November 6, 2009
NOTE: This is a rough, unedited transcript and transcription errors may appear.
Operator: Welcome and thank you for standing by. I would like to remind parties your phones are in a listen only mode. Press star 1 to ask a question. You may begin.
Glen Nowak: Thank you all for coming or calling in for today for the press briefing on H1N1. Today's speaker is the director of the national center of the center of disease control and prevention. She'll give you an update on the disease activity in the country as well as the vaccine supply. I turn the podium over to Dr. Anne.
Anne Schuchat: Thanks, Glen. Good afternoon. The pace or our progress is picking up. Today, we have twice as much vaccine available as we had two weeks ago. I'm going to touch on three areas, an update on the flu itself, the disease and the vaccine supply then the efforts. Flu is still widespread. 48 states have widespread influenza activity. Everything we are seeing is the 2009 H1N1 virus. The rates of disease are higher than normal for this time of year. We wouldn't expect this many states to have this widespread of a disease. Flu can last until May. We don't know what we will see with this virus in general. Most of the illness is in younger people. More than half the hospitalizations are in people under 25. 90% of the deaths are in people under 65. A flip-flop from what we see with seasonal flu. The pediatric deaths are high. Children have died from flu where the typing wasn't done, but that's an increase from last week's number. Two-thirds of the children who died from the H1N1 virus have underlying condition that is increase their risk of this problem. The leading underlying conditions in children who have died are severe neurologic problems like cerebral palsy and muscular dystrophy and asthma in terms of contributing to the severe outcomes. Fortunately, antiviral are effective treatment against flu, including the flu complications. we have updated information on our website for clinicians about some of the myths and misconceptions about antivirals. we are seeing a better supply horizon in the community and we think they ought to be used when there's a severe illness like anyone hospitalized and people with respiratory systems with underlying conditions like pregnancy and asthma. people are getting worse. they are not getting better, antivirals may be important. the next thing I want to catch people up about is the vaccine effort. today, we have twice the vaccine available as two weeks ago. today, there are 38 million doses of H1N1 vaccine available for ordering by the states. the majority of this is injectable doses. about a third of it is the spray form that's recommended for people who are healthy between the ages of 2 and 49 years of age. today's number is up more than 11 million doses from last friday's amount. that is progress. if all goes well, we are expecting about 8 million doses to be available in the week ahead that's if everything goes well. as vaccine supplies increase, we think things should go better. we still don't have enough vaccine. we know that communities are seeing lots of demand and the supply hasn't caught up with that. many places need more. we think we are toward a path of improvement at this point. state and local health departments are going to be in the best position to determine how to effectively use and direct the vaccine doses that become available. the key now is focusing on the priority groups, children and young adults up through age 24, pregnant women, parents or caretakers of babies under 6 months of age. People with chronic conditions and health care workers. Those five groups are key and the focus area for the states and locals. Our goal, really, is to put vaccine in the path of people who are in those priority groups to make it as easy as possible for them to be vaccinated and to really support the state and local health departments that are managing the effort. We know that vaccine is being offered in a variety of venues with a variety of strategies and our goal, really, is to have vaccine accessible in these groups at this point. I want to mention one nice effort we have heard about in the Champaign-Urbana Public Health Department in Illinois. They created a nice department between the private providers and the state special services program. Children with special needs had an easier way to be vaccinated through the clinic. When parents bring the kids in with special needs, they don't have to get out of the car, a nurse comes out. It's been an innovative program. I want to congratulate them for coming up with this partnership. In closing, I want to remind folks progress is being made, but we need to extend that in the weeks ahead. Priority groups are the focus of our activities. We are expecting variation state to state and community to community in finding the best ways to reach the high priority populations. We know the state and local health departments and their partners in health care are working hard to reach these groups. It's really important for every available dose to be used as quickly and effectively as possible. This will become more and more of a challenge. We're going to continue to have a challenge. We aren't at the supply challenge we want, but better than a couple weeks ago. There's much you can do before you are able to be vaccinated. Stay home when you are sick. Cover your cough and sneeze. Wash your hands. Stay informed. Find out about the warning signs to watch for. There's a lot of good information at flu.gov. Let's go to questions. We'll start in the room. Maybe start over here. Okay. I'm looking for the microphone.
Michelle Merrill: thank you very much. I'm Michelle Merrill with hospital health newsletter. I spoke with someone at a major medical center who received zeroH1N1 vaccine. Many hospitals received a small portion of their order, maybe 10%. We had a report that corporations have been getting vaccine. So, I'm wondering, why are hospitals not the absolute highest priority? They have at-risk patients and does CDC have plans to take more of an active role in determining who gets the first doses of the vaccine and as a secondary question, I understand many hospitals have not received their complete seasonal flu vaccine order. I think that's not being produced right now because of the push to get H1N1. Will they eventually be getting that vaccine?
Anne Schuchat: Thanks. The state and city health departments are doing an incredible job directing vaccine to places to reach high priority populations. In our survey of the states, what we understand is that hospitals were highly prioritized by the majority of states. It doesn't mean they got everything ordered. The initial amounts were relatively small. Hospitals that were able to reach health care workers and high priority groups were heavily targeted. We know there are a variety of places to reach people at risk. We think doctors' offices, health departments, schools, hospitals employee clinic that is reach priority populations are reasonable places for it to go. The key thing is to vaccinate as many people in the groups as effectively as possible. Sometimes, focusing on putting the vaccine in the path of where people will be is the strategy. We work closely with the states in support of their efforts and have been emphasizing the importance of the population. You asked about the seasonal flu. I forgot to update you on that. There are 90 million doses that have been shipped out so far. This is a private sector enterprise. The public health system is not that involved in seasonal flu. Up to 114 million doses of seasonal flu vaccine may be produced this year. Exactly the timetable for getting the doses, I don't know. We have seen increased doses coming out each week. 91 million as of the latest update. We are reminding people that the seasonal flu can occur and it's important to be vaccinated. We think there's time. Usually seasonal flu strains don't increase until December through May. Now, everything we are seeing is the H1N1 virus. Hopefully, there will be additional supplies. They may not be ample to reach the tremendous demand that we are seeing this year. So, I think we can do another from the room.
Jennifer Ashton: Dr. Jennifer Ashton. There have been isolated reports of cases out of Pittsburgh of pediatric H1N1 with the complication of encephalitis. I know it's reported as a problem. What are you seeing and is it an emerging trend?
Anne Schuchat: Thanks for the question. We did facilitate the report of neurologic problems last spring and are hearing the reports now. I don't have the updated information of how widespread it is. It's recognized with seasonal flu, some people can develop that problem. It's worrisome to get it. It's something we can look into further. Let's do another from the room.
Mike Stobbe: Thanks, doctor. Mike Stobbe. Two questions. You said swine flu is widespread in 48 states. It's the same number as last week. Do you think it's leveling off? I want to ask about the Harvard poll that half the people surveyed didn't know where to go to get the swine flu vaccine. Could you comment on that, too?
Anne Schuchat: Sure. We are seeing substantial disease, as I said widespread disease in 48 states. Influenza-like illness is at about the same level this week as the week before its 7.7% of doctors' visits for flu-like illnesses. It's still way higher than we would see at this time of year, even though we had a slight downtick in that statistic. I can't say what's going to happen in the weeks ahead, even at the point where there's a peak of disease in one community. Half the cases are still to come. What we have seen in seasonal flu is that after the milder illness, the outpatient illness peaks, one has a delay before hospitalization and a further delay before death's peak. I don't think we are at peak as a nation as a whole. What I can say is that disease continues to occur at very high levels now. The other thing to mention is that in pandemics in the past, it's been tricky to predict too far ahead. In 1957 there was a substantial amount of disease in the fall. People thought, pretty much gave the all-clear sign, then there was an increase in severe disease. Another wave in '58. We are very mindful that there's a long flu season ahead and we are going to be attentive to the needs of the population, the efforts to try to protect people going forward. The second question you had was about the Harvard poll. We have seen the data. I think it's understandable that people were finding it difficult to find vaccine at the time of the poll because we were and still are at a point where the supply is relatively limited in comparison with the demand. The result of the poll was nine out of ten people who looked for vaccine and didn't get it planned to try again. They weren't giving up. They recognize the value of trying to protect them with vaccine and sticking with it through the next several weeks. You know, I'm very mindful of the frustration people have had, whether from information gaps or just the basic availability of the vaccine. I think it should be getting better over the weeks ahead. A question from the phone?
Operator: If you would like to ask a question over the phone, press star 1.
Reporter: Thanks for taking the call. I have a question today about the IV antivirals. They purchased the drugs. Can you tell me, what level of demand have you seen from doctors wanting this treatment for the most ill patients and whether you expect that demand to rise and whether you expect that there will be enough of the oral antivirals.
Anne Schuchat: It's the first antivenous viral. We are providing that to clinicians who request it. The indication is for a severely ill person who cannot tolerate other roots of administration where the intravenous route is preferred or necessary. We know there are other intravenous medicines under review. Maybe we will get more products in the future. At this point, demand for that product is from critical care personnel to care for their patients. We have had more than 300 requests through our system, so far. We believe that our supply will be fine, given the recent order of product and we will not have to have an interruption in supply. Okay. Another from the phone.
Operator: John Cohen, Science Magazine, your line is open.
John Cohen: Thanks for taking my call. Could you give us specifics of what triggered that? If it was corporations receiving the vaccine, was there evidence they were using the vaccine in low-risk groups? If so, what corporations and what happened?
Anne Schuchat: We have no evidence providers were giving vaccine outside the recommended priority populations. We were aware of concerns and reports and the letter was sent out to the health officers as a reminder to emphasize how important it is, at this time, where supply is limited, that we focus on the best ways to reach the populations targeted for vaccine. Next question from the phone.
Operator: CNN medical news, your line is open.
Reporter: Thanks for taking the question. It's a follow up to the corporation question. Some folks think that the CDC may have been able to do a better job of communicating that corporations are also a place to get vaccinated and get the vaccine to high-risk groups. All though, the guidelines you put out for businesses do say that. Whose job is it to more clearly tell their folks that this is what we decide or do you think looking forward that the CDC may need to do more to communicate that information better?
Anne Schuchat: There are a variety of places where vaccination can reach high priority populations. We think the state and local health departments are in the best position. They know their communities and population and providers, they know the capacity of the care system. What we are seeing state to state and city to city is a variation. A lot of vaccine going to hospitals for health care workers, going to health care departments, managed care organizations and can reach them. Vaccine in many states, going for school located clinics reaching a large number of young people who don't have that many doctor's visits. We're seeing vaccine going to employer based occupational clinics. When you look at adults and where they get vaccinated, the workplace is a common place for adults to be vaccinated. It's convenient and accessible. There's nothing wrong with an employer based clinic. Our focus is helping the states and locals reach the priority populations. Pregnant women are in the work force. Adults with health conditions like asthma, diabetes, we recommend vaccine for that group. Parents of children under 6 months. I think there are many different ways where the adult populations can be reached and we want to support the states and locals in getting the vaccine as quickly and effectively out to them. Next question from the home.
Operator: ABC, your line is open.
Reporter: Could you go into detail on the status of production, whether there are new glitches, are the old ones still resolved and give me a best case, worst case scenario of when you think it's going to field to the public like there's plenty of vaccine out there and they don't have to wait in line.
Anne Schuchat: I'm not aware of new glitches in vaccine production. People have heard, the vaccine strain has been slow-growing and the manufactures have had a challenge in getting a yield that we are reliably producing batches week to week that met their predictions. There's been intense outreach between the services and manufacturers trying to get the best information. Our secretary reached out to the manufacturers to help where it's possible. I'm not aware of new problems. Looking forward, it's extremely difficult to predict when things are going to feel easier in one community. I want to go through a couple things with this because I have been asked that quite often recently. The supply is increasing. We have twice as much vaccine today as two weeks ago. It might not feel like that wherever you are. The demand for H1N1 vaccine and seasonal flu vaccine is high now. This could change area to area. It can change week to week. So, when we get to that sweet spot where there's ample vaccine and demand can be met easily, is hard to predict. I'm expecting in the next several weeks things will get better and better. We have all been burned on prediction. I'm not going to get more specific than that. Next question from the room. Is there one in the room? Okay. Sure.
Reporter: I just want to follow up from the earlier question ant about the poll survey that half of Americans didn't know where to go. What do we draw from that? I have one more question. have we learned any lessons from Europe that say some have been more efficient and effective of finding the people and getting them in for appointments. Any lessons learned or things we can copy from Europe?
Anne Schuchat: Right. I think it's not surprising that many people didn't know where to get vaccine. I think the first few weeks of the program; vaccine has been in very limited supply. In some states, vaccine was sent out to provider's offices so patients could get it through their doctor. It wasn't publicly advertised. In many cases they were directing the vaccine for school located clinics, they were really focusing on children. There wasn't that much product being offered to the general population either to doctors and health care workers or schools. The other people who had priority conditions weren't necessarily able to find vaccine. There are a number of states that held mass clinics that were accessible to the community at large. Many, many states have vaccine in the local health departments offering it through mass clinics or appointments. The hospitals have gotten vaccine they can share. I think the principle is that when you have limited supply, advertising is difficult because you don't have enough. You don't want to frustrate the demand. What I can say is we have all learned how important communication is. Even if there aren't public clinics this week, they have been trying to get the planning going forward settled so that people would be able to look at the website at flu.gov and look at the locator. There's nothing in my community this week, but in two or three weeks perhaps that pharmacy will have it. It's a challenging environment. In terms of Europe, it sounds promising. I'll talk with you later about which countries you are talking about. A number of states have been working well. Some states have immunization registration and can figure out where things are with that. I know the health plans are using their information systems to identify, okay, let's make sure we have a handle on our people with asthma or other conditions and we know how to reach them and let them know they should come in for vaccine. It's a good way to make sure you reach priority groups and innovative communication efforts. We have been working with faith based organizations, community based groups and provider organizations to find best ways to reach people that might not be watching it have or reading the newspaper for the announcements. Question from the phone.
Operator: USA Today, your line is open.
Reporter: Thanks. Two quick questions. Do you have any idea about how many doses of vaccine have been delivered or actually administered up to this point? And my second question is, there are a lot of folks who have gotten flu-like illness with high fevers, the characteristics of flu, but haven't been tested. I get a lot of questions about whether they should be vaccinated any way.
Anne Schuchat: We don't have great estimates, yet, about how many people have been vaccinated. We are carrying out coverage surveys done by telephone to track at a national lever and p state by state, the percent of population that received the H1N1 vaccine. The information we have gotten is the baseline before there was much vaccine out there. Very, very low levels. What we are expecting is to be able to report to you the figures as we get them. The second question was about people who believe they have had the H1N1 infection, fever and cough, but didn't get tested. Should they get the vaccine? We recommend it. The vast majority of people would not know, for sure, if they had the strain, the H1N1 virus. There's not that much testing capacity and we don't think there's harm getting vaccinated. Many things that look like influenza or the H1N1 influenza are something else. The recommendation, if you are in the priority group, when it's available in the community. Another question from the phone.
Operator: Fox news, your line is open.
Reporter: We know up to this point, theH1N1 virus has shown no signs of mutation. Can you quantify the risk of this happening in the future? It is unlikely or something you expect with happen with this virus?
Anne Schuchat:Well, influenza viruses change. That's inevitable. Mutations with occur. The key part is will we see something in the near future that makes it change markedly to something more severe than what we are seeing or is there a change that would occur to leave the virus to escape the vaccine? Both of those changes are possible. Fortunately, we haven't seen any of those, yet. We have been testing many of the viruses. It hasn't changed genetically or the immune characteristics. The vaccines we are making available are very good matches with the virus. It is -- it has been seen with pandemics in the past that over the couple years after a new strain emerges, it starts to change a bit. It starts to drift and become something that would need a change in vaccine formulation, so that's one of the reasons we make up new vaccines every year for seasonal flu. Viruses may change from year to year and we may need to modify the vaccine. Another question from the phone.
Operator: Wall Street Journal, your line is open.
Reporter: Hi, thanks. One of my questions was answered, but I wanted to ask you about the number of doses being delivered in the coming week. I think you said 8 million are expected in the next week or weeks. In the past two weeks, there were 10 million or more new doses. I just wondered if, you know, you could talk about why the slowdown, if that is a slowdown and secondly, I wonder if you have more detail on formulations that are currently available. I know you talked about injectable versus nasal spray. How many single-dose vials and pediatric formulations. Do you have that available?
Anne Schuchat: I don't have the specific details of the formulations. There's several. Pediatric single dose syringes, multidose vials, they are multiple companies. I can say the majority is injectable, not the mist. The majority is the multidose vials, but there are single-dose syringes. The other question was about whether we should read into expecting 8 million doses of vaccine this week and having gotten about 11 million and 10 million the weeks before. I wouldn't read into it. What's happening is batches of vaccine are being prepared and produced. The batches have to be ready. It's not something where week by week you can directly compare. We are expecting, if everything goes well, we will have another 8 million doses this week and going forward, we'll get more information about what to expect. I don't think there's anything to be read into an 8 million expectation for next week versus11 million this past week. Based on everything I know. Another -- time for two more questions from the phone.
Operator: Web MD your line is open.
Reporter: Thank you very much. I would like to follow up on Betsy's questions. we have seen 10 million this week and 8 million next week, can we see the flow is about 8 million to 10 million a week and is that the flow you are expecting or will it vary from week to week? I'm not sure what the flow looks like.
Anne Schuchat: I think we have been trying to stay away from getting too far ahead of the flow. We were wrong in the past when we did that. But, I think that I'm not actually aware of what happens after the 8 million that we are expecting this next week. You know, that's what I can say. Did you have a second question? Or that was -- okay. Next I guess the last question from the phone.
Operator: Minnesota public radio, your line is open.
Reporter: Thank you for taking my call. Some of the estimates we have heard suggest that the waves of illness last six to 12 weeks. Here in Minnesota, we saw a jump in illness ten weeks ago. What are your calculations in terms of how long the wave has been going on and is it similar to what they saw in the southern hemisphere in their flu season?
Anne Schuchat: That's a great question. We have been trying to look community to community in how long things are lasting. What we are seeing is different in different communities. You know, as we said, the southeastern states, some of the southeastern states has rises as early as august. Quite a lot of disease in September and October. A number of those states are seeing drops. They are not down to baseline, they are still elevated. About to say how long does it last is tricky. We have seen parts of a city, then another part of the city. I wish I could tell folks in your community what to expect, but it's difficult to. Thanks everybody. I think Tuesday we will be on, again or somebody will be out here Tuesday.