Transcript for CDC Telebriefing: Zika Summit Press Conference

Press Briefing Transcript

Friday, April 1, 2016 at 12:30 pm E.T.

Please Note:This transcript is not edited and may contain errors.

MICHELLE BONDS: Good afternoon.  Thank you for joining us today at the press conference at the Zika Action Summit, I am Michelle Bonds, the Director of Public Affairs at CDC.  Today, you will hear from five speakers and then we will take questions. When we take questions from the room and from the phone, please state your name and affiliation before asking a question. Our first speaker is the Director of CDC, Dr. Frieden…Dr. Frieden.

TOM FRIEDEN: Good afternoon, everybody, thanks very much for being here. We’ve had a terrific response to the Zika Action Plan Summit. We had more than 300 people from all around the country here.  We have over 2,000 people participating by web and we have heard from the manufacturers of Deet that there is a lot of concern about Zika … the increase in the purchase of mosquito repellant.  The bottom line here is that we are all working here to protect pregnant woman.  The key here is to reduce the risk to pregnant women. It has been to the day ten weeks since we first issued a travel advisory about Zika. and in that ten weeks, we have learned an enormous amount, we’ve done an enormous amount, but there is much more to learn …… Some of what we learned is the risk associated with Guillain-Barre and a range of adverse pregnancy outcomes. We’ve also learned that sexual transmission is much more likely than we anticipated and we learned from focus groups with pregnant women in Puerto Rico and elsewhere, that there is a great desire on the part of women to do whatever they can to protect themselves.

That itself is the bottom line.  The risk of pregnant woman and the developing fetus and all of our activities need to be focused on mitigating that risk.  In the past ten weeks, we’ve issued series of guidance and advice, on travel, on clinical care, testing on sexual transmission prevention and we’ve been able to scale up laboratory testing to provide Zika test kits to states around the U.S. and to countries around the world.  We are working intensively if Puerto Rico to protect pregnant woman to the greatest extent possible, to reduce mosquito populations and to increase access to effective voluntary contraception for women who choose to delay pregnancy. Nothing about Zika is going to be easy or quick; the control of this particular mosquito is hard, and although we’re learning a lot quickly, there is still a lot we don’t know.  There is an urgent need to both learn more and do more and all of us have a role to play.  In the federal government, there has been a terrific across federal government collaboration involving not just us at the CDC but many other parts of HHS in which you’ll hear about in a minute — as well as HUD, EPA, and many other parts of the government working together robustly and rapidly as possible. In addition, we’ve had some generous submissions from private foundations to the CDC Foundation and that’s allowed us to move quicker and do things we would have not been able to do otherwise.  We appreciate that tremendously.  We are all in this together.  There is something for everyone.  Whether it’s at the federal level, state, private, local and territorial levels, public sector, private sector, with commissions, patients, reducing the risk of pregnant women is crucial to protect future generations.  The enthusiasm that we see for this response indicates the urgency with which Zika is appropriately seen. Many things at this summit both decidedly determined to move forward if terms of the localities and states doing more, but at the end, it’s really important we have the resources we need to respond effectively.  Because many things do cost money and without additional resources we will not be able to get the resources to the state and local entities that they need for our robust response.  We won’t be able to do the innovations we need to get ahead of not just this mosquito-borne threat but other mosquito-borne threats as well and we need the resources in order to provide Americans with the protections that they deserve.  Thank you.

MICHELLE BONDS: our next speaker is at the White House Deputy Homeland Security Adviser.

AMY POPE: Good afternoon, everyone.  It’s been a real pleasure to be here today at the Zika Action Plan Summit.  It’s really a critical opportunity to bring together key players of state, local, private sector and fawn government organizations as well as our federal subject matter experts to refine our risk-based Zika Action Plan for states. On behalf of the white house, we are thrilled to be partnering with the National Governor’s Association on combatting Zika in the homeland.  Since late last year, we at the white house have been very concerned about Zika and its possible association with birth defects such as microcephaly and this rare neurological disorder called Guillanne-Barre syndrome. At the president’s direction, we have been working very aggressively to combat this virus – taking measures to ensure we are all prepared. We take this threat very seriously.  While it’s a very different disease, and will require a different response, than Ebola, for example.  We learned many valuable lessons from Ebola.  Number one is the value of preparedness. As the white house Ebola response coordinator, i know from first-hand experience, that we cannot wait until we see wide-spread transmission in the United States before taking steps to prepare – it’s just too late at that point.  That’s why on February 22nd, the white house sent an emergency supplemental request to congress for $1.9 billion — to support our preparedness and response activities.  Our quest includes money for fortifying our domestic public health system, to prevent, detect and respond to the Zika Virus.  To accelerate our vaccine research and development to provide a long-term strategy to limit Zika.  To expand our diagnostic testing capabilities.  To educate health care providers, pregnant women and their partners.  To improve our epidemiology, to expand our laboratory capacity.  To improve health services and support for low-income pregnant women and to enhance the capability of Zika impacted countries around the world, to better combat mosquitos, control transmission and support the affected population.  We’ve asked congress to act swiftly on our proposal to Zika in the homeland.  Now, I know, that some in congress have suggested that we just use the money we have to fight Ebola to fight Zika.  We said we’re going to look at all of our resources, including some of our Ebola funding.  When we’re bringing the money to this fight but we cannot undermine our fight against Ebola or all the other health epidemics that exist to take the fight to Zika.  But let me be clear, even if we make these hard choices, the money we have now is not enough.  Congress needs to act and do it now.  We need to ensure our state, local, tribal and territorial partners are better prepared to protect the people in their cities and towns.  Now at the end of this summit, we expect the state and local summit participants to go back home with action plans in hand.  We are working to provide resources to these states to help implement these plans.  But we simply can’t do it all without congress. But in the meantime, we’re not going to wait.  We’ve leaned forward in our response, especially in the U.S.  Territories.  Puerto Rico, as you know, is experiencing an outbreak of Zika now.  CDC is leading the federal response there and working closely with the Puerto Rico department of health and with federal partners to protect pregnant women from Zika infection.  But acting now in the absence of the necessary funding is forcing us to make difficult choices about the programs that protect to the health and safety of all Americans.  We cannot erode the gains we made in our fight to Ebola.  Afight is not yet over.  As we are seeing today in Liberia and New Guinea. We will continue to support efforts to mitigate new infections through the developments of vaccines and drugs and stand ready to rapidly respond to new cases.  We also continue to shore up our responsibilities for emergency detection of diseases whewn they’re introduced here.  At this summit, the reason we are here today, because it represents a critical opportunity for states that may be affected by Zika in the coming months. And this is not something we can do alone. We’ve come here together today and we must work together going forward to stop outbreaks of Zika and to protect those most at risk of Zika infection.

MICHELLE BONDS: thank you.  Our next speaker is Dr. Nicole Lowry, Assistant Secretary for Preparedness Health and Response with the Department of Health and Human Services.

NICOLE LOWRY: thank you, hi, everybody, thank you for being here.  As you know, today’s advance is an important part of our work to be sure the state the communities across the country are prepared, in other words, that they have the plan, systems in place to prevent detect and respond to the Zika Virus.  Since the early reports of the potential link between the Zika Virus and epidemiological orders, the department of human services have taken a proactive and increasingly targeted at protecting their people long before the first cases of related Zika in the United States.  We pulled together all the people to be sure we were ready and well-coordinated.  Although, our understanding of Zika and its risks are focused of protecting those most at risk as you heard from Dr. Frieden.  Especially pregnant women and their developing fetuses and women who may become pregnant. 96 to working with state and federal colleagues with Zika, which is what part of today’s event is about.  We’ve activated our countermeasure enterprise.  We did the again well before Zika really came on most of the radar screen.  And we did this actually for Ebola well in advance of the Ebola epidemic.  We found when we put the pedal to the metal, we can all come together and get our diagnostic tests and vaccines developed quickly. Our expectation is that the same will be true for Zika. CDC, NIH, the FDA, the biomedical advance research and development authority, the department of defense, EPA are all working together toward this goal.  Right now we are in dialogue with a great group of developers of diagnostic testing vaccines.  We are really encouraged by their interest and tear progress.  In the meantime the CDC has already developed tests to diagnose the Zika Virus and Zika Virus protection.  But we need to expand that capability and in the long run, we are going to need better and faster tests.  We’ve also worked to ensure a safe blood supply in Puerto Rico, collaborating the industry, to develop and deploy a screening test for investigational use approved yesterday by the FDA.  As we are seeing if Puerto Rico, responding to Zika will require a collaboration across government and based on strong data.  it requires the combination to prevent and reduce transmission, protect pregnant women, who are at highest risk, ensure women of child-bearing age who don’t want to get pregnant have access to effective contraception and response to the excuse and long-term health of those who develop complications that may be Zika related.  Today’s summit is an important step to ensure that those communities across the United States are prepared.  If you heard, we are expecting people to return home, with action plans, to be able to lean forward so that we can all do the best job we can do protect the American people..

MICHELLE BONDS: Our next speaker is Edward Ehlinger, MD, Commissioner of Health for Minnesota and President of ASTHO

EDWARD EHLINGER Good afternoon.  I’m here at the summit as the commissioner of health in Minnesota along with a team i brought with me  i am here also as the President of the Association of state and territorial health officials, which represents 59 states, territories and the district of Columbia.  Thanks to dr. tom Frieden and the CDC for pulling us together.  This is a national problem.  What we are hearing is demonstrating the need for a strong public health enterprise.  We need a strong public health presence at the federal, state and local level.  Because it affects everybody.  Even the states like Minnesota, where we don’t have the Aedes Egypti mosquito, we are dealing with Zika on a daily basis.  A whole variety of ways.  We all know at the state and local level, we need a lot of knowledge, a lot of capacity and under surveillance and monitoring at the local level for assessment and diagnosis of individuals and the community.  We need epidemiology, clinical, lab approaches to go forward.  We need to find out treatments that are necessary for them as we move, particularly with pregnant women.  We need to prevent the transmission and to protect pregnant women.  We need follow-up.  We need a lot of education and guidance for public health and for medical care as we move forward.  So we have to do this all the while we continue to address the other threats that are common to us every single day that really impacts our health and security.  so all of this that we have to do at the state and local level and the federal level requires research and it’s a lot of education and training like we are doing today and it also requires the resources.  The majority, most people don’t know the majority of public health services that are provided in the state are federally funded.  When you look at infectious disease and emergency response, the proportion of federal funding is immense.  We need that federal support and because we are already at a deficit in many of our funding sources leading to inefficient responses to needs and demand, like in my state, Ebola, Lyme disease, west Nile virus, plus the floods and the tornadoes and the lead testing in water and Zika added to the pressures in our jurisdictions.  So this highlights the need for as we’ve mentioned earlier, needed resources.  We need resources to deal with Zika Specifically, but we also need resources to maintain the base level of preparedness that goes on all the time in our states and we need to have some funding to allow us to respond to the next infectious disease that we have coming and we know it’s coming.  We’ve had so many kind of threats in the last five-to-ten years, we know more are coming.  So we need that kind of resources.  We need to work collectively.  We need strong public health enterprise at all levels, certainly those of us in state, local jurisdiction, are pleased to be able to work with our federal partners and strengthen that federal public health enterprise.  Thank you.

MICHELLE BONDS: Dr. Ed McCabe The medical director of the march of dimes is our last speaker.

ED MCCABE: thank you very much for letting us participate in the Summit.  The March of Dimes is very concerned we have a narrow window of opportunity and it will close rapidly.  We have the opportunities to slow the spread of Zika into the United States over the next few months.  If we’re successful, we could save dozens or even hundreds of infants from being born with devastating birth defects.  We must act now.  For over 75 years, the march of dimes has worked tirelessly to prevent birth defects and infant mortality.  For this emergency, the foundation has built a rapid response group with members of the CDC and trusted sources and to update constantly the material on the web and social media in English and in Spanish.  Today we face the virus that appears to be linked to devastating defects, miscarriages and complications of pregnancy. For most birth defects, prevention is impossible.  Because we don’t know what the causes are.  This is not the case with this virus.  We know exactly how to prevent the birth defect.  We must protect pregnant women from being bitten by mosquitos that carry the virus.  The real challenge then is whether our nation will do what is needed to help pregnant women stay healthy.  Today, representatives of states and local governments are gathering to prepare Zika plans and learn from each other.  They are already committed to doing everything they can, but they cannot do it alone.  Congress must also do its part.  The march of dimes and our partners are calling on emergency spending legislation to give CDC, other federal agencies and states the resources they need to combat Zika Virus.  We are grateful for their commitment, extraordinary work of staff and scientists here at CDC and other agencies and in the states.  But they should not have to fight Zika by raiding funds from other important agencies – shifting money from crisis to crisis will have us chasing our tail instead of organizing a holistic comprehensive response to these public health challenge.  We don’t have the time that it took to learn about west nile virus.  we have a short time in next few months to stop the Zika Virus from gaining a foothold.  congress must act immediately for us to provide the resources.  our families depend on it.  thank you.

MICHELLE BONDS: We will now take questions from people on the phone.  In the room, please wait for a microphone.  Then state your name and affiliation.

BETSY MCKAY: I’m Betsy McKay from the “Wall Street Journal.”  Dr. Frieden, I’d want to ask if you are at the point of saying that Zika is the cause of fetal abnormalities and Guillanne-Barre syndrome and if not what remains to be learned before you can do that.

TOM FRIEDEN: One at a time, first in terms of the Guillain-barre syndrome, this would not be particularly surprising a wide range of bacteria viruses, and other challenges with our systems and trigger Guillain-barre syndrome, evidence is certainly highly suggestive. We have now seen one study that does show an association in what was retrospective. I anticipate that that causal connection will be confirmed in the near future; we ourselves, in collaboration with the Brazilian Authorities, have completed a case study of the guillian-barre syndrome in Brazil. We anticipate that will be confirmed, if you look at the formal proof, they are probably not quite there yet in terms of Guillain-Barre.  I think all of us look at it and anticipate that it will be confirmed.  With microcephaly the challenges are different.  It is unprecedented.  It has been more than 50 years since there has been a viral cause of a severe birth defect identified.  So we’ve never identified a mosquito-borne cause of birth defect.  So we want to be extremely careful.  What is clear is that the spectrum of risk to pregnancy is beyond microcephaly. The spectrum includes miscarriage and appears to be present in all trimesters of the pregnancy.  Although, we would anticipate it would peak in the first or second trimester.  In terms of the formal criteria for causality, that is something we are looking at closely.  We will have more information about it in the coming days.

ANDREW JOSEPH: I am Andrew Joseph with STAT News. I am wondering.  Have there been any documented cases yet of sexual transmission from an asymptomatic man? Also, are there any discussions ongoing about broadening your condom recommendations? Because I believe Public Health England has a broader recommendation than the CDC right now.

TOM FRIEDEN: So, in terms of the first question, all of the sexual transmissions that we have documented have been from symptomatic males, when they are symptomatic or during the symptomatic period. However, if you are trying to use that to say that asymptomatic people don’t spread it, you can’t really say that.  Because if you had an illness which is relatively non-specific, you might not if the individual had a secondary case, tie it back to Zika.  If that index case was asymptomatic, in terms of recommendations for reducing sexual transmissions, we recently updated our recommendations, we have detailed guidelines and the reasoning for those guidelines on the web.  There are individual or groups; this is what we think balances most protection and the best interpretation of current and available data. Next question.

ERICA EDWARDS: Hi, I’m Erica Edwards NBC News. There was a report out this morning that cases of Zika are declining in some part of Latin America like Colombia, wondering if that’s what you are seeing.  Also, could that mean the virus is burning out as more and more people are becoming infected and becoming immune.

TOM FRIEDEN: If Zika behaves as Chikungunya and Dengue behaves, and that’s a big if.  We don’t know if it will.  We may see explosive spread in one area followed by a long period of lower level transmission.  However, one area might be one part of the country, one city, one part of the city.  So it’s very difficult to predict what the pattern will be.  What is certain is that the better we track, the better we understand the trend and prevent and respond to the greatest extent possible, but we also, remember, that even if you have widespread transmission in a city, it might only affect 25-30 percent of the individuals.  If we take Puerto Rico as a model, with Chikungunya in Puerto Rico, it was introduced or first identified on May 5th of 2014. Within eight weeks, it was all over the island and in eight months, 25 percent of the adults were infected. But it continues to spread in Puerto Rico two years later.  If we take Dengue in Puerto Rico for example, it spread there and now 90 percent of adults have anti-bodies to Dengue.  They have been infected with at least one of the Dengue types.  The virus unfortunately doesn’t burn out. It may spread with greater intensity or less intensity.

MIKE STOBBE: Hi, Mike Stobbe from the Associated Press Dr. Lurie talked about tests and the need for better and faster tests could you say again, how long does the PCR test take to bring back results, how long does the antibody test? Could you say some people said if we do see local transmission in the fall, there will be a great concern and a great demand to have test results immediately?  Is it likely that we will have a test in place then that would give concerned women a test result that day or within a day?

TOM FRIEDEN: Well, I’ll start and Dr. Lurie will continue.  First off, let me go to what types of tests we have out there. There is the PCR or polymerase Chain Reaction and CDC has just gotten approved through the Emergency Use Authorization Program of FDA a trio-plex PCR that we developed in our laboratories that tests, at one go, Dengue, Chikungunya and Zika. That test actually has to incubate overnight, so it takes a day or two to come back with results.  That’s what the science maximally allows.  And we can produce hundreds of thousands of those tests and have those available. But that only identifies virus when it is present. When the RNA is present, which is roughly a week, in the blood maybe a little bit longer in urine, that’s something that needs to be studied.  The more challenging is to see if a prior test, a prior infection has been present.

For that, we use an antibody test or IGM MAC ELISA that’s also a CDC-developed test which the FDA has issued emergency use authorization for and we’re rolling out the laboratory response network to states all over the U.S. so they can offer testing to take some time for them to validate the test and begin offering it.  An increasing number are doing that in the coming weeks.  If the MAC ELISA is positive, the confirmatory testing needs to be done by a neutralization assay that is done only at the CDC laboratory and that takes about a week to occur.  Because you actually have to grow the virus and the virus doesn’t grow that well and quickly for that to be able to be done.  So the testing is much more available than it was and that is due to literally around-the-clock work of a superb team of laboratory specialists at CDC.  But it’s not as available as we wished it were.  I’ll speak in a moment about some of the innovations our labs are doing.  But we really do need the commercial sector and private sector and others to come forward and do more.  Roche Diagnostics came up with a test for the blood supply the FDA approved yesterday. Which is terrific; it means that in Puerto Rico, they can soon go back to collecting blood, screening it for Zika and using it. That is a very important development. There is work being done on the point-of-care tests and Dr. Lurie may speak more about that.  What we’re doing at this point is optimizing both MAC-ELISA tests so that we can produce it more rapidly, using virus-like particles and cutting edge technique to be able to produce large numbers in shorter periods of time.  The lab works around the clock and will, I think, be able to increase production capacity.  For that neutralization aspect that requires the virus to grow, as soon as it happened, the team had a great idea, which was to create a viral chimera. Create a new virus to be used in the lab, using a faster growing virus but with the Zika proteins embedded into the virus genome so they would produce the Zika antigen, which we then tested.  So if that’s the case, that works, we will cut that one-week confirmation down to a three- or four-day confirmation with a faster growing chimeric virus.  So there are some innovations we are working on.  But the bottom line is, without significantly increased resources, it’s going to be very difficult, to do the kind of innovations that provides rapid testing and rapid control.

NICOLE LURIE: Thanks for the question.  Our focus has been primarily on developing diagnostic tests that will be able to tell a pregnant woman whether she has been exposed or contracted the Zika Virus.  We are also interested in improving the diagnostic test capacity for people who want to know am i infected now?  I think you understand now the difference between those two kinds of tests.  We are working very aggressively with a full course of diagnostic tests developers to do that.  As dr. Frieden says, it takes money.  We’re in a little game of cat and mouse here, because some of the developers are a little reluctant to put a lot of skin in the game, until they know that there will be money to support those efforts.  Nonetheless, we are leaning forward as quickly as we possibly can to do that.  one of the lessons that we learned from Ebola was in order to get to the commercially-developed tests the manufacturer is going to need to validate their tests against a whole bunch of Zika-positive samples and they’re going to need to be able to demonstrate on a lot of samples that they can differentiate Zika from Dengue or Chikungunya and you’ve heard about that cross reactivity. One of the things we are in the process of doing now is trying to compile and curate a full series of diagnostic validation panels so that the developers actually have the material to move forward with to develop their tests.  it typically hasn’t been anybody’s real responsibility across government.  We all got together and recognized that as a government responsibility and we are actively working on that now.  But that requires finding 50 or so people to confirm the Zika Virus, going to where they are, having them be willing to donate blood for that.  We are in the process of doing that.  Our goal is to meet the developer with those diagnostic panels when they are ready with their tests.

MARY BOYLE: Thank you.  Hi, Mary Boyle with NHK Japan Broadcasting.  With regards to the efforts of the hard-hit areas which is Brazil and Colombia, what do you think is the conflict between the guidelines issued by the CDC and those countries’ legal and cultural issues with contraception?

TOM FRIEDEN: Our goal in terms of contraception is that any woman who chooses to delay pregnancy has ready access to the most effective forms of contraception. we have good experience in this country expanding access to long acting reversible contraception. Wwe know that long acting reversible contraceptives are much more likely to succeed. And so certainly for any part of the U.S., we encourage local health care providers and jurisdictions to make effective contraception possible and readily available not just possible in theory. We’re encouraged by some of the comments from various religious leaders understanding in such an unusual time there are important resources that women can avail themselves of. In addition, we think it’s very important to continue to focus on reducing the risk to pregnant women.  This is the essential, the most targeted group at risk of the Zika Virus and target of our response in terms of maximizing that protection. I want to reiterate that here in the U.S., including Puerto Rico, we do not have a recommendation not to become pregnant.  We do have a different recommendation that if a woman and her partner choose not to become pregnant, that there be ready access to effective contraception.

MARY BOYLE: And I have one follow up question. Do you feel the CDC is being too cautious with its guidelines?

TOM FRIEDEN:  Is your question about anything in particular?

MARY BOYLE: infected men are advised to wait six months?

TOM FRIEDEN: We are being maximally protective. The key here is to protect pregnant women.  it may well be that the viral persistence in semen is only a few weeks. But we have no idea if that’s the case and, therefore, we say, if a man has been in a Zika area, and his sexual partner is pregnant, he should wear a condom every time he has sex.  Any other question?

MEGHAN PACKER: Meghan Packer, CBS 46 –What are some of the most important steps to be taken right now in the U.S. at the local and community level?

TOM FRIEDEN:  First off, women who are pregnant should not travel to areas where Zika is spreading.  Men who have been in areas where it is spreading and have a sexual partner who is pregnant, use a condom.  In areas of the U.S. where Zika is spreading such as Puerto Rico, pregnant women should use mosquito repellent, long sleeves, screens on their windows and doors and take steps to reduce mosquito populations. This summit is working through action plans for every jurisdiction that is affected.  That means making sure that they’re prepared to monitor and respond effectively as possible and maybe that will say more about what jurisdictions are doing.

EDWARD EHLINGER:  Certainly, throughout the country, we have states and jurisdictions that are here to really learn what is specific to their area.  What is happening in Houston, where they have the Aedes Egyptii Mosquito, they’re doing a whole lot of different things in terms of mosquito spraying and with the mosquito control district the education and the social media that they are doing to educate folks about decreasing the risk for exposure to mosquitos. Certainly in Minnesota where we don’t have the Aedes mosquito, we’re really educating our providers, the general information about travel and people coming back from travel.  Also, we are trying to describe to our OBGYNs and the physicians in our clinics how to talk to folks about travel and how to do a travel history when they come back.  So it really varies from point to point across the country depending on the risks that are there.  A lot of the things are being implemented in localities throughout the country at the local level and at the state level.


MARYN MCKENNA:  Maryn McKenna National Geographic.  Dr. Frieden, Dr. McCabe made reference to dozens, possibly hundreds of infants who might be affected by birth defects.  At CDC, have you been able to come up with any possible numbers for the potential public health impact of Zika on the mainland U.S.?

TOM FRIEDEN: We don’t want to speculate on what may happen, we want to maximize our preparedness of what we can prevent from happening.

The front line of the battle against Zika in the U.S. is Puerto Rico.  We are very concerned that Puerto Rico could have hundreds of thousands of Zika infections and potentially thousands of pregnant women infected within the continental U.S. It depends very much on several things, how many women travel.  We’ve already had dozens of pregnant women who’ve traveled to become infected.  If fewer pregnant women travel to Zika-affected areas, fewer Zika-infected pregnancies we are going to have. We have two pregnant women, six sexually transmitted total in the U.S.  And in terms of local transmissions within the U.S., we have seen with Dengue and Chikungunya that there can be clusters in local areas. We’ve seen that in Florida, we’ve seen it in Texas, and we’ve seen transmission of Dengue in Hawaii.  So in those areas, we need a maximum protective response to track mosquitos, control mosquitoes and reduce risk to pregnant women.  But we don’t have specific projections of what might happen.  We are looking at what might happen globally but there are just too many unknowns.  Perhaps one of the most important unknowns is what is the range of fetal abnormalities in addition to microcephaly? Microcephaly is not a diagnosis, it’s a description. It’s a description of a devastating fetal malformation that’s occurred and has interrupted normal brain development. It’s highly likely that infants who are not affected by microcephaly but do have Zika trans-placental infection, will have some other effects. Whether it affects our parents in the short term or long term, it will be very hard to say.

ED MCCABE: I agree, when you see the syndrome, which is what we are seeing here, we see the extremes of the syndromes.  As Dr. Frieden has said, we don’t know the impact the infection may have on the baby the baby’s whole life. And to the point about projection, we just don’t want to see that experiment happen in the U.S. There is no reason why we should come back two years from now and say we were right or wrong about our projections.  Let’s stop this.  We know what we need to do to stop it.  Let’s put the resources out there to stop it and not play another numbers game two years from now.

JONATHAN TERRY: Jonathan Terry with Fox News– This morning, we saw a map showing a rather disjointed patchwork of mosquito control districts. What is your best advice to local governments on how they can sort of unify or coordinate that patchwork?

TOM FRIEDEN: This is one of the real challenges, really, if there is one bottom line i have for today’s summit, we need sustainable mosquito control capacity throughout the country and whether it’s Zika or West Nile or Dengue or the next vector-borne threat, it’s so important that we have the resources there and we will do whatever we can at the federal government, the state, local government, also need to do more mosquito abatement. In the morning session, we heard that some of the mosquito districts are very powerful and are very effective.  Others are basically the guy who shovels the snow in the winter and the fog in the summer.  So they’re quite variable in their capacities.  That’s one of the reasons we need money from congress but in addition to state and local governments also need to invest in mosquito control in the long term. Amy Pope?

AMY POPE: The issue you raise is exactly why we’re having this summit today. What we realize is that there was no set of best practices for people who wanted to control this vector out there.  What we do know is there are very good instances of communities that have been able to better manage the vector.  we know from our experiences, for example, there have been very good practices that are in place and so if the goal of today’s summit is to bring all of those practices together in one place, give folks sort of the menu of options so that they can develop a comprehensive plan well in advance of when we see mosquitoes biting around the continental United States.

(UNKNOWN: CONSUMER REPORTS): Can you talk a bit about resistance and if resistance testing is being done extensively and how it’s informing guidelines with respect to insecticides and bug spray.

TOM FRIEDEN: Thank you. In terms of resistance, most of our work has been in Puerto Rico, which is most heavily affected.  We set up the laboratory for resistance in Puerto Rico, I’ve visited and I’ve seen the resistance testing they are doing, it’s quite impressive.  It’s not easy, you have to go out and collect the eggs of the Aedes Egypti Mosquito; then you have to grow them and wait until they hatch into larvae. When they’re adults you have to put them into a bottle.  It’s very simple.  You basically take a glass bottle and you roll insecticide around until it covers all parts of it.  You put 25 mosquitos in there.  Which is harder than you might think or easier than you might think.  You measure, every 15 minutes, what proportion of the mosquitos are knocked down. And I was able to see the test during this visit. Unfortunately in Puerto Rico, many of the pyrethroid insecticides have a high degree of resistance.  So I saw very effective insecticides with mosquitos flying happily around an hour later, it doesn’t affect it whatsoever.  And then with at least one of the insecticides, mosquitoes were knocked down within 15 minutes.  What we found in Puerto Rico, and what we’re finding in Mexico and elsewhere and in our international work is that insecticide resistance can be quite focal. Remember from Dr. Petersen, that these mosquitos don’t fly that far. So you might find as we found in Puerto Rico that there was no one pyrethroid that worked on that whole entire Island.

That makes mosquito control even more complicated.  Even more technically challenging, because you then have to match the insecticide used to the resistance of population.  It’s another area in the U.S.  where we need much better data and much better testing.  It is in some ways similar to antibiotic resistance where you want to know the resistance pattern before you use antibiotics and sometimes using the location and the combination to prevent the further development of resistance.  Other questions?

REPORTER: Talk about each state should have a plan. How many states have plans and how many states say they have the staff and money to implement the plans right now?

TOM FRIEDEN: I think it’s safe to say no state would say they have enough money and staff to respond effectively today.  Because this is a big challenge.  There is a shortage of entomologists out there.  There is a shortage of dollars to do the expensive things needed.  I think most or the great majorities of states have done a lot to prepare.  But this summit is to accelerate that action.

EDWARD P. EHLINGERTHIS: This is a rapidly changing environment.  So what ASTHO (Association of State and Territorial Health Officials) is doing, we are surveying all of our members, to see what they are doing, what resources they are putting into it.  Also asking them what things are they not doing in response to changing those priorities. So we’ll be getting that information.  We know everybody is paying attention. We’ve had multiple calls of all the state officials throughout the country.  We’ve had several calls so everybody is working on it, they’re doing different things. As I mentioned earlier, the needs are a little bit different in Hawaii and Texas and Florida than they are in Vermont and Washington or North Dakota.  But everybody is working on it in some way, shape or form.  We are trying to collect all that, so that we can feed that back to CDC.  What are the needs?  How do they vary?  What kind of resources are needed?  Where do we need to focus our attention?  We will be getting that i am hoping in the next few weeks as we survey our colleagues.

UNKNOWN: Does anybody have a completed plan or are you saying everyone is drawing them up right now?

TOM FRIEDEN:  right now, there is no complete, there is no definition of a complete plan.  We are learning every single day about new things.  We are learning what issues are out there.  We are learning how the virus is moving, how we’re going to be responding, getting new information.  So people, some people have really robust plans from mosquito control to testing to education, to social media, but is that a complete plan?  We don’t know yet, because we don’t know all of the things that we don’t know.

AMY POPE I’d only add this is not the first time that we’re starting this conversation.  Back in February when all of the governors were in Washington to meet with the president we came together and realized that we very much needed this kind of planning because – someone noted the patchwork of mosquito control efforts around the country– and since that time, CDC and our other federal partners have been working with states to develop their plan so that people coming into this already have something in hand and then the goal, today they walk out and they import the expertise and the  knowledge that they’ve gained from their colleges.  But as we pointed out, we are learning every single day.  I would challenge anybody who says they have their complete plan in place. We believe at this point you need to be adjusted to learn more.

TOM FRIEDEN:  We’ll take a question from the phone.

OPERATOR: Thank you.  Our first question from the phone is Dennis Thompson with Health Day.  Your line is opened.

DENNIS THOMSON: My question has been answered.  Thank you.  Sorry about that.

DONALD McNEIL/NYT: If this was World War II and you went to congress asking for money to fight the Japanese, and their response was, well, take it from the money we already gave you to fight the Germans. You would find that an almost absurd response.  I can’t.  You can explain it that way.  I can’t think of the time congress has looked at a new epidemic and said, ah, forget it. Go take the money from one of the old ones. We’ve had a series of epidemics in this country.  Could anybody Dr. Frieden or from the White House comment on why you’re running into this kind of resistance on this one disease?

AMY POPE: Well what I think Congress is doing is asking the American people to choose which disease they want the most protection from and that just doesn’t make a lot of sense. When we worked with congress to get the money for Ebola, we believe they actually showed quite a bit of foresight in saying we’re not going to fight this epidemic by epidemic. We’re going to make an investment in our global health security and we, with the money, the investment that they made, have been working with countries around the world to put together a plan to prevent and respond to vector borne diseases. We think this will ultimately make America safer because we will see things like Zika coming, we will see things like Lassa fever, or Ebola as these outbreaks happen. Frankly, we don’t think funding epidemic by epidemic makes a lot of good policy sense. We don’t think it’s fair to ask Americans to choose. We’re hoping congress will do the right thing and act.

TOM FRIEDEN: I would also comment that Ebola is not over. In fact just this morning a new case of Ebola was confirmed in Liberia. Sadly a women who died from Ebola was confirmed after going through the diagnostic test and that investigation is underway. We also have a cluster in Guinea that we’re following up on. With the global health security dollars that Congress invested, we’re confronting a very large outbreak of Yellow Fever in Angola. We’re dealing with Lassa fever in Nigeria, so it’s a dangerous world out there and the more we can stop diseases from spreading overseas, the safer we can be here at home. Another question from the phone for anything that hasn’t been answered.

DONNA YOUNG (Scripps News): Thank you so much for taking my question. This is for anybody, Dr. Frieden or Dr. Lurie. Talking again about the projections, have you actually provided any sort of cost estimate to Congress, not specifically looking at this disease, but the cost estimate of birth defects in general and maybe compare that to the cost of developing a vaccine and treatment to prevent this from infecting pregnant women? Has there been any kind of economic analysis presented to them as an argument as to why they need to provide this funding to develop the vaccine? Thank you.

TOM FRIEDEN: I will make a brief comment then pass to Dr. McCabe who can say more. The request to congress is $1.9 billion dollars of which $828 million is for CDC. That part of the CDC request covers both our continental US, Puerto Rico and territories, and our international activities. Our birth defects specialists tell us a single child with birth defects can usually cost $10 million dollars to care for or more.

ED MCCABE: I don’t think we can take all of birth defects and talk about these babies. First of all we only know the severe microcephaly that these babies are experiencing. This is devastating. I was chair of pediatrics at UCLA for 16 years. The paper in the New England Journal a couple weeks ago out of Brazil was from the team there. They were telling me that the future of these babies is going to be very, very difficult. We really need to stop that, so that we don’t we don’t see that occurring in the US to the degree we’ve seen it in other countries. The costs are going to be terribly high through the life of that child and unfortunately some of these children aren’t living very long. I think it’s difficult, we don’t have the experience yet to know what the life is going to be and again back to those babies that we see in the pictures from Brazil with severe Microcephaly, we can see them, we know how devastated their brains are. What about the baby who was born and had placenta insufficiency, also in the same New England Journal paper? All of the organs were small because the placenta could not provide the nutrition required for that baby to grow normally. We don’t know what the future of that baby is going to be. Then for the babies who may not even show growth problems, but may yet have unknown problems with their brain development with learning and school. We just really don’t know what it’s going to be like, but it’s very concerning, what we’re seeing so far.

TOM FRIEDEN: Thank you. We will take another question from the phone.

EBEN BROWN (Fox News): Thank you. My question has already been answered, so I appreciate your time.

TOM FRIEDEN: Thank you. Do we have any more questions in the room? One more here.

11 ALIVE NEWS: I’m going to go off topic from Zika for just a moment, only because we don’t see you face to face very often. I’m here in Atlanta with 11 alive news. Just yesterday we heard that there was a CDC worker who got infected with  Salmonella, so I just wanted to have you tell us how that happened and is anything being changed, just from your perspective.

TOM FRIEDEN: The investigation is underway, but we’ve committed to doing and what we’ve done here is be completely transparent with anything that occurs in our laboratories. One individual worker, a trainee, who had been fully trained in safety does appear, not confirmed, appears to have been infected with salmonella in the laboratory. They are well. They are recovered. They are back at work.
No one else was affected. Nothing was released and we created as a result of the recent incidents a laboratory leadership service. This is a set of laboratory detectives analogous to our epidemic intelligence service. They are investigating. They have identified what they think is the probable cause and we’ve already issued to the entire agency measures that would prevent this from happening again. I think we have one last question here.

MIKE STOBBE/AP: I just want to clarify numbers. First of all did you say 2 of the 6 sexual transmissions were pregnant women? And also, when you were presenting earlier I wasn’t clear on how many Dengue and Chikungunya have been reported in Texas and Florida before. I think you said two dozen, but then there was a further discussion and I didn’t catch the final count list.

TOM FRIEDEN: We can get back to you with the exact numbers in both cases. Last question.

UNKNOWN: Dr. Frieden, of the cases in the United States, I know CDC has reported some of the outcomes earlier in your paper, do you have any more updates to give us because I think WHO reported in their latest report that there was a woman from Cape Verde who gave birth to a full term baby, with microcephaly here in the United states. Can you give us the broader context, the numbers of Microcephaly cases?

TOM FRIEDEN: We are now monitoring in the continental US, about 3 dozen women who have been infected with Zika at some point. We’ve seen many. It’s in the 20’s and 30’s in Puerto Rico. In the territories it’s in the mid 30’s. 21 in the continental US. We’ve already seen several miscarriages among those women. We’ve reported earlier outcomes. The case you mentioned, although delivered in the US, was reported elsewhere because of the way the disease reporting is done. It was the earlier case in Hawaii and we’ll continue to provide those outcomes as the pregnancies progress. We’ve seen all stages of pregnancy and some for which the stages are still being determined.   We have seen some women particularly in Puerto Rico who appear to have not had symptoms, so that obviously makes it difficult or impossible to know what stage of pregnancy they might have been infected in. We would be happy to get you information afterwards. I want to thank everyone for being here. There is an enormous amount of work being done across all levels of government. Across the US government, you have White House here, HHS, across state and local governments, you have state health departments represented here. Private sector, we have March of Dimes here. This really is all in response to reduce the risks to pregnant women. All of us have a role to play and we need to do that and we are doing that. With a great sense of urgency and commitment. Thank you all very much.

MICHELLE BONDS: This concludes our press conference.  Media who have follow-up questions can call 404-639-3286 or e-mail us at thank you.


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