CDC Telebriefing on Investigation of Human Cases of H1N1 Flu
May 15, 2009, 1:30 p.m. ET
Operator: The next is from Helen Branswell, The Canadian Press. Your line is up.
Helen Branswell: Hi, thank you very much for taking my question. I was just looking at flu watch for this week, or FluView, excuse me. And it′s really kind of interesting to see there seems to be quite a spike in activity not just for the new H1N1 but for a bunch of different types of flu. Is that an artifact of the fact that more testing is being done now than woo normally be done this time of the year, or is something weird going on?
Dan Jernigan: I can with great certainty say that that is a reflection of the amount of testing that′s going on. For those of you that follow this kind of thing, if you′re looking at the curves, you will see that there′s a nice bell shape to our season from last year -- from this past season, rather. And that significant increase at the end of the season, that significant increase is a reflection of this profound amount of testing that has gone on in the last few weeks. The interesting thing, as you point out is that when we start testing everyone that looks like they have flu, we find a number of them that do have flu and what we′re find is only about half of those have the h 1 -- the new h1 virus. The others have the circulating seasonal kinds of viruses. And so what that means is that there is even at this end of the usual season, the regular season, a fair amount of regular viruses that are circulating in addition to these from h1. But I think the important message is that we would be expecting to see the season to be slowing down or almost completely stopped from the kinds of surveillance systems that we normally monitor. But what we′re seeing is that there are some areas that actually have reports of the amounts of respiratory disease that are coming into their clinics that are equivalent to peak influenza season, and so that′s an indicator to us that there′s something going on with the amount of influenza disease out there. But in terms of us enumerating that, we′re not able to do that at this point.
Operator: The next is from John Cohen, Science Magazine. Your line is open.
John Cohen: I did. You′re saying there′s increased activity from normal surveillance but it′s confusing given that there′s so much more surveillance, how do you factor out whether it′s the increased surveillance that′s leading to this abnormal activity when 50 percent of what you′re seeing is seasonal flu?
Dan Jernigan: Right. I think it′s a difference between the types of surveillance systems. So one of them is the -- what we call viral logic surveillance. It′s where we actually collect the viruses and enumerate them, characterize them, et cetera. And so that′s one that is completely dependent upon people sending in specimens where they can be appropriated tested and characterized. And that′s where you see that tremendous increase at the end of this season. The other is an influenza illness network of 4,500 clinicians and other providers that tell us how many people are coming into their clinics for all causes and also tell us how many of those people are coming in with fever and influenza-like illness symptoms. And so that one is going to be less affected by media and by other factors and is not one that we stimulate through any kind of public health activity but would be in part, perhaps, reflective of some media interest. But even in the time that the interest has waned, we see that those folks are still coming in. And what we also see is that those upticks in certain regions are consistent with anecdotal reports and other reports we get of school closures and of increased illness in communities.
Operator: The next is from David Brown, Washington Post. Your line is open.
David Brown: Yes, Hi, thanks. There′s a report that there is a -- yet another new H1N1 virus that has been found in the states of Durango, Zack teakous and halisco in Mexico that is distinct from both this -- this swine H1N1 and the seasonal Brisbane H1N1. Have you heard of this? And can you tell us anything about this?
Dan Jernigan: We′ve heard of some reports about that, but I have not had any direct information about the specifics of that case. So there′s ongoing dialogue between us and the folks that are in Mexico and so as we know more about that, we will be able to let people know.
Operator: The next is from Kate Trainor, aghp. Your line is open.
Kate Trainor: Hi. Thank you for taking my question. I know the CDC has said you′re going to be looking very closely at the southern hemisphere for what develops down there. So I was wondering if you can tell us what specific signs you might be looking for that SEVERE disease might or might not be coming this way in the fall. And sort of on the other side of that, how do you weigh that information against the fact that the harder you look, the more stuff you′re going to find, kind of similar to what′s going on here as far as finding both the seasonal and new H1N1 flu in the northern hemisphere?
Dan Jernigan: Over the last few years, the CDC and other public health agencies have been working with folks notice southern hemisphere and in tropical areas to try to characterize with the baseline what the amount of influenza is through their seasons. For many countries in the southern hemisphere, their seasons are just now starting and will peak in the next month to two. So we want to be able to work there to identify a couple of things in particular. We want to look at severity and we want to look at the spread of infection. So there are different ways to do that. We work with the laboratories down there to characterize the viruses that are circulating. That will tell us if virus that′s we have chosen for a vaccine are still good or the right ones that are likely to come back. It will also tell us if there′s changes in the virus and also if there′s development of antiviral resistance. The next thing we would want to look at is people who are admitted for SEVERE acute respiratory illness, so there are protocols and process that′s have been worked out over the last few years that will be implemented through our partners in this regions to try to characterize that. And then finally there are estimates of the amount of influenza-like illness in the community, that we welcome working with them as well.
Operator: The next is from Kafi Drexel, New York 1. Your line is open.
Kafi Drexel: Hi, how are you? Earlier today in New York City′s press conference regarding the latest cluster of H1N1 at an intermediate school here, the question was posed kind of by, why has this been happening in schools? And our outgoing health commissioner himself commented that it′s a little surprising to them because they usually don′t see this in a regular flu season where there are situations where 20 or 30 kids at a time come in with high fever on a single day. Also, it doesn′t seem like this is impacting as many older adults as usual at this point. So do you have any further insight as to why some of these clusters may be happening more in school environments? Are you looking at whether or not H1N1 is acting differently in younger people? And then also, regarding the vaccine, if you could talk a little bit more specifically on where the CDC is as far as what′s happening with that and what the thinking is as far as going ahead and developing that for fall. Looking ahead.
Dan Jernigan: Yes. I think you′re pointing out an important feature of influenza, and that is that younger people are often more affected. If we look at who gets influenza each year, the predominance, if you want to call it reservoir of influenza is in the school-aged children′ so, therefore, schools are where a younger place can congregate and share their influenza viruses amongst themselves and that often then allows for other folks to become infected as well. For this particular H1N1, it′s following along seasonal flu in that sense. But when we look at the blood of people who have -- that we have collected over the past few years, we′re able to see that the older you are, the more likely you might have some evidence that you could respond somewhat to the H1N1 novel virus that′s circulating. And so what that suggests to us is that not only are skids as usual affected more, there is a chance that they may be completely naive or immune, not have any immunity to the virus. So that suggests that we want to do something to make sure that we protect them. And so while in the usual season, we may not close schools. Now it may make sense to do that. My understanding is in New York City these school closures have occurred because of the staffing issues and the number of peoples affected, and I believe that was their decision. In terms of the vaccine, as you know, there′s many steps involved with producing a flu sax seen. Vaccine. And we′re working with under HHS agencies and vaccine manufacturers to go through those steps as fast as possible.
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