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CDC Telebriefing Transcript

Safer, Healthier Summer

June 26, 2003

DR. GERBERDING: Thank you for joining us today for this briefing. We're going to be talking about some tips for playing it safe this summer, but before we get into that issue I wanted to just provide a very brief summary of the current status of some of the investigations that are ongoing at CDC.

The monkeypox investigation is still active in several states. We currently have 79 cases of monkeypox that have been reported. Thirty-one of these have been confirmed in the laboratories here and 48 are still under investigation.

Wisconsin has the largest number of cases, 39, followed by Indiana with 20, Illinois with 16, Missouri with two, Kansas with one and Ohio with one, and the good news is that two of the children who have had the most serious illness with monkeypox are both improving.

We also have so far 26 people who've received smallpox vaccine in an effort to prevent monkeypox. These people have either had occupational exposure or at high risk because they live in households with other people who already have the infection.

Now let me just give a very brief update on SARs.

We have good news today. The travel advisories in Beijing and Taiwan have been lifted. So currently there are no countries for which we are advising against unnecessary travel. We do continue to have travel alerts in mainland China, Beijing, Taiwan, Hong Kong and Toronto, and remember, a travel alert is simply a reminder that you are potentially returning from a area where SARs has been diagnosed and that if you develop illness you should contact a clinician.

Worldwide, there have been over 8,400 cases including 800 deaths from SARs. We continue to be cautiously optimistic that the epidemic is truly coming under containment, at least for the time-being, but, again, as always, we have to emphasize the importance of vigilance and close attention to any illnesses that could conceivably be SARs, especially here in this country among returning travelers to those affected areas, because we have learned, over and over again, how quickly an epidemic can once again flare up.

I'll also just mention that we are anticipating the summer's West Nile virus infection activity. So far, we've seen activity in birds or mosquitos in 28 states but we have not yet diagnosed a single human case.

Just as with SARs, we remain very vigilant, we are alert to the possibility that this is not going to surprise us, given that we are seeing the virus in mosquitoes, but we need to stay prepared and take the kinds of steps that I'll talk about in a minute, to make sure that we minimize the risk to individuals from mosquito exposure.

Now let me say a few things about having a safe and healthy summer.

We know that summer is a wonderful time of year. I'm a gardener. I love it when the sun is shining and I can be outside in my hard, where I am soberly reminded, my husband acquired West Nile virus infection last summer. So I think it was a reminder to me, and hopefully a reminder to everyone, that while we're out there enjoying the summer, there are also some very important things that we need to do to stay safe.

Let me give you some of the sobering statistics that were the precipitant for this press briefing today.

Each year, in June, July and August, there are an average of 657 drownings in this country. Each summer, over 400 people die from exposure to heat, and the majority of these occur during June, July and August.

Over a million cases of skin cancer are diagnosed every year and the vast majority of these skin cancers are linked to over-exposure to the sun. Summer is of course the time when ultraviolet rays are the most intense.

And of course summer is also the season for West Nile virus infection, as I mentioned. Last year, we have over 4,000 cases of West Nile virus that we recognized in the United States and we don't know what kind of season we're going to have this year but prevention from mosquito bites is a very important part of summer safety.

So what can we do? I'm going to go through a set of tip that pertain to some specific scenarios where we know there are special problems in the summer, and first and foremost among them, given those more than 600 drownings that happen every year, are tips for safe and healthy swimming.

Children should not be left alone near water. That's the bottom line. The vast majority of deaths associated with drowning among children relate to unsupervised activities near the water, and life jackets really do help. They're incredibly under-utilized but they can really make a difference and we strongly encourage parents to have life jackets for their children.

It's also very important that parents and other supervisors know CPR. It can be life-saving, particularly with drownings, and it's a simple skill and there are all sorts of community resources where you can learn to save a life.

It's also important anywhere in recreational water that you don't swallow the water and that you try to instruct your children not to swallow the water. This would apply to lakes, rivers, pools, in all kinds of water for recreational use.

Also children should not go swimming, or you should not go swimming if you have a diarrheal illness because that can lead to contamination of the water and the promotion of diarrheal illness in those settings.

Let me talk about those heat injuries and deaths. Heat injury particularly affects the elderly, the very young, and people who have other chronic health conditions. It's important to schedule outdoor activities to avoid the hottest times of the day, to pace yourself or use a buddy system, so that someone else is with you and can take note if you start to falter or have the early signs of heat injury.

And it's most important to drink plenty of fluids. Heavy exercise in a hot environment means that you should drink 16 to 32 ounces of cool fluids an hour, sometimes even more than that. Alcohol paradoxically is the wrong thing to drink because alcohol actually causes people to lose even more fluid. So you can't catch up with your fluid losses if you're drinking alcohol.

Skin cancer prevention is a big one. The bottom line is to cover up, wear a hat, wear sunglasses, and by all means wear some sort of solar protection that has an SPF factor of at least fifteen, and that should include coverage for your lips and your face, and this needs to be used every time you go outside, and has the rating to protect against both UVA and UVB protection.

Food safety. Summer's the time for picnics and lots of gatherings, family reunions, and so on, so forth, and yet this is exactly the kind of environment that sometimes promotes exposure to infectious diseases that are transmitted through food.

You have to cook meat and poultry thoroughly before bringing it out on that picnic and it's very important not to cross-contaminate foods. If you've prepared your chicken with one set of utensils, those need to be thoroughly cleaned and replaced before putting the cooked chicken back on the same cutting board.

You need to refrigerate your leftovers as quickly as possible, or toss them out if you can't, and just common sense measures like rinsing fruits and vegetables before eating them or using them for other ingredients that will be taken in raw.

Finally, for West Nile protection, I know we say this over and over again, but we can't emphasize enough how important it is to remove the standing water from your property whenever possible, because that's where mosquitoes breed.

And fortunately, mosquitoes don't have a long flight range. They don't come in for miles and miles and miles. They stay fairly close to where they've bred. So if you can eliminate their breeding, you can reduce the mosquito population in your vicinity. It's also important to stay covered, wear long pants and long sleeves, especially in the evening and the morning, and to use insect repellent, as directed, to reduce further the chance of a bite.

So these are just some of the tips for a safe and healthy summer, and there are others that will be available to you through the CDC Web site which is

Later today, we're going to be pulling together a whole set of factsheets, healthy swimming, drowning prevention, food safety, the West Nile and mosquito infection prevention, skin cancer prevention, extreme heat precautions, and so on, and these will be available through the CDC spotlight on our Web, so that you can find them quickly.

And also I want to draw your attention to this publication which is the so-called yellow book, or the health information for international travel.

This is the newest version of the yellow book; it's just come out. This is the gold standard information for travelers which really provides a comprehensive look at everything you need to know if you're planning to have any kind of international travel, and of course this too is information that can be accessed through the CDC Web site at

So let me stop there and take some questions. Go ahead.

QUESTION: Are you frustrated, perhaps, saying the same statements every year? The statistics seem to be eye-opening in certain categories and the advice seems to be common sense, but we don't seem to be getting the message?

DR. GERBERDING: Well, I think like all health information, you have to repeat it over and over again so that everybody hears it, and one of the things that we're hoping to be able to do is to sustain this message in more of an outreach format, so that it penetrates into all communities that need to receive the information.

Today is sort of the first start, but we will be working to repackage this and make sure that people in every community understand the relevance to their personal situation.

DR. GERBERDING: Is there a telephone question? All right. Then let me come back to ask someone in the room, if you have a question here. Yes?

QUESTION: [inaudible] you went through a series of statistics before you went into the tips.

Are any of the statistics new? Have they jumped since last year?

DR. GERBERDING: I'm not able to give you the specific changes in statistics but these have been fairly constant over the last few years, and I think there are variables that bring them up or down, depending on weather circumstances, or, you know, when we have a bad heat wave, then of course the heat injury goes way up in a particular jurisdiction and we see pockets of much more severe incident rates in circumstances when that occurs.

But I think overall, we just need to bring these particular statistics down to zero. It is not unrealistic to expect that we should be able to eliminate drownings and eliminate some of these kinds of accidents in our country, if we really apply ourselves in a systematic and comprehensive fashion, and over time, that's exactly what our injury center and the other centers at CDC are working toward.

Is there a telephone question, please.

MODERATOR: A question from the line of Betsy McKay with The Wall Street Journal. Please go ahead.

QUESTION: Hi, Dr. Gerberding. Thank you very much. I had two questions. One is, if I might, one is regarding West Nile virus. The advice is to use mosquito repellant with DEET, and I know there have been concerns in the past about side effects from DEET, and I'm wondering if you can give us--the CDC does say it's safe. I'm just wondering if, if--you know, what we should keep in mind about use of such repellents.

The second thing is I'm wondering if, following up on the Immunization Advisory Committee meeting last week and their decision regarding the smallpox vaccination program, if you can update us on CDC's position. Thanks.

DR. GERBERDING: Certainly.

Mosquito repellents are a very important part of mosquito bite prevention, particularly for people who need to be outdoors during the mornings and evenings, when mosquitoes are most likely to be biting.

We have not identified any health hazards associated with DEET. The one caveat is for very young infants. We discourage the use of DEET-containing repellents because the skin is so fragile in infants, that there may be a greater chance of absorbing the chemical into the skin and we have incomplete information about whether or not there are health hazards associated with it.

I think its important that people distinguish between concerns associated with repellents and concerns associated with insecticides per se, and sometimes there is the assumption that the things that are used in the environment are in the same category as the things that are, seem to be safe to use on the skin.

The smallpox advice that CDC received from the ACIP is being evaluated and as with all advice from the ACIP, is taken with a great deal of respect because we recognize the thoughtful and expert perspectives that that committee brings to bear on a variety of immunization issues.

We also recognize that that committee has a very specific charge to provide advice.

They obviously don't make regulations or make policy but they do advise the CDC director and the Secretary, but the perspective of that advice is primarily focused on the safety of the program, and we have to take that advice in the context of the overall goal of preparing our nation in the event of a smallpox attack.

We have no information since December, that would suggest that the threat of a smallpox attack is any less now than it was last year, and our President made a policy decision based on that information, that we needed to be able to protect our country should we have a smallpox attack.

Now preparedness is more than just the number of people who have smallpox vaccine. Preparedness includes our ability to detect the first cases of smallpox and we've seen examples, recently, with other public health conditions where our detection system has worked very well and we have examples where there may still be delays or lags in our ability to detect cases.

So we've got to continue to work on the detection aspect of this.

We also need to be able to isolate and quarantine cases of smallpox. SARs has taught us a great deal about the practical realities of isolation and quarantine and I think we have learned a great deal from that experience that has helped our overall smallpox preparedness planning, but there may be ways to go in communities that haven't benefited from the experience they gained from preparing for SARs.

It's also important that we have enough people in the public health and health care sector immunized, so that they can stand up very quickly, a clinic, to provide mass vaccination against smallpox.

Some communities have already developed plans and have sufficient numbers of people vaccinated.

Other communities still have work to do. So one of the things that CDC has done in its most recent guidance for utilizing the more than billion dollars that's gone out to the states to support overall terrorism preparedness is to help identify specifically the comprehensive approach to smallpox preparedness.

I try to use every opportunity to move people away from counting up the number of people vaccinated and to think about this as a comprehensive preparedness effort because all of the steps need to be accomplished and the more we can do to detect, isolate, and quarantine people, the less we'll need to rely on the pre-vaccination to stand up the overall vaccination clinic.

The short answer to your question is we respect the ACIP perspective but we also recognize that we still have work to do, including ongoing immunization.

Fortunately, the experience from the Department of Defense indicates that with proper screening and attention to safe implementation of the vaccine program, it's actually safer than we had projected when we started the program last winter.

May I have another telephone question, please.

MODERATOR: The next question will come from the line of Carol Taylor-Mitchell with Safetables Priority Newsletter. Please go ahead.

DR. GERBERDING: We can't hear the questioner.

MODERATOR: Your line was open, Ms. Taylor?

DR. GERBERDING: Let me just go on to the next question, please. Is there someone in the room who has a question while we're waiting to get the phone service organized?

[Question not on audio.]

DR. GERBERDING: What about pregnant women, indeed? Again, we have no information to suggest that there's a specific health hazard associated with DEET in the preparations that are recommended, but as with any chemical exposure during pregnancy, if there's any question, pregnant women should discuss with their clinician their recommendations in their particular situation, and, you know, I would encourage women who are pregnant to be especially compulsive about wearing the loose clothing and keeping their skin covered because that's a very effective way to avoid bites, and then you avoid those comments.

Any more questions?

If not, I'm, going to thank you very much for your attention and for participating in this briefing, but I have one other thing that I want to say here at the end, and that is a very special day here at CDC, because Dr. Vicki Freimuth, who's been the director of our communications office for the past several years, is having her farewell party today, and I think it's really a tribute to her leadership and her evolution of the communications capacity at CDC, that we're even able to have a press briefing, and so this is a thank you to Vicki.

Thank you.

Listen to the telebriefing

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This page last updated June 26, 2003

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