December 10, 2009
NOTE: This is a rough, unedited transcript and transcription errors may appear.
Operator: Welcome and thank you all for standing by. Your lines are in a listen-only mode until the question and answer session at which time you may press star 1 to ask the question. Today's call is being recorded. If you have any objections, you may disconnect at this time. I will now turn the meeting over to Dave Daigle. Thank you, sir. You may begin.
Dave Daigle: Thank you. Thank you for everybody for joining this afternoon. We're going to do an H1N1 weekly update with Dr. Frieden, the director of CDC. We'll start with a statement, and then we'll take Q & A's from both the room and the line. Thank you very much.
Thomas Frieden: Good afternoon, everybody. Today we're releasing new estimates as we said we would. Last month we said we would release estimates of the number of people made ill by, hospitalized from and unfortunately killed by H1N1 influenza. Its three to four weeks later, so we're releasing the estimates today. The bottom line is that by November 14th, the day up to which those estimates include, many times more children and younger adults, unfortunately, have been hospitalized or killed by H1N1 influenza than occurs during a regular flu season. We'll also cover vaccine supply which is expanding with increasing access in many parts of the country. And highlight that it is still a good window of opportunity to get vaccinated against H1N1 influenza. Tomorrow we'll provide the Flu View update of what's happening as we do each Friday. It is likely to show that the disease continues to decline as the current wave recedes. What will happen in the future, only the future will tell. Flu season generally lasts until May, and as I've indicated before, when we've asked flu experts from around the country and around the world what they think will happen in the rest of this flu season, about half think will have a lot more cases between now and May. And about half think we won't. The truth is we don't know. Only time will tell. And that's why vaccination remains the most important thing you can do to protect yourself and your family from H1N1 influenza. What we provided last month were the updates from April to October 17th based on the best available data from multiple data sources. What we have seen so far reiterates that people under the age of 65 are most heavily impacted by influenza. By November 14th, many times more children and younger adults, unfortunately, have been hospitalized or killed by H1N1 influenza than happens in a usual flu season. Specifically, there have been, we estimate there have been nearly 50 million cases, mostly in younger adults and children. More than 200,000 hospitalizations which is about the same number that there is in a usual flu season for the entire year. And, sadly, nearly 10,000 deaths, including 1,100 among children and 7,500 among younger adults. That's much higher than in a usual flu season. So as we've seen for months this is a flu that is much harder on younger people and fortunately has largely spared the elderly until now. What that means, if you calculate it, is that about 15% of the entire country has been infected with H1N1 influenza and that means about 1 in 6 people. That still leaves most people not having been infected and still remaining susceptible to H1N1 influenza.
We also are releasing today information on the burden of influenza among the American Indian and Alaskan Native population. This is for 12 states where about half of the American Indian population resides. We find that this is this week's MMWR finds that the death rate is about four times higher for this group. This is most likely largely a reflection of environmental factors and underlying conditions like diabetes and asthma that are more common, access to health care rather than genetic or race ethnicity difference. Since the beginning of the H1N1 outbreak, we've been aware of the potential for greater harm in populations with higher susceptibility and we prioritized vaccine, working with states to insure that the Indian Health Service and other facilities that care for American Indians and Alaskan Natives get enough vaccine and treatment anti-virals early on to reduce the burden of illness and death to the greatest extent possible within existing technology. Vaccine supplies continue to grow. We added more than 12 million additional doses available in the past week. That brings us to 85 million doses of H1N1influenza vaccine available. Many states have increased the eligibility, having met the demand in the five priority groups to the general population and that's consistent with the recommendations of the Advisory Committee on Immunization Practices. This is entirely consistent with what's been recommended. We've seen an increasing number of states do this. Sometimes in individual communities or counties within states, sometimes in entire states. It's important as they have been doing at the state and local level to plan for that, to get vaccine out more widely to the retail pharmacies that can vaccinate, to a wider group of clinicians who want to vaccinate. Doing that has a lot of benefits. Not only does it enable people who want to get vaccinated, get vaccinated, but because there are more providers giving vaccine, it increases the number of people who get vaccinated as well. The more pharmacies and doctors offices, and the more doctors offices and pharmacies that have the vaccine, the more people at high risk as well as others will be vaccinated. This past week CDC consistent with policy where we're located here in Georgia began offering vaccine to all employees. And I'll get vaccinated using the nasal spray vaccine in a few days. And I, of course, will make sure that CDC we continue to prioritize the high risk groups, encouraging those with underlying conditions or care for infants to get vaccinated in particular. This is still a good window of opportunity to be vaccinated. I can certainly understand that many people might say well there's been so much disease and it's going down so much, why get vaccinated now? But the fact is we don't know what the future will hold. Just as in a usual flu season, you get vaccinated because you think it might be a bad flu season. The vaccine is likely to protect you. That's really the situation we're in now. We're at the beginning of December. Flu season lasts until May. And we don't know what the future will bring in terms of H1N1 influenza. We might have a lot more cases. We might have few. There's still spread going on now. And it's likely if there are more cases that it will be different in different parts of the country. It's a different country with different patterns of disease over the past season.
So I hope that all who are interested in being vaccinated will be vaccinated. It's the best way to protect yourself and your family from illness, serious illness, hospitalization or death. And it also, even if you wouldn't become severely ill will protect from you being out sick from school or work for a week. The more people who are vaccinated, the more people who will be protected from influenza, the fewer cases we'll have in the future, the less likely we will be to have a third wave or more cases in the weeks and months to come. Thanks very much. I'll take questions starting in the room.
Mike Stobbe: Hi, doctor. Mike Stobbe from the AP. Thanks for doing this. Two questions. One, could you tell us what is going on with seasonal flu? Is that starting to appear more and which strains of it? And, also, you said you were going to get the nasal vaccine. Why nasal? I thought studies had shown the shots a little more effective in adults.
Thomas Frieden: So in terms of which formulation to get, I think each year the data will show in the end whether they're comparable or one is a little better or one is not. I only got another year to get the nasal vaccine. So I figured I would get it this year. The -- your first question is about seasonal. The Flu View, we will provide that tomorrow. Until recently we have seen very little seasonal flu. We're beginning to see influenza B as have mentioned in the past. We did have a death in a child from influenza B. That is covered by the seasonal flu vaccine. We know that the update of seasonal flu vaccine is fairly widespread. And that the supply is nearing its end for seasonal flu vaccine. But there is still some out there in some places.
Betsy McKay: Thanks, Dr. Frieden. Betsy McKay from the Wall Street Journal. One clarification: is this the same -- are you using the same methodology for the estimates as did you in October? I just wanted to see if we have 10,000 deaths now, is that -- which means there have been 6,000 in the past month? And secondly, I am wondering if you could talk more broadly about how this compares so far with seasonal flu. I mean, I know the time period is different. But are you thinking now that this is, you know, taking a worse toll than seasonal flu generally or less?
Thomas Frieden: So, the methodology details are all given on our website. Please refer to our website for that detail. It's not quite that you can take the current estimate and subtract the previous estimate to see what happened in the past month? There is some correction for late reporting. But there has been a lot more disease in the month that's reported than in the months before. In terms of comparison of this year's flu with H1N1 influenza with seasonal flu, we know that it's much milder for older people. It's much less likely to result in death because older people are much less likely to get infected. But it has been a much worse flu season for people under the age of 65, particularly younger adults and children. The estimate we have -- the estimate that we're releasing here is not done in the same way that gives us the 36,000 estimate. That estimate is a different methodology. And will give a slightly larger number than this number would give. But if you were to compare, even though it's not a directly applicable comparison, under 50 in that estimate, there are less than 1,000 deaths a year in age under 50. We didn't break out in this -- we're not able to at this time, the 50 to 64 versus 50. But a large portion of those adults are under 50. So it is really many times more severe in terms of severe illness and hospitalizations are several times higher for children and young adults as well in H1N1 than in a usual flu season. On the phone?
Operator: Our first is from David Brown, Washington Post. Your line is open.
Reporter: Thanks a lot. Doctor, if the report notes the higher, much higher mortality in aboriginal people goes back to 1918 pandemic, I'm wondering if anything is known about the genetic component of that risk and what the -- where it resides, you know, what mechanism is whether it's the same for aboriginal people in the Americas than in, you know, Australia and places like that or is that just a completely mysterious subject?
Thomas Frieden: There's a lot of debate about why the rate of disease and serious disease is higher for influenza and other infectious diseases. I think it's very difficult if not impossible to tease out the effects of the environment where nutrition starting in early childhood is different, where access to health care is different, where the likelihood of having an underlying condition such as diabetes which is highly prevalent in many populations, particularly in the U.S. of American Indians and Alaskan natives. So I think it's very difficult to tease that out. But the bottom line is the same, vaccination is very important. That prompt treatment of those who are severely ill is very important. The scientific work of sorting that out, I think, still has fair amount to be done. On the phone?
Operator: Tom Maugh, the Los Angeles Times, your line is open.
Tom Maugh: Do you have any estimate for what proportion of the Native Americans have now been vaccinated?
Thomas Frieden: No, we don't have detailed estimates. And because of the sample size, it's difficult to get for American Indians and Alaskan Natives. We do know that although there are large differences between different tribes in different areas, in many places vaccine uptake is quite high among American Indians and Alaskan Natives. Some of the most important vaccine studies that have been done have been done showing effectiveness of different types of vaccine in the indigenous population. Next question on the phone?
Operator: Matt Sloan, CNN Medical News.
Reporter: My question is about H1N1 infection and the homeless population. This is a particularly susceptible population. I'm curious, one, if the CDC has any specific on numbers on how many homeless people have been infected or died, and, two, can you talk a little bit about the vaccination push in that population both in shelters and on the streets?
Thomas Frieden: Many people who are homeless fall into the higher risk categories because of underlying health conditions. And, of course, in any congregate facility such as a homeless shelter, there's the potential of an outbreak. We have not seen as many outbreaks as we might have expected. We've seen more the school-based or college-based outbreaks. But clearly this is a population that has significant medical needs and that we want to try to encourage rapid treatment and if they're in a high priority group, vaccination and now that many states have expanded vaccination to the general population, a group that can be vaccinated. Next question on the phone?
Operator: Bob Roos, your line is open.
Bob Roos: Thank you. I just wondered if you have any kind of estimate at this point of what the level of population immunity is for H1N1 either by vaccination or infection and if anyone can estimate what the level of population immunity it would take to prevent a third wave.
Thomas Frieden: There are a lot of theories over what would and what wouldn't prevent a third wave and how many people are immune through the virus or vaccination. Again, about 15% of the population has been infected and had symptoms of flu by mid-November. That still leaves even if there were a lot of infections in people who didn't have symptoms and a lot of people vaccinated, that still leaves most people without vaccine -- without immunity. And it's going to be different in different communities. There are going to be very different rates. And even within cities, there will be different parts of cities with different rates. So what that means in terms of future cases is very hard to predict. And the only, I think, certain answer is that only time will tell what the future will hold. But we know that the more people who get vaccinated lower the likelihood there will be of additional cases or third wave. Next question on the phone?
Operator: Jessica Zigmond, Modern Healthcare mag, your line is open.
Jessica Zigmond: I would like you to confirm the figures you gave earlier, cases of hospitalizations end up include estimates since the virus emerged in the U.S. until November 14th. Is that correct?
Thomas Frieden: That's correct. It's the first seven months of the pandemic in the U.S. Any questions in the room?
Mike Stobbe: Thanks, Mike from the AP again. There have been a couple developments regarding anti-virals. I think the CDC posted new guidance. Will you speak about that and also -- maybe I'm wrong. But in the BMJ article that suggested that Tamiflu is not effective, or reemphasizes that it is mildly effective.
Thomas Frieden: All of the evidence that we've seen about Tamiflu is consistent with our recommendations. We don't recommend it for routine cases of influenza in healthy people. In this season we do recommend that people who have underlying conditions or people who are severely ill get promptly treated with anti-virals because that will reduce the likelihood of severe illness and death. We've been encouraged that in the Emerging Infections Program sites, the proportion of kids coming in on anti-virals is much higher than it was last year, much higher than in a usual flu season. The message of early treatment of those with severe illness, I think, stands and is quite important to reduce the likelihood of severe illness or death. Other questions in the room?
Beth Galvin: Thank you, Dr. Frieden. I'm Beth Galvin with Fox 5 in Atlanta. Can you talk a little bit about Americans, are they -- how receptive are they? You have done any polling on getting the vaccine now that is beginning to be opened up to the public? You are getting a feel for how many people are willing to get it?
Thomas Frieden: The polling that we've seen has been quite consistent that about half of Americans wants to and plans to be vaccinated. So this is a great window of opportunity for people who have been waiting for their turn to get vaccinated as more states and more communities open up to the general population. On the phone? One or two more questions?
Operator: Richard Knox, NPR.
Richard Knox: Yesterday the Rand Corporatoin released a survey from mid-November about the same -- they were saying -- the number of people who are getting vaccinated this year against seasonal flu as in a normal year although it shifted forward in time. But at the same time, you said in the past that there's more seasonal vaccine out there and you said a minute ago that we're reaching the end of the supply. So I'm having trouble reconciling those two things. Do you have a sense of that?
Thomas Frieden: We don't usually have coverage figures until the end of the season. But we do know that early on, a lot of seasonal flu vaccine was available. A lot of it was given much earlier, as you know, than has been given in the past. And we began hearing reports of shortages of seasonal flu vaccine fairly early as more was being sent out. Remember that seasonal flu vaccine is done in a very different way from the H1N1 vaccine program. The government is involved in the purchase or distribution of only about a tenth of the seasonal flu vaccine. So most of that is just in the private sector. We get our information from health care providers and surveys and from the providers or producers of the vaccine in contrast to H1N1where the vaccine supply is through the health department. One more question on the phone and then one more in the room and then we'll end.
Operator: Anne Geracimous, Washington Times, your line is open.
Anne Geracimous: Hello. Dr. Frieden, I'm reading from the Rand study where it said that 38% of people were trying to get seasonal vaccine said there was no vaccine available when they tried. Yet you indicate that supplies now are dwindling they would have had a chance. Can I have a feel for what that survey is about?
Thomas Frieden: I think there was more interest in seasonal vaccination that year than there has been in the past probably because of the amount of attention to influenza generally. And that probably some people who wanted to get vaccinated didn't have the opportunity to be vaccinated. It's a challenge because when the manufacturers make more vaccine than there is demand, they have excess vaccine at the end of the year as has happened before. It's something of a guess in terms of how much the manufacturers make and how much the market will bear. That's how the seasonal flu program runs. It's up to the manufacturers to decide how much to make. The government only buys about a tenth of that, distributes it through public venues and public clinics. We've been providing more support for that through the Vaccines for Children program and one of the real benefits of the H1N1 experience has been our ability to reach groups that need to get seasonal flu vaccine every year in the future, including particularly school kids with lots of schools now having experience giving vaccine at school. And women who are pregnant. With more and more obstetricians vaccinating in their office as we hope many more will do. Any other questions?
Reporter: I'm curious, is there a mechanism for our CDC guidance for redistribution of H1N1 vaccine if, you know, one outlet has a lot of it and another outlet needs it. That is still the case in some places. Or is that up to the state?
Thomas Frieden: Many states are adjusting within counties. If one county has more than another to address level of demand. What we're seeing is as there's been a big increase in the amount of vaccine available with a doubling of the amount of vaccine available in the past month, there's more opportunities to identify a vaccine that would be available for places with highest demand. We'll be looking at that in the coming days and weeks. Thank you all very much for your interest.