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Press Briefing Transcripts

CDC Media Availability on Human Swine Influenza Cases

April 26, 2009, 3 p.m. EST

Operator: Welcome and thank you all for standing by. Your lines are on a listen only mode until the question and answer session as which time you may press star one. Today′s call is being recorded. If you have any objections you may disconnect at this time. I′ll turn the call over to Tom Skinner. Thank you, sir, you may begin.

Tom Skinner: Thank you all, and thank you for joining us today for this call on the update on the human swine influenza investigation that CDC and others around the country and around the world for that matter are aggressively investigating. Today with us is Dr. Anne Schuchat, S-C-H-U-C-H-A-T, who is going to offer up some very brief opening remarks, and we want to allow time for as many questions as possible, so I′ll turn it over to Dr. Schuchat.

Dr. Anne Schuchat: Good afternoon. I want to first give you a few opening remarks, some brief updates and then have lots of time for questions with you. You know, I think we′ve been saying this and I want to repeat it. Many people are concerned and we′re concerned as well. We are really trying to approach the issue aggressively to minimize the impact of this new virus on health and to slow its spread when we see it. At this point, today we′re officially confirming 20 laboratory confirmed swine flu cases in the United States. There are five states that have confirmed cases at this point. We expect numbers to change, we expect additional states to identify this virus as we go forward, so numbers are very likely to be unstable and we′ll be updating them on a daily basis.
At this point, one patient has been hospitalized of all of the 20 confirmed cases. All of the patients have recovered, but we expect there to be a broader spectrum of disease here in the U.S. and we′re being vigilant to look for it. We do think the virus is spreading from person to person, and we′re taking steps aggressively to try to slow the spread. It′s really important to remember that flu viruses and outbreaks in general are unpredictable and so while we′ll try to be able to forecast, we may not always be right. We are expecting things to change, and we want you to expect change as well. Our recommendations will be interim ones and we′ll be changing them as we learn more, and as we find out more about this particular virus and the outbreak that we′re seeing.

You′re going to see different recommendations in different places and that′s probably a good thing, customizing the interventions to what′s going on locally, so for the public, we really want them to focus in on what their local or state authorities are telling them, and things are moving fast, so messages might be changing in the next day or so. There′s a lot that′s going on and there′s a lot that people can do as individuals. you can focus on reducing your role in spreading respiratory infections, washing your hands, staying home when you′re ill, staying away from other people when you′re sick, and there′s a lot that public health is doing, working together with the clinical community. We, as we′ve mentioned, we have teams in Texas, California, in Mexico. We′ve issued travel recommendations and we are likely to be updating those regularly, so keep an eye out for that, and we also are working with industry and other parts of government to prepare for potential development of a vaccine. So I want to make sure that you know our overall goal is to limit the spread of infection and reduce the impact on health, and that′s really number one at this point, and to provide clear communication to those who need it. So let′s go to the first question, please.

Operator: Our first question is from Betsy McKay,”Wall Street Journal.” Your line is open.

Betsy McKay: Hi, Dr. Schuchat. Thank you very much. I had a couple questions, if I might. One is about the situation in Mexico. At this point, how many samples do you have that have tested positive from Mexico? Is it still seven or do you have more? And how many of those people are those, you know, how many of those people died, if you know that? And I have a second question after that, if there′s time.

Anne Schuchat: Yes, I don′t have updated numbers from Mexico. I can tell you that we know that some of the tests that we have are from patients that were severely ill or had fatal infections. There have been a number of tests of viruses from the past few months that have just shown a seasonal pattern. Apparently, actually we do have 12 samples from Mexico that are positive, so a few more than what you heard about before, I guess it′s 12 up from the 7 that we had earlier, but you know, I wouldn′t focus on the numbers right now. I think it′s very clear that in Mexico, there is confirmed swine influenza, this new strain that looks like the same strain as what we′re seeing here in the U.S., and it′s pretty clear that in Mexico they′re having disease in multiple parts of the country. At this point, there′s lots more we need to understand about the pattern of illness there, and the extent, and we do have teams there trying to learn.

Tom Skinner: Betsy, what′s your follow-up?

Betsy McKay: A follow-up if I might. I recognize I′m getting way ahead of ourselves on this one but I had a question about vaccination. if it does come to mass vaccination with a swine flu vaccination, is there a chance of a repeat of the experience of 1976, with the swine flu vaccination at that point or have there been -- what changes, technological advances and other changes might have been made to make that not happen?

Anne Schuchat: You know, we are thinking about vaccine in terms of the development of a strain of the virus to hand off to industry for possible production of vaccine. We do that when there′s a new strain that′s identified. We′ve done it with some of the bird flu strains you′ve been following, and that′s one kind of decision. It′s a precautionary measure. There are a number of steps involved with producing vaccines and there are expert groups convening to talk about best options for making vaccines for the fall season, as well as possible vaccine production against this new virus. There′s a lot that′s been learned since the 1976 swine flu concern in terms of decision-making, as well as the safety monitoring, as well as understanding production, so I think there′s a lot that′s happened. One great thing here in the U.S. is we really improved our vaccine manufacturing capacity to be ready if we need to scale up.

Tom Skinner: Next question, Rose.

Operator: The next is from Elizabeth Cohen, CNN, your line is open.

Elizabeth Cohen: Hi, thanks so much for having this teleconference. My question, and I have a follow-up as well, this looks like the Mexico and U.S., you′re having the same strain, why is it so much more severe in Mexico? I know you said you were looking into that yesterday. Have you made any advances trying to figure that out?

Anne Schuchat: You know I think right now it′s premature to say the disease is different in Mexico from here. We don′t have that many infected people at this point and we don′t have great information from Mexico yet. Their team′s really trying to work together a lot clearer information in Mexico, and at that point, we′ll be able to understand the pattern. Certainly, we have death in Mexico, and we have not, fortunately, seen them yet here, but we fear that we may.

Tom Skinner: Elizabeth what′s your follow-up?

Elizabeth Cohen: Is it just that our denominator isn′t that big yet, we just don′t have many cases and that′s why we′re not seeing deaths yet?

Anne Schuchat: That′s one possibility. Of course, we may be fortunate and not have them, but I think we really need to prepare for the idea that we will have additional cases, additional affected states and I do fear that we will have deaths here.

Tom Skinner: Next question, Rose.

Operator: The next is Helen Branswell, Canadian press, your line is open.

Helen Branswell: Thank you, very much, I have a couple of questions if I could, please. The Mexico situation is really muddying -- well, the difference between Mexico and your country and my country is really sort of presenting a very muddy picture. Have any other pathogens been found in the testing of samples from Mexico that would suggest that there are other things going on there? And I′m wondering if CDC has any results of antigenic work that would indicate whether or not previous exposure of humans to human H1N1 viruses would confer any immune protection against the swine H1N1?

Anne Schuchat: We have found other seasonal influenza viruses in samples from Mexico, but in terms of non-influenza viruses we don′t have definitive results on that yet. I am aware some tests have been run that were negative but they′re very, very few studies that have been done so far. The second question was about prior exposure to H1N1 in terms of natural immunity and that is among the hypotheses we have right now, whether the elderly or older population might be spared because of circulating  H1N1 disease that they′ve been exposed to year after year. We don′t have information on that yet, but it′s among the things that our scientists are looking at.

Tom Skinner: Next question, Rose.

Operator: The next is from Maggie Fox from Reuters. Your line is open.

Maggie Fox: Hi, thanks very much. Dr. Schuchat, you said at the very beginning that you were taking measures to contain. Dr. Besser said it can′t be contained. I want to be clear on what can and can′t be done to control the spread.

Anne Schuchat: Let me clarify that very important issue. When we talked about not being able to contain this the other day, what we meant is that we cannot stop this at the border. We have infections in many states, and in Mexico, the infections are in several states, and so we don′t think that we can quench this in Mexico or in, you know, if it′s in many communities right now, the difference between San Diego and Texas, for instance, we didn′t think we could contain where the virus is, but we think there′s a lot we can do to limit the impact on health, and to slow transmission in terms of working aggressively when we find new areas that have infections to make sure that patients who are ill are treated and isolated, that they don′t infect other people, and to take, have people take precautions when they develop symptoms to stay home when you′re ill, not get on an airplane or a public transportation, to cough, when you cough or sneeze, to cover that, and not infect other people, and you know, the basics of really washing your hands a lot. So there′s a lot you can do to reduce the spread of respiratory infection and the way that these infectious diseases are transmitted. We think the flow in transmission can have excellent impact on health and that′s really what we′re focusing on now. I hope that can make the difference between totally stopping it at the border and really aggressively responding wherever we find it.

Tom Skinner: Maggie, do you have a follow-up?

Maggie Fox: I do. I just want to clarify, too, that the recommendation is not to do things like stopping flights and closing borders, correct?

Anne Schuchat, CDC: That′s correct. We are not doing that. We′re making sure people are aware of the situation in the communities that are affected, and that people are taking precautions to reduce their chance of illness, and reduce their spread of infection, if they have symptoms.

Tom Skinner: Next question, Rose.

Operator: Thank you, Keith Darce, the "San Diego Union-Tribune" your line is open.

Keith Darce: Thanks for taking my question. I have a first question and then a follow-up. First question, could you describe in more detail what your team or teams in Mexico are doing, what kind of activities are involved in, and also specifically could you say whether any CDC personnel are in the Tijuana or Baja, Mexico, region and doing work there and what kind of work they might be doing there?

Anne Schuchat: Okay, let me say that the teams in Mexico have two general areas right now. We′re -- and we are part of both a world health organization team and a trilateral team that involves the U.S., Canada and Mexico, and we are assisting with the epidemiologic investigation trying to understand what, who is ill from this virus versus from other circumstances, how infection is spreading, what factors increase or decrease the risk of infection, how transmissible is the infection. We′re also focusing on laboratory issues, including trying to work to strengthen the laboratory capacity so that Mexico will have a better ability to detect this new virus on site. In terms of additional work, you know, we are on standby to help with issues like communication and infection control guidance and those matters. In terms of Tijuana and the Baja region, I′m not aware that our, the location of our teams at this point. We actually do have quite a few activities along the border between the U.S. and Mexico that are not part of this investigation. They are a routine border infectious disease surveillance activiy, so I don′t have specifics about Tijuana and the Baja region right now.

Tom Skinner: Next question or do you have a follow-up?

Keith Darce: I do. I do have a follow-up to your comment earlier, linking possible prior exposure to H1N1 to an explanation for why more young people seem to be contracting the infection. Do you have any other theories about why this seems to be more prevalent among younger people than the more common, some of the more common associations of flu with older people?

Anne Schuchat: You know, I think that -- I think there are probably lots of things we could speculate about, you know, with the SARS outbreak, we also saw more disease in the young, healthy adult population than in the elderly or very young, but I think it′s premature to understand all the factors. There are various hypotheses and our study also help try to sort some of that out.

Tom Skinner: Next question, Rose.

Operator: The next question is from Mary Brophy Marcus, "USA Today," your line is open.

Mary Brophy Marcus: Hi, thanks for taking my question. I have talked to a couple of infectious disease experts around the country and some of them have wondered if CDC plans to issue guidelines to hospitals for treating flu-like infections presenting in ERs.

Anne Schuchat: That′s right. There′s a number of guidance documents that we have been working on, and I might not know exactly what′s already on our website. We have issued interim recommendations for anti-viral use for treatment and for diagnostic testing, so I think there′s quite a bit out there. Now, it′s important also to know that things may vary from community to community. Many in the press have been reporting on the situation in New York City, and I know they′ve been developing guidance for their special circumstance there, where they are seeing an outbreak in a school and they′re responding to illness that they′ve already confirmed there. So I think CDC has been issuing various recommendations but we do expect local or state circumstances to vary and some modifications may be quite appropriate. We do know, though, in terms of the treatment that the two newer influenza antiviral drugs, Tamiflu or Relenza or Osletamivir even Zanamivir, whatever you want to call them, that the virus is sensitive to the drugs, so those are the focus for treatment recommendations. It′s important with treatment that it begins within -- the idea is that, beginning it within 48 hours of onset is likely to have more effect than a later start, and severe patients should definitely be treated.

Tom Skinner: A follow-up question?

Mary Brophy Marcus: I know you talked a little bit about this but if could you elaborate at all on the vaccine development process. Would one be ready by this fall if, say a more virulent strain of the virus appeared?

Anne Schuchat: You know, it takes several months to prepare a vaccine, and one of the reasons we start the preparation of the vaccine strain right away when we see a new virus is because of the time lag. We′ll work in the lab to prepare something that can be handed off to the manufacturing industry for them to scale up and so it′s a several-month process. You know every year we talk about early in the spring or late winter picking the strains for next fall′s season. It′s the same kind of thing with a preparation of a vaccine for a new virus like this one. So several months.

Tom Skinner: Next question, rose.

Operator: The next is from Mike Stobbe, the Associated Press, your line is open.

Mike Stobbe: Hi, thanks for taking the question. Of the 20 U.S. confirmed cases, how many have been to Mexico and also, do you have any information on the transmission -- you said you believe transmission is occurring from person to person. Is it occurring past the initial infection like person "a" infects person "b" but is it then infecting person "c" do we know that yet? Also I have a follow-up.

Anne Schuchat: You know, I know that we have confirmation of disease in people who have traveled to Mexico, and I don′t know the numbers, but I know that that is definitely the case in some of our cases, and that′s an important factor to consider. We have a lot of travel to Mexico back and forth between the U.S. and Mexico, and we certainly are looking for illness in those people, so we have asked people to test and we′re finding some illness. In terms of the spread, you′ve asked about person-to-person-to-person, yes, we do think that′s going on, and some of the focus of our investigation in the U.S. are in those dynamics, you know, just what′s happening in a school setting or in a community, so that′s part of what the folks in California and Texas are looking into.

Mike Stobbe: A follow-up. Within those 20, how many had traveled to Mexico and my follow-up is also, should in the U.S. people be wearing masks or buying extra food? What steps should individuals be taking right now?

Anne Schuchat: You know, I don′t have the precise number among the 20 of how many have traveled to Mexico. I think there′s active investigation of a number of those so far, so I can′t give you a number, I′m sorry. People can do many things. The first thing is to stay informed, what′s going on in your community, are there special recommendations for you? Certainly New York city residents have gotten recommendations from their authorities, but in areas where there hasn′t been disease yet, there′s a lot that we can do, and these things sound simple and repetitive, but it′s important for readers to know, washing your hands can reduce you spreading an infection, covering your cough, not touching your eyes or nose, which can prevent you from infecting yourself with a virus that′s on your hand, staying home when you′re ill, not getting on an airplane or a bus, those are really good things to reduce the spread of infection and to keep you from infecting others. Also, when you do have difficulties with respiratory symptoms, high fever, cough, body aches, possibly some other symptoms, you know, consulting your health care provider about whether it′s important to be seen and tested or treated. If you are returning from one of these areas, like Mexico, and you have those symptoms, we do think you should connect with your health care provider, and see whether you might qualify for testing.

Tom Skinner: Next question, Rose.

Operator: Daniel Denoon, WebMD your line is open.

Daniel Denoon: Thanks very much for taking my question. Dr. Schuchat, I′d like you to expand a little further. We′re getting a lot of searches on WebMD for people looking for symptoms to look out for. Could you be very specific about the kind of symptoms that a parent might see in an a child or an adult might see in himself or herself that would trigger alarm. You′ve only got 48 hours to get Tamiflu so could you be very specific and spell this out for us, please? Thank you.

Anne Schuchat: Yes, let me also say that of the cases we have seen in the United States, they have recovered without treatment in general, so the idea is that you′ve only got 48 hours is not really the idea that I′d like to convey. The symptoms appear -- that we know of at this point are relatively non-specific: high fever, cough, sore throat, muscle aches, possibly vomiting and diarrhea in some numbers. Those can be caused by so many different things, and it′s impossible for someone to tell whether those symptoms are caused by this new swine flu virus, another flu virus or one of the many, many respiratory viruses and bacteria that can cause the same kinds of symptoms so this is a dilemma. It′s a challenge and it′s something that we′re wrestling with on the clinical and public health community are wrestling with. There′s not a perfect test right now that will let a person, member of the public or a doctor know exactly what the situation is. So we′re focusing the public on if they′re severely ill, of course they should see their doctor f they′re having these symptoms of fever and respiratory complaints after a trip to Mexico, for instance, that′s a good time to go and check with your doctor and get tested but this isn′t an easy yes/no kind of thing.

Tom Skinner: Do you have a follow-up question?

Daniel Denoon: Yes, just one. So we′ve been advised to be prepared, should the W.H.O. Or the U.S. move to the next step of preparedness. what kind of things should we be think being as Dr. Besser asked us to do, if things do move forward which we hope it won′t, so that we are ready for the next step, should it occur? Thank you.

Anne Schuchat: You know, I think that thinking ahead is a great idea. A lot of those W.H.O. Phases are all about planning, and preparedness. Now, we′ve seen recently in New York City they closed the schools. Certainly in other communities that haven′t seen this kind of problem yet, people might want to think about, what if my child′s school was closed, what would be my plan? Would I stay home with my child? How would things go at work? Who do I have as backup at work, those kinds of things are reasonable, whether it′s a regular problem with a sick child or it′s a community concern, like a school closing for more than a day or two. So I think that working on those kinds of planning exercises is a good idea for people, making sure that you know how to find out information in your community, whether you′re looking at your local health department′s website, or the TV information, sorting out where can you find good information. At the national level, we really want to have great information on our website,, but that′s going to be at the national picture, and so knowing how to find good information, whether it′s from your school, or your workplace, or your health department.

Tom Skinner: Next question, please.

Operator: The next is from Daniel Steinberger, CBS news, your line is open.

Daniel Steinberger: Hi. Two questions. I′ll start with the first one. Can you confirm reports that there may be officials in Mexico who are investigating like industrial-scale hog facilities as a potential source or capos? And I have a follow-up.

Anne Schuchat: No, I can′t confirm that. I can say that the U.S. Department of Agriculture is working with other parts of government on animal sources. You know, we′re doing that as a routine part of this kind of investigation. We′re at the point where we don′t have information about illness in pigs related to this virus, but that would be a normal thing to be looking into.

Tom Skinner: Do you have a follow-up?

Daniel Steinberger: Yes, and also, are there any CDC officials or health officials conducting extra screenings at airports from people coming in from Mexico?

Anne Schuchat: No, we′re not doing that. We think it′s most important for travelers to have information about what signs and symptoms to look for, and how to report illness if they have it, but we aren′t doing screening in the U.S. airports.

Tom Skinner: Next question, please.

Operator: Deborah McKinsey, "New Scientist" magazine, your line is open.

Deborah McKinsey: Hello, thanks for taking my question. I have two questions, please. The first one is, you said that some of the eight genetic segments of this virus were similar to sequences that have been seen in bird and human avian flu viruses, sorry, avian and human flu viruses, as well as the segments that are similar to swine flu viruses. Can you tell me which genetic segments are similar to bird and human consequences?

Anne Schuchat: No, I′m not going to be able to answer that, I′m sorry, but let me just add an item to my previous answer. We are working rapidly to prepare yellow cards to hand out at the airport for travelers, you know, giving them information about the signs and symptoms to look for and how to report illness, so we′ve done that in the past for various kinds of outbreaks and situations, and so that′s one of those travel advice steps that we′re taking.

Tom Skinner: Do you have a follow-up question?

Deborah McKinsey: Yes, I do, please. Have you done any tests to see whether there′s any antigenic cross-activity between this virus and currently circulating human H1N1? I can′t believe you haven′t done a human inhibition test, for example, it′s pretty straightforward. Do you have any idea whether this thing shares antigenic reactivity in common with H1N1?

Anne Schuchat: The tests that we′ve done so far against the seasonal flu vaccine strain of H1N1 is very pessimistic. It does not look like there′s cross-reacting antibody from the seasonal vaccine H1N1 to this particular virus. We haven′t yet ascertained about natural H1N1. I believe that work is ongoing.

Tom Skinner: Next question, please.

Operator: The next is from Delthia Ricks, "Newsday."

Delthia Ricks: Hello there, Dr. Schuchat, can you tell us what the age distribution is in the 20 cases and how many of -- and whether New Yorkers comprise the majority of those cases and then I have a second question.

Anne Schuchat: I think that the age, it′s as young as I believe it′s as young as 7 and up to 54 at this point. Of the 20 confirmed cases, eight of those are from New York. So you had asked about the majority, that would be the site, the state with the largest number, but it′s not more than half so it′s 8 of 20.

Tom Skinner: Do you have a follow-up, Delthia?

Delthia Ricks: Yes, I do, and that as you mentioned a little earlier that elderly people might be spared, you mean spared from infection or spared from death because they′ve been exposed to H1N1 swine strains in the past or just H1N1 in general?

Anne Schuchat: You know, it′s really too soon for us to conclude that older persons are spared. the information we have so far about the 20 cases that we have found in the U.S. don′t have people over, you know, beyond their 50s, and there may be many reasons for that. In Mexico, they looked for illness in a very focused way, and that might have missed older patients. Our preliminary information in Mexico from their hospitalized patients is that they′re younger, but I think you know, we don′t have enough to know, although like you, we are speculating about what might be different about older persons.

Tom Skinner: Next question, Rose.

Operator: The next is from Jonel Aleccia, Your line is open.

Jonel Aleccia, MSNBC: Hi, thanks very much for taking the question. I′m wondering if you have some really basic information about this virus that would help provide a little clarity. Do we know the basic reproduction number and the generation time for this virus yet?

Anne Schuchat: No, and we are very keen to find that out. That′s part of what the intensive epidemiologic investigations are about, to understand the transmission pattern so we don′t have those numbers or we don′t have those estimates yet.

Tom Skinner: Do you have a follow-up?

JoNel Aleccia: Is that because the, because of the logging of the cases in Mexico or -- that′s pretty fundamental information not to have yet, from what flu experts are telling me.

Anne Schuchat: Well, I think that part of the issue is getting sufficient numbers to have reliable estimates, and part of the information is where we are in both the Mexico and U.S. investigation. So we have numbers that are changing and we′d like to have a little bit more stability in that, but we welcome advice for the academic community, and we are reaching out to them aggressively, actually.

Tom Skinner: Next question, Rose.

Operator: The next is from Brian Thompson, KS Public Radio, your line is open.

Brian Thompson:Hi, thanks for taking my question. My first question deals specifically with Kansas, since I′m only aware of two cases here so far, if you can update me on that, I′d like to have you do it, but I want you more to tell me, should people in Kansas, who become ill with these general symptoms, go on the presumption that it′s this virus?

Anne Schuchat: The patients in Kansas that we are, that we have confirmed laboratory results on, the number two, so it′s only two that we have confirmed, and the circumstances there are, it′s a husband and wife, one of the couple traveled to Mexico, became ill, and two days later the spouse became ill, so that′s an important event, but we have no information about broader transmission within Kansas, and so it is important if people are ill in Kansas, they use their judgment about whether they′re able to see their health care provider but we wouldn′t assume there′s a large scale problem in Kansas at this point.

Tom Skinner: Next question.

Operator: The next is from Bob Roos, CIDRAP News, your line is open.

Bob Roos: Thank you, thank you. Covered some of this already but I was wondering what you know about the age distribution of the patients in Mexico and particularly in relation to severity of illness there.

Anne Schuchat: Yes, you know, we would love to have more information and we are working on gathering that. What we know so far is that many of the patients that have been identified are in their 20s, 30s and 40s, but we′re still lining up information about which of those actually have illness caused by this virus, so there′s a lot of gaps in what we know about, and I think as you know, there are so many causes of respiratory illness even in that age group so not everything that′s being counted is definitely caused by this virus, but it′s in that under 50 age group that we′re seeing of adults.

Tom Skinner: Do you have a follow-up, Bob?

Bob Roos: No, thanks.

Tom Skinner: All right, next question, Rose.

Operator: The next is from Matthew Harper from "Forbes" your line is open.

Matthew Harper: Hey, I have three really quick, I think related vaccine questions. The first is just is how quickly could a vaccine be produced for the fall season? How much of an impact would that have on seasonal vaccine production? And would any new technologies that have been in development for producing flu vaccine but may not yet have FDA clearance be considered for producing vaccine if this does turn out to be a worrisome epidemic?

Anne Schuchat: Okay, we think that it takes several months to produce a vaccine, whether it′s the seasonal flu vaccine or vaccine against the new virus like this swine flu virus. The specifics depend on how well the virus grows. That′s part of the challenge, and so we are working on that beginning step at this point. The second question is about new technologies and yes, that′s part of the discussion, the cell lines as opposed to the egg-based production. BARTA is kind in the lead on new technologies and there′s a lot of discussion about, as you say, the technologies that didn′t yet, hadn′t yet been used for our seasonal flu vaccine but that we really invested in just in case we would need such for this kind of eventuality. And then the third question was about the impact that making a vaccine against a new swine flu virus would have on seasonal flu vaccine production. You′re right that there could be an important impact but there are a number of things under discussion, whether or not to produce a vaccine against the new swine flu strain, whether to produce seasonal flu vaccine that includes the swine flu strain, but may substitute the swine flu strain for one of the other strains, or make even a quadrivalent vaccine. There are lots of things being discussed and there′s some expert groups providing input into those very important decisions.

Tom Skinner: Rose, we′ll take questions from one last caller here.

Operator: Thank you, the next is from Joe Neal, NPR, your line is open.

Joe Neal: Hi. I′m a little -- I want to go back to the screening travelers issue. I′m a little confused. At the White House briefing today, Secretary Napolitano was quite specific that all people entering the U.S. from a location of human infection of swine flu will be processed through appropriate customs and border protocols and goes on in saying, making very specific points about how people will be taken and isolated if they have symptoms. So I′m wondering if there′s a disconnect here between what customs and border protection might be doing to screen people coming into the country and what the CDC is.

Anne Schuchat: No, there′s no disconnect at all. We′re working closely with the Department of Homeland Security, and the border personnel on those types of issues. What I was trying to say was, we are preparing the yellow cards to hand to people. You know that we have quarantine stations in most of the major airports, and that the Customs Border Patrol does a lot of regular screening. I think that we′re not trying to disagree. I think we′re on the same page.

Tom Skinner: Is there a follow-up?

Anne Schuchat: If I gave the impression that I′m in conflict with the secretary, I apologize.

Tom Skinner: And this is Tom Skinner, you know, there are standard procedures in place that are in effect all the time, when sick passengers on airplanes are identified when they do enter port of entry here in the United States, if a sick passenger is identified, there are steps to have someone meet that person at the port of entry and do an assessment, so standard procedures do catch people that come into the country that are sick. Do you have a follow-up procedure?

Joe Neal, NPR: No, I was just going to say --

Tom Skinner: Question?

Joe Neal: -- That′s quite a bit more than just yellow cards so that clarifies it, thank you.

Anne Schuchat: That′s really our routine procedure, that our staff do.

Tom Skinner: Okay, well, Rose, we′re going to conclude the call and thank you, everyone, for joining the call and please, we′ll keep you posted with information as it becomes available. So thank you very much for participating.




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