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CDC H1N1 Flu Media Briefing


1106 Atlanta GA


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. Todayís speaker is the director of the national center of the center of disease control and prevention. Sheíll 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. Iím 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. Itís 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. Itís really important for every available dose to be used as quickly and effectively as possible. This will become more and more of a challenge. Weíre going to continue to have a challenge. We aren't at the supply challenge we want, but better than a couple weeks ago. Thereís 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. Thereís a lot of good information at flu.gov. Letís go to questions. Weíll start in the room. Maybe start over here. Okay. Iím looking for the microphone.

Michelle Merrill: thank you very much. Iím 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, Iím 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 doctorsí 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. Itís recognized with seasonal flu, some people can develop that problem. Itís worrisome to get it. Itís something we can look into further. Letís do another from the room.

Mike Stobbe: Thanks, doctor. Mike Stobbe. Two questions. You said swine flu is widespread in 48 states. Itís 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 doctorsí visits for flu-like illnesses. Itís 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, Iím 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: Itís 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. Itís 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. Weíre 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. Itís convenient and accessible. Thereís 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: Iím 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. Thereís 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. Iím 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. Iím expecting in the next several weeks things will get better and better. We have all been burned on prediction. Iím 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 providerís 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. Thereís nothing in my community this week, but in two or three weeks perhaps that pharmacy will have it. Itís a challenging environment. In terms of Europe, it sounds promising. Iíll 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. Itís 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. Thereís 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. Thatís 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. Thereís 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. Whatís happening is batches of vaccine are being prepared and produced. The batches have to be ready. Itís 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 Betsyís 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? Iím 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 Iím 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: Thatís 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.




CDC H1N1 Flu Media Briefing


1103 Atlanta GA


As physicians it's frustrating for us not to be able to give vaccines to the patients


NOTE: This is a rough, unedited transcript and transcription errors may appear.

Operator: Your lines have been placed on a listen only mode until the question and answer portion of today's conference. The call is now being recorded. If you have any objections to please disconnect at this time. I would now like to turn the call over to Dave Daigle, thank you, sir. You may begin.

Dave Daigle: Thank you, operator. Thank you for joining us either in the room or on the line. I'm Dave Daigle with CDC media relations. Today the director of CDC will update us on 2009 H1N1.

Tom Frieden: good afternoon. And welcome to our routine briefing about H1N1 influenza. The virus continues to spread and we're having a steady vaccine. Flu continues to be widespread and virtually all the flu we're diagnosing is still H1N1. So almost no seasonal flu yet. What the rest of the season will hold, only time will tell. It's important, though, to recognize that if you have a fever, if you have a cough you may or may not have H1N1 influenza. For people with asthma and other underlying conditions it's particularly important to get vaccinated when vaccine becomes available and also if you have fever and cough to get treated promptly. People with asthma account for about 1/3 of all of the people hospitalized with H1N1 influenza. We know only half of those people with asthma when they got sick with flu, all people with asthma when they got sick with flu sought care from a medical provider. So if you have asthma or another underlying condition seek care promptly when you have fever with cough.

As of today there are 31.8 million doses of flu vaccine available. We are therefore on track to hit the 10 million increase that we had been hoping and anticipating for in the current week. We'll update you Friday as to whether the 10 million mark was met and where it has been shipped. The amount that was available as of earlier in the week. That is a continuing steady increase. That's encouraging. We know it's not nearly as much as we would have liked. We know it's frustrating, inconvenient and disruptive for people to try to get the vaccine and not to be able to. As physicians it's frustrating for us not to be able to give vaccines to the patients. As health officials it's frustrating because we know in part many people who seek vaccine will not get vaccinated later. They would have benefitted from it. When the vaccine wasn't available they didn't get vaccinated and might not come back. We ask people to continue to be persistent. We know people are coping well for the most part. People are being creative and seeking vaccine the way there have been along the lines. We regret that. People understood that sometime sit's difficult to avoid that. And the supply does continue to improve day after day. Different states are taking different approaches to vaccinating people. Some states are sub prioritizing. But because there are different vaccine forms with the live continuing vaccine only for healthy people ages 2 to 49, the live vaccine, the nasal spray is primarily used for health care workers and healthy children. We're also continuing to see really unprecedented demand for seasonal flu vaccine. This is something that unlike the H1N1 vaccination effort is handled by the market. Only about 10% of all seasonal flu vaccine is purchased by the government, and nearly 90 million doses have been distributed to providers throughout the U.S. We continue to hear that people are unable to get the vaccine. We think this year will be the highest ever up take on seasonal flu vaccine. We anticipate there being around114 million doses of seasonal flu vaccine available through the market by the end of the year. It may be there is even greater demand than that by the end of the season.

Antivirals are effective at reducing the effect of severe illness. If you're severely sick with flu. If you're having trouble breathing, if you got better and then got worse again, or if you have an underlying condition such as asthma, heart disease, lung disease, diabetes, then seek care promptly. It does make a difference and it reduces the likelihood that you'll get severely ill or hospitalized. If patients are hospitalized increase the likelihood we'll get out sooner and healthier. And protect others around you by staying home if you're sick. Protect yourself and others by washing your hands frequently and covering your mouth when you cough and sneeze. Flu season lasts until May. We don't know what will happen. We will continue to monitor and we will continue to do absolutely everything that we can to help people and prevent the -- or reduce the spread of flu and reduce the likelihood that people who do get flu become severely ill. With that I'll stop and be happy to take any questions that you may have. Starting in the room. Joanne --

Joanne Silberner: Thanks. You mentioned before the idea that half the people with asthma once they've gotten sick have not come in. Where does that number come from?

Tom Frieden: this is from telephone survey day that that we have. We call randomly households. We identify a subset of people who have had influenza-like illness in the previous 30 days. Then for the subset we ask a series of questions about what conditions they have and what they did to seek care. We don't know what the baseline is for that. We haven't asked that survey, that question on that widespread basis before. We know we would like more people to seek care if they have an underlying condition with flulike illness.

Joanne Silberner: From the survey you don't have a sense of what happened to them because you didn't seek care. You know that from other information.

Tom Frieden: They were still answering the phone and answering our questions a few weeks later. In that regard, we think nothing terrible happened.

Diana Davis: Diana Davis from WSB Atlanta. You said most of the stuff going around is still H1N1. Are you starting to see any signs of seasonal flu at all?

Tom Frieden: there's almost no seasonal flu so far. A few strands here and there. Overwhelmingly it's still H1N1, and it remains very tightly matched, the vaccine strain and with no changes that would suggest an increase. Let's go to the phone for a couple of questions.

Operator: our first question from Marian Falco, CNN Medical News.

Miriam Falco: Hi, thank you for taking the questions. I have two. The first question is something you've addressed in the past. You said we're still waiting for data. Can you talk about obese people and what risk they may have from the H1N1 virus?

Tom Frieden: people who are very obese, a body mass index of 40 or above are at increased risk of complications of flu. Most people with a body mass index that high also have health problems such as diabetes or heart disease that may increase their risk of getting complications for the flu. So for those at an intermediate level of obesity with a body mass index in the 30 to 40 range the data is more mixed. It may be people in the range are at increased risk of complications, but that's not entirely clear at that point.

Miriam Falco: My second question is about a report we're getting out of Pennsylvania that 6,000 flu shots had to be discarded because they were improperly stored. Evidently they were kept in a refrigerator in the school and not at the proper temperature. Given that folks are desperately trying to get a hold of these, what do you say about something like this happening?

Tom Frieden: Keeping the cold chain at the right temperature in any vaccination program is extremely important. It's obviously frustrating, and we regret it when there's any loss of vaccine. You think about we have had 30 million doses out there. There have been only a few examples of improper handling that have led to vaccines being disregarded. Either if it's frozen because that inactivates the vaccine or out of temperature. It's something that is important to monitor and track. Why it's not easy to scale up vaccination programs. Not everyone has the right kind of refrigerators. This kind of thing is inevitable to happen virtually. We're glad it's been relatively rare. Next question on the phone.

Operator: Next question from Tom Maugh from the Los Angeles Times.

Tom Maugh: I'm assuming you've seen the report today on the hospitalizations and deaths in California. Was there anything in there that you found surprising or out of the ordinary?

Tom Frieden: We see a continuing high level of hospitalizations particularly in the country. Children under the age of 25 account for most hospitalizations. We continue to see high rates of hospitalizations in places where there's more flu. In terms of specific report, we haven't reviewed it in detail.

Operator: The next question is from Martin Enserick of Science Magazine.

Martin Enserick: Hello. Thank you for taking my question. The world health organization says it believes that the United States will start delivery of donated vaccines in early December. But the health secretary was quoted saying that oh, groups will be vaccinated first. Can you tell me when the U.S. will start sending vaccines to developing countries?

Tom Frieden: The U.S. government has been in touch with the world health organization to explore ways of getting other countries vaccines around the world. There has been difficulty with production. There are shortages and different countries are at different points of readiness inbeing able to vaccinate. In terms of specifics of when other donations will be available and when they'll be made, that has to be determined as the production schedule becomes more clear in the weeks to come. Next question from the phone.

Operator: Our next question from Robert Bazell from NBC News.

Robert Bazell: Thank you very much. This goes back to the paper from the California health department being published this afternoon. One, it comes up with a warning. Even though you repeatedly said this disease strikes young people preferentially. It also says that other people can be at high risks of complications, including death. Question number one is, is there a chance that because everybody is familiar with this being a disease that strikes people who are mostly young, is it that cases in older people might be overlooked by patients or providers themselves. You said you haven't taken a look at this data. How can something come from the largest health department in the country, the largest state health department in the country and you haven't had a chance to thoroughly review it?

Tom Frieden: The article talks about the severity of illness in different age groups. What we've seen in that article as in our own data and data from around the country and the world is that the level of severity among those who become ill is similar to seasonal flu. So if they get it, it can be every bit as severe as seasonal flu. That data, which is referred to in the article you mentioned is quite consistent with the data that we've seen from our own data around this country as well as globally. And it does emphasize that providers should have -- should think of H1N1 influenza in all age groups. It doesn't change what our recommendations would be for vaccination. Still the number of people who are affected by H1N1 influenza are people under the age of 65. Next question on the phone.

Operator: Next question from Alice Park from Time Magazine.

Alice Park: I want to follow up on the question about obesity. One paraphernalia seems to indicate the people with higher BMIs tend to have a greater vulnerability with respect to H1N1. Is there any evidence they did not see the similar sort of increase among folks with seasonal flu? Is there any reason or indication that there is something different about H1N1 in the way it works in the body that would put folk who is have high BMI at greater risk?

Tom Frieden: I think that would be very theoretical given the better information we have in some situations and the much higher attack rate of H1N1 influenza for people in the middle years of life, younger adults and others. We are in the midst of an epidemic of obesity. Obesity has doubled in adults and tripled in children in the past few decades. We're still understanding what all the implications are for people's health and increase of susceptibility to infections is one. Reduced respiratory reserve and the ability to fight off infections is another. This is something we need to learn more about and all of the evidence and information that's provided helps us to determine what more we need to know and how we can better respond?

Operator: Our next question from David Brown from the Washington Post.

David Brown: Thank you very much. Dr. Frieden, I was wondering if you could elaborate more on the contributions. My understanding is originally when the pledge was made it would be in November. Now I guess it's going to be in December. Are the American demands going to be totally satisfied before you assign some of the production to WHO? Talk to me more about when that is going to happen and who is making the decisions?

Tom Frieden: In the U.S. government we're looking at a variety of options for how to support the efforts of other countries and recognizing the responsibility that we have to the American people. One reason that we have difficulty with vaccine availability is because other countries have insisted that vaccines made in their countries are used in their countries. One of the challenges is with a scarce resource how do we ensure it's most equitably distributed. Right now the maximum activity of the virus is in the temper --areas. Generally the most virus circulation. We still don't have the degree of predictability that we would want. I think it will be difficult to say with certainty when and how much vaccine we'll provide to other countries. This will be discussed at a broad level within the U.S. government. Next question on the phone.

Operator: The next question from Karin Zeitvogel from AFP.

Karin Zeitvogel: Hi, thanks for taking my question. I have a question about vaccine production and in particular cell based technology. Back in June the department of health and human services announced a $35 million contract for a U.S. company that's developing a flu vaccine using insect cell technology and at the time Kathleen Sebelius said that we believe the technology has advanced to the point where it could help meet a surge in demand for seasonal and pandemic flu. Well, it would seem that we have that surge in demand. So are we taking this any further?

Tom Frieden: right now we're using the egg-based method of vaccine production. There are some newer methods. We hope they will be ready within the next couple of years. They're not ready now. We're not cutting any corners. The procedures used are complex and cumbersome. They involve growth and testing mechanisms and are time consuming and take a long time to be done. We need to have better vaccine production methods, but they're not ready yet. This is an investment for the future. And we hope that in future years, probably not -- certainly not this year and probably not next, but in the not too distant future that we might have newer vaccine methods -- newer methods of producing vaccine that would be able to provide vaccine at a more rapid pace to adjust to the types of strains circulating more promptly. The challenge we have is a challenge not unlike what happens each year. Each year we decide in February what strains to put into the vaccine that will be given in September, October, November, December. If the virus circulation changes between the wintertime and the following fall/winter, we may miss the strains that are circulating. So whether it's for a pandemic such as H1N1 or for the changes in flu that happen each year, we do need better technologies. We've been investing in them. We need to continue to invest in them. Maybe two more questions for the phone.

Operator: The next question is from Andy Pollack from the New York Times.

Any Pollack: I was wondering if you had information on how many health care workers are hospitalized or have died from this flu. And if you do have that, do we have indication whether they are catching it from their patients or from some other source?

Tom Frieden: we have limited information so far about the number of health care workers who have gotten the flu. When a health care worker gets flu whether they got it at home or in the workplace, and in the workplace whether nay got it from a patient or another worker are all things that need to be determined. One preliminary piece of information we have that is somewhat encouraging is to seasonal flu vaccine we're seeing a higher up take of influenza vaccination by health care providers this year so far than in previous years. We have to wait to see how high that goes and how extensive it is. But at least we've seen an uptake in health care workers getting vaccinated. On the phone.

Operator: Our next question from Maggie Fox from Reuters.

Maggie Fox: You said one of the problems has been that other countries have insisted on having vaccines made within their borders, used within their borders. Other than Australia, where else has that happened?

Tom Frieden: that's been the primary example of that occurring. Were there any other questions within the room? Okay. Well, thank you all very much. Thank you for your interest.



CDC H1N1 Flu Media Briefing

1030 Atlanta GA

This is a younger people's flu

In a usual flu season, 90% of the deaths are among people over the age of 65

In H1N1, 90% of the deaths are in people under the age of 65

In the past two months, we've seen more hospitalizations in people under the age of 65 than in most entire flu seasons

NOTE: This is a rough, unedited transcript and transcription errors may appear.

Operator: Welcome and thank you all for standing by. At this time I would like to remind parties that your lines are in listen-only mode until the question and answer session. At which time you may press star one to ask a question. Todayís call is being recorded. If you have any objections you may disconnect at this time. Iíll turn the meeting over to Dave Daigle.

Dave Daigle: Iím Dave Daigle, CDC media relations. And today there's another media update with the CDC director on 2009 H1N1.

Thomas Frieden: Good afternoon, everyone. What we have today is essentially more virus, more vaccine and more treatment. The disease continues to be widespread and is currently widespread in 48 states. Weíre seeing some states decrease, particularly in the southeast of the U.S... But we don't know whether that's a decrease before an additional wave. Itís only the end of October and flu season lasts until May. In the past two months, we've seen more hospitalizations in people under the age of 65 than in most entire flu seasons. So we know that there's been a lot of disease from influenza, from H1N1, in virtually all of the influenza we're seeing is still H1N1. Genetically, the virus has not changed. Itís still closely matched with vaccine. We have not seen mutations that would suggest that it would become more deadly. And some of our recent survey data helps us understand what people are doing in response to the data. Iím sorry, in response to the virus. One of the things that we've been surprised to see is that even among people who have an underlying condition, such as asthma or heart disease or lung disease, only half sought care for influenza-like illness. Only half went to their provider. This emphasizes that whether or not vaccine is present and whether or not people recognize that they have an underlying condition, people with underlying conditions, who have fever and cough, should see their provider promptly. Children are particularly high priority for prevention and for treatment. This is a younger people's flu. In a usual flu season, 90% of the deaths are among people over the age of 65. In H1N1, 90% of the deaths are in people under the age of 65. Up until now, there have been 114 laboratory confirmed deaths among children. More than two-thirds of those have been children with underlying conditions. In terms of the numbers of cases, hospitalizations and deaths, our focus is to prevent cases as effectively as possible. And to encourage treatment. Counting cases, particularly the numbers of people who had influenza-like illness, is not something that's likely to be productive or accurate. We know that there have been many, many millions of cases. In terms of hospitalizations and deaths, we can provide information and we do on our website, each year, of the number of confirmed laboratory confirm hospitalizations and deaths. We know that that's an underestimate of the total. Because there are people who don't get reported or laboratories that don't test. Or laboratory tests that are falsely negative. And over the coming weeks, we hope to be able to give you the best available estimate of the number of hospitalizations and deaths to date. The number that you're familiar with, of 36,000 deaths per year from influenza in a normal flu year is based on estimates. Based on the best available scientific data of the burden of influenza. and we will having learned as much as we can from the pattern of H1N1, particularly in the communities where we have very intensive monitoring of hospitals and other sites of care, be able to estimate how many cases that are likely to have been or a range or an at-least number. H1N1 vaccine supply is increasing steadily. Thereís not enough for all providers or people who would want it. And this understands to be frustrating. But the gap between supply and demand is closing. Last week, we had 16.1 million doses available. As of Friday morning, 5:00 a.m., for shipment. As of today, we have 26.6 million doses available for shipment. Thatís an increase of 10.5 million doses in that seven-day period. With that vaccination, with that increase in vaccine availability, we're seeing more schools doing vaccine clinics. Weíre seeing more health care workers getting vaccinated. More people at high-risk are being vaccinated. More providers are getting the vaccine. But it's not nearly as available as we'd like. Also, we're seeing really, very strong demand for seasonal flu vaccination. And Iím sure that all of the media attention to influenza is driving that. But we are not seeing any spread of seasonal influenza yet. But there's no reason to think that we won't have a flu season this year. With other strains of flu. Only time will tell. So we do continue to recommend seasonal flu vaccine. But we recognize that of the 89 million doses that have already been distributed, by the manufacturers, the overwhelming majority has already been given. Manufacturers report that they'll be providing additional vaccines in November/December. So additional vaccine should become available. And the seasonal vaccine program is not run in the same way that the H1N1 vaccine program is run. In the seasonal vaccine program, it's the manufacturers selling directly to providers. And providers who order more, may be able to get more. But there's right now, not enough seasonal flu vaccine for all who would want to receive it. We continue to do everything that we can to reduce the impact of H1N1 influenza. One of the issues that's arisen is a shortage or spot shortage in some areas of the liquid form of Tamiflu. On October 1, we released 300,000 courses from the strategic national stockpile. We are now releasing an additional 234,000 courses of liquid Tamiflu from the strategic national stockpile. That is the entire supply from the SNS. We held back some portion before, because in early October, it wasn't clear whether some parts of the country might need more than others. And we kept it back for that purpose. Itís now clear that with disease throughout the country, it makes sense to release what we have. And to get more from manufacturers as soon as they can provide it. In addition to the liquid Tamiflu, we have worked with many of the national chains, which are willing to compound, to make the syrup from the adult Tamiflu. something that is safe for a pharmacist to do. Please don't try this at home. This is something that should be done by a professional pharmacist. And this is something that the pharmacy can do by taking adult Tamiflu capsules and carefully measuring it, putting it into a syrup that's palatable for children. And with this, it should be possible sometimes with more effort than we would have liked, but should be possible for people who want to get Tamiflu, need to get Tamiflu, to get it. And we're appreciative of the cooperation of the pharmacy chains in that effort. When we released from the stockpile, it's done on a population basis to all parts of the United States and territories. Weíre also working hard to improve vaccination efforts. And I want to take a moment just to reiterate some of the basic information, nothing new. But we continue to hear that there's confusion about who should get vaccine and when. We have left for each state, jurisdiction, to have some flexibility within the priority groups, if they want to subprioritize. But the overall priority groups remain as shown on this slide. Five priority groups -- and the slide outlines which of them -- there we go, which of them can be used for, can receive which types of vaccines. pregnant women, at this point are only recommended to receive the injectable vaccine. Care-givers of infants under the age of six months can receive either the intranasal spray or the injection. Unless of course, they have an underlying condition or are pregnant. Children and young adults age six months to 24 years of age can receive either the intranasal spray or the injection. Unless of course, they have an underlying condition or are pregnant. People aged 25 to 64 with an underlying medical condition, should receive the injection. And health care or emergency medical service workers can receive either the spray or the injection. Of course, again spray only if they don't have an underlying condition and are not pregnant. These are the five priority groups. There are some places that have subprioritized within that. And that's up to jurisdictions, that may depend on local supply and availability. the availability of large amounts relatively speaking of the intranasal spray, which is most easily used for health care workers, and for school children, is facilitating work in that area. There is a little bit of an urban legend that health care workers shouldn't get intranasal spray. Itís an attenuated virus that is cold-adapted. So it can't cause a continuous chain of infection. It does not present a risk to patients. In contrast, in unvaccinated health care worker does present a risk to patients. So we encourage health care workers to get vaccinated. In closing, I want it reiterate that we have more virus, we have more vaccine and we have more treatment. We encourage the prompt treatment of people with underlying conditions and we recognize that states have real challenges to balance the increasing supply with the large demand. And there will always be some mismatch between supply and demand. But we're all working as hard as we can to get the vaccine out as rapidly as possible. And as widely as possible, to those five high-priority groups. And of course, it's always something that everyone of us can do, to stay home if we're sick. Cover our cough and sneeze and wash our hands. And for more information, always check flu.gov. Thanks very much and we'll take questions starting in the room.

Reporter: Dr. Frieden, the figure that you gave on pediatric deaths, 114, how much of an increase does that signify over the previously-reported figure?

Thomas Frieden: For laboratory confirmed? Itís an increase of 19. Laboratory confirmed, pediatric deaths one week to the next.

Reporter: When was the prior figure reported, last week?

Thomas Frieden: Itís a weekly report. Mike?

Mike Stobbe: Mike Stobbe from the AP, thanks, doctor. of the first with the pediatric deaths, that's the largest or one of the largest single-week jumps. can you explain what happened? is it the volume of disease in general? And then I wanted to ask about the swine flu vaccine doses. Do you know who is getting them? Has there been a breakdown? Is it mostly children?

Thomas Frieden: Thereís a certain rhythm of flu spread in a community where we see first an increase on the number of cases generally first in children. Then in older people. Then an increase in hospitalizations, as people develops complications. And then tragically, deaths following that. And the hospitalizations may follow by about a week. The number of the peak in cases, peak in hospitalizations can happen about a week later. And the peak in deaths, two to three weeks after the peak in cases. So we are expecting to see, sadly, increasing numbers. And one of the reasons we've emphasized that only half of the people who have underlying conditions have even sought care. Let alone gotten treatment. but sought care for their influenza-like illness. If you have asthma or heart disease or lung disease, if you're pregnant and you get the flu, see your provider right away, it's important. In terms of who is getting the vaccine, about half has gone to children and half to older people, only about 1% to 2% to people over the age of 65 at most. That, however, is very preliminary and partial information. We hope to have more in the coming week about who's been receiving the vaccine. Our focus has been to get it out and getting reports in on who has been vaccinated has taken more time. We know that in some states and jurisdictions they've done a terrific job of getting kids vaccinated in school-located clinics and have also welcomed others in the community to get vaccinated in those same clinics. Clinics during the school day, for example. Where people can just, school kids can get vaccinated without disrupting their learning, to be brought out of class for one period of time, one part of class at a time. Thatís been a very successful model and an important one. because in future years as we try to increase seasonal flu vaccination, that's the kind of infrastructure and experience that's being established, that is an investment and will help us to address seasonal flu in the years to come. Betsy?

Betsy McKay: Just a couple of questions. About the virus itself, do you think it's still mostly children who are getting this? We hear so much about schools. You don't hear a lot about workplaces, adults. I know there are adult deaths and deaths of pregnant women, so there have to be adult illnesses. Is it still mostly limited to the younger people? And the second question is, maybe it's early to ask this, but do you have any information on adverse events from vaccination?

Thomas Frieden: Weíre seeing increases first in kids. But also in young adults and adults up to the age of 50, we've seen pretty substantial increases in many areas. So it's not just kids who are getting the disease, we're seeing a fair amount in younger adults. For adverse reactions, it is early. But we have systems in place to see are there more adverse effects, adverse events than we would anticipate. As we know, every time there's a vaccine given, there's a risk of something bad happening. Something bad could happen whether or not the vaccine is given. And for more information, we'll be coming out shortly, about what are the expected background rates of serious bad things happening, like Gullian-Barre syndrome, sudden death, heart attack, miscarriage. Those are some of the things we look at. Just because something happens after vaccination, doesn't mean it happened because of the vaccination. Weíve seen a small number of deaths following the vaccination for all of those things that we have investigated. Thereís been a clear explanation that it's not vaccine or infection or condition. So it does not appear that the vaccine was related in any way. Weíll see a small number of people with allergic reactions that are concerning, but not higher than anticipated. So it's still early. If there were a problem, to have seen it. But nothing we've seen so far is concerning. On the phone?

Operator: Thank you, at this time if you'd like to ask a question, press star 1 on your touch-tone phone. Our first question is from Jeffrey white, "Dallas morning news."

Jeffery Weiss: Iíve been watching the per capita delivery of the vaccine as your shipment numbers have come out week to week. And taking a look at today's most recently-released numbers, there's still a petty broad difference. 8.4 doses per 100 in Alaska and Vermont. Down to Florida, at 4.1 doses per 100. And there's a pretty good range. And I know that the allocations are being done on based on population. Do you have any explanation for why the shipments don't seem to be matching that?

Thomas Frieden: Weíre working very closely with the states. Some of them are leaving vaccine in their allocation because they want to have it shipped directly to schools. Where they're doing a school-located clinics. Others have had some challenges in getting the system up and running. Weíve worked very closely with each of the states. Itís quite a challenge. Weíve report a global number. But there are actually multiple different products. Thereís not just the intranasal versus the injection. But for the injection, there are different formulations of it. And that has to be broken down by 100s or in some states, thousands of providers and sent out to the providers. so it's not such an easy job to get the vaccine out in the first days of vaccine being available, there was a lot more variability than there is now, in the proportion that's being drawn down. Weíre at over 80% of everything that's being indicated rapidly, and we want to increase the number sometimes the number that we provide you the snapshot and so the vaccine reporting is available. So there's a little bit of a lag that can make it look like it's not being drawn down as rapidly as it is. In some situations where there's been slower-than-anticipated ordering, we've worked directly with the states to see what we could do to report it. And whether there are any issues that need to be addressed. On the phone?

Operator: Rob Stein, "Washington Post," your line is open.

Rob Stein: Hi, Dr. Frieden thanks very much for taking the questions. I was curious about your thoughts for recommendations that came out this morning for the W.H.O.'s stage committee on vaccinations sort of suggesting that kids may only need one shot, not a booster shot as well. I was curious what you thought about that.

Thomas Frieden: Weíve looked at that. The NIH has done clinical trials and they're anticipating perhaps as early as next week, additional data on that. The preliminary data did not show the kind of response in younger children that we would have hoped for in order to say -- a single dose would be sufficient. But only the data will show. Throughout this entire response, our approach is, look at the data and follow the data. Follow the best science that's available. We hope to have that within the next week or two. And working with NIH, if the data show the difference, we will reconsider our recommendations for the time being. Weíre sticking with what the ACIP has recommended.

Operator: Steven Smith, the "Boston globe," your line is open.

Steven Smith: Good afternoon Dr. Frieden, thank you for taking the call. Clearly in regions such as New England and elsewhere in the nation, we have seen sharp rises in reports of influenza-like illness, visits to medical offices. The ILI data in Massachusetts released today showed visits happening at a rate above the peaks of the past two flu seasons. Iím hoping you can assess, based on the constellation of surveillance data at your disposal, whether this truly means more people are stricken with flu than previous years, or conversely, to what extent this is actually reflect patients seeking care more aggressively than in previous years. Which would potentially skew the sense of the rapidity of spread.

Thomas Frieden: Thatís a great question. What we're seeing is quite characteristic in many places. A steady increase in the proportion of people in emergency department who are there for influenza-like illness. And an exact mirror image of that, of people who are, who have influenza-like illness and get admitted to the hospital. That suggests that people are going to emergency department who don't need to be there. If you're sick with flu and you wouldn't have gone to the hospital emergency department before you ever heard of H1N1, you probably shouldn't go now. on the other hand, if you have an underlying condition, if you have asthma, heart disease, lung disease, trouble breathing, or you got better and then get worse again. Or you've gotten very sick with flu, by all means, seek care promptly. But yes, we do think that a significant proportion of the demand, particularly for emergency department care, is related to the lack of, to the concern and the media attention to influenza at this time. However, where we have intensive monitoring of about 25 million people in various states in the country were able to seek a hospitalization rate for flu. That hospitalization rate, which wouldn't, we think really be much affected by people who are coming in to just because they're concerned, that hospitalization rate is higher than an average flu season already. And we're still early days, nationally, in the spread of H1N1. So we do think that there is truly, more disease this flu season. Joanne?

Joanne Silberner: Thanks, Joanne Silberner from NPR. Iím a little confused about the Tamiflu issue. Yesterday I heard something about you could break up the capsule and mix it with chocolate chirp. And you're saying not to kpaund, what's the difference?

Thomas Frieden: There are adult capsules and pediatric capsules. The pediatric capsules can be mixed with syrup or chocolate, something sweet to make the medicine go down. For the compounding that pharmacists do, taking the adult capsules. So if the pediatric dose, you can mix the pediatric dose you can mix it with something sweet to give it to the kids. If the pharmacist, him or herself wants to make you a liquid and give you a liquid from an adult capsule, then only the pharmacist should do that.

Tom Regan: Dr. Frieden, two questions, please, Tom Regan with channel 2 news. You mentioned the pediatric deaths earlier. Do you have any update on adult deaths since last week? I had one other question, I forgot it. But if you could respond to that one, first.

Thomas Frieden: I forgot the second question you asked, anyway. Adult deaths, we have to estimate. We can't know exactly how many adult deaths there are for many reasons. Some people die outside the hospital. Some people die without being diagnosed in the hospital. Some people who are tested have the test be falsely negative, or inconclusive, or aren't tested at all in the hospital. Or aren't recognized as having flu. Thatís why the most accurate, it's a little counter intuitive. The most accurate accounting of deaths is an estimate, rather than an actual enumeration. And within the next couple of weeks, we hope to give you the number on more of a real-time basis. Weíve presented at a scientific meeting yesterday, some information about what the ranges may have been through the summer. In terms of the number of deaths and we want to move that forward, that we can get real-time within a couple of weeks. On the phone?

Operator: Marilyn Serafini, "National Journal," your line is open.

Marilyn Serafini: Thanks for taking my question. I wanted to ask you, you said that in some areas, that the trend is going down a little bit. That perhaps, it sounds like what she's saying we may have reached the peak at least of this particular wave? Is that what you're saying?

Thomas Frieden: No, nationally we're still seeing influenza-like illness increase. So although there are some areas that have shown decreases, including here in Georgia, overall there are many that are still seeing increases. And as a country overall, the overall number is still increasing. Mike?

Mike Stobbe: Mike from the AP. Doctor, could you repeat how many courses of pediatric Tamiflu have been released? What day were they released. And also I wanted to ask you, you talked to the president recently. Is he conveyed to you, his concerns about how the response is going or the has he asked for any changes or new initiatives?

Thomas Frieden: We released on October 1, 300,000 courses of pediatric liquid Tamiflu. And we are releasing in the coming days, the remainder of the strategic national stockpile which is 234,000 additional doses. Weíre talking with the states and localities today, they're available for calling. Itís possible that not all states will call them down. But that's the number that can be released, that's the number that exists in the stockpile. The president is deeply concerned about strain strain. Heís directly involved. Heís briefed regularly. He asks a series of important and relative questions and wants to make sure that we're doing everything that we absolutely can to respond as effectively as we can, and learn the lessons for the future, so we can get our technology in better shape through a real focus on influenza and other emerging diseases in the future. On the phone?

Operator: Robert Bazell, NBC news, your line is open.

Robert Bazell: Thank you. Do you recommend, Dr. Frieden, any special precautions for Halloween? Weíve had enormous amounts of email and questions from over the telephone about people wondering, should they send their children out? Should they take any care with the candy they select? Should they be aware of what homes they're going into, and gatherings and I just -- you want sick kids it stay home. But is there any advice beyond that?

Thomas Frieden: Have fun, stay safe and yes, if your kid is sick, please keep them home. From all activity, school, for Halloween. We have time for two more questions. On the phone?

Operator: Miriam Falco, CNN Medical News, your line is open.

Miriam Falco: Iíve got two questions. The first question is, do you have any data on how the school vaccinations clinics are going? How many children are taking advantage of these flu vaccine locations. and also, can you clarify, especially in the confusion from the W.H.O. briefing this morning, how many vaccines, a 6-month-old, for instance, would need, of H1N1. And also how much of the seasonal flu.

Thomas Frieden: Weíre just beginning to get information in on school-located vaccine clinics. We have distributed a best-practice document describing some of the experience from Maine. Which has been very effective at getting large-scale involvement in getting vaccinations done in schools with the minimum of disruption. We are encouraged, if we see half or more of the kids get vaccinated in the schools, we don't expect to see anything like 80% or 90% of kids getting vaccinated. Though if it happened, that would be great. But even to get significant proportion vaccinated is a real accomplishment. Itís hard to get the consent forms back. Itís hard to arrange the logistics; kids are out sick sometimes, so they can't be vaccinated if they're not there. In terms of number of doses under age ten. Two doses of H1N1. And for seasonal flu, it's a little more complicated. The first year you have seasonal flu vaccine, two doses. In subsequent years, if you got your two doses, then one dose. Last question on the phone? Weíll take one more from the phone.

Operator: Donald McNeal, "New York Times," your line is open.

Donald McNeil: Youíve given away the last of the pediatric Tamiflu pediatric stockpile now. What are the chances of replenishing that stockpile? And are you willing to start importing generic Tamiflu, if necessary if there's a shortage from the brand manufacturer?

Thomas Frieden: We have ordered additional Tamiflu from the manufacturer. And we are looking forward to delivery early next year, if that stays on schedule. In any case, because of the availability to make liquid Tamiflu from adult capsules, we think that the pharmacies will be able to provide that as a service, going forward. We didn't see a reason to keep it in reserve when we have so much illness in children out now. And since it is widespread throughout the country, there was a reason to I think, provide it everywhere now. In terms of generic, we're certainly open to all possible considerations. Everything would have to be FDA-approved. We would not want to have non FDA-approved medications here and we'd have to look at what the legal and other issues are, if there is a lack of availability. Tom, last question.

Tom Regan: Yeah, Tom Regan, WSB TV. Weíve heard stories of schools closing as a result of mass illnesses related to flu. Are you aware or is the CDC aware of any public facilities building throughout the country that have taken that kind of action as a result of mass illness or sickness?

Thomas Frieden: We haven't heard of other facilities closing. We have seen some schools closures, generally because they've had such a high degree of absenteeism. We reiterate for schools you really can stay open, even with high degrees of absenteeism, if you have the administrative wherewithal to continue operating and if you don't have kids, a large proportion of kids who have serious health problems like muscular dystrophy or schools for kids that are medically quite frail. Weíve heard about schools that have had to close for very understandable reasons if they don't have the staff to open or operative effectually. But the key, I think with school closures and general community approach is we want to minimize the disruption. We want to protect the public's health while minimizing disruption. So people can go about their lives, go about their work, and go about their schools without undue difficulty. Thank you all very much.


CDC H1N1 Flu Media Briefing

1029 Atlanta GA

Tamiflu supply concerns for pediatric cases

Operator: Welcome and thank you all for standing by. At this time I'd like to remind parties that your lines are in a listen only mode until the question and answer session at which time you may press star to ask a question. Today's call is being recorded if you have any objections, disconnect at this time. Thank you, sir, you may begin.

Dave Daigle: Hi, I'm Dave Daigle from CDC Media Relations. Today the director of the national center for immunization and respiratory diseases will give us an update on the H1N1 virus.

Anne Schuchat: Good afternoon, everyone. Weíve been carrying out full press briefings. A lot of people are asking about a few issues about vaccines. So I'll just briefly catch folks off that. The vaccine distribution and a little bit about anti-viral use. We're expecting a more full briefing tomorrow with new epidemiologic data as well. I want to let you know that as of today, there are 24.8 million doses of the H1N1 vaccine that are available for the states to order. That's 1.6 million more than yesterday. And as we've been saying, although we aren't where we want to be with vaccine availability, we are seeing forward progress with more and more doses becoming available regularly. I know that it's hard to find in many places. And a lot of people do want to be vaccinated which is great. I appreciate the frustration people are seeing as they are unable to find vaccine. And over the next several weeks it should become more easily available. And as I've been saying each day we are seeing forward progress. We're expecting a lot of vaccination effort this is weekend in a number of places. I want to express my appreciation for the incredible work that the state and local health departments are doing in what is a challenging circumstance. We all had hoped to have more vaccine by now than we have. And so states and locals have had to adapt their plans about how many doses will be coming in the days ahead. And where to have them delivered, about how to run those clinics. Around the country, more and more states have been finding that they have sufficient doses to initiate school located clinics and some other mass clinics. As well, many doctor's offices are beginning to get doses. So hopefully things will be getting better. As I said, we're not where we had hoped to have been at this point. I want to mention a few things about antivirals. There are concerns about people having trouble finding antivirals. A few weeks ago the secretary ordered 300,000 courses of the liquid Tamiflu for children to be shipped out to the states. And that's all going out to the state through the strategic national stockpile. We know there are also capsules of the anti-viral medicine. There are many different size capsules. Many of those are fine for children. In addition, we're working closely with the manufacturers to really understand the supply horizon and understand what is out there in the commercial sector. We're working closely with the states who are managing their stockpiles of these antivirals to get them to the places that don't have them. What we think is going on is really much more of a spot shortage that here and there, you know, there's a pharmacy that doesn't have usually the liquid formulation. There is quite bit of the capsule formulations. Pharmacists can use the capsules to adapt dosing that is appropriate for children. And we've worked with the FDA and the pharmacists and pharmacies to get information about how no use those capsules, something called compounding where you basically break up the capsules and mix it with a liquid syrup and can have an appropriate dose for kids. So we know that a number of chain pharmacies are doing compounding now. And this should be much more accessible to parents. There's also information for parents. If your doctor prescribed capsules for your kids but your kids are just not going to take a capsule, there's a way for you to at home break up the capsule, mix it with a liquid syrup like chocolate syrup or unsweetened chocolate syrup and have something that your child can tolerate. I want to remind people about antivirals. They are very important part of our response to the H1N1 virus. Fortunately, most people who get infected with the H1N1 will do fine just with a few days of bed rest and care and, you know, not going to work or school and infecting other people. But don't need to seek care. But some people do need to seek care and do really need to receive the anti-viral medicines. And there are really great tips for parents on flu.gov about warning signs to look for in your child, whether it's important to seek care or not, or whether things are looking okay but start to look worse and you really need to get back in touch with your provider. So when antivirals are prescribed, we want to let people know that there is more out there in the supply system. The formulation that you thought you were going to get may not be the one you were expecting. But that kids can take the capsules mixed in with the syrup and that should be just fine. We're working very closely with the states to understand their needs and be able to fill the gaps that are there. So with that I want to move to questions that people may have. We can start with something in the room if there's a question here.

Betsy McKay: Betsy McKay with Wall Street Journal, a couple questions. I wondered if you'd be able to tell us how many doses have been shipped and also how many -- do you have how many doses have actually been administered? And the second thing is do you have an update on pediatric deaths?

Anne Schuchat: tomorrow we'll be updating on the pediatric deaths. We do know that a number -- the number of children who have died has increased since our last report. But the full summary will be available tomorrow. And we expect there to be more, unfortunately. The issue with the doses shipped, last spring we sent out about 11 courses of antivirals including a number of courses for children. October 1st there was an order for an additional 300,000 bottles of the liquid Tamiflu to go out to states to supplement what was already there. The commercial sector is increasing production of the Tamiflu and, of course, there is also Ralenza available. Important to say that capsule production is what is -- has really been increased. There are more and more capsules being made or shipped out. And what we want parents to know is that capsules are fine for kids, even kids that can't swallow pills because there's a way for the pharmacist or for you at home to convert that capsule into a liquid. The -- I think those were your questions. Did i miss one? I'm sorry. Okay. Right. So that number I don't have. It will come tomorrow. What we're trying to do, just to say we realize that people want information. We want to get you more information, more readily than we have. And i believe pretty soon we'll start to really just post something every day so you can keep track of it. But the shipping information comes in a little bit later than the doses allocated. So hopefully fairly soon you'll be able to follow the progress without us having to call you in for a press briefing. Okay, another one from the room?

Beth Galvin: Thank you. I'm with Fox 5. I'm just wondering, talking to the flu vaccine manufacturers, what are you hearing from them? What about the delay? Is that going to be something that's going to be on going into the future?

Anne Schuchat: there's very active communication with the manufacturers. Of course, we have been talking about this delay in production. And a couple of the factors that led to that are the slow growing virus, the virus just not cooperating in the eggs. And really working closely with the manufacturers to understand what's coming out of manufacturing and what we can expect week to week. Very important to get accurate information so that we can pass that along to the states who are really planning how to use very quickly the doses that get to them. So I know that there's active dialogue. I don't have an update on projections. We had announced that, you know, we were not expected to make the targets by the end of this month. Of course, we won't be making them. But as I said, we are at, as of today, 24.8 million that is allocated to the states for order. So going forward, I think, you know, there is some of the challenges that they have which we believe they've been able to improve. You know, changing the strength so the virus is growing better and some of those lines that need to be cleared are now cleared. So we're really trying to avoid estimating exactly how much we're going to have from week to week other than working closely with the states so that they can use the doses as they come out to them. Question from the phone?

Operator: Elizabeth Weise, USA Today your line is open.

Elizabeth Weise: Thank you for taking my call. I wanted to find out, you were talking about the pediatric death rates. Do we have overall death and hospitalization rates for the first wave in the spring and then now the full ever since the flu began?

Anne Schuchat: Right. I can call people's attention to a paper that just came out online in emerging infectious diseases. Carrie Reed is the author of that paper. She and her colleagues here at CDC estimated the burden of disease in the spring really going from April when this virus first emerged to I think it's July 23rd, really using a modelling approach to take cases that were reported or hospitalization that's were reported and estimating how much really happened? We have been saying that we were just finding the tip of the iceberg with our laboratory confirmed reporting. And, of course, in July we switched away from an individual case counting to other methods. In that paper, although there have been about 44,000 lab confirmed cases reported during that time period, the estimate was between 1.8 and 5.7 million total cases. So a lot more cases than were actually reported through that lab individual case system. Now when you have common conditions like this, it's just not that efficient to use resources to individually count every one of them. And what we do is move to modelling approaches. They also estimated that there were between 9,000 and 21,000 hospitalization cases during that same time period. Again, more than what we got reports of from the lab confirmed system. And just to think it through, not every case that occurs will result in a person seeking medical care, not every person who seeks medical care will be tested for flu. Not every person who is tested for flu will have a result that is positive. Not every positive result will get reported. And so forth. And so you can imagine how what we count, whether it's cases or hospitalizations or deaths will be underestimates of the full burden. And more and more epidemiologists are looking towards modelling. We don't have an update since the July 24th with this modelling approach. But as Dr. Frieden said, we believe many millions of people have already contracted this virus here in the U.S. and that we have had, you know, probably by now well more than 20,000 hospitalizations. This model suggests that even by July we had 20,000 hospitalizations possibly. So, you know, the important thing to say is we're working actively on understanding what's going on and looking forward. And really the priority is to minimize the continuing serious illness and death that we're seeing through these interventions like prompt use of antiviral medicines and vaccination as soon as it becomes available. Another question from the phones?

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

Mike Stobbe: Hi. Doctor, thank you for taking the call. Hey, the Tamiflu shortage for children, that was first reported a month ago. Can you tell me has it been getting worse or better or have the shortages been moving to different parts of the country? What's been going on in that last month?

Anne Schuchat: you know, we've seen an increased use of the Tamiflu from the surveillance tracking systems. We're seeing increased use. We believe a higher use among those with underlying conditions who are, you know, when they get flulike illness we recommend they be treated. We are not aware that things are worse. When he done supply projections last month that led to that shipment. October 1st we shipped out the liquid Tamiflu projected on projections. We were looking at how much is out there and how much is in the system and if things continue with children and children get ill will we have enough of the different formulations? So we tried to ship that out before there was a problem. We're not aware of a widespread problem. We are aware from media reports of anecdotal concerns where people are having to call around a lot to find a pharmacy that has the medicines. And so we take that kind of concern seriously and want to let people know that the capsules should be an ample supply and the adult capsules in very ample supply and you can convert the adult capsules into medicines for kids. And then, of course, the pediatric capsules can be mixed up at home with the syrup. So we're not aware that it's getting worse. We're just aware that, you know, we're seeing a lot of people with flu illness seeking -- who are being prescribed medicine. We want to help with the shortage that's have been reported. So another call -- question from the phones?

Operator: the next is from Daniel DeNoon, WebMD.

Daniel DeNoon: Doctor, going back to the EID paper. There is a multiplier that has been used to estimate the cases of 79 cases for each report that you received. Do those -- and a similar is for three per hospitalizations. Do the multipliers still apply? Could we use those kinds of modelling to guess how many people, how many cases there have been and how many hospitalizations there have been as of now?

Anne Schuchat: I think that paper is very helpful in providing a method, a methodology. I think the multipliers need to be taken for a grain of salt. If we think back to April and May, early cases, of course, there was a keen interest in finding out whether this virus had arrived in a place. And a lot more people with milder symptoms were being tested. We don't actually get reports anymore of the individual cases. We only get summary reports of hospitalizations. So the case multiplier would be a challenging thing to track. The hospitalization multiplier might also need to be taken with a grain of salt at this time because we do also have a possibility that some people were being hospitalized early in this outbreak for different reasons than they would be now when this was a new -- newly recognized virus. There were probably some precautionary hospitalizations. So i think that it's an instructive and very helpful analysis. But taking it sort of exactly as is with those multipliers might lead to problems. Next question from the phone?

Operator: The next is from Robert Bazell, NBC news.

Robert Bazell: Hi, doctor. Thank you for taking my call. Two questions if I may. The first is speaking to practitioners, especially pediatricians and internists who are not infectious diseases specialists, they say they're confused by the recommendations about whether to use antivirals. I know you've changed them over time and that the perception of whether there's going to be a shortage and the perception of whether there is a risk of creating resistance has changed over time. And I don't know that you could clear this up in a second. But do you understand why that's the case? And I do have a second question if you'll stay with me.

Anne Schuchat: Sure. Clinical judgment is always important. And i really value the hard work that private -- either the frontline practitioners are doing to care for people and to determine whether their patients should come in to see them or just talking with them over the phone. What we recommend right now for anti-viral medicines is that focus be on treatment, not on preventative use of the medicines. And that the focus be on treatment of people who have severe presentations, anyone who is hospitalized with suspect or likely flu, whatever kind of flu, should be treated. And you shouldn't wait for the results of a test because that test results even a negative may not be right and it may take some time. So prompt treatment of people with severe illness like those who are hospitalized is important. People with respiratory symptoms and fever, influenza like illness who have chronic conditions like asthma who are pregnant, who have diabetes, who are very young like children under 2, those are groups where we do recommend anti-viral use be the general approach. And then for people who are older -- healthy, otherwise healthy without the chronic conditions who are not pregnant. If they have severe presentations or warning signs, they may not be hospitalized, but they may be actually showing some warning signs in terms of difficulty breathing and so forth that medicines could be important in those circumstances. But for the vast majority of people who have an illness that isn't severe and who don't have the underlying factors like very young age pregnancy or chronic health conditions, probably just bed rest, fluids and a little TLC is the right way to go. You know, in all of our guidance we really stress that that provider-patient relationship is very important. We think doctors probably do know their patients well and can sense whether things just aren't right. For parents, at flu.gov, there is really helpful information about warning signs to watch for for your children. I encourage you to take a look at. That if your child is ill and things changing a little bit, look that up again and see how they're doing or give your doctor another call if you're worried. We know that parents have pretty good intuition of something not being right with their children. You have a followup?

Robert Bazell: Yes, can still understand why parents and providers is going to be wanting to have antivirals because of just fear and this is the drug that's out there, it's available and it can be used. And you say the patient-doctor relationship is important. Of course this is something that is fairly new to a lot of people. They haven't seen so much illness in young adults. This is one thing. The second thing is that I want you -- would like you to answer is that -- we talked to pharmacists who say they will not formulate Tamiflu because they don't know how to do it. Yet, you're saying that parents should do this at home. Isn't there a danger of parents mixing up drugs at home with chocolate syrup or something else that could end up giving the child the wrong dose?

Anne Schuchat: Thanks for those two questions. I definitely understand that the challenges of our anti-viral -- of our antiviral messages. This is not a black and white situation. Unfortunately, a lot of clinical medicine is like that that evaluation, careful evaluation, talking to the parent really understanding what's going on is very important. What we've tried to do at CDC and with health care community in general is to put out put algorithms that can be helpful or for general guidance that can be benchmark for people knowing that that clinical judgment is just as important. Unfortunately we donít have a perfect black and white test that will tell you that this personal absolutely needs medicine, this person definitely doesnít. But we can say that the vast majority of people get better without medicines. And that some people need medicines very promptly. So it's tricky message. I hope it's one we can work together in getting out more clearly. Your second question is about the pharmacists and parents. It's just apples and oranges. We are asking pharmacists to do something called compounding. They're taking capsules and looking at body weights and dosing and sort of mixing up a couple capsules, maybe more than one capsule with a certain amount of liquid and doing something really under pharmacistís attention that is with a prescription sort of guidance. We know that some pharmacists don't want to do. That but a lot more and more are saying that they will be part of the solution. A number of the chains, I think I mentioned Walmart and Walgreens and CVS and many states are saying the pharmacist will do this compounding. Very, very different what we're telling parents. Parents should not compound. At flu.gov, there is information for patients. If you come home if the pharmacy with a prescription from your doctor that is pills and says one pill a day or whatever and you can't get your child to take that pill, there is -- there is a way for you to break up open that pill, mix it with a little syrup and have your child take the full spoonful of the syrup. Very, very different than what we're asking the pharmacist to do. We don't want parents to become pharmacists. You have a full-time job being a parent. Next question from the phones?

Operator: Dr. Jon LaPook, medical correspondent, your line is open.

Jon LaPook: Hi. Public health officials believe that vaccination will make a big difference in the survival of people with H1N1. In parts of the world that don't have these resources right now, is there evidence of increased mortality compared to that seen in the United States?

Anne Schuchat: Iím not aware of information about that yet. But that's a really good question. We work closely with the world health organization and partners around the world to understand what's going on and try to help with the situation. We do think that each country has their own challenges and so I don't actually have data to speak to that. I can say, though, that way that we track illness is a bit different in different countries. You know, some are focusing on illness that's in the hospital. Some are focusing on community surveys of what's going on. So even just comparing what the mortality is country to country is relatively complex. And I think we have time for one more question from the phone.

Operator: The next is from Brian Hartman, ABC. Your line is open.

Brian Hartman: I wonder how tightly do you control the throttle and production of the vaccine? I know that, you know, once the initial you are rush of doctors who really want this vaccine get their shots and get the nasal spray. How do you then calibrate the supply so you don't just end up with a warehouse full of doses that nobody's ever going to get?

Anne Schuchat: we are working very closely with the manufacturers and the states and the private sector to make vaccine available as quickly as it's produced. You know, it's going from manufacturers to a central distributor and then out to the states. And they have a population based formula for how much they get. They are using it as quickly as they you know, ordering it as it becomes available and sending it out to many places. I think over the weeks ahead we'll get an idea of where supply is and possibly changing demand. One thing I do want to say, though, is over the weeks and months ahead, we may see fluctuations in disease. Disease may go up further. It may start to come down. Even if disease comes down, I think we need to be mindful of the lessons of the past. In 1957 disease went up and then came down towards the end of the fall. And people thought, you know, we don't need to bother to vaccinate. It turned out there was a big, big wave after the first of the year in February and March. And so I think that we'll need to be keeping our eye on demand and the increasing supply and understand the best way to prevent disease as much as we can. So thanks everybody for this and there will be something more detailed tomorrow.


CDC H1N1 Flu Media Briefing

1027 Atlanta GA

We wish we had more vaccine available now

We wish we had better technology

We wish we had a technology that could produce a vaccine in weeks or months rather than the 6 to 9 months it takes given the current tried and true technology

NOTE: This is a rough, unedited transcript and transcription errors may appear.

Operator: Welcome and thank you all for standing by. At this time, I would like to remind parties are in a listen-only mode until the question and answer session at which time you may press star 1 to ask a question. Today's call is being recorded. If you have any objection, you may disconnect at this time. I'll turn the call over to Glen Nowak.

Glen Nowak: Thank you for joining us. This briefing again, focuses on H1N1, both the disease and the vaccine supply. The briefing will be conducted by Dr. Thomas Frieden, the Director of the Center for Disease Control and Prevention. I'll turn the podium over to Dr. Frieden to make some opening remarks and answer your questions. Dr. Frieden?

Tom Frieden: Good afternoon, everyone. Today, H1N1 influenza remains widespread throughout the United States and although we have seen some areas have decreases in disease, we are also seeing increases continuing in other areas. We continue to track the pattern of illness and there's been no change in the pattern of what age groups are affected or what people are most seriously affected by H1N1, there's also been no change in the laboratory testing of the virus. So there's been no difference in the likelihood that the virus strains are that are in the community will respond to the vaccine that's bees produced and distributed and there's been no change in the virus that would suggest it would be more deadly at this time. While it's still too hard to get the vaccine, vaccine is becoming difficultly more widely available.

This week, as of today, we have 22.4 million doses available for shipment out directly to providers and we're getting to the level where it will become significantly easier to find and receive vaccine. We're working closely with the states to ensure that vaccine, once it becomes available is order, delivery is overnight directly to the provider. And eventually, there will be enough vaccine for all who want to get vaccinated to get vaccinated. We wish we had more vaccine available now. We wish it had been available weeks or even months earlier but we're beginning to get to a significant increase in the availability. If you just look from last week to this, we went from about 14 million doses last Wednesday available to today, 22.4 million, that's an increase in 8 million doses in about a week or less than a week. That allows enough vaccine to be available in states and localities that it can be increasingly widespread. That's good news, not as soon as we would have liked it, but it does represent a significant advance. We're also working with states and localities to identify best practices because having the vaccine out even though it's not as large quantities as we would have wanted, does mean that we have to work hard to ensure that what is available is given and to the priority groups as conveniently as possible.
One of the key areas is school located clinics. Some jurisdictions have done things such as have community forums, have community leaders coordinate this, sent consent forms home by regular mail as well as e-mail. Conducted vaccination programs during school hours when it's more convenient for people to get vaccinated. All of these are important and in general, trying to make vaccine as easy for people as possible whether it's in their doctor's offices or as more becomes available in pharmacies or in schools or for health care workers in particular in workplace, these are all important are opportunities, also it does seem that people are getting more used to the nasal mist that's available. In past years there had been some reluctance to use it, it's recommend for people between the ages of 2 and 49 who do not have underlying health problems.

We wish we had better technology. We wish he had a technology that could produce a vaccine in weeks or months rather than the 6 to 9 months it takes given the current tried and true technology. Notice supply chain is working hard. Manufacture, government, distributors, health departments, providers and the public and I think all of us are frustrated that we haven't had more vaccine that we don't have more vaccine now. When the season is over it will be a good time to look back and think of what could have been done differently or better. Clearly, the vaccine production technologies need to continue to improve. We're still using eggs. We're still using technologies that have been around for a long time, that's good news in terms of safety. We're not cutting any corners, we're not trying anything new or experimental in this season, but we wish we had vaccine technologies that could be quicker. We also are struggling with complex vaccine manufacturing process and the procurement and distribution process and figuring out how that can work best is also something that's worth looking at specifically. But there's a lot that the also gone quite well. Six months after the virus emerged, we have a vaccine available increasingly. We have high degree of confidence in its safety. It's an excellent match with the strains of virus that are circulating. We did not cut any corners in terms of vaccine safety. All of the safeguards are being used, we're using the same production method, the same factories, the same safeguards to make a vaccine that's been used for hundreds of millions of doses with excellent safety record. And while we know that there will inevitably be events that occur after vaccination we'll have a system in lace to determine are whether those events are by chance or whether they may reflect any problem with the vaccine. So we take vaccine safety very seriously.

Two final -- or three final points. First, that this is a collaborative effort. Many parts of the federal government are involved, manufacturers are involved, the health care providers, the health departments who have been central in ordering, identifying providers and distributing the vaccine and the public in identifying and prioritizing people at high risk to get vaccinated as soon as vaccine is available, even when vaccine is available and particularly in places where it's not as widely available as we would like, it's very important to remember that treatment can be highly effective. And if you are severely ill, having trouble breathing after having flu or if you have an underlying condition like heart disease, asthma, then you should be treated promptly and see your provider right away if you have fever and flu-like illness. And of course, very effective, always in preventing the spread of flu and protecting yourself and others is to stay home if you're sick, to cover your cough and sneeze and to wash your hands frequently. So while we still have many people who want to get vaccinated and don't yet have ready access to the vaccine, we will be seeing in the coming weeks, significant increase in vaccine availability and predictably there will be challenges in ensuring that the vaccine that is available gets to the people who want to get vaccinated and I expect that will be a challenge in areas more than others. This is something that is never easy. And particularly when there is the level of concern are and interest in vaccination that there is now and so we're very grateful that the excellent work is being done at all levels by states, by providers and that people understand that this will likely take more time than we would all have liked. Thank you, we'll take some questions starting in the room.

Diana Davis: Thank you. Diana Davis from WSB in Atlanta. You've mentioned several times about the outdated production tech knowledge. Rather than eggs, what would be an improvement? Would it be genetic engineering, synthetic? And do other countries use this?

Tom Frieden: There are several other potential vaccine manufacturing mechanisms, cell-based is one, DNA technologies are others, protein-based are others. They're all still experimental, we're not using any of them in this and I'm not aware of any other country that's using the new technologies there. Is some use of adjuvant in other parts of the world, we've opted not to use it here.

Mike Stobbe: Hi, Dr. Mike Stobbe from the AP. You said swine flu illnesses are increasing in some parts of the country and decreasing in others. Could you be more specific, where is it increasing and decreasing? Could you put us in context? Are we in, would you call this the second wave right now or is the second wave still in the future?

Tom Frieden: You could say that we've had one flu season that's been continuous from April to now. But there was a lull over the summer with fewer kids in schools and now that summer has ended and kids are back in school, more cases. We're decreases in Georgia as was reported in the press. It's quite focal, so it's not one region or one part of the state. But parts of state, different parts of the city are seeing the spread at different times. This consistent with influenza, it tends tour patchy. That's important because it means that although many people have had H1N1 influenza and we wish there had been vaccine for them earlier, there are still many people at risk and it certainly not too late to get vaccinated when vaccine becomes available. In terms of the detailed information, we make that available each Friday on Fluview.

Betsy McKay: Hi, Dr. Frieden, Betsy McKay from the Wall Street Journal. I'm just wondering if you have thoughts on what can or should be done to make more vaccine available more quickly right now or if you think that needs to be done? Thinking of expanding who can get nasal mist or different formulations. And then the other question just logistically, do you know how long it takes from the time a manufacturer ships vaccine to the point that you're able to say that you have it available for states to order?

Tom Frieden: So the shipping goes directly to a set of warehouses. They're logged in at the warehouse and becomes available for ordering for within about a day. This then shipped overnight once the order is received. We've cut as much cycle time out of that process as possible. Every single shipment is checked to ensure that the temperature has been maintained at every step of the way so hasn't gone out of temperature and in terms of the just trying to get the vaccine out as rapidly as possible, the challenge is work at the state and local and provider level to ensure that when vaccine is available it becomes known to those for whom it's a every or the to get vaccinated, that information is increasingly available at flu.gov through a threw locater. There are other states and localities that have other information. Different states have chosen different routes to try to get vaccine out widely. Many have used providers. So it's a question of providers signing up and receiving their allocation of vaccine. We anticipate in the next week or so, will be a significant increase in the perceive and real availability of vaccine as we go from the 10 to 15 million range to the 25 million range in terms of doses in the community. That should provide a significant difference. Remembering that in a normal flu season, we vaccine about 100 million people over about four months. So roughly speaking that's 20 million to 30 million doses per month. So having more than 20 million doses out, we think, will provide some greater availability of vaccine for a lot of people. On the phone?

Operator: First question is from Helen Branswell, the Canadian Press, your line is open.

Helen Branswell: Hi, thanks for taking my question. I would ask a question and follow-up if I could, please. You know the people who don't want vaccine are quite vocal about their concern about the vaccines, but the lineups you're seeing in the United States also speak quite loudly. I'm wondering if CDC has any kind of current data from polling that you've done that gives you a sense of how willing Americans are to get this vaccine, where things stand at this point?

Tom Frieden: We do have steady polling information. And the results are interesting. First there's still widespread in getting vaccine. There are some people, as you note, who really dent want to get the vaccine. They've made that clear. That's their choice. Interestingly, if you compare attitudes towards seasonal vaccine versus H1N1 vaccine, there's some things that are puzzling in the public perception. That I think that I mean that all of us need to continue to emphasize certain messages. One is that there is a difference in the confidence in the effectiveness of seasonal versus H1N1 vaccine and we have every reason to believe that the H1N1 vaccine is an excellent match with the virus that's circulating and that it will be highly effective as effective as a highly effective flu seasonal flu vaccine. Second, there are more concerns about safety, with H1N1 vaccine than there are with the seasonal flu vaccine. Again, we've said it, I don't know how else we could say it but it's the same manufacturing process, it's the same factory, it's the same safeguards and if we had had H1N1 earlier in the season, we would have most like included it in the seasonal flu vaccine so it would have just been part of the regular seasonal flu vaccination program as it will be for the southern hemisphere in the coming flu season. There's also the perception that seasonal flu is riskier or more likely to be a problem than H1N1, where we really don't know what the future will hold. We do know that H1N1 is very widely circulating now, the rest of the flu season, we'll only know what will happen later on in the year. But certainly, H1N1 is the dominant strain circulating now and there's every reason to be vaccinated if you're in a priority group as soon as the vaccine becomes available. Did you have a follow-up question to that?

Helen Branswell: I do have a follow-up question. Earlier, you talked about the production technologies and challenging they are under these circumstances. And last week, when you had your press conference, you also said the technology we are using although tried and true is not well suited for pandemics. Once this is over, do you think it's time to decide that egg-based vaccine production really cannot answer the needs of a pandemic?

Tom Frieden: That's not a question of deciding. It's a question of investing in the research and the technology development to come up with new vaccines and try to get those into our seasonal flu production process. We need to get comfortable with a new vaccine process. I don't think any of us would want in an ideal situation to try a new vaccine during a pandemic. What it tells us is that there's an important need for ongoing significant investment in new vaccine technologies. Next question from the phone.

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

Maggie Fox: Thanks very much. I want to follow up on this question about the perceptions about the vaccines, is it frustrating to you that people on the one hand are saying, hey, we can't get this vaccine but then there's plenty of people saying don't get the vaccine it's dangerous. I know the last time that there was a shortage of vaccine, you ended up throwing doses away. Is there a risk of that happening here?

Tom Frieden: I think the likelihood is that we are currently in a situation where we too little vaccine in the community. It's quite likely that that too little vaccine is one of the things that's making people more interested in getting vaccinated, frankly. Were we have shortages we see an increase in demand. It is likely also as we produce more vaccine and as both people are given the opportunity to get vaccinated, and as disease maybe wanes in the future, we will have significant amounts of vaccine that can't be used. The challenge at this point is to get what vaccine we have out now available to people, provide it to doctors offices, school, health care facilities and others as rapidly as possible so that as much as is available can be used. One of the messages for states, localities and health providers is not to reserve vaccine that they have available, to give it out as soon as it comes in, because more is on the way. And the production is now in a scaled up mode, so more being produced, not as much as we would like, but more is being produced and made available as soon as it can be. Another from the phone?

Operator: The next is from Miriam Falco of CNN Medical News.

Miriam Falco: Hi, Dr. Frieden, thanks for your taking the question. CNN opinion poll only had 49% thinking the vaccine was safe. My question is do you think you'll meet the downsized goal of 28 to 30 million doses by the end of next week which is the end of the month?

Tom Frieden: We're at 22.4 million as of the end of today. We'll let you know what is achieved by Friday. Is there a question in the room?

Beth Galvin: Beth Galvin Fox 5 News. Thank you for doing this briefing. I'm wondering for Americans who are trying to get the vaccine and feeling frustrated, when do you think it will be widely available for people who don't fit into a high-risk group but really do want this vaccine?

Tom Frieden: Our focus is really is the high-risk group, the groups most likely to bet severe illness, most likely in the case of illness to spread severe illness. That's the focus now, while others I understand want to get vaccinated, I think all of us can respect that the vaccine should be used first for those who will benefit most, those who are most at risk. Those children who are between six months of age and young adults 24 years, anyone with an underlying health condition, health care providers who provide care for those who are ill, those who provide care for people under the age, infants under the age of 6 months. Those are the groups at the highest risk of severe illness and highest priority for vaccine.

Beth Galvin: Can I just follow up and ask about widespread availability. Do you have any idea when we'll have a potential stay mount for people?

Tom Frieden: Significantly more vaccine is becoming available. I do anticipate that in most states within the next couple of weeks, it will seem to be much more widespread and much easier than it is now to get vaccinated. The big increase from last week to this week in availability translates into more vaccine availability in the community from this week to next week and increasing spread availability after that. On the phone?

Operator: The next is from Elizabeth Wiese from USA Today. Your line is open.

Elizabeth Weise: Thank you for taking my call. I want to check on the nuns you were are giving for vaccine is that cumulative or just new out this month or this week?

Tom Frieden: Cumulative. So as of today, 22.4 million doses are available for ordering or basically can be shipped -- the weight process works is that the manufacturers ship it to the central distribution place, they log it in, ensure that the cold chain has been maintained every step of the way, make it available for ordering, the orders are placed by the states, then the orders go directly from the manufacturer in most cases, directly to the provider, whether it's a hospital or a clinic or a private doctor's office, or a health department. On the phone? And then in the room.

Operator: Amy Berkholder from CBS News, your line is open.

Amy Burkholder: Yes, hello, thank you, Dr. Frieden. Quickly, the CDC's algorithm for distributing the vaccine, is that based on population only and not where the illness is most acute and is that effective?

Tom Frieden: Our decision was to provide it on a per capita basis so each state and each state has an equal likelihood of being able to get the vaccine. One of the characteristics of using the distribution system that we are using is that it's not reliant on the market, so it's not that if you're a provider or a drugstore or a hospital has a better relationship with the distributor or manufacturer, they'll be at the front of the line, everyone has the same chance of getting the vaccine that's available. I'm sorry, the other part of that question was?

Amy Burkholder: The second question and that do people who say they're frustrated by either a lack of updated on the flu.gov link or some unreliable information on where to get the vaccine, you would respond?

Tom Frieden: It's challenging with a limited amount of vaccine for a lot of people who want to get vaccinated. And this means that asking your provider, checking with your health department, checking on flu.gov may be necessary whereas we wish it would be easier for people to find out where they could easily get vaccinated. In the room?

Mike Stobbe: Mike from the AP again. Doctor, you just told us some stuff that suggests maybe good news on the horizon, there's more vaccine becoming available, reduction in cases in some parts of the country, but over the weekend, we had the emergency declaration from President Obama which suggests the anticipation that things are going to get worse. Can you tell me what triggered that declaration? Where are we? What are we anticipating in the next month or two?

Tom Frieden: It's really a preemptive move that gives the government and providers another tool they can use to respond if they need to deal with a large influx of patients coming in. So there are some hospitals that are challenged and this is preemptive or preparatory step, it's not a response to anything that worse and over the past few days or weeks. It's the ability, it strengthens the hand of the government to respond as we go forward in the season. One more question from the phone?

Operator: Stephen Smith, the Boston Globe, your line is open.

Stephen Smith: Good afternoon, thanks for taking the call. The Roman Catholic archdiocese of Boston this afternoon is going to announce that it is recommending to parishes that they stop providing communion holy wine through the chalice and also recommending that parishioners not extend physical greeting of peace that typically happens during the mass. I was hoping to get your sense of the necessity of adopting such measures? And I'm also curious as to whether you're hearing in other arch diocese and other denominations whether similar measures are being undertaken in an effort to curtail the spread of the H1N1 virus?

Tom Frieden: A variety of things are being done in different communities and by different groups to reduce the potential risk of getting influenza or other infectious diseases. I wouldn't want to comment on any particular denomination or group's decision. Only to say that sensible means are important and effective. Stay home when you're sick. Cover your cough and sneeze. And wash your hands frequently. This is a challenging time. We wish we had more vaccine available. As you know, we had anticipated having significantly more available by now than we do. And that's been frustrating to all of us. We are, though, beginning to see significant increases in vaccine production, distribution and we think it will get easier to find vaccine in the weeks that come. So thank you all very much for your interest and we look forward to continuing to provide you information as soon as we have it available. Thank you very much.












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