Study: Indirect transmission can trigger influenza outbreaks in birds

New data on the persistence of avian influenza viruses in the environment has allowed a team of University of Georgia researchers to create the first model that takes into account both direct and indirect transmission of the viruses among birds. The model, which is detailed in the early online edition of the journal Proceedings of the National Academy of Sciences, has the potential to shed new light on how outbreaks begin in wild bird populations.

“The environmental transmission of avian influenza among birds is quite rare, but our model shows that it can play an important role in outbreaks,” said lead author Pejman Rohani, professor in the UGA Odum School of Ecology. “There are situations where ignoring the possibility of environmental transmission would cause you to significantly underestimate the probability, magnitude and duration of an outbreak.”

Rohani explained that current models of avian influenza only take into account the direct transmission of the virus that occurs when infected waterfowl and shorebirds shed the virus in their feces and those nearby drink contaminated water. But research in the UGA College of Veterinary Medicine has revealed that some avian influenza viruses can persist in water for up to 150 days. So even when no infected birds are present, Rohani said, virus present in the water can trigger an outbreak. Models that only take into account direct transmission, he pointed out, would incorrectly conclude that there’s no risk of an outbreak when no infected birds are present.

The viruses the researchers studied are known as low-pathogenicity viruses and do not infect humans. Low-path viruses only cause mild symptoms in birds but have the potential to swap genes and give rise to high pathogenicity viruses that can cause massive die-offs in poultry and—in rare cases—can infect humans. The H5N1 avian influenza virus, for example, has a 60 percent mortality rate in humans and is responsible for 262 deaths worldwide since 2003, according to the World Health Organization.

“We need to understand low-path viruses because they are a storehouse of genetic variation that can give rise to new and potentially dangerous strains,” said study co-author John Drake, assistant professor of ecology.

In addition to the environmental persistence of the virus, the team’s model takes into account variables such as lake size and the rate at which infected birds recover to describe likely and worse case outbreak scenarios. The model also reveals that environmental transmission extends the duration of an outbreak by infecting birds that haven’t come into contact with other birds yet have consumed contaminated water.

The data on the environmental persistence of avian influenza viruses comes from the lab of David Stallknecht, associate professor in the department of population health in the UGA College of Veterinary Medicine. In a study recently published in the journal Veterinary Microbiology, Stallknecht and lead author Justin Brown determined the persistence of 12 low-path avian influenza viruses under natural ranges of pH, salinity and temperature.

The researchers found that the duration of persistence varied widely among viruses, but that the viruses generally are most stable at a slightly basic pH, temperatures of less than 63 degrees Fahrenheit (17 degrees Celsius) and in fresh to slightly brackish water.

“The role of the environment in the transmission of avian influenza has been almost completely undefined, and that’s what makes this research so exciting,” said Brown, a post-doctoral researcher. “Migration and other factors relating to the biology of the avian host are still very important factors that drive the epidemiology of avian influenza, but now we can look at various environments and ask if they’re better or worse for the transmission of avian influenza.”

The research was funded by the Centers for Disease Control and Prevention, the Morris Animal Foundation, the James S. McDonnell Foundation and the Southeastern Cooperative Wildlife Disease Study.

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UGA College of Public Health to hold community forum on influenza virus

In an effort to engage the Athens community as a partner in prevention, the University of Georgia College of Public Health is hosting a community forum on the influenza virus. The forum will be held at 6 p.m. on Thursday, May 28 in room 175 of the Paul D. Coverdell Center for Biomedical and Health Sciences.

Two physicians and a veterinarian epidemiologist will lead the forum, which is free and open to the public.

Dr. Christopher Whalen, professor of epidemiology in the College of Public Health, is a physician who is board certified in infectious diseases and internal medicine. He is also a member of the Infectious Diseases Society of America and will provide information on preventing illness and current treatment methods.

“People should recognize the signs and symptoms of influenza-like illness—that would be fever plus respiratory symptoms such as coughing and sore throat,” Whalen said, “and they should seek advice from their physicians if they develop those symptoms.”

Dr. Steven Valeika, an infectious disease epidemiologist and veterinarian in the College of Public Health, studies the transmission of diseases that affect animal and human populations. He is especially interested in the processes that allow an infection to jump from animals to humans, as has happened with the new strain of Influenza A (H1N1), also known as “swine flu.” Valeika is a co-author on two recent articles about avian influenza.

Dr. Claude Burnett, a preventative medicine physician, is the Georgia Department of Human Resources Northeast Georgia District Health Director and an adjunct faculty member in the College of Public Health. As District Health Director, Burnett oversees and manages the operational plans for the entire health district that includes Barrow, Clarke, Elbert, Greene, Jackson, Madison, Morgan, Oconee, Oglethorpe and Walton counties.

At the forum, Whalen, Valeika and Burnett will provide a brief overview of the current H1N1 flu outbreak and answer questions from the community.

The symptoms of the influenza can seem mild, and individuals often go to work with a headache, muscle aches, a cough or a runny nose. Yet, in the United States alone, 36,000 people die from influenza-related complications each year. The current H1N1 virus outbreak is an example of how quickly influenza is capable of mutating and how easily new strains of the virus can emerge.

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HHS Takes Additional Steps Toward Development of Vaccine for the Novel Influenza A (H1N1)

HHS Secretary Kathleen Sebelius announced today that the department will
take important steps necessary to prepare for potential commercial-scale
production of a candidate vaccine for the novel Influenza A (H1N1). The
Secretary is directing approximately $1 billion in existing funds that
will be used for clinical studies that will take place over the summer
and for commercial-scale production of two potential vaccine ingredients
for the pre-pandemic influenza stockpile.

"Preparation and planning are critical to keep Americans safe in the
face of a potential pandemic," Secretary Sebelius said. "Our goal
throughout this new H1N1 outbreak has been to stay one step ahead of the
virus. An important part of this effort has been our work to develop a
potential vaccine because vaccines can help prevent and control
influenza virus outbreaks. The actions we are taking today will help us
be prepared if a vaccine is needed."

The funds will be used to place new orders on existing contracts with
companies that hold U.S. licenses for flu vaccines. With these orders,
they will produce a bulk supply of vaccine antigen and adjuvant. Antigen
is the active ingredient in a vaccine that causes the human body's
immune system to develop antibodies that help fight an invading virus.
Depending on the results of clinical studies, adjuvants could be added
to a vaccine to improve the immune system's response and potentially
reduce the amount of antigen necessary for the body to recognize and
fight a virus.

Having both antigen and adjuvant on hand provides maximum flexibility in
a future immunization program, if a program is recommended. For example,
if needed these ingredients could be used in vaccine to help protect
health providers and other members of the critical workforce, as
recommended by the National Strategy for Pandemic Influenza.

With these funds manufacturers will also prepare pilot lots of potential
vaccine for use in clinical studies to determine the proper dose for a
vaccine, determine if adjuvants are appropriate and ensure a vaccine is
safe and effective. The U.S. government will share as much information
as possible from the results of these clinical studies with the World
Health Organization and the global community so that other countries can
benefit from the U.S. efforts to determine dosage, safety and
effectiveness.

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CDC Briefing on Investigation of Human Cases of H1N1 Flu

May 6, 2009
1 pm EST

Glen Nowak: Thank you and thank you all for your interest and attendance today, both on the phone and in the room. The media briefing on H1N1 virus will be conducted by Dr. Richard Besser.

Richard Besser: Thanks very much, Glenn. I want to thank you all for being here for today's briefing. This remains a dynamic situation. Each day, we learn a lot more about transmission here and around -- around the world. And I want to say that we remain concerned. I will be giving the number shortly but we are seeing continued spread around the country. We are seeing increase in numbers of cases and I want to make sure that people understand that changes in guidance that take place are based on science, based on what we think are the appropriate measures to maximize people's health. As we learn more, as the science develops and is refined, we are able to tailor those measures more appropriately. Yesterday, we heard in the news at the CDC the death of a woman in Texas. I want to send my sympathies to the woman's family. Any death is bad. This reminds us that influenza can be a very serious infection and it's one that we need to continue to take very seriously. Yesterday, we refined our guidance, we issued new guidance on school closure and day care closure and I want to make sure people know that those guidances are up on the web. This is a good example of how we use science to inform policy and so as we've learned more about the severity of the virus, as we learn more about the severity of infection, as we learn more about transmission, we are going to continue to refine our guidance and that's something that people should expect. We have had some questions from the media about the length of time for school closure and why we had 14 days before and why we are talking now about 7 for children. This plays in, again, to the issue of uncertainty and severity. At a time when we still knew very little, when the reports out of Mexico were of a much higher severity disease than we are currently recognizing, the guidance was saying up to 14 days. The reason for that is one incubation period is about 7 days and so if you're dealing with something that's quite severe, you may see some variability on shedding. You go for safety zone. And there we recommended two incubation periods. As we now see this infection, it is not as severe as we had initially feared, we can cut back on that. And realize that, yes, after 7 days there maybe some children still shedding but they will be shedding less virus and appropriate action after 7 days they can may return to school. Let me give the case number updates. As of 11 a.m. today, we are reporting 1487 probable and confirmed cases in 44 states. That's an increase of around 400 from yesterday there are around 850 probable cases and 642 confirmed cases. The confirmed cases are in 41 states, increase of three states with confirmed cases from yesterday. In terms of the age range the median age for cases is 16 years with a range of 3 months to 81 years. 58% of the cases in the U.S. are under 18 years of age. We have reported a total of two deaths and we have 35 hospitalizations, which are confirmed. Plus 17 hospitalizations that are -- that are probable. The median age of -- for hospitalized patients is 15 years. That's for confirmed hospital case and that's about the same as for cases, in general. The age range for hospitalization is 8 months to 53 years. We have reported hospitalization confirmed cases from 14 states. Looking at underlying disease for the 13 individuals for whom we have that detailed information, seven of them had known conditions that would put them at risk for more severe infection. The world health organization is reporting 1500 cases, roughly 1500 cases in 22 countries, with Canada, Spain and the united Kingdom having the highest counts outside of the U.S. and Mexico. Mexico had been reporting 822 confirmed cases and 29 deaths. We have been talking about what does the epidemic look like in Mexico? We have quite a number of people in Mexico, I will talk about that in a moment. But I think that we need to put in context the idea of is it going away in Mexico? What we hear about in Mexico is what we are seeing and will continue to see here is when you see a large outbreak or an epidemic, it's frequently made up of a series of smaller outbreaks and epidemics, so, what they are seeing in Mexico is parts of the country where they are seeing increases in disease and parts of the country where they are seeing decreases. When you add that all up together it may show some leveling off but it doesn't really give a sense of how dynamic the situation is. Here in the United States, each day we are reporting new states that are seeing disease. And so, we will start to see in those states increases and at some point, we will be starting to see in states decreases. The rapid increases in confirmed cases that I had predicted for today that were reporting is largely due to the ability of more and more states to do testing and so some of the backlog on testing is going to lead to catch up and we are going to continue to see those numbers increase. In addition, we are going to see additional people get sick. I don't want to attribute it all to testing, but in terms of our ability to confirm cases, we are seeing more of that around the country. We are continuing to see virus spread in the United States and around the globe. The majority of the confirmed cases in this country are in younger people. And it's important that people have respect for this virus, because it does cause severe disease, hospitalization and death. We don't know yet about issues of population immunity. What we are seeing, as we talked about in previous days, we are not seeing as much disease in the elderly. This could be due to some underlying protection or it could be due to just the dynamic of it starting with the younger population before it traveled to the elderly. Everything we've seen to date leaves us with the understand that we need to remain vigilant. We cannot let up on this it's important that people understand that there's shared responsibility, that people need to continue to wash their hands, cover their coughs and most importantly, when they are sick, not send their children to school, not go to work when they are sick. Those measures can help reduce the spread in communities and keep people protected. An update on some of the public health actions, the stockpile of -- all states have received their 25% allotment. We are in the process of replenishing some of our stockpiles through purchases. CDC has been actively engaged, over 900 CDC employees are responding to this outbreak that does not include our individuals around the globe who work in laboratory, working with other countries on their surveillance. We have 93 people in the field, including 16 in Mexico, and we have 33 more who are pending deployment. The PCR test kit has been deployed around the country, so all states and Puerto Rico, we have shipped it as well to 16 countries, so this will help with the diagnostic capabilities around the world. And as I said this will also increase the number of cases through testing alone. We continue to work to understand the virus and the illness that it is causing. It's very important that we understand transmission in various population. We are working with Texas and California and we will be tending to investigation team there is to look in particular at the issue of health care worker transmission. We want to see what are the dynamics of transmission, are there certain practices putting people at risk and if so, what can be done to tailor the guidance that we currently are providing in that area? I want to put a little focus today on the issue of pregnancy and disease risk. So far, we are aware of six confirmed and five probable cases of H1N1 infection involving pregnant women. This is not a higher rate than would be expected in the general population. However, pregnancy is a risk factor, a known risk factor for known disease. We want to make sure that clinicians have information on how they should approach the issue of infection in pregnancy and that women who are pregnant have this information as well. So, on our website, we have for pregnant women, fact sheets on what pregnant women should know and guidance for clinicians, if they have a patient who is pregnant, they will understand how anti-virals should be used what, the treatment strategy should be in that circumstance. So, in closing, I want to remind you, we do expect to see more school outbreaks. We do expect to see more clusters around the country. We do expect to see more transmission and we do expect to see disease in all states. We it continue -- continue to be working actively in the area of vaccine development and that is a critical part of strategies moving forward. Seasonal vaccine is in production. We are moving forward on the development process for novel H1N1 vaccine. We are taking those initial steps that are very important and necessary should a vaccine need to be made. There are a lot of decisions that would need to be made between now and people receiving a vaccination and the decisions will be based on the best available science. Lastly, I want to just address the issue of who and levels and as we have discussed before, who levels have to do with the number of factors. One is there sustained transmission of a novel virus? We have met that. For us to move or for W.H.O. to move from a level five or level six, they will look to see is there sustain vaned transmission of this virus in more than one W.H.O. region? They have not confirmed that they just have the same transmission in this world health organization region. With the number of cases in other countries, I would be surprised if we don't get to a level six. But we are not there yet and W.H.O. has not made that move. One of the hallmarks of any virus is they undergo constant change, we are actively looking at the virus in the laboratory. As the flu season starts in the southern hemisphere, what takes place there is going to be incredibly important, how does the virus compete with other viruses that are circulating in the community, does it change, does it mutate? If so, in what way? Does it develop resistance?Those are factors, studies that will be ongoing as we move through that period. When continue here at CDC to give you the information we when know it continue to tell you what we don't know and provide the daily updates as long as necessary for that, let me turn to your questions. Starting here in the room.

Betsy McKay: Thanks, Dr. Besser. I'm from the Wall Street Journal. I have two questions, one about vaccine and one about hospitalization. On the vaccine question is would -- if the virus change, mutates and becomes more virulent, sort of a 1918 pattern, are we able to know right now that a vaccine that you're developing would be protected against the more virulent form? The second about hospitalizations. I'm wondering how a normal a pattern the age group that is hospitalized, how normal that really is for, you know, compared with seasonal flu vaccine, the median age is 16 seems really young.

Richard Besser: Right. The first question, in terms of, you know -- if the virus changes over this period of time, will the vaccine work? That's great question. Each year with seasonal flu, the virus changes and at the time decisions are made as to what strain goes in the vaccine, you don't know what will be here the following season. And so there's a process to pick that each year for seasonal flu. And it involves experts from around the world making their best science-informed decision. But at some point, there will need to be a decision if you're going to go forward, which strain you use. And you don't -- you won't know for sure until you know what's circulating in the following season. But what we're seeing so far during the short period of time is a fair amount of stability in the virus, but what happens in the fall is not known. In terms of the age distribution, you're right. We are seeing the same distribution in hospitalized parents as we are in milder cases in the community. And that's younger than what you would see in seasonal flu. In seasonal flu, you tend to see a predominance of burden to the elderly and the very young. And here, we are seeing it more in younger population. And so, that is something we are keeping our eye on, that is something that raises concerns and it plays into the question of why is that happening? Is it because that's the population that got sick first? The population that may have traveled to Mexico on spring break or is it something else regarding a protection, elderly potentially protected for some reason? Those are things that we are continuing to look at, but that is a great question. Another question here in the room?

Ceci Connolly: Doctor, Ceci Connolly from the Washington Post. You mentioned Mexico. I'm wondering if you can elaborate a little bit more in terms of exactly your teams are doing there, now that we are two weeks or so into this. Are you starting to gather more useful information and you mentioned epiteams going to California and Texas to look at health care workers. Can you elaborate on that? Do you have a particular concern at this point?

Richard Besser: Let me start with Mexico. I'm looking for the numbers, how many people I said down in Mexico. Thank you. Yeah. 16 from Mexico and we are -- we are going to be sending additional people there. There are two -- a number of things we are doing. One is just working on trying to describe the basic epidemiology. That's been so incredible useful over the past five days in helping us understand the issue of severity. When initial reports out of Mexico were of very high rates of hospitalization and death, that was suggesting a very severe virus, a virus that could have devastating consequences. As we've learned more, we've seen that this is a virus that appears to be widespread in the community and that the issue of hospitalization and death was the tip of the iceberg phenomenon. So, that has been very useful, getting laboratory set up is something that Canada, the U.S. and Mexico work on together and that has been very helpful in sorting -- sorting that out to. Looking at spread around the country, Mexican government is putting teams in various states to be able to describe in more detail the epidemiology on the state basis. That is something that we do here and it is very useful, because your decisions on what you're going to implement are most appropriately taken at that state and local level .Different areas will be seeing different things and experiencing the outbreak in a different way. So that's part of the assistance. But some of the new work that's going to be going on there is in the area of health care worker transmission and transmission to contact the cases. This will be very useful in understanding prevention strategies. You know, when you're thinking about risk, who comes in contact with the most individuals who are sick and have flu? Health care workers, people come in when they are sick. And we want to make sure that our guidance is as evidence-based as possible. And if there are opportunities to prevent infections in that setting, we want to know what those are and what works. We have guidance up on the web now, but as I've said, as we gain more information, we will be able to tailor those interim guidance so that they are most effective. So, that's the kind of work that's going to go on in Texas and California and that's what the teams are assisting the Mexican government with as well. Take a question from the phone, please?

Operator: The first from Ann Pistone at ABC. Your line is open.

Ann Pistone: Thank you very much. Doctor, from the experience of the CDC and the public health community has garnered the last few weeks dealing with H1N1, what is the most important changes or enhancements that need to be made to biofence, better prepare for more severe or intentional outbreak?

Richard Besser: Thanks. Biofence is an electronic surveillance system that took place in many places to look at various syndromes, so we can look and see how many people are coming in with flu-like symptoms, see how many people are coming in with a number of different conditions and it's one of the systems that we are currently using to look at visits to hospitals. It's a useful piece of surveillance information. And so, you know, we will -- we will, as we go forward, look to see what pieces of surveillance information were most useful and provided good insight in terms of what was taking place on the ground and what wasn't. I think it is premature for me to comment on any of the particulars, because we haven't done -- we haven't done the look become to say, okay, which pieces of information were critical, critically important to decisionmaking at what point? How can we make sure that we've got a detail understanding of what's going on in various places? Next question from the phone?

Operator: The next is from Robert Lowes, Medscape Medical News. Your line is open.

Robert Lowes: Dr. Besser, the people at W.H.O. have announced they will be looking a at possibility of one starting wholesale or mass production on the H1N1 vaccine as well as possibly halting production of seasonal flu vaccine. That is predicated on how much has been produced of the seasonal flu vaccine. What is your reaction to that? Is it a prudent step? Consider halting seasonal flu vaccine production?

Richard Besser: I missed the first part. Where did you say that was taking place?

Robert Lowes: The officials at W.H.O. announced today they would be convening experts to consider wholesale production of a new implemented virus as well as halting production of seasonal flu vaccine.

Richard Besser: Thanks. The world health organization has an expert committee they convene to address global issues around pandemic flu. That's the body that helps inform them whether it's time to move phases of a pandemic. And that's body that will help inform them as well in terms of the global position on vaccination. And the U.S. government has participation on that committee. I think we have three members on that committee. And so I will be very interested to see what their discussions say and where they come down on vaccine production. Here in the United States, we are pushing forward with production of seasonal flu vaccine and that's moving forward very aggressively. We are also undertaking those steps in the development of an H1N1 vaccine that are necessary to do now, so that's providing the virus strength, growing that up as a stock and once that's grown up, providing that to manufacturers so they could do initial study it is they were to move forward with the vaccine. And so you know, world health organization has a responsibility for developing recommendations for the world and we would definitely welcome and we will be participating in those discussions. Let me take the next question here in the room.

Mike Stobbe: Thanks, from the AP. Two questions, following about hospitalizations and the age, is age appearing to be as great or greater a risk for hospitalization than underlying conditions? And second --

Richard Besser: I wouldn't put too much data on the hospitalization. In terms of condition, that was based on 13 people, there is -- that kind of information, dealing with very small numbers is subject to great change. And given the number of people hospitalized is very small, you run the risk of overinterpretation, the range there is three months from 81 -- eight months to 53 years, so it is a very wide range. You talk about it as a median, middle number of 15 it may signal a little more than you want to interpret there. But looking at hospitalizations and risk by age is really, really important. I mean, as this progresses, I fully expect we are going to see more hospitalized individuals and we are going to continue to look at that factor.

Mike Stobbe: Second question, on underlying conditions, understanding the point you just made about the small number of cases, can you tell us what underlying conditions are recurring in those, I guess, 13, and there's a lot of attention on the death yesterday. Was the pregnancy in that case be an underlying condition or did she have something else that you believe exacerbated the death?

Richard Besser: I don't have any additional information on the woman from Texas. The other patients, it was a wide range. There wasn't something that was popping up as predominant, but there were only seven people with a chronic condition. As we gathered more information on that what we will be looking to see is there a risk factor that is putting people at greater risk? Is it something that we can alert people to that would have protective value? But right now we don't have that information. Thankfully, the number of hospitalized individuals is small. In the room?

Michelle Marsh: Michelle Marsh from CBS Atlanta News. I have two questions. One is how soon do you project a vaccine will be available? And second, various health officials are discussing the possibility of asking people to get three vaccinations by this fall, one for the regular flu and two installments for the H1N1 virus. I just want to get your response to that and whether these a possibility.

Richard Besser: Well, when the vaccine would be available, you know, is difficult to say. That is -- [ inaudible ] making sure that that's going to be available for manufacturers, engaging the discussions with the industry so they understand the virus and understand what studies they are going to need to be undertaking. In terms of a number of doses to put it in perspective, before a vaccine is administered to anybody there is a series of studies that need to be taken under the direction of the NIH and approved by the Food and Drug Administration. They what they are looking at is they need to do studies to determine how much stuff needs to be in the vaccine, how much of an antigen needs to be in the vaccine to stimulate protection and immunity. Then they also need to see, do you get sufficient immunity from one dose? Do you need more than one dose? And with each vaccine, it's different. With different age groups, it's different. And so, it is really early to say how many vaccines someone's going to need till those studies are done. But that's going to be very important information because it will -- the number of doses you need will impact on how many people you will be able to vaccinate. And, you know, hopefully, we will be able to find a vaccine that worked very readily with one dose. Back to the phone?

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

Elizabeth Weise: Hi, thanks for taking my call. I actually a question about the number of cases in Illinois, which has jumped and is now the highest in the nation. I know part of that's testing artifact, because they just got their kits over the weekend, but do your folks there have any sense of why Illinois has even more cases than New York at this point?

Richard Besser: No I would have to refer you to the folks in Illinois to understand the testing dynamic. Mayor Bloomberg was here visiting CDC a little while ago and his comment when he was meeting with the media was you want 200 more cases? We will test 200 more people. And so, you may see in different places different approaches and strategies to testing. And so I don't know the specifics on Illinois, but I'd refer to you them on that. But differences you will see by state are have to do with viruses and transmission. Some are going to do have to be much more where they are in ramping up their laboratory testing capability and what they report out. Another from the phone?

Operator: The next question is from Suzanna Hoholik with the Columbus Dispatch, your line is open.

Suzanne Hoholik: I know you keep talking about these test kits and the Ohio authority said they have not received theirs even though a couple of days ago, it was supposed to be on their way. How many are coming and when will they be here?

Richard Besser: Well, I will follow up after this press conference and see what the situation is there the test kits have come out. Some of the states have not been able to fully use them yet because the first five runs need to be validated with our laboratory. And so, we will follow up and see what's going on with Ohio, but I appreciate that information. Next question from the phone?

Operator: The next is from Delthia Rick of Newsday. Your line is open.

Delthia Ricks: Thank you, Dr. Besser. I would like to know rather than a pandemic strain, could this possibly be a newly emergent H1N1 that may compete with or replace the current H1N1 in circulation?

Richard Besser: I think I missed the beginning, whether this H1N1 could replace the current H1N1?

Delthia Ricks: Pandemic strain that is newly emergent but ultimately replace the H1N1 in is circulation? In other words, we may not really be looking a at pandemic strain?

Richard Besser: What we need to look at is what happens in the southern hemisphere, and that is going to be very important. How does the H1N1 compete with other H1N1s and other strains in circulation in the difference between this strain and other H1N1 is that this is a novel strain. That originally -- has many components, has a swine component, it has an avian component, it has a human component and it is a strain to which we feel the population does not have immunity. The other H1N1 that's been circulating is one to which many people probably have some baseline immunity, given that if they were vaccinated last year or they have been exposed to this before. So it's kind of a confusing point. There are different H1N1s. This one here -- this novel strain is one we feel more people would be at risk for and that's why it's different than the one in circulation. Whether it replace it is or not, it will be hard to say but that is what we want to look at coming up. Back to the room.

Michelle Marsh: Just a follow-up to the question that I had before. There's been a lot of concern that by the fall season, this may look like the calm before the storm. Can you speak to that as to what is being done to make sure that when the fall season comes around, things are not -- we are not overwhelmed with even more cases than we are seeing now?

Richard Besser: Thanks. You know, I wish I could predict what we are going to see in the fall because that would make it very easy to make the kinds of decisions we are going to need to make as a nation over the next few months. And we could see a number of things happen. We could see the current strain fizzle out and never come back again. We could see the current strain come back as it currently is or see it mutate and change and come back in a more severe form. What we need to do during this period is really a shared responsibility and that is make sure that we are prepared and that is making sure that we are prepared as a government and as a public health agency and that our laboratories are ready and our epidemiologists are ready and we are ready, should this come back much more -- as a much more severe infection. We need our communities to be ready so that they would know, what would they do if this came back and was really severe and we needed to take measures like closing schools? How would they ensure that children who got school lunch got that at home? We are not going to see problems in terms of nutrition. How do we ensure that parents who want to do the right thing and stay home with their child when they are sick can do that and not lose their jobs? That kind of preparedness efforts over this period of time will really help minimize or reduce the impact, should this come back more severe and will also leave us prepared for any other type of emergency that could come to our community. Okay, last question from the phone and then we will take the last one in the room.

Operator: The next is from David Brown, Washington Post. Your line is open.

David Brown: Yes, thank you. Dr. Besser, does CDC or HHS have any preproduction contracts, standing orders, so to speak, with vaccine manufacturers to buy a pandemic strain vaccine? And I'm not talking about H5N1 which is already bought, but standing orders now? And if it does, how many doses do you have on a standing order and with what companies?

Richard Besser: David, I'm going to have to refer you on that question. Bruce Gellin in the department is the head of the national vaccine program office. And that's the -- that's the office that really coordinates a lot of these efforts and I don't know the answer to that question, but he would be able to address that. Last question in the room?

Mike Stobbe: Thanks. Doctor, just following up on your comment about preparation for the fall. When mayor Bloomberg was here this morning, we asked if he was -- had any special preparations under way for the fall. He said no. What should local communities be doing? Should the health departments be hiring or certain staff be trained in giving vaccinations? What do you they communities should be doing specifically?

Richard Besser: I think just to clarify the mayor's comments, New York has done intensive pandemic plans and so, in terms of doing something special based on this, I think they are doing what everyone's doing, and that is looking at their plans, making sure that they are making the changes to those plans based on this strain and what's circulating and what needs to take place. At the federal government, we are doing that. We are constantly looking to see what have we learned so far what changes do we need to make? As we go forward to the fall, what pieces of information are going to be critical to some of the decisions that need to be made? What do we need to be sure that we are ready? I mean, one of the things that we have done that I already mentioned is already worked to replace some of the stocks of anti-viral and Tamiflu distributed so we will be building those stockpiles back up, so should they be needed, we have them ready. Thank y'all very much. Appreciate it.

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Statement by HHS Secretary Kathleen Sebelius and Acting CDC Director Dr. Richard Besser Regarding the Change in CDC's School and Childcare Closure

Statement by HHS Secretary Kathleen Sebelius and by Acting CDC Director
Dr. Richard Besser

Since the beginning of this outbreak, the CDC has been working to
update, or in some cases, quickly develop interim guidelines to help
healthcare providers, health departments and communities take effective
action to prevent the spread of this novel H1N1 virus. In doing so, we
acknowledged that our interim guidelines would be based on the data
available at the time, be guided by science, and designed so that
resources and efforts would be directed toward actions and activities
that would make a difference in preventing spread of this virus. If new
information or developments indicated a need to adjust our guidance, we
indicated we would do so.

Today, we are announcing a change with respect to CDC's interim guidance
on closing schools and childcare facilities. The initial guidance CDC
issued on May 1st recommended that affected communities with
laboratory-confirmed cases of influenza A H1N1 consider adopting school
dismissal and childcare closure measures, including closing for up to 14
days depending on the extent and severity of illness. At the onset of
this outbreak of a previously unknown influenza virus, we believed it
could be helpful to close affected schools while we learned more about
the virus's transmission and the severity of disease. Further, the U.S.
national strategy for pandemic influenza suggested that ongoing
community-wide closure of all schools and daycare centers should be
considered in the event of a severe outbreak, especially if these
measures could be implemented early.

As CDC's daily press briefings have illustrated, much has been learned
quickly about the virus's severity and its spread. We now believe that
the disease currently being caused by this novel flu virus is similar to
that typically caused by seasonal influenza. Although many people will
get sick and a small number, unfortunately, may become quite ill or even
die, the available data do not indicate that this virus is causing
unusually severe influenza at this time.

With the modified policy being issued today, CDC no longer recommends
that communities with a laboratory-confirmed case of influenza A H1N1
consider adopting school dismissal or childcare closure measures.
Rather, in line with policies being undertaken in Seattle, New York and
Canada, CDC has modified its policy to recommend implementation of
measures that focus on keeping all student, faculty and staff with
symptoms of influenza out of schools and childcare facilities during
their period of illness and recuperation, when they are potentially
infectious to others.

More specifically, at this time, CDC recommends the primary means to
reduce spread of influenza in schools focus on early identification of
ill students and staff, staying home when ill, and good cough and hand
hygiene etiquette. Students, faculty or staff with influenza-like
illness (fever with a cough or sore throat) should stay home and not
attend school or go into the community except to seek medical care for
at least 7 days even if symptoms resolve sooner. Students, faculty and
staff who appear to have an influenza-like illness at arrival or become
ill during the school day should be isolated promptly in a room separate
from other students and sent home.

It's important to note that schools that were closed based on previous
interim CDC guidance related to this outbreak may reopen. That said,
decisions about school closure are at the discretion of local
authorities based on local considerations, including public concern and
the impact of school absenteeism and staffing shortages.

We appreciate the efforts that communities, particularly school
districts, have taken to protect students and staff from this influenza
A H1N1 virus. Communities and schools are at the forefront of
protecting people's health, and we are committed to providing them the
flexibility they need to deal with local conditions, and the best
possible guidance that reflects our most current understanding of the
scientific and medical facts.

Finally, we should add that there are many individuals in our
communities -- the elderly, the very young, and individuals with
suppressed immune systems -- for whom influenza represents a potentially
lethal threat. The 2009 influenza A H1N1 virus is likely to circulate
widely in our communities; if not now then almost certainly in the fall.
We all have a special responsibility during this time to protect
ourselves and protect our neighbors and others in our community by
behaving responsibly and doing whatever we can to minimize the spread of
disease. A virus that may only cause sniffles and mild inconvenience in
one person may put the next into the hospital.

We have more information on the 2009 H1N1 virus today than we did only
one week ago, but much uncertainty remains. We should all be prepared
for a potentially rocky influenza season this fall. The Administration
and the CDC will continue to actively investigate this outbreak as it
unfolds and protect the health of the American public.

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FDA, FTC Warn Public of Fraudulent 2009 H1N1 Influenza Products

The U.S. Food and Drug Administration and the Federal Trade Commission are alerting the public to be wary of Internet sites and other promotions for products that claim to diagnose, prevent, mitigate, treat or cure the 2009 H1N1 influenza virus. The agencies are also advising operators of offending web sites that they must take prompt action to correct and/or remove promotions of these fraudulent products or face enforcement action.

“Consumers who purchase products to treat the novel 2009 H1N1 virus that are not approved, cleared or authorized by the FDA for the treatment or prevention of influenza risk their health and the health of their families,” said Michael Chappell, acting FDA Associate Commissioner for Regulatory Affairs. “In conjunction with the Federal Trade Commission, the FDA has developed an aggressive strategy to identify, investigate, and take regulatory or criminal action against individuals or businesses that wrongfully promote purported 2009 H1N1 influenza products in an attempt to take advantage of the current flu public health emergency.”

Products that are offered for sale to the public with claims to diagnose, prevent, mitigate, treat, or cure infections caused by the H1N1 influenza virus that have not been proven to be safe and effective for these uses must be carefully evaluated. Many of these deceptive products are being sold over the Internet via illegitimate web sites. The operators of these web sites take advantage of the public’s concerns about H1N1 influenza and their desire to protect themselves and their families. These fraudulent products come in all varieties and could include dietary supplements or other food products, or products purporting to be drugs, devices or vaccines. Such fraudulent products will not prevent the transmission of the virus or offer effective treatments against infections caused by the H1N1 influenza virus.

“The last thing any consumer needs right now is to be conned by someone selling fraudulent flu remedies,” said FTC Chairman Jon Leibowitz. “The FTC will act swiftly against companies that resort to deceptive advertising.”

Consumers are urged to contact their health care providers or legitimate medical supply services if they have questions or concerns about medical products or personal protective equipment. Consumers are also urged to visit the FDA and Centers for Disease Control and Prevention web sites for more information about this emergency, and to determine which products the FDA has approved, cleared or authorized for use to diagnose, treat, prevent, mitigate or cure infections caused by H1N1 influenza virus.

Consumers should also visit FDA's web site for tips about how to protect themselves when buying medicines online: http://www.fda.gov/buyonlineguide/

The two antiviral drugs approved by the FDA for treatment and prophylaxis of the 2009 H1N1 influenza virus are Tamiflu (oseltamivir phosphate) and Relenza (zanamivir). Tamiflu and Relenza, in addition to their approved labeling, have Emergency Use Authorizations that describe specific authorized uses during this public health emergency.

For more information about FDA-approved antiviral drugs for influenza, see http://www.fda.gov/cder/drug/antivirals/influenza/default.htm.

For more information on CDC recommendations regarding use of antiviral drugs against the current novel 2009 H1N1 influenza strain, see http://www.cdc.gov/swineflu/?s_cid=swineFlu_outbreak_001.

For more information about personal protective equipment see http://www.fda.gov/cdrh/ppe/.

At present, there are no licensed vaccines approved for this new H1N1 influenza virus.

Consumers are urged to report any suspected fraudulent products or criminal activity relating to FDA regulated products associated with H1N1 Flu Virus (Swine Flu), including the names of web sites that may be offering these products for sale, to the FDA by visiting: http://www.fda.gov/oci/flucontact.html .

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Video: Pandemic Imminent

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Maplecroft Flu Pandemic Maps Reveal Countries Most at Risk

/PRNewswire/ -- With swine flu topping the agenda of business around the world, global risks specialist, Maplecroft has released three new maps and indices revealing the countries most at risk from an influenza pandemic.

The Influenza Pandemic Risk Index (IPRI) consists of three categories: Risk of Emergence, Risk of Spread and Capacity to Contain. Each index generates a list of countries most at risk and that require a tailored policy response on the part of government and business. Maplecroft's research focuses on global risks to business.

The map of Risk of Spread shows the United Kingdom most at risk to the spread of an influenza pandemic, ranking number 1 out of 213 countries. The Netherlands, Germany, Italy, Russia, Canada and Japan are also categorised as extreme risk because of their high population density, urbanisation and busy airports.

Even though the UK and other developed Western nations are at extreme risk of spread, their capacity to contain influenza pandemics ranks low risk. Large stockpiling of drugs and a sophisticated health infrastructure, which the Capacity to Contain index captures, means they have very effective measures with which to fight human influenza.

Sub-Saharan Africa stands out as the area least able to contain pandemic influenza with 27 out of the 30 most extreme risk countries. The capacity of a country to contain the spread of human influenza depends on factors of wealth, health infrastructure, education resources, information and communication networks, and governance.

The Risk of Emergence index unsurprisingly categorises Mexico as extreme risk and ranks the country as fourth most at risk, whilst Vietnam, China and Bangladesh top the table.

Countries most prone to risk of emergence of swine or avian flu in humans are poorer countries that have dense rural populations, with living quarters in close proximity to livestock. This is compounded by poor hygiene, lack of access to clean water and sanitation and poor public health education.

"It is important to see a newly emerging set of global risks - whether pandemics, conflict and terrorism, resource security including water stress, or climate change as inter-related," states Alyson Warhurst Chair of Strategy and International Development at Warwick Business School and one of the founding directors of Maplecroft. "Climate change is causing drought and flooding which in turn leads to crop failures and the destruction of livelihoods which in turn lead to poverty and the conditions that we see increase vulnerability to pandemic flu."

IPRI sources include: WHO, UNESCO, FAO, World Organisation for Animal Health, World Bank, Environmental Research Group Oxford, World Resources Institute and the International Telecommunications Union (ITU).

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CDC Statement on Oseltamivir (Tamiflu®) Resistance and Antiviral Recommendations

On December 19, 2008, CDC issued interim guidance for health care professionals on the use of influenza antiviral medications this flu season. The guidance was issued in response to early data from a limited number of states indicating that a high proportion of influenza A (H1N1) viruses are resistant to the influenza antiviral medication oseltamivir (Tamiflu®). Worldwide, the proportion of H1N1 viruses that are resistant to oseltamivir has been increasing so this development is not surprising....More

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Maxim Health Systems Launches Georgia Flu Vaccination Program

PRNewswire/ -- Maxim Health Systems launched its influenza vaccination program on October 1 across the state of Georgia, after recent debates within the state over whether flu shots would be available to patients outside of Physicians' offices.

In early September, the Georgia State Board of Pharmacy and the Composite State Board of Medical Examiners issued statements that the influenza vaccine is a "dangerous drug" and therefore requires a patient-specific prescription. This classification called into question the legality of nurses administering the flu vaccine without a patient specific script.

Dedicated to making the flu vaccine available at convenient locations for Georgia residents, Maxim contacted its retained counsel, Robert Highsmith and Paul Vranicar of Holland & Knight LLP. Highsmith and Vranicar worked with Georgia Governor Sonny Perdue and the Division of Public Health (DPH) of the Department of Human Resources to enter into an agency agreement with Maxim to invoke a provision of Georgia law allowing nurses who are agents of the DPH to order and dispense "dangerous drugs" under nurse protocols. In essence, this agreement permits Maxim nurses to continue administering flu shots in Georgia without patient-specific prescriptions.

The Governor also issued a public statement calling on "healthcare professionals [to] act in the best interests of public health and continue prior practices" concerning the administration of flu shots. As a result of the Governor's decisive action and the cooperation of the Division of Public Health, Maxim customers will not experience any impact on the quality of services they have come to expect or the quantity of flu shots available this flu season.

Maxim has partnered with local Georgia retail stores, a list of which can be found at http://www.findaflushot.com/, as part of a national campaign to offer immunizations at more than 25,000 retail locations across the U.S. The program aims to increase the number of people who get vaccinated, a step determined by the Centers for Disease Control and Prevention (CDC) as the single most effective way to prevent flu. Maxim's Web site, http://www.findaflushot.com/, helps users quickly locate nearby vaccination sites by simply entering their zip code. This will provide users with the address, driving directions, dates, and times for flu shots at local clinics. The Web site also provides the latest news on influenza and links to other resources to learn more about the flu and prevention strategies.

Each year as many as 65 million Americans fall victim to influenza and flu-related complications, such as pneumonia. This results in approximately 200,000 hospitalizations and 36,000 deaths, which is more than the number of Americans who die each year from breast cancer, and two to three times as many as those who die from HIV/AIDS.(1) Everyone is encouraged to get vaccinated, especially individuals considered to be at higher risk. The CDC defines those with an increased risk of developing influenza-related complications as:

-- Children aged 6 months -- 18 years old
-- Pregnant women
-- People 50 years of age and older
-- People of any age with certain chronic medical conditions
-- People who live in nursing homes and other long term care facilities



"We believe that everyone who can, should get a flu shot and we especially encourage those in high-risk categories along with their family members to get vaccinated," says Steve Pellito, National Director of Maxim Health Systems.

For those who prefer to find a convenient location over the phone, Maxim provides a toll free number at 877-962-9358. Maxim also offers clinics to corporations, senior living facilities, schools, and Physicians' offices to help create ease of access and ensure those at highest risk of contracting the flu have ample resources available to obtain a vaccination.

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FDA Clears New CDC Test to Detect Human Influenza

The U.S. Food and Drug Administration (FDA) today cleared a new test
developed by the U.S. Centers for Disease Control and Prevention (CDC)
to diagnose human influenza infections and the highly pathogenic
influenza A (H5N1) viruses.

The device, called the Human Influenza Virus Real-Time RT-PCR Detection
and Characterization Panel (rRT-PCR Flu Panel), uses a molecular biology
technique to detect flu virus and differentiate between seasonal and
novel influenza.

The device is used to isolate and amplify viral genetic material present
in secretions taken from a patient's nose or throat. The viral genetic
material is labeled with fluorescent molecules, which are then detected
and analyzed by a diagnostic instrument called the Applied Biosystems
7500 Fast Dx, also cleared today by the FDA for diagnostic use
simultaneously with the CDC's rRT-PCR Flu Panel.

The test panel and diagnostic system can detect and identify commonly
circulating human influenza viruses as well as influenza A (H5N1)
viruses. Results can be available within four hours and the system can
test multiple samples at once.

"This is a significant achievement for public health surveillance," HHS
Secretary Mike Leavitt said. "The test allows us to better support
laboratories on the front line of influenza testing in the United States
and abroad."

"The application of the test to detect an emergent influenza virus would
be especially important in the early stages of a pandemic," Secretary
Leavitt added. "This breakthrough allows for a more timely detection of
a pandemic virus, which helps in determining when to begin broad control
strategies as well as life-saving mitigation measures, such as closing
schools, cancelling social gatherings and informing businesses to begin
work-at-home policies."

The test will be available to CDC-qualified laboratories for diagnosing
influenza this fall, and some laboratories will be able to obtain
reagents (certain substances used in the testing process) at no cost.
This test should help ensure the accuracy of influenza testing results
among the different qualified laboratories that conduct influenza
subtype testing.

"This new test provides us another tool in our toolbox to fight seasonal
influenza, a virus that unfortunately kills thousands of people each
year in the United States," said CDC Director Dr. Julie Gerberding.
"We'll now be able to detect influenza in the community faster, which
allows us to take steps more quickly to protect and save lives."

Since influenza viruses are always changing, test reagents need to be
evaluated regularly against circulating viruses to ensure the
sensitivity and specificity of the test to diagnose current influenza
viruses.

"Because the test can tell the difference between seasonal human
influenza viruses and novel viruses, it will also provide qualified
laboratories with a means to rapidly detect new influenza viruses that
have not been identified yet and that could pose a pandemic risk," said
FDA Principal Deputy Commissioner and Chief Scientist Dr. Frank Torti,
M.D., M.P.H.

The CDC, Applied Biosystems of Foster City, Calif., and the Association
of Public Health Laboratories collaborated on the development of this
new test. State public health laboratories in Virginia, Iowa,
California, Massachusetts, Wisconsin, and Washington performed clinical
evaluations of the new flu panel.

Scientists around the world are concerned that the H5N1 virus could one
day mutate and acquire the properties needed to quickly spread between
people, resulting in a pandemic. H5N1 viruses circulate widely in birds
in Asia, Africa and Europe and have caused human illness and death.
These viruses have never been detected in the Americas.

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CDC Awards $24 Million for Pandemic Influenza Preparedness Projects

Georgia awarded over $770,000 in Project Money for Pandemic Influenza Preparedness.

The Centers for Disease Control and Prevention (CDC) has awarded $24 million to fund 55 projects in 29 state and local public health departments that could serve as innovative approaches for influenza pandemic preparedness.

“What is learned from these projects can benefit everyone because it could improve national, regional and local public health detection and response to a pandemic involving influenza,” said Richard Besser, MD, Director of CDC′s Coordinating Center for Terrorism Preparedness and Emergency Response. CDC intends for the recipients to implement promising practices or to develop effective approaches and models that can be replicated nationally, Dr. Besser said.

A total of 184 funding applications were submitted by state and local health departments in a competitive application process. Eligible applicants for the awards were limited to the 62 state, local and territorial public health departments that currently receive federal funding through CDC′s Public Health Emergency Preparedness (PHEP) Cooperative Agreement.

The 29 award recipients have one year to complete the projects, which begin on September 30, 2008. The projects focus on seven key areas and include:

1. Use of public engagement as part of the public health decision-making process
2. Electronic laboratory data exchange to support influenza pandemic monitoring
3. Integration of state-based immunization information systems to track distribution of influenza pandemic countermeasures.
4. Development of statewide electronic death reporting systems compliant with Public Health Information Network (PHIN) requirements
5. Collaborative planning among healthcare providers to ensure the delivery of essential services during an influenza pandemic
6. Development of interventions that promote preparedness for pandemic disease among identified vulnerable populations
7. Distribution and dispensing of antiviral drugs to self-isolated or self-quarantined persons in an influenza pandemic event

A list of the 29 award recipients and their projects can be found at http://emergency.cdc.gov/cotper/coopagreement/07/funding-schedule-pan-flu.asp.

The $24 million for the new projects are part of $600 million in PHEP supplemental funding appropriated by Congress to accelerate state and local influenza pandemic planning efforts. The focus of the funding, which was distributed in three phases beginning in 2006, was on practical, community-based procedures that could prevent or delay the spread of an influenza pandemic.

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Most Parents Are Unaware of Expanded CDC Flu Vaccination Recommendations

PRNewswire-USNewswire/ -- Only one in 10 parents is aware of the recommended age range for children to be vaccinated against the flu, according to a new survey. The Centers for Disease Control and Prevention (CDC) expanded the flu vaccination recommendations in February 2008 to include all children from 6 months through 18 years old, expanding vaccinations to 30 million more school-age children.

The survey also found that during the past two years, nearly 60 percent of parents did not get their children vaccinated against the flu. To drive awareness of the new recommendations and the importance of flu vaccinations, Families Fighting Flu (FFF) -- a group of parents who have lost a child to the flu -- the Visiting Nurse Associations of America (VNAA) -- the largest non-profit network of flu immunizers -- and The Clorox Company have teamed up to help educate families about the broadened recommendations and to increase the number of people getting flu vaccinations nationwide through the Say "Boo!" to the Flu program.

"My wife and I didn't realize how important one flu vaccination could be until we lost our daughter, Amanda, to the flu," said Richard Kanowitz, President of FFF. "That is why this program is so important to us -- Say 'Boo!' to the Flu educates parents on the importance of getting their kids vaccinated and other steps they can take to help prevent the spread of the flu virus."

In its third year, the Say "Boo!" to the Flu program educates families nationwide on how to treat the entire family to a healthier, happier flu season. The program features a bus tour that will travel across the country, stopping along the way to vaccinate families in 12 cities and give them the tricks they need to fight the flu virus this flu season.

"It's crucial that parents stay informed and make it a priority to vaccinate their families against the flu every year," said Mary Ann Blade, a VNAA representative. "Say 'Boo!' to the Flu brings flu prevention to the whole family, since the CDC says that household contacts and caregivers -- moms, dads, grandparents, nannies and other child care providers -- should also get vaccinated."

Everyone is Saying "Boo!" to the Flu!

The Say "Boo!" to the Flu bus tour will kick off September 27 in Atlanta, bringing flu vaccinations and simple prevention tips to families across the country throughout the month of October, before flu activity peaks. Halloween games and giveaways like stickers, t-shirts and Clorox Disinfecting Wipes are part of every event.

In addition to the traveling Say "Boo!" to the Flu tour, other groups will be signing on to help say "boo!" to the flu, too. Visiting Nurse Associations across the country, pediatricians' offices, flu shot clinics, child care centers and moms' groups nationwide will receive Say "Boo!" to the Flu materials, resources and tools to help prevent the spread of the flu virus in their communities.

Visit www.SayBooToTheFlu.com for the complete tour schedule, downloadable family activities, a flu clinic locator and simple flu prevention tips.

News for Parents

The survey, conducted by the Say "Boo!" to the Flu program partners, also found:

Parents need to brush up on their flu facts.

-- Only 10 percent of parents knew that the CDC recommends the flu
vaccination for children from 6 months through 18 years.

-- Ninety percent of parents did not know that a child can be contagious
for more than seven days after becoming sick.

-- Flu vaccinations are not a top priority on parents' winter to-do
lists.
-- When parents think about fall and winter woes, most name the high cost
of heating fuel as their biggest dread this coming season. Only 15
percent said they most dread the possibility of a family member
catching the flu.
-- A majority of parents (52 percent) are only slightly or not at all
concerned that their child or children will catch the flu within the
next six months.
-- Nearly 60 percent (57 percent) of parents have NOT gotten their
children vaccinated against the flu in the past two years.
-- Most parents who don't get their children vaccinated against the
flu say they don't think the vaccine is necessary (29 percent).
-- Among parents who have not taken their children to get a flu shot
within the past two years, 58 percent said they would be likely to
do it if they could get the flu shot at locations such as schools,
shopping malls, grocery stores or public parks.

You Can Scare Away the Flu, Too!


Aside from getting vaccinated against the flu, there are other simple steps families can take to help prevent the spread of the flu virus -- and other potentially harmful bacteria and viruses -- in their homes:

-- Wash Hands Frequently: Wash hands with warm water and soap for at
least 20 seconds (the time it takes to sing the "Happy Birthday" song
twice).

-- Disinfect Germ Hot Spots: Kids can touch up to 300 surfaces in 30
minutes, so disinfect the surfaces kids touch most frequently -- like
doorknobs, light switches, faucets or plastic toys.

-- Do the Elbow Cough: Cough and sneeze into your elbow instead of your
hands to help prevent the spread of germs from touch.

-- Follow Good Health Guidelines: Eat right, exercise, and get plenty of
sleep to help boost your body's ability to fight the effects of colds
and the flu.

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FDA Approves 2008-2009 Flu Vaccines

The U.S. Food and Drug Administration (FDA) today announced that it has approved this year's seasonal influenza vaccines that include new strains of the virus likely to cause flu in the United States during the 2008-2009 season.

The six vaccines and their manufacturers are: CSL Limited, Afluria; GlaxoSmithKline Biologicals, Fluarix; ID Biomedical Corporation of Quebec, FluLaval; MedImmune Vaccines Inc., FluMist; Novartis Vaccines and Diagnostics Limited, Fluvirin; and Sanofi Pasteur Inc., Fluzone.

Approval information and specific indications can be found at http://www.fda.gov/cber/flu/flu2008.htm.

This season's vaccines contain three strains of the influenza virus that disease experts expect to be the most likely cause of the flu in the United States.

Each season's vaccines are modified to reflect the virus strains most likely to be circulating. The closer the match between the circulating strains and the strains in the vaccines, the better the protection.

There is always a possibility of a less than optimal match between the virus strains predicted to circulate and what virus strains end up causing the most illness. Even if the vaccines and the circulating strains are not an exact match, they will provide some protection and may reduce the severity of the illness or prevent flu-related complications.

"One of the biggest challenges in the fight against influenza is producing new vaccines every year," said Jesse L. Goodman, M.D., M.P.H., director of FDA's Center for Biologics Evaluation and Research. "There is no other instance where new vaccines must be made every year. The approval of flu vaccines is a part of FDA's mission to promote the health of Americans throughout the year."

The FDA changed all three strains for this year's influenza vaccine—an unusual occurrence, as usually only one or two strains are updated from year to year. A list of the strains included in the 2008-2009 vaccine can be found at http://www.fda.gov/cber/flu/flu2008.htm. Of note, two of the three strains recommended for the U.S. this year are now in use for the Southern Hemisphere's 2008 influenza season, which is currently underway.

Each year, experts from the FDA, World Health Organization, U.S. Centers for Disease Control and Prevention (CDC), and other institutions study virus samples and patterns collected throughout the year from around the world in an effort to identify strains that may cause the most illness in the upcoming season.

Based on those forecasts and on the recommendations of its Advisory Committee, the FDA each February decides on the three strains that manufacturers should include in their vaccines for the U.S. population. The FDA makes this decision early in the year so that manufacturers have enough time to produce the new vaccines.

Vaccination remains the cornerstone of preventing influenza, a contagious respiratory illness caused by influenza viruses. According to the CDC, every year an average of 5 to 20 percent of the U.S. population gets the flu, more than 200,000 are hospitalized from flu complications and there are about 36,000 flu-related deaths. Some individuals—the elderly, young children, and people with chronic medical conditions —are at higher risk for flu-related complications. Vaccination of these groups and of health care personnel is critical.

"Currently, only 40 percent of health care workers in the United States are vaccinated against influenza," said Department of Health and Human Services' Assistant Secretary of Health Joxel Garcia, M.D., M.B.A.

"Increasing the number of vaccinated health care personnel can be a strong front in the annual battle against the flu," said Garcia. "Health care workers can set an example for the patients they serve as well as decrease the likelihood of contracting and transmitting the virus."

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