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CDC Telebriefing Transcript

Microbial Threats to Health - Institute of Medicine (IOM) Report

March 18, 2003

CDC MODERATOR: Thank you, Mary Sue. Welcome, everyone, and thanks very much for joining us. Today we're going to discuss this week's Institute of Medicine Report on Microbial Threats to Health. Online with us to discuss the report is Dr. James Hughes. I’ll spell: J-a-m-e-s,
H-u-g-h-e-s. He's an Assistant Surgeon General and Director of the CDC's National Center for Infectious Diseases. We'll begin with a short statement by Dr. Hughes and follow with questions and answers.

At this time I'd like to introduce Dr. Hughes.

DR. HUGHES: Thank you, Dave. Good afternoon, everyone. Thank you very much for joining this call.

I'd like to take a few minutes and give you an overview of this very important Institute of Medicine report that has been released today. This is a follow-up to a 1992 report that the Institute of Medicine issued that was called "Emerging Infections: Microbial Threats to Health in the United States." That was really a landmark report, and I want to just hit a highlight or two of it before we turn to the current report.

That report highlighted the complacency that had developed in the United States and in many other developed countries regarding infectious diseases as having been largely controlled. As a result, that report pointed out that the public health systems at the local, state, national, and global level required to address and control infectious diseases had been allowed to deteriorate. And the committee felt that it was critical that those systems be rebuilt.

The timing of the publication of that report in the fall of 1992 was uncanny because within eight months of its publication, the country encountered a multi-state foodborne outbreak of disease caused by an emerging foodborne pathogen, E. Coli 0157:H7, related to a commercial food establishment; a huge waterborne outbreak of cryptosporidiosis in Milwaukee, with over 400,000 cases; and then shortly after that the recognition of what is now known as hantavirus pulmonary syndrome that was recognized initially in the Southwestern part of the United States.

The committee made a number of recommendations at that time, 15 in total. Many of these were directed at us at CDC. We took that report very seriously, developed an emerging infections strategy for CDC, and have been working with many partners at the local, state, national, and global level to implement that strategy over the past ten years.

We've made some progress, and I think the current IOM report points that out. But at the same time, this report issued today emphasizes the fact that much work remains to be done.

More recently, substantial investments in public health capacity to detect and respond to bioterrorism threat agents have been provided to local and state and other federal partners. These investments in bioterrorism preparedness complement those that are being made to strengthen the capacity to deal with emerging and re-emerging naturally occurring infectious diseases.

Now, the report that's issued today, let me make a few comments about it. You'll notice that the title is different. It's "Microbial Threats to Health: Emergence, Detection, and Response." You might wonder how is this report different than the 1992 report? On a quick review of the report, I think it's different in a number of ways.

It goes beyond the concept of emerging infections. It talks about other global microbial threats: the HIV pandemic, tuberculosis, and malaria, in particular. The report's scope is much more global than the 1992 report, which was primarily focused on U.S. capacity. The current report provides many reminders of the fact that we live in a global village and emphasizes the fact that infectious diseases, both naturally occurring and those resulting from bioterrorism, are a potential threat to national security.

The report puts considerable emphasis on antimicrobial resistance, which is even more of a challenge today than it was in 1992. It puts substantial emphasis on vector-borne and zoonotic disease. It highlights the experience with West Nile virus infection in the country since 1999, and as you know, the virus this past year has spread to a total of 44 states.

Another important aspect of this current report is the emphasis it puts on the role that microbes play in chronic diseases. We've come to recognize a number of examples of that over the years. I think the future holds recognition of more. And this is important because of the prevention opportunities that will be provided.

Another important aspect of the report is a discussion of the factors that contribute to infectious disease emergence and re-emergence. The original report had six factors. This one actually has 13. I'll mention just a couple of the new ones, the role of poverty, the role of climate and weather, the role that war and famine can play in dissemination of infectious diseases, and the importance of mounting political will to confront these threats.

Another important aspect of this report is the emphasis it puts on strengthening the linkages between the world of clinical medicine and the world of public health. And, equally importantly, this report puts considerable emphasis on the need to increase linkages between the worlds of human medicine and public health, on the one hand, and veterinary medicine and public health, on the other hand.

If you take a close look at this report, you'll see it contains 21 recommendations. About two-thirds of those are directed in whole or in part at CDC. And as you look at these recommendations, I would ask you to think about them in the context of the problem that we're currently confronting, the severe acute respiratory syndrome, or SARS, that you are all familiar with. WHO, as you know, is leading an international effort, of which CDC is a member, to address this threat. But this current ongoing experience drives home in spades the importance of the recommendations made in this report.

When you look at the specific recommendations, you'll see that they start with an emphasis on strengthening global response capacity and strengthening global infectious disease surveillance capacity. The remaining recommendations deal a good bit with domestic issues. They emphasize the importance of strengthening surveillance systems in the United States at the local, state, and national level. They point out the need for rapid diagnostic test development, the issues related to having available antibiotics to treat the broad range of infectious diseases in the face of antimicrobial resistance that continues to emerge. They emphasize the need for development of new vaccines and increasing supplies of existing vaccines. And they place considerable emphasis on the importance of continuing efforts to improve antimicrobial usage.

The report highlights the need to train the next generation of scientists, clinicians, and public health officials to ensure that we have the broad range of skills that are required to deal with these complex challenges. It emphasizes the need for a research agenda around emerging and re-emerging infectious diseases. It stresses the importance of communication. And the last recommendation is one that I would call to your attention because it calls for creation of interdisciplinary centers of excellence for infectious diseases, which the committee envisions as academically based centers drawing together people from academia and public health, but across a broad range of disciplines.

In closing, I'd like to say at CDC and for the Department of Health and Human Services we welcome publication of this report. We think we have an unprecedented opportunity in the country right now to continue to rebuild the systems required to deal with infectious diseases.

We see this report as a call to action. We well know that we need to continue to be prepared to confront the unexpected, and this experience with SARS is just the most recent wake-up call in that regard.

We will be moving forward to develop an updated CDC infectious disease strategy based on the recommendations in this report, and we will do this with other federal, state, and local partners, including a broad range of professional societies and in collaboration with the World Health Organization.

So I'd like to thank you for your attention, and I think we're ready for questions.

CDC MODERATOR: Thank you, Dr. Hughes.

Mary Sue, at this time we'd like to open it up for questions and answers. We'd ask that you identify yourself and your organization.

AT&T OPERATOR: And, ladies and gentlemen, if you wish to ask a question, please press the 1 on your touch-tone phone. You will hear a tone indicating that you've been placed in queue.

If you pressed 1 prior to this announcement, we ask that you please do so again at this time. You may remove yourself from queue at any time by pressing the pound key. If you are using a speakerphone, please pick up the handset before pressing the number.

Once again, if you have a question, please press the 1 at this time. And our first question comes from Amanda Spake with U.S. News and World Report. Please go ahead.

QUESTION: Hi, Dr. Hughes. This is Amanda Spake from U.S. News and World Report. My question concerns an emerging problem that is actually not SARS. It's MRSA, which seems to have moved in the community or into some communities. I know this is an issue that CDC has been following, and I wonder if you could comment a little bit about how that particular organism has jumped from hospitals to the community and how this report would relate to curbing the spread of that organism.

DR. HUGHES: Amanda, thank you very much for raising that very important issue. As I mentioned, the report places considerable emphasis on the continuing threat posed by emerging resistance to antibiotics. We've seen this threat in both health care and community settings.

As you know, MRSA for a number of years has been a problem in health care settings. In recent years, and particularly now in recent months, we've seen a number of clusters of infection of what we're calling community onset MRSA infection, and these are occurring in a variety of settings quite widely around the country.

It's another wake-up call in terms of the continuing threat that drug-resistant organisms pose and a reminder of the threat--of the need to continue to develop a broader range of antimicrobials.

Now, fortunately, these community onset MRSA strains are susceptible to a number of currently available antibiotics. But we're working with state and local public health partners in an effort to get these diseases made reportable so that we can monitor them better. It starts with good, timely surveillance, a reminder of the need to use antimicrobials appropriately. It's very much of a reminder of the need to be sure that clinical and public health laboratories are using appropriate techniques for the detection of methicillin-resistant strains.

It's very important, and certainly I haven't had a chance to read word for word the entire report, so I'm not sure if this specific issue is addressed in there or not. But certainly the concept is.

QUESTION: Right. Thank you.

CDC MODERATOR: Thank you, Amanda.

Next question, please?

AT&T OPERATOR: Our next question comes from Larry Altman with the New York Times. Please go ahead.

QUESTION: Jim, I came into this late so I didn't hear the beginning of your discussion, but can you relate the findings being reported this morning about paramyxoviruses and how this report might influence on it?

DR. HUGHES: Hi, Larry. Thanks for the question. Sorry you missed the opening statement. I really focused on the content of this Institute of Medicine report that was issued today, but I did mention SARS in the course of the discussion, and I suggested to people that as they look at this report, they ought to keep this ongoing experience with SARS in mind because the report speaks to it quite well, although obviously the committee couldn't have anticipated this as they put the report together beyond their urging for us all to continue to expect the unexpected.

The SARS experience reinforces the need to strengthen global surveillance, to have prompt reporting, to have it linked to adequate and sophisticated, if necessary, diagnostic laboratory capacity. It's a reminder that we need better capacities to move diagnostic specimens from remote settings where these diseases often appear to get them to reference laboratories.

There are a number of labs around the world now working with specimens from patients, and, you know, we're anxious to get a number of additional specimens shipped here to CDC for work.

I can't comment on the details of the German investigation of the patients--the individuals that were taken off the plane in Frankfurt. We don't have any specimens here from those patients.

QUESTION: But is it--if it were paramyxo, can you speak to that in terms of the report, or a member of the paramyxo family?

DR. HUGHES: Yeah, I mean, we have a long list of organisms in the differential diagnosis, including a number of paramyxoviruses. So, I mean, they certainly are candidates to be potentially involved in this, and we're going to be following with interest the results of the German investigation, and we'll be offering assistance to them if they feel they need it.



Next question, please.

AT&T OPERATOR: Our next question comes from Miriam Falco with CNN. Please go ahead.

QUESTION: Hi, Dr. Hughes. Bouncing off of what Larry just asked, I know that your comments are mainly directed toward the IOM report. But since you did bring up SARS, number one, can you tell me how many suspected cases there are in the U.S. right now? I understand the number may have gone down. And, also, can you tell me if any other labs outside of Germany have found the paramyxovirus in their specimens?

DR. HUGHES: Okay. Let me give you today's case counts from both WHO and CDC. I somehow thought this might come up.


DR. HUGHES: No, that's all right. That's all right. That's fine.

The WHO case count today is 219, with four deaths, and this is information that is up on their website now.

CDC, the current figures are nine suspected cases. It did decrease from yesterday when you heard the number 14, I believe. I think many of you have followed these outbreak investigations in the past, and you know that the case counts, particularly early on, are a constant moving target because information is coming in, it's being analyzed and followed up on, and we're constantly adding and dropping potential cases, depending on the results of the initial information collection.

QUESTION: And what about other labs who may--outside of Germany that might have found the paramyxovirus?

DR. HUGHES: I'm not aware of other labs that are reporting evidence of paramyxovirus yet. But, again, you know, this is a work in progress, so we all need to stay tuned.

QUESTION: Thank you.

CDC MODERATOR: Thank you, Miriam.

Next question, please.

AT&T OPERATOR: Our next question comes from Maggie Fox with Reuters. Please go ahead.

QUESTION: Hi. Thanks very much for doing this. I want to ask you, in terms of bioterrorism, people are being frightened and might--there's some indications that they're stockpiling their own antibiotics. In view of this report, can you speak to the danger of people doing that and maybe being frightened by the first sniffles and popping an amoxicillin or a ciprofloxacin right away?

DR. HUGHES: Oh, thank you. I hope nobody on the call would do that.

Yeah, that's a very important question, and, again, it takes us back to the report and the emphasis it places on the critical importance of what I think is a global clinical and public health problem, and that is antimicrobial resistance. A lot of that resistance relates to misuse of antimicrobials in humans, and we know that an awful lot of that misuse occurs in the context of upper respiratory tract infection that is most often viral in nature.

We in general discourage people from keeping supplies of antibiotics at home to be used when an illness occurs in an individual or in a family member. Part of our efforts to educate the public about appropriate use of antibiotics includes a suggestion
that people take antibiotics when they're prescribed appropriately, that they be taken for the full duration and that they not be, that people not stop in the middle of a course and sequester drugs for possible future use.

MS. : That advice said, we've also got all these frightening reports saying we don't have enough in the stockpile. I'm sure you saw the P&S [?] projection from Dr. Wein [ph] yesterday saying that if somebody dropped anthrax on New York people would be lined up for too long and people would die waiting for their antibiotics.

Considering that, don't you think it's difficult to convince people not to protect themselves?

DR. HUGHES: Well, we--yes. Thank you for coming back with that. I actually had not seen that estimate or comment.

But we have a national pharmaceutical stockpile that we used in the repose to the anthrax attack. Obviously that wasn't of the magnitude that you're talking about, is something that hopefully won't have to confront.

But we have large amounts of antimicrobial stockpile. We can move those quickly to areas in which they are needed. We would definitely not recommend that people go out and start stocking up on antimicrobials to be kept at home.


CDC MODERATOR: Thank you, Maggie [?]. Next question, please.

AT&T OPERATOR: Our next question comes from John Lowerman with Bloomberg News. Please go ahead.

QUESTION: Hi; thanks for taking my question.

In light of this report, what do you think is most likely to change at CDC, or in the infection control approach, in general?

What did you learn from this report that you would like to put into place?

DR. HUGHES: Well, I think the report really dramatically reinforces the sense that we have that although progress has been made there is much work that remains to be done.

I mean, again, I hate to keep coming back to SARS but I do it because it's such a dramatic example of the importance of global surveillance and response capacity ,ensuring that good working relationships exist between WHO, WHO regional offices, country offices, ministries of health. We have more work to do on that and we are a strong partner of the World Health Organization--

QUESTION: So if that's the case, if you're already a strong partner of the World Health Organization, then what would you like to change? What do you want to do that--what have you learned from this?

DR. HUGHES: Okay. We've learned that we, WHO I think needs better ability to have early access to information on outbreaks or clusters of unexplained illnesses, regardless of where they occur, and it's a reminder of the fact that these infectious diseases, when you first see a cluster, people need to recognize that they, these clusters can have global implications, and this is a dramatic example of that.

I think, you know, we hear the message that we need to continue to work to educate the public and the policy makers about the importance of the U.S. engaging in an aggressive way in helping WHO and other countries improve their infectious disease surveillance and response capacity.

QUESTION: Thank you.

CDC MODERATOR: Thank you, John. Next question, please.

AT&T OPERATOR: Our next question comes from Jeremy Manyea [ph] with Chicago Tribune. Please go ahead.

QUESTION: Thanks very much.

Dr. Hughes, if you could comment maybe on any new methods of infectious disease detective work that you're able to use now with SARS that might be encouraging in the future to deal with, emerging infectious diseases.

I wonder if you could especially comment on the idea of creating databases for local hospitals to track symptoms that might be suspicious, something that I think some people are saying would be especially useful with SARS which does start with some fairly nonspecific symptoms.

DR. HUGHES: Yeah; good. Thank you very much for asking that. The report does put a lot of emphasis on--let's talk domestically now.

It puts a lot of emphasis on improving electronic capture and reporting of data from clinical settings, from laboratory settings and from related settings, where information such as antibiotic use, for example, or use of over-the-counter medications to treat respiratory infections,

All these sorts of data sets might, you know, need to be monitored in a real-time fashion to allow us to detect naturally occurring disease earlier, on the one hand, or disease resulting from bioterrorism.

Actually, as I'm talking, I'm remembering, you know, the way that huge outbreak of cryptosporidosis that occurred in Milwaukee back in 1993, the way that was recognized was the media got ahold of reports that the pharmacies had run out of over-the-counter anti-diarrheal agents.

Now we would, in the current climate we would hope that that wouldn't happen again, but you can imagine, if pharmacy sales were being monitored in a real-time fashion back in Milwaukee in 1993, that outbreak would have been detected much earlier than it was.

There's a lot of discussion about the importance of syndromic surveillance, and in the bioterrorism arena, a lot of work has been done to develop those systems.

The report emphasizes the fact that these innovative approaches need to be rigorously evaluated and they're not going to replace the alert clinician who plays a critical role in early recognition of unusual syndromes as happened in Queens in 1999 with West Nile and as happened in South Florida in October of 2001, where the first inhalational anthrax case was recognized.

QUESTION: Thank you.

CDC MODERATOR: Thank you, Jeremy. Next question, please.

AT&T OPERATOR: Our next question comes from Lee Bowman with Scripps Howard. Please go ahead.

QUESTION: Hi, Dr. Hughes. Thanks for doing this.

The last episode with anthrax and the lessons learned I guess from that, you now are in a situation where you have the Operations Center up to deal with this one situation worldwide, and you're also on a heightened state of alert to possibly be dealing with anything else that might happen domestically here.

Can you talk a little bit about what kind a better shape you might be in to deal with it than in 2001 or in 1999.

DR. HUGHES: Well, we've learned a lot from our West Nile experience and we certainly learned a lot from the experience with the anthrax attack. You saw evidence, last summer, of us working in the emergency response mode to help address the increasingly complex array of challenges that West Nile poses and I'm sure it will continue to pose once transmission begins this year.

Having the emergency operations center in place--now we have a semipermanent one in place--that greatly facilitates our ability to work with partners throughout CDC and our sister agency, the Agency for Toxic Substances and Disease Registry. It greatly facilitates our ability to interact and exchange information with the Department of Homeland Security and with the World Health Organization.

For example, we were on a video conference linkup this morning between CDC and Secretary Thompson's command center in Washington and Dr. Heymann and his colleagues in Geneva.

In terms of lessons, we're well aware of the communications issues that the anthrax attack exposed and that's one of the reasons you see us doing these sorts of telebriefings and press conferences on a much more regular basis, in order to keep you informed so that messages can be provided to the public.

QUESTION: Thank you.

CDC MODERATOR: Thank you. Next question, please.

CDC MODERATOR: Our next question comes from Ann Cairns with The Wall Street Journal. Please go ahead.

QUESTION: Hi, Dr. Hughes. I'm sorry, I'm cutting into the call late, but I wanted to follow up on your comment about alert clinicians and their role in sort of identifying these new infections or new outbreaks, and I'm wondering, in the current SARS investigation, if alert clinicians played a role in sort of the 14 cases that the U.S. had to check out in this, if those came from doctors getting reports from their patients, and just how that played out?

DR. HUGHES: Ann, thank you very much for asking this because it gives me a chance to illustrate how this plays out in the real world.

Some of the investments that we made as a result of implementing the CDC emerging infections strategy that initially responded to the 1992 ILM report, included putting in place some sentinel surveillance networks.

One of those is called Geo Sentinel and it's a worldwide network of travel clinics. There are a number of them in the U.S. and there are a number overseas.

There's one in Toronto, Canada, and that site, in Toronto, played a role in the recognition of the family cluster that you're familiar with, the family cluster of SARS that resulted from the visit of some family members to Asia.

In terms of what we're doing in the U.S., we have several sentinel surveillance networks here, one of them is called the Emerging Infections Network, and we do that in collaboration with the Infectious Diseases Society of America.

We've kept them full informed as the investigation has progressed and I was looking at my e-mail right before I got on this call and I saw a transmission from Dr. Michael Scheld, who's the current president of IDSA, who sent a notice this morning to all IDSA members, including the clinicians in the Emerging Infections Network, providing them with updated information that we provided to him, and providing links to appropriate Web sites.

Beyond that ,we see clinicians as very important partners in surveillance of naturally-occurring and purposely-caused disease. We had a telephone call yesterday with a large number of professional societies that represent clinicians and Dr. Gerberding provided them with updated information as well.

So this is, you know, in terms of another lesson from the anthrax experience, this is one.

QUESTION: Can I just specifically--the Toronto example is great. I'm just wondering if you know if any of the other reports--how they filtered in, if they came from doctors, travel clinics or any of these other alert networks that you have in the U.S.

DR. HUGHES: They come in in different ways. We hear from patients, from patient families, and from clinicians.

We have the specifics. I don't have that at my fingertips. But because the word is out, we're getting lots of calls and we have a public hotline as well as a set-up to handle clinician calls and we're doing that 24/7.

Let me clarify one thing. I think you may have mentioned that there were 14 cases, suspect cases. That was yesterday. I had mentioned earlier that that number was revised today and it's currently nine.

QUESTION: Okay. Thank you.

CDC MODERATOR: Thank you, Ann. Next question, please.

AT&T OPERATOR: Our next question comes from Marin McKenna with the Atlanta Journal-Constitution. Please go ahead.

QUESTION: Thank you. Hi, Dave, hi, Dr. Hughes, thanks so much for doing this.

Dr. Hughes, in the IOM briefing this morning about the report, Peggy Hamburg said that one of the things that IOM committees when they're writing these reports don't do, is they don't talk about money.

I'm wondering if you could talk about money. The number of suggestions that they are making about things that the CDC and health authorities overseas ought to do in terms of surveillance and building additional networks sound, in some cases, quite expensive, and I'm wondering, given the practical realities of both the tax cut and our imminent going to war, in that setting, how this all plays out.

DR. HUGHES: Okay, Marin, let me speak a bit to that, thank you for raising it, it obviously is an important question.

As Dr. Hamburg said in her briefing, the Institute of Medicine committees, when they do their work, they do not make cost estimates.

You know, I can say from my experience that investments in rebuilding the public health system indicates that these investments definitely do pay dividends and the cost of not rebuilding the system can be substantial.

We obviously haven't yet digested the potential fiscal implications of the recommendations in this report. As we develop the new CDC emerging infections strategy in response to this report, we will cost it out, however.

QUESTION: Can I just ask a follow-up. Going back ten years to the initial '92 report and the emerging infections strategy at CDC that resulted from that, how long did it take you to get the level of funding that you thought you need? A year, two years, five years?

DR. HUGHES: Well, we have received incremental increases in funding for implementing the CDC emerging infections strategy starting really back in 1994.

We estimate that the current CDC emerging infections strategy that we now have, that the cost of full annual implementation would be $260 million, and the appropriations that have come over the years to support that are up to, in the current year, $167 million.

CDC MODERATOR: Marin, does that work for you?

QUESTION: Yeah; that's good. I'm sorry. Thanks.

CDC MODERATOR: Next question, please, Mary Sue.

CDC MODERATOR: Okay. Our next question comes from Alice Park with Time Magazine. Please go ahead.

QUESTION: Good afternoon, Dr. Hughes.

I have a question. I'd just like to follow up on the issue of detecting and identifying new emerging threats and obviously SARS falls into this.

Could you speak a little bit about where, how we get to a point of having some very general symptoms to the point of perhaps thinking that it might be, you know, a paramyxovirus? How do we--it's not just a matter of looking at samples and doing lab work but also of including some work of looking, for example, at animals in the region, histories of reports of similar symptoms.

Just walk us through sort of broad steps in terms of how you go about identifying a new bug like this.

DR. HUGHES: Okay. Thank you very much for asking that. Let me first caution everyone to not put all the eggs in the paramyxovirus basket at this point. Keep an open mind is a lesson that we've learned repeatedly and I would like to emphasize to everyone who's listening here.

You know, we're all anxious to determine, as quickly as possible, what's causing this, and a broad range of labs are using a broad range of techniques. So we don't want to jump prematurely to a conclusion.

So having said that, what's the approach to a complex outbreak investigation? and we could spend all afternoon on this and I'm sure you prefer not to do that. So let me just make a few comments and pick up on a couple of the points that you mentioned.

First, we need to get an accurate description of the clinical syndrome. We'd like to have better information on the response to therapies that are being used, to get beyond anecdotal reports and to a more systematic collection of data.

We'd like to have a better handle on the clinical laboratory results. You probably heard that some of these patients have low white blood cell counts and low platelet counts, and that's providing some sort of clue in terms of what's actually causing this.

We'd like to get appropriate diagnostic specimens handled in an appropriate way, collected early in the course of illness to reference laboratories with a broad range of sophisticated techniques available to them.

We'd like to coordinate the work of these laboratories and in fact WHO, every day, leads a conference call with representatives of all the reference laboratories around the world that are working on specimens from the outbreak, so that information is being shared on a daily basis.

You mentioned the issue of animals and it's very important. You know, in 1999, with West Nile, it took quite a while for people to recognize that the problem in the crows in New York was related to the problem in people.

So we've raised the question of whether there's any other hints of anything else going on in these cities where the cases are occurring and I've not heard any indication yet of any clues in that arena.

This also will raise, inevitably, as all these emerging infections do, a number of research questions that will need to be addressed. So let me stop there but I hope that gives you a sense of some of the complexity in dealing with this.

QUESTION: Yes, it does. So, in other words, it's both a molecular biology as well as a epidemiology issue.

DR. HUGHES: Yeah, and we shouldn't forget tired and true traditional laboratory techniques either, and we're not neglecting those, and one of those is what was used to recognize Legionnaire's disease back in 1976. It took six months to do that. We hope it doesn't take that long in the current case.

QUESTION: Thank you.

CDC MODERATOR: Thank you, Alice. Mary Sue, I'm afraid we only have time for one more question.

CDC MODERATOR: Our least question will be from Lynn Atree [ph] with ABC News. Please go ahead.

QUESTION: Yes; thank you for doing this call.

I'm curious as to what agents have been reasonably eliminated as possible causes of SARS and what type of cultures and serologies have been done.

DR. HUGHES: No agents have been eliminated as far as I'm concerned. We're keeping an open mind. We are working here, at CDC, in all of our relevant laboratories on specimens as we receive them. We've not received very many specimens, to date, but we have a substantially increased number en route, and should be receiving them, I hope today, later today, and tomorrow.

We've looked for a broad range of bacterial and viral pathogens, in particular, and w have a lot of negative results, and we have a lot of studies still in progress.

QUESTION: And what kind of testing?

DR. HUGHES: Well, there's culture, there's serology, there's histopathology, there's immunohistochemical staining, there's inoculation of suckling mice, there's various molecular techniques, polymerase chain reaction, et cetera, being performed, and other approaches being discussed.

QUESTION: Thank you.

CDC MODERATOR: Thank you, Lynn. Mary Sue, thank you for your help today and thanks, everyone, for joining us.

CDC MODERATOR: Ladies and gentlemen, that does conclude our conference for today. Thank you for your participation and for using AT&T executive teleconference service. You may now disconnect.

Listen to the telebriefing

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