CDC briefing on H1N1 flu activity and vaccine supply, January 2010: transcript

Key points

• As of the briefing, 136 million doses of H1N1 vaccine were available for states to order, and most states had opened vaccination to anyone who wants it.
• Four states (Delaware, Maine, New Jersey and Virginia) reported widespread activity, and all circulating flu virus was H1N1.
• Schuchat used the 1957 mortality graph to warn against complacency, since deaths rose again after an early all-clear.
• National Influenza Vaccination Week was starting, focused on high-risk groups, pregnant and postpartum women and seniors.
• The CDC's best estimate was at least 60 million people vaccinated, with much of the vaccine going to children.
• Asked about Europe returning vaccine, she said the U.S. had made no such decisions and was focused on encouraging vaccination.

Chapters

1. 0:00Opening and introduction of Dr. Schuchat
2. 0:40Vaccine supply and availability
3. 1:52Current flu activity and surveillance indicators
4. 3:51Lessons from the 1957 pandemic graph
5. 5:37National Influenza Vaccination Week and high-risk groups
6. 8:04Questions on pneumonia and influenza deaths
7. 10:01Influenza-like illness uptick and vaccination numbers
8. 11:44Length of the flu season and 1957 comparison
9. 14:32State flu activity classification
10. 16:33Complacency, demand and vaccine expiration
11. 19:23Weather, seasonality and European vaccine returns

Full transcript

0:00Welcome and thank you all for standing by. At this time, I would 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 1 to ask a question. Today's call is being recorded. If you have any objections, you may disconnect at this time. I will now turn the meeting over to Glenn Nowak. Thank you, sir. You may begin. Thank you, and thank you for coming here today or calling in for this update on H1N1 influenza and H1N1 influenza vaccine. Today's briefing will be conducted by Dr. Ann Schuchat. Dr. Schuchat is the director of CDC's National Center for Immunization and Respiratory Diseases, and I will turn the podium over to Dr. Schuchat.

0:40Well, good afternoon, everyone, and happy new year. It's great to see some of you back and have some of you on the phone. The H1N1 virus is still circulating and it is still causing disease, hospitalizations and deaths. Many people are still susceptible to this virus and would benefit from vaccination. We want to avoid complacency. Today I'm happy to say that we have a very good supply of the H1N1 vaccine all around the country.

1:15Many people have gotten the vaccine already. Many more people want to get the vaccine, and we want more people to get the vaccine. As of today, 136 million doses of H1N1 vaccine are available for ordering by the states. There are ample supplies of H1N1 vaccine in most of the country. The vaccine should be easily available pretty much anywhere you live, whether it's at your doctor's office, through the health department, through clinics that are being arranged for the community, school clinics that are also being held, at pharmacies and retail centers.

1:52We believe there's vaccine all around the country right now. Most states have opened up vaccination to anyone who wants it. more places and more providers are offering vaccines making it even easier for those of you who want to be vaccinated to protect yourselves and your families to be able to do that I want to briefly mention flu activity we don't have a new report today tomorrow the flu view information will be coming out but since we didn't hold one of these last week I want to remind you where we are. The H1N1 virus is still circulating. We have an uncertain future.

2:34We want and need to avoid complacency. As of this past week, four states continued to report widespread activity. Those states are Delaware, Maine, New Jersey, and Virginia. We were seeing drops in laboratory-confirmed hospitalizations and deaths, but we actually did see activity increasing in a few other indicators. We still have more activity than we usually have this time of year, though it's certainly much below where it was several weeks ago.

3:12All the virus that we're seeing right now is the H1N1 virus. We haven't yet seen the emergence of seasonal flu strains in any numbers at all. We saw a slight uptick in the last week's reporting in the influenza-like illness visits to the doctors or emergency departments. That can sometimes happen right around Christmas so we don't know if that will persist. We also saw an uptick in pneumonia or influenza deaths in this past week and that isn't something that we necessarily see around the Christmas holiday so that's something that we're really keeping our eye on.

3:51People are still becoming ill. Though the numbers are down from the past, they are still happening, and it's an important opportunity for us to do something about that. I'm going to talk about a graph that those who are in the room will be able to see up here, and those of you on the phone or looking at this online, if you go to CDC's website after the press conference, the media part of the website will show this graph. This was the mortality graph in 1957. This is really a reminder of why we are saying that we need to remain vigilant. This is why my colleagues and I in public health are encouraging people to be vaccinated, especially those who are at risk of complications. None of us can predict what's going to happen, but if you look at this graph, the bottom part of that curve, you know, there's the camel hump and then it comes down to that valley well that's where we are right now in that valley we don't know what's going to happen over the next

4:53several weeks or months but in 1957 they essentially gave the all-clear whistle in that December January time period they had vaccine but they didn't encourage its use and yet they did go on to see that increase in mortality Experts disagree about the probability of that additional amount of illness and particularly severe illness occurring, but the best thing for us to do is not focus on the probability and really focus on the idea that vaccine is the best way for us to reduce the chances that we will have ongoing disease, hospitalizations, and deaths. As long as this virus is circulating, it has the potential to cause illness.

5:37This next week, or beginning this weekend, we're going to be kicking off the National Influenza Vaccination Week. This is a concerted effort of the CDC, Health and Human Services, and all of our partners to encourage vaccination. It includes a focus on people at high risk for complications, adults with emphysema, diabetes, cancer, children, pregnant women, and seniors, really a focus on encouraging vaccination for anyone who hasn't yet been vaccinated and wants to be vaccination is especially helpful for adults with those chronic conditions they have a higher risk of being hospitalized and we know right now that they're less likely to have been vaccinated than our children vaccine is still important for pregnant women and for postpartum women they've had terrible complications from this flu virus and although many have been vaccinated we know others haven't and we do encourage vaccination of pregnant and postpartum women.

6:33We think it's the time now for seniors who've wanted to be vaccinated, but have stepped aside so younger, higher-risk people could be vaccinated. This is your time, too, to come and get the vaccine. It should be available in much more places near you. There's lots of information at flu.gov about the National Influenza Vaccination Week, and also information about where to find vaccine near you. Going forward, the H1N1 virus is still circulating in the U.S., and we expect it to continue to circulate for some time.

7:04We need to stay vigilant. One piece of that vigilance is good surveillance, and as such, we really are urging doctors to continue to test patients with severe respiratory illness. People who are hospitalized with suspected flu really need to be tested. We'd like to know whether they definitely have flu and which type. So this is a call out for docs to keep testing your patients with severe flu-like illness. We need to continue our efforts to prevent more cases.

7:34Although many have been vaccinated, more people are susceptible and do need to be protected to reduce their risk of getting this virus. Having as many people vaccinated as possible is our best course of action, even if we can't read the tea leaves of the future. The illness is down. There's plenty of vaccine. It's this key window of opportunity. We don't want to repeat the story from 1957. So I hope that that is the update for today. And let's turn to the questions.

8:04We can start with a question from the room. Mike, Happy New Year. Happy New Year, Doctor. Thanks for doing this. I just wanted to follow up on something you said about an indicator being up of flu activity, the pneumonia, and influenza deaths. The last flu view I looked at, it seemed like it was going down. Do you mind offering some numbers so we understand your concern? Yeah, no, it was actually up this past, yeah, the week before it was down and then it went up again. So in the flu view that came out Friday.

8:34Yeah, so the actual numbers, I don't have them. I think it's, we can get to the percentages, it's seven point something but I'm not sure. So essentially what we track is the, we look at 122 cities that track pneumonia and influenza deaths among all deaths. They look at death certificates regularly and look at what proportion of those death certificates are because of, are deaths caused by pneumonia or influenza conditions. And we track the percentage of that. And there's an expected number, and then there's an amount that's above the epidemic threshold. And for much of this fall, continuing to now, we have been over the epidemic threshold. So that's what I was speaking about. But the percents we'll give you afterwards when we look them up. Let's go to a question from the phone.

9:24If you have a question over the phone, you may press star 1 on your touchtone phone and record your name. Our first question is from Daniel De Noon, WebMD. Your line is open. Thanks for taking my question. Happy New Year, Dr. Schuchat. I have two questions. They're kind of related. One is, could you say a little more about the uptick we saw this week on that ILI? It did look like things were trending down very precipitously, and then suddenly in many areas the country sort of jagged back up. And I wonder if you could comment a little further on that. And secondly, do you have a number on how many people you estimate have actually received the H1N1 vaccine?

10:01Thanks for both those questions, and Happy New Year to you as well. Influenza-like illness is measured through visits to doctors and visits to emergency departments, and we track the percentage of those visits to either the doctor or the emergency room that are caused by influenza-like illness with a case definition that involves temperature and respiratory symptoms. What we saw was things were trending downward and went down as low as 2.7% of visits, and then this past week they went up to 3.2% of visits, a little bit of an uptick and again above that expected threshold.

10:41now that could be because flu is getting worse but it could also be because people aren't making doctors visits for other things you know it was the holiday season during the period when that number came in and that might have just been because the routine preventive and non-emergent visits weren't happening so that's why we're not really sure that that means a whole lot yet you also asked about how many people do we think have been vaccinated our best guess right now is that probably at least 60 million people have been vaccinated. We are getting more information and we're hoping in the next near future to be able to update you in more detail about the coverage, you know, about the progress in vaccination. We know that a large proportion of the vaccine that's been given out has gone to children. And so that's one of the reasons we're really focusing on the message for adults who really were waiting for their kids or kids in the neighborhood to get vaccinated. It's the time now for adults and seniors to also be able to be vaccinated um do we have another question from the phone

11:44the next is from heidi spleet internal medicine news your line is open hi dr shuckett thank you for taking my question I was wondering whether, since this started last spring, usually flu season goes through the spring. Are you at all thinking in terms of an end to this flu season? Are you thinking more in terms of this is just going to be sort of a chronic flu season? Are there any thoughts about that and maybe how doctors should think about this flu season?

12:16We need to stay vigilant. The community and doctors are used to the idea that flu season can last through April into the beginning of May. This past year we had that surprise of a new flu season starting right on top of when the last one was ending with the emergence of this new virus. We do think the next few months will be very important ones to understand whether seasonal flu strains start to circulate and cause disease and to understand how much more of this H1N1 virus circulation occurs.

12:48So I wish that I could tell you exactly when this particular strain will stop circulating, but we don't know that. Next question from the phone. The next is from Helen Branswell, the Canadian Press. Your line is open. Hi, thanks very much for taking my question. I'm at a disadvantage because I can't see the graph that you're pointing to on the slide that you have there. But I'm wondering, can you refresh my memory? In 57, that second dip that you're talking about, was that the second wave?

13:19And if so, is that... Is that the situation actually analogous to the one that we're in now? Because most of North America has already been through two waves. Thanks, Helen. We'll make sure that you get a look at the graphic. It's a graph looking at mortality, and it actually looks different than the graph in the same article that looks at influenza-like illness. In 1957, there were summer outbreaks of disease, particularly in one Boy Scout Jamboree, and then there was a big fall wave of disease, and there was this additional mortality wave in the spring or winter spring in 1958 that was seen.

13:59No pandemic is identical to any other pandemic, so I think that we try to learn from the past, But we have to be careful about being confident or overconfident about what to expect. So I do not know that the 1957 story is what we're looking at today. But I do know we have a lot of vaccine, and we have a chance to not have to repeat history if that's the particular history that this strain has in store for us. Next question from the phone. Again, if you have a question, you may press star 1 and record your name.

14:32The next is from Heron Rutnayaka from Delaware News Journal. your line is open hello thanks for taking my question I had a question it has to do with The flu activity levels. As you've mentioned earlier, Delaware is one of four states that's considered widespread. And I want to know if public health officials from each state are required by the CDC to take their baseline flu activity level in their region into consideration when they decide to classify their level each week as either widespread, sporadic, local, or regional.

15:10I will answer as best I can, and we may need someone a little closer to the surveillance to give you more details. The state public health leaders have some flexibility in how they interpret the data for their state in order to classify disease as widespread, regional, sporadic, or local, or local or sporadic, I guess, or no disease. That said, each of the states tends to use a similar system over time. So we have looked at the state public health official classifications to see how well they correlate with what we see from other surveillance systems in terms of influenza-like illness activity against their baseline or the 122 cities or other systems that we have that can be linked to states.

15:58and we see good correlation. So while we give flexibility to the state health authorities to use the best information they have available, we believe they're doing a pretty good job of designating the category for the state. Let's go to a question in the room. Beth, Happy New Year to you. Happy New Year, Dr. Schickett. I just had a quick question. Do you have any new numbers on maybe an estimate of how many Americans have been sickened by this virus? And also, are you concerned that Americans are going to think that the threat is really over because we're not seeing so much right now and so it's not necessary to get vaccinated?

16:33we're hoping that by next week we'll be able to update the numbers that have gotten ill who have been hospitalized and who have died to add on to the estimates that we provided about a month or so ago so we're working hard to get that estimate updated I am concerned that people may be complacent that people may think this is all over I would hate for people to make decisions thinking there is no risk and then get sick or severely ill. We have the chance for people to protect themselves and reduce the risk of serious complications. So I think complacency is probably our top enemy right now. Is there another question from the phone?

17:16Bob Rose, CIDRAP News. Your line is open. Thank you. Dr. Schuchat, I wonder if you Sure. Have any idea of the demand for vaccine at this point? And also, is there any concern that there will be vaccine left over or that some of the vaccine doses that are available will expire before they can be used? I understand that some of those have an expiration date or shelf life of three months. We've been tracking demand both quantitatively and qualitatively, and we do continue to have demand, but we know that people are changing their opinions week by week.

17:57There's been a pretty stable amount of demand among people who are definitely sure they want to be vaccinated. That's been a pretty stable pattern, but among people who think they probably want to get the vaccine, that's slipping down, and I think it gets to the last question about complacency. am I out of the woods or not? So we are seeing a drop in those who are certain that they want to get the vaccine. Still, there are a lot of people who want to get the vaccine who haven't, and there's a lot of vaccines, so there's plenty available for those who want to be vaccinated, and it's a chance for everyone to talk to their loved ones about the chance to be protected. The question about expiration dates and throwing out vaccine, we're at a point where we're really focused on getting people vaccinated and making vaccine available. We believe Right now, we have ample supply that will be vaccine that's good through the next several months that will be active and effective in people.

18:50The vaccine that we have right now is a perfect match with the virus strains that are circulating. More than 60 million people have gotten this vaccine, and we think it has a great safety experience. So everything we know says we have lots of vaccine now that's available for people to protect themselves, and a lot more people can take advantage of that. We have time for two more questions. Let's go to the phone. From Randall Bloomberg News, your line is open. Hi, Dr. Schuchat. I was wondering if you could talk a little bit more about the ethic in pneumonia and mortality.

19:23Specifically, I'm curious if historically if there's been any correlation between weather and pneumonia and mortality. I know we've seen some unusually cold temperatures across a very wide swath of the U.S. in recent weeks. yeah there's a tremendous seasonality to pneumonia and influenza mortality and pneumonia in general as well as flu in general the seasonality patterns have been ones that scientists have been fascinated by lots of speculation about humidity and crowding and the light cycle maybe that short daylight daylight has some effect we don't know we do know that sometimes after the holidays we see an increase in Respiratory illness, including pneumonia and influenza. Possibly related to everybody who got together over the holidays and possibly completely unrelated. So we don't know whether this incredible weather that some of the country is experiencing will lead to any changes in the influenza transmission. But we do know there's a lot of vaccine and a chance for us to interfere with those kinds of trends by reducing the risk that people will get sick. So let's go to the last question from the phone.

20:29Joanne Allen from Reuters, your line is open. Oh, hi. Thank you very much for taking the call. In my decision today by Germany and some other countries in Europe sort of giving back supplies or canceling orders, I'm wondering if the U.S. has any plans to do that or if there's been any discussion given that we do have a plentiful supply. Is it an oversupply? We are actively encouraging vaccination right now. And as you've seen in the past few months, demand has been a challenging thing to predict.

21:01And we've had supply and demand mismatches at various points in this virus's trajectory. Right now we're at a point where we have ample supply and we're really encouraging people to be vaccinated. So we haven't made decisions here in the U.S. like some of the ones people have mentioned in Europe about giving back vaccine. Where we are right now focused is on vaccination and making opportunities available for people to be vaccinated. So thanks, everybody, for participating, and we'll see you soon.

Source and licence

Recording: File:CDC 2009 H1N1 Press Conference, January 7, 2010.webm by Centers for Disease Control and Prevention (2010-01-07), via Wikimedia Commons. Licence: Public domain.

The transcript is machine speech-to-text by the TidyTools Audio & video transcriber; the summary, key points and chapters were written by Claude from that transcript. Both may contain errors: check the recording before quoting it.