the overall picture in the country, and so at this point I can't
tell you definitively whether anyone has died from influenza or not. I don't
have that information.
In terms of what CDC or how we figure out whether there are anthrax deaths
occurring among those influenza statistics, you know, this is what the
medical system does. There are an extremely good group of physicians out
there, and they are the ones who see the individual cases, and they are the
ones who make the diagnosis of whether we're dealing with influenza or we're
dealing with anthrax or we're dealing with some other respiratory diseases.
And so, you know, it's that group of physicians out there that have
identified the cases that we know of so far, and they are the ones who are
largely going to be doing the real work for distinguishing between anthrax
deaths and deaths from other causes.
MR. JAMES: I'm just wondering, if I can follow up, what the likelihood is of
physicians in some instances being mistaken and calling, scoring some deaths
of flu deaths when they could be anthrax deaths? I'm just, again, I'm
hypothesizing that there will be thousands of deaths going forward from flu,
right? And so I imagine that, again, this could be a problem, but maybe it's
not going to be a problem. But I'm just wondering, again, can you speak
to--if I can follow up what the likelihood is of--it would depend on the
level of the work-up that a physician would do, wouldn't it?
DR. FUKUDA: I mean I really can't speak to the probability right now. I mean
all I can say is that we have had a small handful of deaths from anthrax and
then, you know, in a typical year we will expect to see a large deaths
associated with influenza, but again, you know, we have limited information
on the anthrax situation, and so it's very difficult to give you any kind of
MR. : To date, there have been no deaths from flu, though, is what you're
DR. FUKUDA: I don't know of deaths from flu, but again, we don't monitor
individual deaths. What we do is look at death statistics and aggregate.
MR. : Well, that's what I mean. I mean that's what I'm talking about. So
there have been--when you look at the statistics, there have been--again,
there's no--have you had any deaths from flu so far in this flu season?
DR. FUKUDA: Well, again, you know--
MR. : Again, looking at the aggregate. I mean--
DR. FUKUDA: What we do is that we look at the death data which comes in from
a large group of offices in the country that report vital statistics.
MR. : Right.
DR. FUKUDA: That's for the country. And then we look at the number--you
know, we sort of estimate what number of deaths we expect to happen, and
then when we have more deaths occurring and we know that there are influenza
viruses circulating, then what we are able to tell is that there is an
increase in deaths that are associated with influenza.
So, again, we don't follow individual deaths.
MR. : Right.
DR. FUKUDA: And we don't call up doctors' offices and find out which people
have died in their offices and so on, so it's very difficult to sort of
answer the question in the way you're asking it.
MR. : Well, again, I understand you don't follow individual deaths. I'm
asking about an aggregate.
DR. FUKUDA: No, on the aggregate, what I can tell you is that there has not
been an increase in deaths. There has not been--you know, we have not gone
above that sort of expected threshold of deaths.
MR. : Okay. So there have been flu-related deaths so far in this flu season,
which is still early, but there--
DR. FUKUDA: Again, let me make sure you get this straight. As we go into the
year, we have a sort of baseline number of people who we expect to die from
pneumonia and those kinds of deaths. And then during the year, when we see
influenza viruses, we frequently see that number of people dying from
pneumonia and influenza-related causes to increase above that baseline.
MR. : Okay.
DR. FUKUDA: And so far we have not seen an increase in those deaths above
MR. : Okay.
DR. FUKUDA: Okay.
CDC MODERATOR: Thank you all for being on the telebriefing. The transcript
from this conversation will be available online later this afternoon. Just
go to www.cdc.gov and click on "In The News."
AT&T MODERATOR: And, ladies and gentlemen, that does conclude your
conference call for today. Thank you for your participation and for using
AT&T's Executive Teleconference Service. You may now disconnect.