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CDC News Conference Transcript

Influenza Update

December 11, 2003

DR. GERBERDING: Good afternoon. Thanks for joining us for this briefing today, an update on influenza.

I'm very pleased to say that Secretary Tommy Thompson from Washington is going to be joining us through the telephone linkage, and so I would just like to thank him for taking time to sit in on this press briefing, and also for his leadership in this influenza situation that he's been doing with so many of the outbreaks and difficult public health circumstances over the last several months. Every time we've asked him to step up to the plate and help us out, he's been there with his leadership, and so he's here today and he has an announcement to make.

Secretary Thompson, can you hear us?

SECRETARY THOMPSON: Yes, I can, Julie. Thank you so very much for your leadership. You're doing an outstanding job, as everybody knows, at CDC. I mentioned you today at the Cabinet meeting with the President, how great our trip was in Africa and how well we did up with the CDC experimental program inter-rural(?). The President was very moved when I told him about our stories.

But I want to thank all the press today for being on this teleconference, and some of you present in Atlanta. But more than that, I want to thank all of you for informing the public about the vaccine. So I appreciate very much your interest in this issue.

As we all know, there's been a greatly increased interest in the flu this year. We hope that translates into more people, especially those at high risk getting their flu shots early in future years. We certainly will continue to encourage that and will want to work with manufacturers to be ready for it. I hope that more people come to understand that flu is a very serious disease, not just this year, but each and every year.

We've been conveying this message for many years, and it's important for people to understand it. In getting our message out about the importance of getting the flu vaccine, the media plays a very important role, and we thank you for that, and we appreciate your efforts in all of these regards.

As you all know, HHS and CDC have been aggressively looking at all of our options as to possibly acquiring additional supplies of flu vaccine due to the high demand here in the United States. You also know that CDC has been surveying the states to find out how much vaccine is out there and where it's located.

The CDC today has released recommendations on how vaccines should be used based on what has been learned to date about the supplies. Some areas of some states have an extra amount. Others are very scarce. We want to make sure that it's redistributed wherever we possibly can.

But right now I'd like to let you know what steps we have taken as of today. The Department has just completed the purchase of 100,000--I want to underscore that--that's 100,000 doses of adult vaccine from Aventis Pasteur. It is being shipped to state health departments now. It is expected to arrive in the states by the end of this week. Each state's supply will be based upon its population. We've also purchased from Aventis Pasteur an additional 150,000 doses of pediatric vaccine and expect to have it ready for shipment to the states by January of next year.

We also will continue to look for other vaccines wherever possible. We're exploring all options for possibly purchasing, as you can well imagine, additional supplies.

As we move along we will keep you apprised of our actions, let you know of our individual purchases so you'll be able to report it. Again, we appreciate your interest in this issue. I'd now like to return the call back to Dr. Julie Gerberding, Director of the CDC.


DR. GERBERDING: Thank you, Secretary Thompson.

I'm first just going to give a brief update on the situation of the epidemic this year, of the details reported in today's Morbidity and Mortality Weekly Report, and there's a great deal of information in here that you might find useful as a reference.

I think the bottom line is spelled out in this graphic which shows that we're now showing widespread influenza activity in 24 states. All jurisdictions are reporting flu, and it's clear that the epidemic has not peaked this year, although there is some early information suggesting that possibly things may be leveling off in some of the states that were hardest hit. It's just too soon to say for sure whether or not that indeed is the case.

We know that the predominant virus this year is H3N2 strain. 75 percent of those are the Fujian strain, which is the strain that is not in the vaccine, but again, we're hopeful that vaccine will provide protection for this strain, given the laboratory evidence that we have and past experience when we've had slight mismatches between vaccine and circulating influenza strains of this type.

We don't have scientific evidence or epidemiologic evidence to suggest that this year's influenza outbreak is worse than it has been in in the past or that the strain is more virulent than strains that we've dealt with before. It's just simply too early in the course of the outbreak to say for sure how this will compare overall, but obviously the early start and the early widespread activity has given us a great deal of concern, and obviously, it's concerned a lot of people, and that's why there's been such an interest in getting the vaccination this year.

Secretary Thompson gave us the good news that we have been able to secure the doses of both adult and pediatric vaccine. The pediatric vaccine won't be available to us until January, but it's very important that we do have those extra doses available to us.

We are working with the states to distribute the vaccine based on population in the states, and then at the state level, decisions about who should receive these extra doses will be based on what is the overall availability and need in that particular jurisdiction. We're prioritizing use of vaccine in those who are over age 65, children between ages 6 months and 23 months, anyone with a chronic medical condition, and women who are in the second or third trimester of pregnancy.

In areas that have vaccine sufficient to meet those needs, we are also encouraging vaccination of contacts of high-risk individuals, and that would include household as well as health care contacts, so that there is an additional layer of protection around individuals who could develop the most severe complications of flu.

We wish we had more vaccine, but there are many steps that we can take besides vaccination that will be able to have an impact on the scope and magnitude of the problem. There are some very specific steps that we can all take this year. One of those is to be sure that we stay home when we're sick because this will help reduce transmission of any respiratory illness that we might have to others. So fever and a flu-like illness is an indication to stay home from day care, from school or from any other situation where close contact with individuals who may be susceptible would occur.

In addition, it's important to remember that for healthy people, for the vast majority of us, influenza is an annoying illness, it's certainly not fun, but it's something that we will recover from with common sense self care. It's not necessary to go to the emergency room or to visit a physician simply because you have the flu. The treatment is good old-fashioned rest, fluids and the over-the-counter medications that we typically use to treat symptoms.

One reminder not to use aspirin in children because aspirin is associated with conditions that can complicate influenza, and we don't want to do anything to precipitate that. So if fever needs to be treated to use alternatives to aspirin in children.

We also have some specific advice for people who are in high-risk groups for influenza complications. First and foremost they should see their provider or contact their provider to see whether or not they can access flu vaccine in the community, and the providers are working with the local health agencies to try to determine where and when they can get vaccine and how to refer people to the resource where it's available.

If influenza vaccination is not available or if the individual develops symptoms of fever or influenza-like symptoms, they should see their clinician early in the course of that illness because it's possible that treatment for influenza or other conditions that could complicate influenza may be indicated. There are antiviral drugs that are effective in reducing the duration of influenza illness in health people. They may be of benefit to people with chronic medical conditions or people who are in the older or youngest age groups, and it's important to seek medical attention to ascertain whether or not treatment is important.

These drugs can also be used for preventing influenza in certain situations, for example, someone who's had close contact with someone known to have influenza or someone who's in an institution where there's an outbreak of influenza. And so again, seeking medical attention if you're at risk for complications is very, very important, and do it soon rather than later, because the drugs are less likely to be beneficial if treatment is delayed.

People in high-risk groups should also do what's necessary to avoid unnecessary contact with others who may have flu, just to reduce they opportunities for exposure. And all of us should practice good respiratory etiquette, which means to cover our mouth or nose when we sneeze or cough and to practice good hand hygiene, which means to clean hands before and after having contact with respiratory secretions so that there's less chance of passing any of the influenza or influenza-like viruses from person to person.

But again, this is a situation that's unfolding. We are very appreciative to have some extra flu doses so that we can prioritize those people who need them the most. But the flu season is far from over, and we can expect ongoing shortages of the vaccine. So we're going to have to really focus on the other steps that we can take to help contain this outbreak.

Thank you for your attention. I'll be happy to take some questions.

QUESTION: April Nelson from CBS 46. Aventis Pasteur is one of the makers that announced it had run out of dosage here in the U.S. Is this the British supply that we're getting?

DR. GERBERDING: Aventis Pasteur has the remaining doses that we're purchasing right now, so both 100,000 adult and 150,000 pediatric doses are the last of the Aventis Pasteur supply that they've been holding for us as the last doses available.

QUESTION: One hundred million doses. That doesn't seem like very many.

DR. GERBERDING: A hundred thousand doses. A hundred thousand doses is small compared to the 83 million doses that we started out with. But by focusing it into some of the highest-risk populations, those doses can make a difference to those people, and we certainly are grateful to have them.

May I thank a telephone call, please.

OPERATOR: Thank you. Maggie Fox with Reuters, your line is now open.

QUESTION: I think Secretary Thompson answered my question, but I was going to ask if the whole flu story was the shark-attack story of this fall, if the media was in fact exaggerating the flu epidemic. But it sounds to me, from what Secretary Thompson said, that you all are in fact quite happy that, for once, people are aware of how dangerous the flu actually is.

DR. GERBERDING: This is a very important issue. We believe that about 185 million people in this country are at risk for influenza, and we never get anywhere near that number of people vaccinated. So one silver lining from this year's situation may be that people will appreciate that flu is a very serious condition, that we do have an effective vaccine, and that we need to put a high priority on getting enough vaccine available so that we have it when we need it, but also people being willing to get their flu shot. We know that, on average, 36,000 people die every year in this country from influenza, and many of those deaths are preventable. So that's one very important take-home message that we will intend to continue to emphasize as we look for ways to prevent this kind of situation occurring again in the future.

Is there a question here in the room?

QUESTION: Thank you, Dr. Gerberding. Betsy McKay from the Wall Street Journal. Two questions, if I might. One is, do you know at this point how many doses are left--not yet administered, in the pipeline? I know that number changes by the hour.

Secondly, the other day you talked about efforts that--or steps the government might take to resolve the mismatch between supply and demand of vaccine in the future, such as funding the purchase of extra stocks. Could you update on that, on further conversations about that?

DR. GERBERDING: Sure. We are continuing to get information from a variety of resources about where the vaccine actually is located in various jurisdictions across the country. That information is coming in from clinicians, from health officials, and from professional organizations. And to give you the short answer on exactly where it is, the most important point is that there's big hoard of vaccine anywhere. There are places that still have some doses. There are places that have run out but have been able to get doses from other providers in the community. And there are places that are having difficulty getting doses. And so it's a very spotty picture right now, but we don't have any information to suggest that there's a big reserve hidden away somewhere that we would be able to tap into. And that's why we're taking this so seriously and why getting these additional doses for the highest-risk people is an important step for us.

In terms of the longer-term picture, how we would be able to prevent this kind of situation from occurring, there are two main issues. One is the way in which this vaccine is manufactured, which is a fairly old-fashioned methodology. And in order to scale it up, or to speed it up, we would have to, really, change the overall approach to vaccination. And that's something that the security has placed a high priority on. We know we need more research to be able to use tissue culture-based vaccine, but it's technologically possible, and there are also genetically engineered approaches that look technologically possible. But the investments from moving those good ideas from the laboratory all the way through the manufacturing and approval process is going to take an investment not only of science but an investment of dollars.

The second major strategy involves how we purchase vaccine. I mentioned that 185 million people probably have indications for immunization each year in this country, but unlike children, who we know exactly how many kids are in each year's birth cohort, 185 million people are difficult to pin down accurately. And so the size of the market and the location of the market is unpredictable. We also need more information about why all those people don't get their vaccine, so that we can overcome some of those barriers.

The manufacturers will make what they can sell. Obviously, in the past years where vaccine has been thrown away, that represents a serious loss of revenue to the manufacturer. So government can work to either more carefully define the market so that we're confident that all the doses will be sold, or we can purchase vaccine so that we have a stockpile of it in case of a surge, knowing that in many years that a stockpile would be wasted. Or other arrangements, such as guaranteeing to the manufacturer that we would buy back unused doses of vaccine at a discounted price, to help protect them from any financial losses from overproduction.

We also wish we had more vaccine manufacturers out there. There are not a lot of people in the business anymore, and that's another factor that in years past has contributed to shortages. If one manufacturer has a production issue or a problem, that creates vulnerability in the whole system.

These are very important options. There may be others, and that's part of what we are working on right now with Secretary Thompson and the Congress, is what can we do to make this last year that we have such a difficulty with supply not being up to the demand.

QUESTION: Hi, Miriam Falco of CNN. You addressed how it's too early to tell how this season is going to pan out in terms of deaths, will there be more or not. But so far we are hearing reports about children and younger people, 16-year-olds, college kids. What do you know about those specific cases? What do you think is the reason why we're not hearing about the elderly yet?

And secondly, there have been some reports that Chiron, the other manufacturer of the vaccine, is suddenly able to make 400,000 more doses. Do you know about that? Is there any effort made to possibly purchase those? Evidently, despite what we learned on Tuesday, they have something so that they can produce it rapidly. And if you have anything more on that, that would be helpful.

DR. GERBERDING: The first question about children this year, we are very sad to learn about deaths from children that have been associated with either influenza or bacterial or other complications of influenza in several areas of the country. Those individual cases are being evaluated to determine what if anything we can learn about why that happened and what could be done about it from the clinical standpoint. But this is not something unheard of. Influenza affects all age groups, and in patches there have also been children who have been affected in many situations, hospitalized, and sometimes death attributable to influenza does occur in kids.

What we can say right now from all of the information we have available, there is no evidence that this particular flu season or this particular Fujian strain is any more dangerous than similar strains that we have experienced in the past, but we are concerned and obviously we are putting high emphasis on investigating and evaluating it.

The situation in the elderly is one that may not be in the news as much, but clearly there are elderly people who are also disproportionately affected this year, as in past years, and we won't be surprised to hear additional reports of outbreaks among the elderly if they haven't been vaccinated, or are in situations where a spread is occurring.

So this is flu, and this is the kind of situation that we see over and over again. I think what's different this year is people are really focusing in on it, and it's getting the kind of attention that it probably should have had for a long time.

The situation with Chiron is still under evaluation, but they are not making new doses of influenza. They happened to have a few doses left, less than half a million doses, and we will be looking to see whether it makes sense to purchase that. It is a licensed vaccine in the United Kingdom, but it is not cleared for use in the United States. So the safety and the availability of that are still something that the FDA and Secretary Thompson's staff are looking into. So no decisions have been reached, and that's all I can really say about that at this point in time.

Can we take a question from the phone,

OPERATOR: Thank you. Kerry Fehr with the Arizona Republic. Your line is now open.

QUESTION: Yeah, I'm just curious. With all the reportable diseases that cause death, why has flu never been a reportable disease, and is there any move to make that, so that the numbers -- and we can really assess and have good data about this?

DR. GERBERDING: One of the difficulties, and there are several, in conducting accurate surveillance for influenza is that influenza, like illnesses, can be caused by so many different pathogens, and so in the absence of widespread availability of laboratory testing for influenza, it is just not possible to know whether someone actually has influenza, or whether they have a disease caused by a similar respiratory pathogen.

So we have three ways of conducting influenza surveillance. One is to monitor the virus in the system of laboratories that really spans the globe, so that we have the most accurate information possible about the molecular details of the virus and the strain and so forth.

In addition, we conduct surveillance in the set of locations of the number of visits for influenza-like illness, because over time this has proven to be a very reliable marker of influenza activity, influenza severity, and overall epidemiology.

Finally, we conduct surveillance in sentinel locations of pneumonias and deaths due to pneumonia and influenza-like illness as a measure of disease severity. That is in progress this year, as are the other two means of surveillance that I mentioned.

So those methodologies have in the past given us a very good picture to describe the epidemiology of flu at a fairly high level.

We also are in the process of initiating a number of specific projects this year to answer some of the other questions that we need answers to, such as is this particular flu season characterized by any differences in the impact on children or the elderly. Is the vaccine efficacious. If so, how efficacious is it. And some of the other more scientific research-based questions that we would like to have answers to.

Unfortunately, the data from these additional studies are not going to be available to us in the very near future, and as we get information or preliminary results, we will make it available.

Let me take a question from here in the room.

QUESTION: Trevor Pettiford, Fox 5 News. My question is one you may have answered at a previous news conference, but I'll ask anyway. We've had a lot of diseases this year. It's been very busy for the CDC, with SARS and with West Nile virus. Could those have played any part in people being more vulnerable to this -- to the flu this season or not?

And also, with us now looking for more of the vaccine, how is this going to play a part in next year's search for the vaccine that will be?

DR. GERBERDING: Thank you. This has been a very busy year for people in health, and particularly people in public health and at the CDC. We've had a large number of public health outbreaks and infectious diseases and many other high priority activities. But the medical consequences of those outbreaks have been limited to a very small number of people compared to the overall population. Influenza is an illness that just about everyone who's not vaccinated is vulnerable to, and there's really no long-term protective immunity.

So I think the characteristics of the flu season this year are mostly due to the fact that this is a new strain of virus circulating, and that people are getting it in the same way that they have in years past.

For those of us who have been working hard on a lot of different outbreaks, we may be a little more tired than usual, but I don't think that we are medically at increased risk for influenza.

How this will impact on the development of vaccine for next year is a very important question. I think the most important issue for us is how can we assure a volume of production of vaccine next year? Since we won't have any new kinds of vaccine, how can we assure that the volume of vaccine production will exceed the demand and that we'll have a margin of safety should we have another unusually severe year in which people have a much higher demand for the vaccine?

And it is important to remind everyone that flu mist, the live attenuated vaccine that's available for health people between the ages of 5 and 49 is still generally available, although that may not be the case indefinitely since we were starting out last week with about 4 million doses, and there probably has been some reduction in that over the last several days. But healthy people still can access flu mist. We're not reporting widespread shortages of that. And it will remain to be seen what we can do to assure an adequate supply of all of the vaccines that we need next year.

Can I take a question from the telephone, please?

OPERATOR: Thank you. David Walberg with the Atlanta Journal Constitution, your line is now open.

QUESTION: Thank you. Just to clarify about the Aventis Pasteur vaccine,that again was a supply that they had in store here in the United States as opposed to other countries?

And then can you say what the earliest could possibly be if you are able to secure some of the vaccine from Chiron that it could be available given the steps you may have to take?

DR. GERBERDING: The Aventis Pasteur vaccine is just the last doses that they had set aside and let us know that we could make a purchase of those doses if we thought that would be appropriate, and we did, as you heard Secretary Thompson announce. So this is not new production. It was not unexpectedly discovered vaccine. It was just simply the last doses in the lot, and they were thoughtful enough to make them available for our purchase so that we could try to facilitate distribution to the highest-priority areas.

The issue with the Chiron vaccine product is still unfolding. It remains to be seen whether or not this will be a useful strategy for us to pursue. If it does look like it would be helpful in terms of this year's flu season, we would really need to work with the FDA to determine what could be done to clear the vaccine for use in the United States.

As I said, it's a licensed product, meaning that it meets the standards of production that the FDA requires, but it has not been approved for actual human administration, and that involves things like sterility testing, which generally take a couple of weeks at least, and a series of other regulatory issues, which if we decided to purchase the vaccine, I'm sure we would do everything possible to expedite the movement into the system, but it's too soon to say whether or not that's going to be the case or not.

Is there another question here in the room?

QUESTION: I've got two quick questions. One thing that Secretary Thompson noted was that he was very kind to the media for covering this, but others might say that our coverage--some folks might be panicking when they don't have to. You've mentioned several times before that if you're generally healthy, you'll be annoyed by the flu but you're going to get over it.

One of the questions we've been getting from viewers is should we be wearing masks? People are actually thinking about wearing masks. So should people wear masks if they're in areas where there's a lot of flu, Colorado, Texas, et cetera?

And then also you mentioned the necessity of getting the antivirals early when you have symptoms. Do we know if the antivirals are effective against the Fujian strain as well?

DR. GERBERDING: Thank you. Right now--I appreciate you for mentioning the issue about how annoying this is to some people, but in general it's not a life-threatening illness for people, although occasionally it is. The complications are usually in those that we recommend vaccinations for

We are not recommending masks for the general public at this point in time. There's absolutely no evidence that that would be effective in any way, shape or form at preventing flu. And the hand hygiene is actually a relevant concern because the viruses that are associated with most respiratory illnesses can move from person to person on hands or by droplets if you cough or sneeze into your hands, then there's a possibility of those means.

There are some data to indicate that flu is an airborne illness in certain circumstances, and if you were in a hospital environment, a level of protection to protect vulnerable patients in the health care facility might include masking of individuals, but that's a really special case and not something that we would recommend for the general public at this point in time.

But we have said, when we were working on the SARS preparedness guidelines, that when people with undiagnosed respiratory illnesses come to a health care setting where they're sitting in a confined area with very vulnerable people who are there for a whole variety of other medical reasons, that until communicable respiratory disease has been ruled out, that masking the individual may be appropriate, and individual health care facilities have worked out the guidelines and protocols for doing that.

It's sort of a generic recommendation that existed before SARS, but it's been emphasized since SARS. It first evolved in the days of TB concern when undiagnosed tuberculosis patients were sometimes the source of transmission before they had x-rays and medical evaluations.

But we're really using a common-sense approach at this point in time, and I think the most important advice--and I know it's hard and we all want to be heroic workers--but when people are sick with an illness that may be the flu, they really should stay home and sort of voluntarily protect others from coming in contact with their respiratory secretions.

Let me take a telephone question, please.

OPERATOR: Thank you. Elizabeth Callidin with CBS News, your line is now open.

QUESTION: Thank you. Hi, Dr. Gerberding. I'm just a little bit confused, and maybe you can clear this up. If this strain is--if there's no evidence that this strain is any more virulent than usual and is not causing any more illness than usual, yet it's not covered in the vaccine, can you please clarify what in particular is new or threatening about this flu season if anything?

DR. GERBERDING: Yes. Let me just try to provide a little bit more information about this strain. The H3N2 Fujian strain that's accounting for about 75 percent of the influenza cases so far this year is a strain that's a very, very close relative of the H3N2 Panama strain that's contained in the vaccine.

The reason we have to get a flu shot every year is because flu viruses constantly evolve and they drift, which means small genetic mutations occur which change the characterization of the strain. Doesn't necessarily change the properties of the strain, but it can affect the ability of the vaccine to offer complete, or optimal protection.

What we know so far about the Fujian strain is that in animals that are used to test the efficacy of the vaccine, there's good cross protection between the Panama strain and the Fujian strain, and that's a good hint that the vaccine will offer protection. And we also know from past year where similar situations occurred with other strains of influenza that generally the vaccine will protect against the drift strain. Protection is not always as good as it would be if there was a perfect match, and we don't know how good until the season is close to being over, at least farther into the season than we are right now. That's one of the reasons why we're doing those special studies I mentioned.

So the reason that this particular flu season has gotten special interest and why we emphasized the need for flu vaccination this year is because first of all it got off to an early start. Starting as early in October as we saw this year is somewhat unusual for influenza, and sometimes that early start has been a marker of a more severe or a more widespread outbreak.

In addition, we saw widespread activity in Texas, first, and in other states much earlier in the flu season than would be average. So it was the early onset and the rapidity with which the illness became widespread in certain jurisdictions that caused us to take the steps we did to really focus in on improving overall vaccination coverage.

We're real sorry for the mismatch between supply and demand, but the good part of that is that we really do have more people vaccinated this year than we probably ever have, and so, at-large, our population is probably the best protected that we've ever seen in a situation like this.

So, hopefully, we'll be monitoring flu viruses throughout the flu season. It wouldn't be surprising if later in the season a different strain of influenza popped up somewhere. That's typical, and that's why we have this sentinel laboratory of flu viruses so that we can keep track of that and anticipate what viruses might be the most relevant next year.

Let me take another phone question, please.

OPERATOR: Thank you. Robert Bazell, with NBC News, your line is now open.

QUESTION: Hello, Dr. Gerberding.

The CDC website today says, as of right now, it says that high-risk group include people who are 50 and over, and it says, "Most people who want to lower their chances of getting the flu can get vaccinated."

You've said that 250,000 new doses is a drop in the bucket. What is your message here? You're telling people still get vaccinated, and yet in many parts of the country there's no vaccine.

DR. GERBERDING: Well, first of all, let me draw attention to the fact that we do have a new website for influenza which we have just pulled together over the last several days, and that can be found at, and there is a topic there to take you to the new flu website, which provides information about vaccination, but also about chemoprophylaxis, and we'll be providing updated interim guidance on this website over the next several days as we develop more information about localized sources.

But what we've done today in the MMWR is really update people on what we consider to be, under the circumstance of vaccine shortage, the highest priority for vaccination, and that is to vaccinate the people at the greatest risk for complications. The highest priority right now is people over 65, the people with chronic medical conditions, children between the ages of 6 months and 23 months, and pregnant women in their second and third trimester.

The recommendation that we had received from the ACIP for this year about influenza vaccination of anyone over age 50 was based on the fact that that age cohort between 50 and 63 is enriched for people who have chronic medical conditions. And so because we wanted to try to be as inclusive of all of the people with chronic medical conditions, it was just a simpler recommendation to say anyone over age 50.

Now, we're in a situation where we really do have shortages of vaccine, and we wanted to be sure that we are putting the highest priority on those that clearly have the medical risk for complications. Healthy people between the ages of 50 and 63 are probably not at any greater risk of the serious flu consequences of people in the younger age group.

We are also recommending in areas where there is vaccine available that contacts of the high-risk groups also get vaccinated as a means of protecting them from exposure.

Is there a question here in the room?

QUESTION: Just one clarification, if I might. Based on the data that you have to date in the MMWR on the number of specimens you've tested and so forth, is it fair to characterize this flu season as being, the influenza as being more widespread this year than in the most recent severe season, if it's not more severe than in previous years? If I make any sense.

DR. GERBERDING: One thing that we should try to be specific about is what we mean by severe. Severe can mean a greater tendency to cause hospitalization, serious complications and death. So medically severe versus epidemiologic severe, which mean more geographically widespread or affecting a larger proportion of the population or population jurisdictions.

Right now, the epidemic, from an epidemiologic perspective, was more severe earlier in the season, meaning there was more widespread activity and an earlier onset than would be average for influenza.

But some of the other markers of the epidemiology of the situation are giving a mixed picture right now. For example, the number of visits for influenza-like illness this year, compared to the same point in time in previous flu seasons, is a little higher than it's been in the last couple of years, but not as high as it was in the 1999-2000 season. So it's sort of in the middle.

And if you look at the number of pneumonia and influenza-like illness related deaths in the sentinel areas of the United States, we are not at the level where we would characterize it as the epidemic threshold, which is a statistic marker for saying that we are seeing the number of deaths that we expect with a fairly typical flu season. But it's really very early in this particular flu season, and so we don't want to make any projections about where this is going to take us or what we would ultimately conclude about severity, either medically or epidemiologic frameworks.

I'll take one more question from the telephone, please.

OPERATOR: Thank you. Raja Mishra, with the Boston Globe, your line is now open.

Raja Mishra, your line is now open. Please check your mute feature.

[No response.]

OPERATOR: We'll go on to our next question. Our next question comes from Nancy Metcalfe, of Consumer Reports magazine. You may ask your question.

QUESTION: Thank you.

I wanted to go back to the school-age children, for a minute, because I notice that they are not on your new priority list in today's MMWR, and yet you have, in the narrative that goes along with it, and as you already mentioned, you are seeing some severe cases in that age group, and my sense of public concern about this is that a lot of concern is coming from parents of kids in that age group.

I wondered if you could clarify for them, number one, how worried they should be; and, number two, what they should do about it, short of vaccination or should they seek out FluMist or what?

DR. GERBERDING: With all of this focus on the flu, I can certainly understand why parents are concerned or worried about their children, and the pediatric infections and the deaths in kids have been very sobering and worrisome for all of us.

The basis for immunization of children between the ages of 6 months and 23 months is based on science that indicates that flu vaccine reduces the need for hospitalization in those age groups. So our Expert Advisory Committee has looked at that information, made the decision that this year we really should encourage immunization of that population.

Overall, children have a very low risk of developing the severe complications from flu, but that doesn't mean that it would never happen, and occasionally it does, and I think that's one of the things that parents perceive as very alarming. That's why we're very happy to have FluMist available this year because it is there for healthy kids between the ages of 5 and 49--children between the ages of 5 and 18 and adults between the ages of 18 and 49, I should say more accurately.

And so parents who are really concerned about protecting their children should contact their pediatrician and get their advice on whether or not the FluMist would be helpful to them.

Thank you very much for your attention, and we'll provide more information when we have it, and please do check the website,, and we'll be posting updated information about vaccine availability in the course of the epidemic as we get it.

Thank you.


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