Monday, June 29, 2009

H1N1: CDC Briefing Transcript by Dr Anne Schuchat

CDC Telebriefing on Investigation of Human Cases of Novel Influenza A (H1N1)

Here's the statement from the CDC, by Dr Anne Schuchat (the full transcript is available by clicking on the weblink above):

Anne Schuchat: "Thank you, good afternoon, everyone. We've just completed 2 and a half days of our Advisory Committee on Immunization Practices, a lot of which did focus on the novel H1N1 influenza virus and so what I want to do this afternoon is briefly give you a situation update about what is going on here in the United States, a little bit about the Southern Hemisphere and provide a few pieces of information related to vaccine planning.

The novel H1N1 influenza is continuing to spread here in the United States and around the globe. What we're seeing is varying by region in the United States and in different countries. The key point is that this new infectious disease is not going away.

In the U.S., we're still experiencing a steady increase in the number of reported cases. Of course, reported cases are really just the tip of the iceberg. The number of new cases that were reported to us this past week was actually the largest number we've had reported since the beginning of the outbreak.

Today, we're describing the 27,717 lab-defined cases have been reported to us here in the U.S., including over 3,000 hospitalizations and 127 fatalities. There were more than 6,000 of these cases reported to us within this past week.

W.H.O. is now reporting almost 60,000 cases of this new virus in more than 100 countries and they report being aware of 263 deaths. Here in the U.S., 12 states are reporting widespread influenza activity, those include Arizona, Connecticut, Delaware, Hawaii, Maine, New Jersey, New York, Pennsylvania, Rhode Island, Utah and Virginia. And you'll notice some of those states have been having widespread activity for a while and some of the states that had widespread activity a while ago, like Texas or California, aren't actually on that list right now.

It's very unusual for this time of year to still be having so many states reporting regional and widespread activity and that's just one feature that helps us know that what we're seeing this year is quite different than what we usually see with seasonal influenza.

In terms of the virologic testing that's being done, the new H1N1 virus is now making up more than 99% of all the typed isolates we're testing here in the U.S. with our collaborating laboratories, so virtually all the of the influenza that's circulating that's getting a diagnosis is this new strain right now here in our summer months.

We're also tracking milder illness, outpatient visits for what we call influenza-like ill this and this is now returning below the national baseline but in -- at the national level, but two of our ten regions of the country are still above what we think of as a baseline for this time of year. Those two regions are New England and the New Jersey/New York area, regions 1 and 2, where they're still seeing more influenza-like illness than you would expect to see at this time of year.

Those regional numbers can mask outbreaks of clusters at smaller geographic areas and we know some communities are still coping with outbreaks of this disease. Influenza-like illness increase during week 24 in 6 of the 10 regions compared to week 23. That's unusual. Usually this time of year, things would be going down instead of going up.

As you may have heard yesterday, we at CDC are estimating that those reported cases are really just the tip of the iceberg. We're saying there have been at least a million cases of this new H1N1 virus in the United States so far this year. That's really not a perfectly accurate estimate. It's just a number, a ballpark figure, that we think for sure there's been more than a million of these new infections. We know we're not tracking every single one of them.

There have been community surveys in a couple of areas looking at influenza-like illness in areas where we know there's a lot of the strain circulating and in many of those communities, they're reporting proportions of about 6% of their community members having had an illness that's consistent with the new virus.

I want to just briefly next some clinical features. We continue to say there most of the impact of this new virus is affecting younger people compared with what we see with the seasonal flu when, of course, seniors, people over 65, are so greatly affected. We're seeing high rates of illness among people under 50. When we look at hospitalized cases, nearly 80% of people who have been hospitalized in the U.S. and reported to us have been under 50. The median age of hospitalized cases is 19 years old.

When we look at the most severe outcomes, the people who have died, the age is a bit older. The median age of those who have died is 37, still quite young for anyone to be dying of an infectious disease, but a bit older than the hospitalizations and the average cases.

We think it's important for everyone to be aware of this new virus that's circulating in so many parts of our country and the world, but it's particularly important for those of us who have underlying health conditions.

We might think of these as big problems because they're just part of our day-to-day life, but people with asthma, people with diabetes, heart disease, people with chronic lung disease and, of course, people who are pregnant night to be especially concerned if they develop respiratory symptoms, fever and a respiratory illness.

You've heard us talking about obesity and sometimes we talk about what doctors call more bid obesity or extreme obesity. That's showing up in our lists of people who are hospitalized with this condition and among some of the deaths that we're seeing. We want to clarify that.

We think that people who are severely obese, the extreme obesity or what doctors called more bid obesity are people who also have chronic lung disease. The heavy weight that people are carrying around can compromise the lungs and can put you at risk for influenza, so it's not really a new risk factor for influenza, it's just a repackaging of that chronic lung disease that we've always known was a risk for influenza.

I want to mention a particular feature that we've been hearing about this past couple weeks and that's outbreaks of influenza occurring in summer camps. Earlier in the spring, we were talking to you about outbreaks in schools and now, the state health departments are letting us know about a number of outbreaks in summer camps that are affecting people, both children, teenagers and adults associated with these camp communities. It's quite unusual to have this many outbreaks of influenza in camps, but it's not actually that unexpected given the continuing spread of this virus and the fact that when at-risk people congregate in close quarters, it's easier for things to spread.

We are aware of 34 outbreaks of the novel H1N1 virus occurring in 16 states around the country and this is an important issue for public health and for parents to be aware of. Camps have taken a number of steps to reduce illness among their campers and their staff. They're isolating sick campers from others. Some have delayed sessions or sent kids home who were ill. Some have actually closed for the summer.

And we want to make sure people know that we have guidance about Congress with this new virus in the summer camp setting that's on our website at Of course for camps that are catering to children with medical conditions, that's a particular concern because those children are so vulnerable.

Next I want to briefly mention the Southern Hemisphere. We talked to you a lot in the weeks that passed about our keen interest in what would happen in the Southern Hemisphere as influenza continues to circulate because the Southern Hemisphere, of course, is going into their winter season, their flu season.

There are reports of this new H1N1 virus circulating at the same time as the seasonal H3N2 influenza viruses and other influenza viruses in the southern Hemisphere. They're outbreaks of the new virus that have been reported from several countries. There's significant numbers or cases that have been reported in particular from Australia and on Argentina and Chile and in some of these places we have heard reports that the health care settings are actually having difficulty coping with the numbers of people coming in, so just as we saw some challenges here in cities around the country in the U.S., some of the Southern Hemisphere countries are also having that type of challenge with the onslaught of these new cases of illness.

We do expect that this new strain is going to continue to spread in the Southern Hemisphere and intensify over the weeks ahead and we are continuing to watch this closely. We'll be watching for changes in the virus. We have not seen any changes in the virus that are important as of this point. We'll also be watching for changes in disease patterns. We've mentioned that people over 65 don't seem to be getting this illness or getting it in very great numbers here in the U.S. We'll be watching to see whether older people start to get this virus in the Southern Hemisphere as the flu season progresses. Those kinds of concerns have not shown up yet but we're continuing to watch. We'll also be continuing to watch the virus to see if it develops resistance to the oseltamivir type of drugs. We haven't seen that yet but it's the kind of thing we'll continue to look for.

Lastly, I want to say a few things about vaccines. We've told you in the past that vaccine development is going on in the U.S. Five manufacturers are working on this particular strain of influenza, making candidate vaccines that can be tested in clinical trials that will be happening over the summer months. And then, as many of you know, the CDC hosted our regular advisory committee on immunization practices here in Atlanta the past couple days and we had two sessions devoted to the novel H1N1 virus and really, the pandemic planning in general.

It's too early for decisions by the ACIP about who might get this new vaccine that's being worked on or for specific target groups to be clarified. It's really important that we have open and candid discussions about the planning and that's what went on here in Atlanta. A very thorough set of presentations about vaccine development, virologist, about the guidance is important pandemic influenza vaccination that are being developed over the last few years, re-evaluation of that guidance in light of the scenario we are seeing today. We've heard about the plans for tracking vaccine effectiveness and vaccine safety and about the public health issues related to implementing immunization program against this new virus, a pandemic virus. It was a good meeting with a healthy set of discussions.

I want to let you know a few of the features of the discussion. Although we haven't made decisions about actual vaccination and who will be vaccinated should a safe and effective vaccine be developed and available, it's very important for states and communities to begin intensifying their efforts on planning to administer a vaccine should such be necessary in the fall. So, we want to do what we can to help states and local health departments and the partners within their communities move forward in that planning.

We want states and communities to be ready to offer and administer the vaccine should one become available against this novel H1N1 virus and to help with that, we expect to be providing specific planning scenarios to states and communities that they can use in trying to understand which populations they'll need to be reaching.

While the CDC and our partners have not finalized those planning scenarios, based on what we're currently seeing with respect to the virus and the epidemiology, we want states and communities and health care providers to be thinking about how they would be able to vaccinate younger people, pregnant women, people who have underlying health conditions like diabetes and answer ma that put them at higher risk from severe complications from this new influenza virus so the idea that this virus has been greatly affecting young people including school children, pregnant women, babies, and adults, particularly younger adults with those underlying conditions, those are the kind of populations that the state, local and health care providers can really begin thinking about.

That action doesn't mean we've finalized any vaccine recommendations. Of course, we'll be looking to the advice of the advisory committee on immunization practices and other stake holders as well as the public as we move forward in our plan, but it's very important for planning to go on and to move forward expeditiously because if we do need to vaccinate, we'll need to have good plans in place.

So, in some way, this influenza virus, this new H1N1 virus that the W.H.O. has declared to be pandemic, is not going away. It's continuing to cause illness, deaths and outbreaks here in the U.S. and it's causing illness in the Southern Hemisphere in great numbers. The government and public health are busy taking steps to be ready to respond to this virus as we see what happens in the fall and to be ready for a great increase in the illness and outbreaks that this virus will cause.

We want communities and families to also be thinking ahead about how they can ready themselves to cope with this virus should increased illness and community outbreaks occur. Coordinated planning is important and this is a partnership really between government, the private sector and the public and it's also important that we coordinate between the federal, state, local and really community levels and those are the kinds of efforts that we're going to be focusing on over the weeks ahead so, I think I'll stop with that and answer questions that you have."


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