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CDC News Conference Transcript

Influenza Update

December 19, 2003

DR. GERBERDING: Good afternoon. Thank you for joining us for today's update on influenza. CDC and the Department of Health and Human Services continues to pull all the stops to really combat the influenza epidemic this year, and we have some new information that we'd like to share with you today.

As you know, we've been operating out of our Operations Center here at CDC to help coordinate this complex, multijurisdictional problem, as we have with many of the public health situations that we've encountered in this past year. And we do have a whole cadre of CDC scientists from two of our centers directly engaged in influenza, as well as individuals from virtually every center at CDC who are contributing in one way or another, either through the communications teams or through some of the field teams that have been deployed to states in combating this problem.

So let me just remind you that the flu season is not over yet. You can see that the United States map continues to get red. We may be seeing some leveling off in the states that had influenza early this year, but so far there are many new jurisdictions who are reporting widespread activity. And we know that it's too soon to predict how this is ultimately going to turn out. We won't be surprised to see additional red states over the next few days as the epidemic progresses.

The epidemic is widespread in 36 states. We know that we have experienced many deaths. So far we are reporting 42 deaths among children. Influenza is not a reportable illness formally in any state right now, but we are working with our states to developing reporting mechanisms so that we can learn about deaths in children. Obviously, this is very sobering and very worrisome to us. We are investigating the nature of the illness in children, and we will be reporting in some detail on the characteristics of the pediatric cases so that we can understand better what's happening in this population and we'll be able to provide better guidance to parents and clinicians about how to handle the situation.

It's also the holiday season, and I think we all want to enjoy the holiday season with our family and friends, and there's really no reason that the influenza season this year should interfere with holiday plans. There's no special risk associated with travel or other activities. But we do want people to use some common sense.

In addition to the things we've emphasized already about helping to prevent spread of flu, which includes staying home when you're sick, using good hand hygiene, cleaning your hands frequently, and especially after sneezing or coughing, we do also want to reassure people that the vast majority of people who encounter influenza--and that's about 10 to 20 percent of us every year--do perfectly fine and there are no special health concerns other than the annoyance of having an illness for a few days.

We also know that people are very concerned about flu, and there's a tendency to go to the emergency room if you have any concerns. And we'd like to provide some advice today--and you'll see posted on our Internet in a little while--to help people make better decisions about when they do need to see a clinician and when they can simply follow common sense and take care of their problem or their children's issue at home.

So let me start by just mentioning some of the differences between influenza and the many other viruses that are associated with respiratory illness at this time of year.

Colds generally creep up on people and are associated with runny nose and a lot of nasal congestion, sore throat, and sneezing. Those symptoms of congestion, sneezing, and runny nose are less common with flu, although we do see them. Colds usually begin gradually. Flu is more likely to be having a sudden onset, although not always. Colds rarely involve fever. Influenza almost always involves fever, sometimes with temperatures above 102 degrees.

Flu is mainly characterized by the aches, sore muscles, sore bones, and the tiredness and fatigue that goes along with that; whereas, colds less commonly have those sort of systemic symptoms.

When you do have the flu, it's important to stay home and rest, to maintain hydration, to take the over-the-counter medications that help address specific symptoms, and to remember not to give aspirin to children or teenagers because of the complications of the encephalopathy that can be associated with aspirin in the context of viral illnesses.

There are some warning signs, however, that should alert people to see a clinician or at least contact a clinician. One of the warning signs is certainly trouble breathing. If you have children who have fast breathing or difficulty breathing, those children should be seen immediately by a clinician. Temperatures that are high and remain high for more than four days among children are also a serious sign that something could be complicating the disease and would be an indication to seek medical attention.

For children, if the skin color is not right, if there's a blue tinge to the skin, if the child is unable to maintain their hydration, not drinking enough fluids, if the child is exhibiting any kind of symptoms of altered mental status, being lethargic or especially irritable, or if the child has seizures, it's certainly indication to seek immediate medical attention.

If the flu symptoms go away and then come back worse, that could be a sign of a complicating bacterial infection or some other problem that also is a reason to see a clinician. And then, finally, if the underlying medical condition is getting worse, the child should be seen just in case.

Those same sorts of principles apply to adults as well. Again, a prolonged fever that lasts more than four days, any kind of chest pain or discomfort, feeling faint, feeling confused--these are signs that there could be a complicating problem and should encourage people to seek medical attention.

Then, on the other hand, in the absence of those signs, flu is something that for the vast majority of people can be managed at home. If you have a doubt, give your clinician a call, but it's not necessary to go in and seek medical attention unless there's concern for an exacerbating problem.

It's important that people who have special risks for flu complications seek medical attention early, and those, again, including people who are over age 65 years, people who are pregnant, people who do have an underlying medical condition. And if you're in one of those high-risk groups, you should seek care early and not wait.

There are things that employers can do this time of year as well. One of them is to just help remind employees about the etiquette that we're talking about that helps people prevent the spread of respiratory diseases in the workplace and also to encourage people who are sick to stay home so that they don't serve as a source of transmission to others in the work environment.

CDC is posting these guidelines for self-triage and for helping people make decisions about when to seek medical care on the Internet today, and this is just one in a series of actually 13 things that we've done this week to try to put information out to target audiences. We're receiving about a thousand calls a day for information about influenza. We had a satellite broadcast just a couple of hours ago that targeted information specifically for clinicians to help clinicians understand how to use antiviral drugs for chemoprophylaxis, how to apply infection control guidelines in health care settings, and how to triage access to the flu vaccine. So I would refer people to that broadcast, which is Webcast and available on the Internet for those who missed it.

In addition, we are hosting a flu summit, which is a convocation of many dozens of professional organizations that have a stake in influenza, and we are getting their advice on three things: number one, what can we do in the future to try to enhance vaccination of the 185 million people we think ultimately should be vaccinated every year; second, what can we do to enhance the supply of flu vaccine in the future; and, third, what can we do to improve the modernization of the manufacture of the influenza vaccine. So that advice will be very useful to us.

In addition, we will be hosting a roundtable of the manufacturers of the various products that are relevant to influenza management and prevention to see how we can work together more effectively in the future, particularly to track where products are so that we'll be able to identify localized shortages earlier in the season and have the kind of information we really need to help plan for ensuring adequate access to these products in the future.

So even though it's the holiday season and we wish everyone to have a very, very happy and healthy holiday season, there's a lot of work still going on here at CDC and elsewhere in the Department of Health and Human Services to do everything we can to minimize the impact that this year's flu season has on folks.

So let me stop now and take some questions. I'll start with a question here.

QUESTION: Dr. Gerberding, is there any way for the CDC to track the effectiveness of the current vaccine? When we started this flu season, we were told that there had been a little bit of drift, that the vaccine was made for several strains, then the Fujian A strain emerged, and it may not cover that. Do we know whether the current vaccine is actually doing the job? Do we know if people are getting the flu who have already gotten flu vaccinations?

DR. GERBERDING: We have several evaluations of the effectiveness of the vaccine that are currently in progress in various locations around the country and various populations. What we can say right now is in some animal studies in the laboratory, there does appear to be a good promise of cross-protection, and our experience with this in the past where we've had drift strains that didn't match the vaccine strains, we were able to show that the vaccine had efficacy. How much efficacy with this particular situation remains to be seen. We're hopeful but we don't have the data yet to answer the question, quantitatively, at this point in time.

QUESTION: Can I ask another question?


QUESTION: How far has the CDC and HHS and Congress gotten in terms of what to do next time about the flu vaccine? Is there any thought to government subsidies for the manufacturers, so that all the 185 million doses can be manufactured and the manufacturers don't, aren't holding the bag at the end of the year?

Any thought to government subsidies about making sure the level is there or any push to encourage a different way of manufacturing tissue culture versus egg?

DR. GERBERDING: Secretary Thompson has made it perfectly clear to us that we need to do everything possible to prevent this problem in the future, and some of the things that the Department is looking at working with Congress on include how to allocate the requests for $150 million over the next two years that we're expecting to receive from Congress, and looking at ways to incentivize, enhance production of vaccine is certainly high on the list of things that we're looking at.

There are a number of different ways of doing that, but ensuring that the manufacturers have a minimum risk for overproduction is on the table right now for consideration.

A question here.

QUESTION: Betsy McKay from The Wall Street Journal. Dr. Gerberding, last week you gave us a little bit of information on the causes or probable causes of death of some of the children that were in the MMWR.

I'm just wondering if you have any more information on the 42 pediatric deaths, what complications there were?

The second question, if I may give you two at once, is do you have a handle on supplies of antivirals for flu, how the supplies are right now?

DR. GERBERDING: Let me answer your first question. We are in the process of preparing a report on the children who have died of influenza this year, so those details will be coming out very soon, if not today, imminently.

What I can say so far is that of the 42 children that we have information on right now, about 40 percent had an underlying medical condition. The others either did not have a medical condition or we have not completed the investigation to know whether they did or not.

About 55 percent of the children were less than

5 years old but the others were in the older age group, and we don't have vaccine information, vaccine status on all of the children yet. So it's a little premature to report on that.

But we do know that several of the children had not received vaccinations, and several of the children had not received more than one dose of vaccine which was the schedule recommended for those that are, age is 6 months. So we are hoping to get that information out as quickly as possible, and also, we will do our best to describe the clinical illness.

There are at least three children whose influenza was complicated by bacterial infection. That's one of the things I try to emphasize in making decisions about when your children should seek medical care for influenza illness.

That is, if you have flu and it gets better, and then the child has a follow-up fever or a worsening respiratory condition, that could be a sign of a bacterial complication and obviously those children need--because they would need evaluation and potentially antimicrobial therapy.

The other question about the availability of the antiviral medication, what we're doing right now is we are surveying members of the Association of Professionals in Infection Control, or APIC, A-P-I-C. Every hospital in the country has an infection control professional to deal with contagious diseases in the health care environment.

That association has generously agreed to poll their members, and will be assessing the availability of the four different antiviral medications that have indications for either flu treatment or chemoprophylaxis. So we'll be expecting to have a very--out a report about that early next week.

I'll take a question from the phone, please.

MODERATOR: Thank you. Miriam Falco from CNN, you may ask your question.

QUESTION: Hi, Dr. Gerberding.

Following up on the children that have passed away, 42 is what you know about right now but there could be more out there, correct, since it's not reportable? And can you tell me when this flu summit is going on and what about the vaccine that has been supplied over the past week, the additional vaccine that's been bought by HHS?

Have those run out now too? What's the status on that, because I think what the public wants to know is how can they get the vaccine that's been made available?

DR. GERBERDING: Thank you. The children that we are aware of right now, the 42 children whose deaths have been attributable to flu or the complications of flu, may not represent the entire spectrum of illness and so we are working with the state health officials to make sure that we get as complete information as possible.

We are requesting, as we did in the MMWR, that any illness that's attributable to influenza among children be reported to CDC and we will be providing state health officials with information on how to go about doing that.

The flu summit is actually a telephone summit, so we're not bringing people here physically. We're having conversations over the telephone in order to expedite this, didn't want to wait until after the holidays, so that will be something we can report out about, when we have the perspectives back from those individuals and they will be asked to also provide written input. So we're using a variety of methods to gather their perspectives.

So a vaccine that was made available, the 100,000 doses of the vaccine that were made available this week have been allocated to states on the basis of population, and they in turn are working out through a variety of means to redistribute vaccine where it's needed most. Most of those doses obviously will be accounted for very quickly because there are several locations that have had a very difficult time getting their hands on vaccine.

We knew that the 100,000 doses were not going to solve all of the problems. We also emphasized that Flumist, the internasal vaccine is still available for healthy people, and Department of Health and Human Services is--they're working on ensuring the support of equitable distribution of that product as well.

So healthy people can still access Flumist and those that are in the risk groups should work with their clinicians, because the clinician community is in contact with health agencies and they're doing the very best they can to contribute.

Let me take another question from the phone, please.

MODERATOR: Thank you. Elizabeth Kaledin from CBS, your line is now open.

QUESTION: Thank you. Hi, Dr. Gerberding. Back to the pediatric deaths again--sorry to keep going over this--when you say that 40 percent of the children had underlying medical conditions, can you give us any kind of more specific number about the vaccine situation.

You say several children had not received the vaccine. Was it the majority who had not received the vaccine? What details can you give us about that, the vaccine situation in the children?

DR. GERBERDING: As I indicated we're still in the process of collecting information from the reporting states on these children, and we just don't have it all compiled yet. Some of them are still very scant data, so we cannot answer your question accurately until we complete the investigation.

The children with underlying medical conditions are, again, something that will be included in the CDC report when we get all of the information together. So just bear with us. We're working on this as fast as we can because we know it's of vital interest. And, of course, as is true in every influenza year, when we have a viral infection like this that affects so many people in our population, not just children but also adults, we take every death seriously, and we want to do everything possible to help the clinical community as well as parents understand what's going on so that we can try to prevent it.

I'll take another question from the phone.

OPERATOR: Thank you. Daniel Yee from Associated Press, your line is now open.

QUESTION: Hey, thanks for doing this. I was just wondering about the field teams. Where have the teams been deployed? How many teams are out there? And what are they doing?

DR. GERBERDING: I would ask Mr. Skinner to get back with you about the details of field team deployments at this point in time. But basically one of our highest priorities right now is to evaluate the efficacy of the vaccine product, so we're working in a variety of settings across the country to try to collect the data that we need to assess efficacy among patient populations, efficacy among children, and efficacy among health care personnel who are involved in some of the outbreak areas. So we'll provide what information we can about that as--if you want to get back in touch with the public affairs office.

QUESTION: Beth Galvin from Fox 5 News here in Atlanta. Talking about the health care personnel, you had a press conference I guess a month or two ago, and you mentioned, I don't know, maybe 50-percent compliance or something among health care personnel. Have you gotten any indication, are they getting their shots?

DR. GERBERDING: Some of the information that we're working on collecting with the Association of Professionals in Infection Control that I mentioned will include an assessment of health care worker vaccination. We had some good news in some of the facilities in the Atlanta metro area indicating that there were unusually good vaccination rates among health care personnel, some hospitals reporting more than 70 percent, which is a record high for most facilities. So it's a very good sign, and we're not receiving reports in the local area yet of health care worker illnesses sufficient to interfere with bed capacity or patient care activities. So we will have more information on that after data come in from the survey that's in progress right now.

We'll take another phone question, please.

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

QUESTION: Hi, Dr. Gerberding. What can you say about the percentage of people that are getting tested for flu and the percent that are coming back positive for influenza? Are more people in general being tested for the virus than in years past, and is this because of SARS? And can you comment on the figure that is generally cited that says about 50 percent of respiratory deaths never get fully diagnosed?

DR. GERBERDING: You're asking a very--a series of very important questions. Respiratory viral illnesses are very common, and we don't generally work hard to make a diagnosis of them, and for many common respiratory illnesses there really isn't a diagnostic test because colds and the things that are so common have not really needed a diagnosis since there's no specific therapy. But that's beginning to change, and I think it's starting first with influenza where we do now recognize that it is important to be able to make a diagnosis when there's treatment and the antiviral therapies that we have are specific for influenza, though there is certainly more utilization of the antigen test for influenza this year than we've seen in the past. That may be part of the reason why we have more reports of illness, but we're not predicating use of antiviral treatment on the basis of a test. I think that's very important. People don't have to have a flu test to be diagnosed with influenza if flu is known to be widespread in their community.

So the testing is improving, but there are still many respiratory illnesses that remain undiagnosed because we don't have tests for all the pathogens and would require special laboratory processing and not something that we have at the bedside.

We'll take another telephone question.

OPERATOR: Thank you. Rob Stein from The Washington Post, your line is now open.

QUESTION: Hi, Dr. Gerberding. Thanks a lot for doing this. I just was hoping you could help put that 42 pediatric deaths in some sort of context. Is that--I know you don't typically have reporting--that kind of reporting, but does that seem to be above usual, about the same? Any idea?

DR. GERBERDING: This is a really difficult question. Just again let me emphasize that (?) a statistic, these are not pediatric deaths, we're talking about children here, and so that makes it very important. But we don't have detailed, accurate information on the number of children who die every year from influenza specifically because it hasn't been a reportable illness. Mathematical models have suggested that somewhere around 92 children between the ages of 0 and 5 years old would be expected to die from influenza in an average year. But that is the mathematical model, and I want to emphasize that.

So the fact that we have identified a total of 42 children this year of a much broader age distribution certainly is not--is certainly within the estimates of that mathematical model. But it's just too early in the year to really draw any conclusions, and that's why it's such a high priority for us to assess these individual children, as well as the overall epidemiology of influenza in children during the season.

We've gotten excellent cooperation from state and local health officials, and I think everyone is very motivated to help us get the information we need to be able to answer your question more accurately. So stay tuned on this one.

There's another question here.

QUESTION: Do you think flu should be a reportable illness? And is it possible to do that?

DR. GERBERDING: It's very difficult to have influenza illness per se be a reportable condition because, as I said, about 20 percent--between 10 and 20 percent of Americans get flu every year. So that would present a formidable reporting task for people in the health and public health sectors.

But serious influenza illness is something that we will be looking at. Now that we have a reliable diagnostic test, we can have more accurate information more often about what is truly influenza and what is an influenza-like illness caused by something else.

But I think our system right now of the sentinel measurement, where we're not asking for reports from everyone but through a sample of facilities or a sample of clinicians, we're getting the picture of influenza that helps us identify where disease is widespread. That's a system that's been very useful to us, but when children die of influenza and there's special concerns about that population that may have an impact on future decisions about vaccine recommendations, having more specific information in that subpopulation may very well serve us, and we have requested the state health officials to make decisions about reportable diseases focusing on this and make a decision as to whether or not that will be a formal recommendation in every state.

We'll take a question from the telephone, please.

OPERATOR: Thank you. Steven Smith from Boston Globe, your line is now open.

QUESTION: Hi, Dr. Gerberding. Good afternoon. I'm just wondering if at this juncture CDC has any better sense, has been any better able to tease out whether, in fact, the strain of vaccine in circulation this year is more virulent, if, in fact, more people are really becoming ill? Or is it an artifact of people being more conscious of the flu this year? Is it an artifact of the season arriving earlier and we'll see an earlier peak and this will sort of become a typical season? What is the working sense of that?

DR. GERBERDING: I wish I had a scientific-based answer for your question. It's just too early in the year to really have that information available. It's definitely true that the season started earlier than average, we know that, and it's definitely true that there's more widespread activity for this time of year compared to most years when we deal with influenza.

But whether or not the people who have flu are more likely to be hospitalized or more likely to develop complications and death from this particular strain, we just simply can't say. It takes time to sort that out and that again is part of the reason why we have these ongoing investigations right now, so that we'll be able to get the answer to that as quickly as we can.

In general, the reason we were concerned about influenza this year is because the H3N2 strains of flu do often tend to be associated with more severe illness and higher hospitalization and death rates, but that's based on a retrospective look, and as we know, the past doesn't always predict the future, so we really do need to get the accurate scientific information to put this into perspective.

It isn't something that can be done quickly but it is something that's being done with the team of CDC scientists that have been deployed and it's a high priority for us.

Let me take another question from the phone, please.

MODERATOR: Thank you. Anita Manning from USA Today, your line is now open.

QUESTION: Thank you. Dr. Gerberding, there's a story on the wire that says CDC has activated its emergency operations center. Is that something that just happened, and if so, what is the significance of that? And then I will have a follow-up question. Thank you.

DR. GERBERDING: CDC's emergency operations center is the way that we now coordinate complicated epidemiologic activities for us, because it is a coordinating mechanism that encompasses our communications, our logistics, our scientists and our overall integration as an agency.

We have so many centers of CDC that are contributing personnel to this, and we have activities going on in so many locations around the country, that we utilize this state-of-the-art facility to really coordinate these activities.

So the fact that we're operating out of our operations center I think is a statement of how we're doing business in a more efficient and effective way and not a sign that there's anything about this particular situation at the moment that constitutes a new public health emergency.

The operations center has been the locus of our activities for the last two weeks and it is again just a tried and true method that we've learned throughout previous situations with West Nile and SARS and monkeypox, and so forth, that’s a very good mechanism for coordinating and taking advantage of the communications capabilities, the satellite communication, the video broadcasting and the overall logistical support that our operations center team contributes to this sort of effort.

QUESTION: Thank you. And then just a quick follow-up. This was touched on before. But can you tell us what we should be telling our readers and viewers about who they should ask about, when they're looking for flu shots? Should they be going to the state health and local health departments? Or what should they be doing?

DR. GERBERDING: For the people who are at high risk of influenza, the most important resource is of course their personal health care provider and that really should be the first point of contact.

Health care providers and state and local health officials are in communication. Health care providers who have extra doses of vaccine are being asked to let the local health people know, and people who are experiencing shortages are similarly asked to contact health officials so that the public health personnel are brokering the available vaccine to make sure that it goes as far as possible.

So the bottom line is contact your clinician. I'll take another question here.

QUESTION: I was just wondering, have we reached the level of an epidemic yet and is there any hope that this could be an early peak?

You know, it could have come on early and it could be peaking off right now and drop off in a couple weeks?

DR. GERBERDING: No, there's no firm dividing line between what's an epidemic and what's not an epidemic, but I think when you look at a map that shows widespread influenza activity in 36 states, that we regard it, from a common sense perspective, as an epidemic.

From a mathematical, statistical perspective, and one of the surveillance tools that CDC uses, the number of cases has not exceeded our epidemic threshold, but that's really a mathematical, epidemiologic, kind of scientific perspective and not a common sense view of what's really happening.

So we're referring to this as an epidemic of the flu like we see every year. Whether or not it's peaking, it's too soon to tell, but we're hopeful that we'll begin to see firm evidence of peaking in the states that were hit earliest on. That's been a pattern that may be occurring in Europe and some of the other countries that had early onset activity, so we're watching that very carefully.

We may have a better sense of that next week. I can't promise that but we're not really willing to say that for sure at this point in time.

I think I'll just take one last question from the phone.

MODERATOR: Thank you. Larry Altman from New York Times, you may ask your question.

QUESTION: Yes. Julie, I believe this is the first time you've used the term epidemic. It wasn't in the MMWR yesterday with the 36 states. Have you used this before or are we correct, that this is the first time you're using the word in that perspective?

DR. GERBERDING: I don't think it's the first time I've used the word epidemic.

QUESTION: I mean for influenza.

DR. GERBERDING: Okay. Because I have used the word other times in my life. Larry, I can't tell you for sure, but again, I don't want to imply a degree of precision here in how we characterize this, that it's not based on any kind of hard dividing line between outbreak, epidemic, pandemic.

I think what we're experiencing here is the typical pattern of influenza in the United States with an earlier onset. It remains to be seen whether it'll be worse or the same as or less severe than previous influenza seasons.

But from a practical perspective, given the number of people affected, I think it's fair to refer to as an epidemic.

Let me end with that and to wish everyone a very safe and healthy holiday season. Thank you.

Listen to the telebriefing

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