Press Briefing Transcripts

Media Availability on CDC Investigation of Human Cases of Swine Influenza

April 25, 2009, 1 p.m. EST

Thank you, sir, you may begin.

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Glen Nowak: Thank you. And thanks to all of the folks who have dialed into today of this media availability of CDC investigation of swine influenza. One of the things I want to note for people, sometimes people may wonder why we don′t start these things at the anointed hour. One of the reasons we don′t, it takes a while to get everybody into the phone queue. For instance on this call, as with the last couple of calls, we′ve got several hundred of people dialing in. It takes about 10 to 15 minutes. No matter what time we set this before, we would be starting 10, 15 minutes after the point of the hour. So, the explanation we′re sometimes, we′re often 10 minutes to 15 minutes starting after our announced hour. Today, I have with me, Dr. Anne Schuchat. Dr. Schuchat is the interim deputy director for science and public health program at the Centers for Disease Control. And she′s joined by Dr. Daniel Jernigan. He′s the director of the influenza division. I′ll turn it over to Dr. Schuchat. We′ll primarily take questions from the media today.

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Anne: Thank you so much for joining us on this call. We hope we help you in providing you with information. We want to start with confirming the general concern. We′re worried and we′re acting on a number of fronts so you don′t have to worry. Our new goal is to address new questions. There′s not a lot new from yesterday to report. I want to go over some of the information from yesterday so we′re on the same page and be available to clarify things. At present, there are still eight confirmed human cases of swine influenza in the United States. And, there is a serious situation in Mexico. With severe disease and number of confirmed swine influenza infections among -- generally among adults in parts of Mexico. These are very dynamic times. And many things will be changing and as you all know from seasonal influenza it′s very hard to predict exactly the next step. We need to all be prepared for change and be prepared for what we tell you has been updated, and from our interim recommendations. We′re committed to sharing information as we get it and help you keep the public informed. There are a number of state and local investigations that are going on as we have heightened attention to this concern around the country. The public health and the communities have really rallied and looking into a number of possible issues. We work closely with the state and local health departments. But we really appreciate the hard work they′re doing. Typically, they will investigate in their state laboratories to evaluate possible cases and CDC is available to confirming. Lot of changes and reports from communities. We′ll need to stay connected. Today, I can tell you that we have teams that are helping in southern California. And we do have CDC experts that have arrived in Mexico to help in that investigation as part of the global community. We′re working closely with Mexico and Canada as well as the world health organization and our international partners around the world. We have issued some new information. I encourage everybody to look on our website. Information available around infection control. How to help interrupt -- how to help protect health care workers or how to handle specimens that are being collected. Our website is www.cdc.gov/swineflu. It′s a new site that′s easier to navigate. As we mentioned yesterday, there′s an outbreak notice for Mexico. This doesn′t mean travel restrictions or that you can′t go to Mexico. We like people who are traveling to Mexico, we want them to be aware of the outbreak and that information is changing. A few other key points, many of the actions that you see in your communities or that you hear us talking about are really taken with an abundance of caution. We′re trying to take actions early before things get worse. And so, you′ll see a lot going on and it may be different in one community than another. Circumstances can differ. Just to stay tuned to the likelihood that you won′t see exactly the same thing unfolding in different places. I want to stress a couple of points. We′re very fortunate so far, here in the united states, all of the cases that we are aware of that are confirmed to be swine influenza have been mild. Only one of the eight was hospitalized. That can change. That may change. Of course, we′re concerned about the situation in Mexico, where much more severe disease has been seen. So far, we have been quite fortunate. We want you to know that it′s time to prepare and think ahead and be ready for some uncertainty and know that the public health and the clinical communities are working hard on this and working together across country lines. I think that -- probably the key things that I want to communicate. Because I know you have a lot of specific questions. I think we can probably go to the line for questions.

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We′ll take the first question.

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Our first question is from Reuters.

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Caller: Good morning. I wanted to ask where you′re specifically doing some active investigations. All sorts of reports of proposed clusters of flu?

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Anne: Thank you for that question. You know, the way things work for an outbreak in general, including this one, is that state and local public health has the lead in investigating and responding to rumors and concerns and working them up in a typical way. Figuring out what the illness is. Are there laboratory characteristics that would suggest this is caused by a new virus. As of now, the California health department has asked for our assistance and we′re helping support the county and state in California. Texas has asked for our assistance and the Mexican government has asked for W.H.O. for assistance and so we′re a part of that team. And what I can say is that routine public health does this kind of thing all the time. Of course, our alert is much higher right now. When there′s a cluster of respiratory illness, public health will be looking into that. That′s why public health is there through a great extent. The public health laboratories have been trained specially for unusual kind of influenza; based on that bird flu. H1N1 situation. We do have public health laboratories able to type influenza and recognize that something is new and that it needs to be forwarded on to us. So, a long answer. We′re not basically the lead on investigations right now.

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Thank you, next question.

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Caller: Hello, good afternoon. I would like to ask you in October 20, 2008, there was an information to date, compliments of the U.S., discovering of 1977 of h5n1 strain of avian influenza in the U.S. and the need to implement the so-called act -- in this specific case of the word of Mexico and the U.S. source, told me that the next step would be the introduction of the homeland security department. I wonder what investigations do you have on these h5n1 strain and two, please what would follow, what work would follow with the homeland department of security and three, what is the update that you have about what took place a few minutes ago between Mexico and Switzerland, because we have the Mexico, the director of the world health organization, Ms. Margaret Chan in Mexico, taking action in Mexico.

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Anne: Thank you. Let me clarify a few points h5n1 influenza virus that you were speaking of, many people call that bird flu. That′s the bird flu since 1977 has been circulating in some bird populations and a much smaller number of people mainly in Asia. That′s not what we′re talking about here today in the United States or in Mexico. But, because of the H5N1 concern, many increased efforts were made to improve preparedness in the United States as well as around the world. We′re not talking about that particular influenza virus. We′re talking about a new virus; human infections with a new swine flu virus, a combination of a couple of different components of swine, human and bird influenza. The Department of Homeland Security does get involved when there are major emergencies that cross from health to other sectors of society. And, even in routine public health efforts, the Health and Human Services Department or public health often works quite closely with the Department of Homeland Security. We are working with them in regular contact. In terms of Mexico and the World Health Organization, what I can say is that there are frequent communications right now between leaders in the health communities in Mexico and the U.S. and Canada. And of course, at the World Health Organization in Switzerland. And the world health organization has some special roles when it comes to public health emergencies and to the question of pandemic influenza and the W.H.O. has been taking, taking many measures to stay on top of things. When we make ourselves available to press inquiries at certain times, as I mentioned before, there are a lot of things going on in a lot of places at the same time. What′s going on in Geneva I′m not prepared to report on. So, just to say that, when I say public health was on alert and engaged not only here in the U.S. but around the world.

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Thank you, operator, we′ll take the next question.

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Robert Bazell from NBC.

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Caller: Thank you very much. Two things, the World Health Organization. I realize you don′t speak for the World Health Organization. It′s our understanding there was a decision just now, not to go into phase four in this, how does this not -- the definition of phase four, human transmission of a new virus and the other thing is, I think again it′s not your responsibility, the entire pandemic for the world called for isolation early on of a new virus, yet this seems to have gone on in Mexico at least a month before you guys even knew about it. How did that happened?

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Thank you, Robert. I think I′ll have Dan Jernigan answer that question and maybe Anne can offer additional thoughts.

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Daniel: There′s a lot of facts that the W.H.O. take into account. That activity is ongoing now. A committee of individuals that have been selected from various different countries and different backgrounds that involved the W.H.O., so that process is ongoing now. From our understanding there′s not been any changes in the phases. A question regarding that process. Can you restate the question?

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Caller: Yeah, why hasn′t there been a change in the phase given by everything that′s written on paper this is a phase four now?

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Daniel: I think there′s an amount of time they need to be able to respond to that, the information, they want to look at how efficient the spread is from person to person and how sustained the transmission is. I think all of that information is now being gathered. We look to them to take that information and translate it into changes. At this point, my understanding is they′re still evaluating that understanding.

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Anne: Let me add some comments. I think it′s easy to focus on the World Health Organization process and the state. The phases the W.H.O. might decide upon. But what′s really important for people to know, that we are preparing, actively working and a change, from the W.H.O. perspective, whether they decide to do it or not, doesn′t change our very forwardly leaning efforts. Here in Mexico. People are actively looking for this virus and we′re taking steps to prepare for more serious concerns. We are testing the isolates very carefully and preparing it for vaccine production should that be necessary. We′re going through the efforts that might be needed. We′re not trying to focus on the classification. Changes in the W.H.O. classification will signal a conclusion by an expert committee about how things are and how sure we are things are at a different point. The public health response is quite aggressive right now. Things continue to evolve in a serious way. Next question?

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The next is from the Canadian press.

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Caller: I was hoping you could answer a couple of questions. You know, it seems clear that public health authorities are taking very seriously. People who follow the flu are taking it seriously. But I′m not convinced that it′s on the radar of a lot of other people. Dr. Schuchat, you said it′s time to be prepared. Do you have concerns that message hasn′t gotten out yet?

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Anne: Thank you for that question. I think it′s always a challenge to get messages out. One of the values with the media is to help us with our communication. The situation is serious. We at CDC, we′re in close contact with very high levels of leadership in the United States, in other countries, and at the World Health Organization. The fact that the W.H.O. committee was reviewing this issue suggests that people are taking this extremely seriously. What it means for everyone out there in America is a different story. So, I do think we have gotten the message to the leadership engaged in the important decision making that we have a serious situation going on. And we also need to put this into perspective about people′s day-to-day lives. I think that we are succeeding in contacting with the public health and the public health community. But, this is a serious concern and they are, you know, I′m sure we have gotten the message out to them in terms of our regular communications beyond those that go through the media.

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You had another question?

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Caller: What′s going on in Mexico and whether in fact there′s more severe disease there than so far has been evident in the America cases, or is there something else confusing the picture? There may be other viruses or suggest -- I′m wondering if testing CDC has done or anything you have learned suggest that there′s something else out there?

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Anne: You know, that′s a very good question. And one that we′re all asking here. What we know so far, severe disease is happening in Mexico and some cases of severe disease has been confirmed to be caused by a swine influenza virus. We also know that mild disease has been detected in the United States, a very small number, and none -- the same virus appears to be causing this mild disease. We′re actively looking for severe disease here in the United States and we may find some. So far, we haven′t. In Mexico, they were looking for severe disease and they found some. They may not be looking as widely for the milder disease. For respiratory infections we′re quite challenged. There are many causes and they can look exactly the same. Lots of viruses and bacteria that can cause those viruses. So, it can take some time to put the whole story together. Many people are thinking about why does the pattern look different in the two places? It may look different because we don′t have good enough information. It may look different because the virus is different or other co-factors. We′re at a too early stage to conclude on that. Intensified investigations in Mexico and why the U.S. public health has really raised their alert. We′re looking at other pathogens in concert in Mexico and in our cases here in the U.S. we′re mindful to the idea that sometimes, infectious diseases don′t behave the way we expect them to and influenza is notorious for that.

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Thank you.

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The next question is from "The Wall Street Journal."

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Caller: Hi. Thanks very much. I wanted to ask a question related to W.H.O. communiqué from yesterday. They mentioned that the U.S. in addition to the confirmed cases is investigating nine suspect cases. I wonder if you could give us any information on these cases. Maybe as part of that, more broadly, can you tell us, given what you know about this virus and where it has been identified and its geographical diversity, how widely could it have spread in terms around the U.S. and other countries?

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Anne: Thanks for those questions. We have a number of active -- excuse me, the public health community has a number of active investigations of viruses going on. They′ll be looking at people who have respiratory illness, who travel to Mexico. Who have respiratory illness that′s suspicious. Somebody who′s been in one of these communities. There′s quite a lot going on. It takes some time for those cases to work through the system. Whether they′ll turn out to be confirmed or something else. I would say, it′s impossible to give a static figure for how many cases is under investigation. That′s why we′re focusing on the confirmed cases. You asked how widespread this might be? We have important information already about this. Definite lab confirmed cases in California and Texas and in a couple of different parts of Mexico, it′s clear that this is widespread and that is one reason we have to let you know, we don′t think we can contain the spread of this virus. If we found only swine flu -- a new influenza virus in one place, in a small community, we might be able to quench and contain it. In many different communities as we′re seeing, we don′t think that containment is feasible. On the other hand, that′s not surprising with what we know about seasonal influenza that goes through many communities around the United States. Containment would be fantastic. There are many, many tools in our tool box to reduce the illness and the suffering that this virus is causing. So, I think it′s important to know that we do think there′s, having found virus where we found it, we′re likely to find it in many other places. We′re hopeful, so far the cases in the U.S. have been mild and we′re quite mindful the situation in Mexico appears to be much different. We′re trying to prepare for those different contingencies.

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Thank you. Operator, next question?

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The next question is from the "San Diego Union Tribune."

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Caller: Thanks for doing this call. Mentions of two things that I would like to ask about. First off, two days ago one of the patients here in San Diego county may have traveled to Mexico, prior to being sick, wonder if you can provide any information or details about when that travel occurred and which patient that is in terms of age and gender. Secondly, there′s been reports of possible cases being identified in Mexicali, a community just across the border of San Diego County. Can you comment on that?

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Anne: Yeah, you know, I think that San Diego county health department will be your best source on the specifics of the situation as I understand it, the travel was rather remote. But as Dr. Besser mentioned yesterday, if we honed in on people who traveled to Mexico, who live in San Diego, it′s almost everybody in San Diego that′s traveling to Mexico at one point or another. The other issue about Mexicali there′s a border infectious system, a collaboration between the U.S. and Mexican governments. In that system, we have been looking at people with several respiratory illness and testing for flu. We have more regular seasonal influenza and as we mentioned to detect the first, the first -- we actually detected two confirmed cases through that border infectious disease surveillance. So, we′re looking more actively in that area. In terms of Mexico in general, I would say that, efforts are just getting organized through the Mexican public health authorities to really implement a broader surveillance system. You know, they′re doing quite a bit in a very intense period. So, as I mentioned, a couple of days ago, you know, some of what we′re finding is really as a result of where we have been looking. Now we′re looking more widely, I suspect us to find more throughout the country. So, I think the key point there is, based on what we know so far, we do expect more cases and we expect them to occur in other communities.

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Operator. Next question.

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The next is from CNN.

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Caller: Thank you. Any thoughts on this seems to be more in Mexico than in the U.S. for example, a matter of increased flu shot protection or about the age of the victims or perhaps, is there a second virus there? My second question is, has president Obama been briefed on the current situation? And I would like to ask you, if you can kind of put the transmissibility of this flu into perspective? What are we talking about just like regular flu? Can you get it from a bus or your waiter or do you know yet?

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Anne: Thank you for those questions. The question about why the virus appears more virulent in Mexico, is one that we′re looking intently into. Rather than speculate about reasons, I think it′s going to be important for science to lead us on this. There will be some careful evaluations going on. I hope we′ll find out the answer to that with better information and with careful evaluations. You asked about the transmissibility. That′s a key thing that we are looking at as part of the routine public health evaluations that are going on. Trying to understand when someone is ill with this, how does it spread. How many people it might infect? We had a circumstance where some people didn′t transmit. Influenza is quite transmissible. We′re looking in more detail to ups the transmission properties of this particular virus. In terms of leadership briefings, I can tell you that public health is working both with federal, state and local levels and across different sectors beyond our public health zone in terms of making sure that leadership is appropriately informed. I think we are certainly working across the department and working with our state and local leaders. Next question, please.

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The next is from BBC.

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Caller: Hi. Thanks. Do you have any more information at the St. Francis preparatory school in queens, New York, where 75 students reported flu-like symptoms.

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Anne: Thank you for that question. New York City has a fantastic health department. They′re actively investigating that school. I defer to the health department to share their findings of their investigation. We′re in close contact with the New York City health department. They′re doing as usual a fantastic job.

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Our next question.

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Caller: You mentioned that you′re working on isolates on possible vaccines. Can you tell us how long it would take to get the vaccines?

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Anne: The vaccine production is quite complex and has many steps. We′re taking the initial steps to hand off to the industry partners who produced large quantities. It does take months to produce a vaccine and it′s a very important step to take. The quality control measures and the preparation to gather the right virus, isolates and prepare them through the quality control measurements. It′s a many months process. When we find a new virus like this, we prepare vaccines. It′s a question of readiness. Working closely with the FDA. Manufacturing capacity is at an all-time high right now. As you know with the seasonal influenza we have been getting more and more vaccine available. There′s been tremendous efforts to prepare both a regulatory production and the scientific communities so we would be able to scale up more rapidly than we used to. There′s a lot of progress on that front. Even with that progress, we′re not going to have a large amount of vaccines tomorrow. We′re taking that very aggressive forwardly leaning progress to make sure we can produce a vaccine from this virus if necessary. Next question.

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David Brown, "Washington Post," your line is open

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Caller: Thank you very much. Basic facts here have been very hard to get. Most important is the epidemic curve in Mexico. Is that -- the outbreak there ongoing, or is it over? And they′re simply counting up the cases? If it′s ongoing, are the number of cases being -- is there a rising curve, is it a falling curve, when was the last onset of a fatal illness? Or do you not know the answer to those questions?

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Anne: Those are important questions. I would like to start by saying I don′t know the answer to those questions. Even with teams and people working actively in Mexico, it may take some time to get those questions. The syndrome that we′re hearing about in Mexico is nonspecific or general, severe pneumonia. There′s a lot of severe pneumonia that happens all the time. Separate from an influenza, a new influenza virus. So, the ability to link viral testing with a clinical syndrome is necessary to tease out what is the background. What are the trends in respiratory illness, pneumonia, with what is new here. So, even if we do have many new virus associates with respiratory illnesses they′ll be occurring on a backdrop of other routine baseline respiratory infections. Here in the U.S., we have been looking at the surveillance system, to see if we′re seeing any blips in this background. We haven′t seen any increases yet. I′m going to say it′s going to take some time for the epidemiological investigation in Mexico to tell us whether it′s over or ongoing. We′re operating on turned assumption that there are ongoing concerns. I think that′s what we should be assuming at this point.

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Thank you. Next question.

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The next question is from the Associated Press.

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Caller: Thank you for taking a question. I have two questions. First, I was looking for an update on lab analysis. That CDC, yesterday, you said 14 samples from Mexico, 7 positive. Is that still the count? Of those that have been positive, any of those -- were any of those deaths? Part two of that question, you were looking at context family members of the eight people in the U.S., have some of those tests come back negative then?

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Anne: At this point, the only laboratory positives that we have from Mexico are those that we announced yesterday. The positives do include severe or fatal cases from Mexico. We continue to be doing investigations of contact, we haven′t identified additional laboratory positives from those. There are many investigations ongoing. In our laboratory. And we prioritized the testing that we do. So even, I wouldn′t say that you may not assume based on us not having results that -- we′re basically working actively, testing quite a bit and prioritizing the testing that will really change our planning for the most urgent assessments. We have continued to look at the viral characteristics. Based on what we have tested so far, the genetic, the strains from Mexico and the united states are the same essentially. But there are additional ways to look at the viruses that are not completed. There are really, I would say frankly, there are phenomenal first-rate laboratory testing going on to understand the situation.

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Daniel: To clarify a little bit, much if not all, the first-line testing is happening in state and local labs.

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Thank you. What the routine is, a person who′s being evaluated for influenza, often in a clinic or hospital test can be carried out, they can tell you rapidly whether this is flu or not and can tell you, a or b or negative. They can be forwarded to the testing lab they can do more. They can differentiate this new h5n1 bird flu in Asia. The seasonal influenza strain and they can tell us if something it′s not untypable. Those untypable strains are influenza a. Those are the ones that get forwarded here. Many times when we get an untypable strain from a lab, it turns out to be untypable in our experience. Sometimes we find something new and that′s what happened with the swine flu cases. And so, the laboratories, the public health laboratories are testing a lot more right now. We don′t test everyone for any virus. Now that they′re getting more tests, they′re running them. There are a few of the laboratories that can do a little bit more themselves. Again, CDC is the confirmatory lab. So, next question.

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Caller: Thank you for taking my question. On that seem, I want to return to something that Robert Bazell asked. Bob asked why did you -- why did you wait until cases in the U.S. surfaced to ask Mexico for samples and following up on that, the test that you do at CDC as I understand it, depends on what reagents that other places don′t have.

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Anne: You know, the CDC influenza laboratory is an international lab. It′s a W.H.O. collaborating center. It′s one of four around the world. And we routinely receive specimens from many countries, including Mexico. So, we get specimens from Mexico all the time. We didn′t wait until we had a problem in the U.S. to ask Mexico to share with us. The second question was about reagents. When you have a new virus, which is what we have here, reagents don′t exist and so, they need to be prepared based on the new virus. The CDC has been preparing reagents based on this virus and its characteristics and those can be then shared with state public health departments. There are some technical things that make it difficult for sharing reagents. What I can say is, we already shared with the reagents that the public health system needed based on an FDA approval on a new kit. I′ll let Dr. Jernigan give you more information.

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Daniel: The CDC actually creates or develops the reagents that are sent out to national influenza centers around the world. Kits that we put together and send without cost to those laboratories. We also make other kinds of kits that are for the PCR testing. It′s a more complicated test to help detect the subtypes of influenza. Those kits we also send out around the world and to about 140 laboratories in the United States. Once we identified this new swine flu, h1n1, we actually fixed our test so it would better detected. We′ll send those kits out to those 140 participating laboratories. We′ll make that available the recipe so they can make these reagents themselves. If there′s any appearance that things aren′t available to people, it′s mainly because it′s a new virus. We′re making the reagents for it. Very soon that those reagents.

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Operator, we have time for two more questions.

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Next question is from the USA Today.

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Caller: I′m sorry I′m in a loud place right now. As of today, you confirmed eight cases in the U.S. and wondering if you can tell how many specimens are waiting influenza typing this particular new strain at CDC labs right now.

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Anne: I can′t give you that number, sorry. We received specimens all the time. In large numbers and have gotten, you know, we have quite a few specimens that we′re looking into. Some as background seasonal flu and some for other purposes. Those numbers aren′t readily available. I′m sorry.

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Next question.

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The next question is from Elizabeth Cohen, CNN, your line is open. Go ahead. Elizabeth Cohen, CNN. Please unmute your phone. The next question is from MSNBC. Your line is open.

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Caller: Hi. Thanks very much for taking my question. I′m following up on what a couple of other people said. I understand that CDC has to be invited to help communities. I′m wondering about the communities where you are watching very closely, possibly expecting an invitation to help. Can you give us an idea of how communities and specifically what those communities are in the U.S.?

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Anne: I would like to give you a bigger picture of the response effort. In a multistate scenario, we work in a supportive role, helping to provide guidance to all communities with regular phone calls and issues of materials and directives and the state and the locals will be doing these active investigations. As we go forward over the next days or even weeks. I think it′s not going to be really a question of where is the CDC? I think it′s a question, where is the country and the world? I′ll be trying to gather that information. So, in our planning effort, we imagined that the important questions need to be answered early in the evolution of a new virus. And we know that Mexico is planning to look into questions carefully and that some of the other, you know, Texas and southern California, will be looking carefully, you know, the other thing to let you know that, specimens are going to change. We′re at a stage here where we have some important questions, how transmissible is this virus? Which ways is it being transmitted? And, you know, keeping an eye on a resistant pattern. So far it′s a sensitive virus. These are the kind of questions that we′re looking at now. If things get worse, we′ll be looking at different questions later. Many of these issues aren′t where the CDC field team is an essential factor. Public health and the clinical and academic communities are working together on this. Many important findings may come from other sectors and not from CDC.

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Thank you.

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A couple of things for participants. There′s going to be a 3:00 press briefing. Those interested in that, I have seen the press media advisories. If you don′t have it, you might want to call the New York City Public Health Department. It′s 3:00 eastern time. We expect we′ll be doing another press briefing, similar press briefing to today, probably sometime early tomorrow afternoon. Thank you. Look forward to talking with you soon. And that concludes today′s press briefing.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES