Press Briefing Transcript

National influenza vaccination week telebriefing

Monday, December 5, 2011 – 12:00pm ET

• Audio recording  (MP3, 9MB)

Operator: Welcome and thank you for standing by. At this time all participants are in a listen–only mode until the question and answer session of today's conference. At that time you may press star1 to ask a question. I would like to inform all participants that today′s conference is being recorded. If you have any objections, you may disconnect at this time. I would now like to turn the conference over to Mr. Glen Nowak. Sir, you may begin.

Glen Nowak: Thank you. And thank you all for joining us for today's telebriefing on us influenza activity and vaccination rates for the current season. We′re going to have two speakers today. The first will be Dr.  Howard Koh, assistant secretary for health, department of health and human services. And Dr.  Koh is going to provide some opening remarks and address vaccination in health care providers and health care workers. Dr.  Koh will be followed by Dr.  Anne Schuchat, who is director of the national center for immunization and respiratory diseases here at the centers for disease control and prevention. And she is going to provide an overview of what we're seeing this season as well as highlight some of the other findings from our surveys like influenza coverage. So I will start by turning this over to Dr.  Koh.

Howard Koh: Thank you, everyone, for joining us for this important call and thank you, glen, for all your hard work to make this call happen. It′s my great pleasure to join you, along with my wonderful colleague Dr.  Schuchat, for this briefing. And we are here to first kickoff national influenza vaccination week and secondly to report to you on early vaccination coverage.

So, first of all, national influenza vaccination week reflects the work of literally hundreds of organizations around the country collaborating to highlight the importance of flu vaccination through the holiday season and beyond. Flu vaccination is the essence of prevention and prevention is the essence of public health. So that's why this call is very important. Two years ago the h1n1 flu pandemic generated a great deal of national awareness. And flu was in the headlines all the time and everyone was talking about it. Doctors, patients, families sitting around the table and work colleagues around the country.

We all understood then the serious nature of this new virus and the importance of vaccination, and many people responded to the message by getting vaccinated to protect themselves and their loved ones. So now we want to build on this foundation and accelerate the momentum for this season and beyond. And we want to stress that flu remains a serious and unpredictable disease. Even healthy people can get the flu. And, in fact, each year in the us on average an estimated 5%to 20% of the population may be infected and more than 200,000may be hospitalized during the flu season. So it's critical to protect yourself and your loved ones against the flu and do that by being vaccinated. And that's why the CDC and the Department of Health and Human Services recommend that everyone six months or older should be vaccinated. And this is the second year of the so–called universal recommendation. It's particularly important for certain high risk individuals such as young children, pregnant women and seniors it's important to get vaccinated because such individuals can experience serious complications from the flu ranging from dehydration, pneumonia or even death. It′s also critical that people with chronic conditions such as asthma, diabetes, and heart or lung disease be vaccinated because they are at particular risk for complications and more than 130 million Americans have at least one chronic condition. So this message is particularly important for them. Flu vaccination is also important for health care workers as well as others who live with or care for high risk individuals, including babies. So it's noteworthy that since the H1N1 pandemic of several years ago vaccination rates have increased for some of the highest risk patients. For example, before the 2009pandemic we saw very low flu vaccination rates among pregnant women, often less than 15%.last season, almost half of pregnant women were vaccinated and in a minute Dr.  Schuchat will tell you more about this year′s trends. Also, last year about half of our nation's children were vaccinated and we saw no racial ethnic disparities in vaccination coverage for the flu among minority children. So it's absolutely critical we continue this progress because flu can be deadly for kids. We saw 1,000 pediatric deaths during h1n1 and more than 100pediatric deaths last flu season. And, again, Dr.  Schuchat will tell you in just a second about trends for this year.

Allow me to make some specific comments about health care personnel vaccination Tthis is a topic I know well as physician who has cared for patients for over 30 years. It′s a critical issue because health care workers who get vaccinated protect not only themselves but also their families and also their patients. So health care worker vaccination is a win–win–win. Today we're very pleased to report some good news regarding health care personnel vaccination uptake. In the past, less than half of health care personnel traditionally received flu vaccination.

Fortunately those rates increased through 2009 and ever since. And to gauge results for this year, an internet panel survey of health care personnel was conducted between November 1 and November 13th, 2011 to provide national estimates. Almost 2,500 health care personnel completed this survey and we are pleased to report that as of november 63% of all health care workers have been vaccinated, which represents a7% increase from this time last year. So that's good news. And also noteworthy is that majority of such personnel who were vaccinated, 79%, were vaccinated at work, demonstrating the importance of worksite wellness. I want to thank the doctors, nurses, pharmacists and other health care personnel who have been vaccinated and telling themselves, particularly their patients.

We want this trend to continue the rest of this season. And in particular, if you're health care worker caring for pregnant woman or persons with heart or lung disease, diabetes or other chronic conditions, it′s especially important to recommend the flu vaccine. We know doctor′s recommendation for flu vaccination is powerful. And, in fact, it can double the chances that a patient will get the vaccine. That′s why we stress that so strongly. And we're also very encouraged that more obstetricians are making these in addition to pediatricians and other specialties. It's important to note that there are an increasing number of places to get vaccinated, just no doctor's offices and clinics and health departments but also work places, pharmacies and grocery stores. Many employers offer flu vaccine to their employees. And because of the passage of health reform, the affordable care act, flu vaccines are now covered without having to pay a co–payment or deductible except some grandfathered health insurance plans. So in short, as the holiday season approaches, take time to get vaccinated. It′s not too late. It′s not too late to vaccinate.

With that, I′ll turn this over to my wonderful colleague Dr.  Anne Schuchat from the cdc and I want to thank her for her national leadership on this critical issue. Dr.  Schuchat.

Anne Schuchat: Thanks so much, Dr.  Koh. Happy influenza vaccination week to you and to everybody on the call. Thanks for calling in and listening. I want to update you about what we're seeing so far with the flu season, the disease that′s spreading, and then primarily provide you with early estimates of flu vaccine updates so far in the united states. As you'll hear, many Americans have already gotten vaccinated, but there are many high risk people who are still unprotected. We're hoping in the days and weeks ahead that many more people will be getting themselves and their children vaccinated and that we use all the remaining doses. The more vaccine we use, the more people who are protected and the best scenario is we use up all the vaccine that's there and really protect our communities and country. So what's going on with flu disease? We're seeing little flu across the country right now. But that doesn't mean it's not right around the corner.

We have had confirmed cases of influenza in 30 states and we know that influenza is most active in the winter months, often increasing in  January and hitting hard most years in February. This means that now is a great time to get vaccinated, to get the most benefit from flu vaccination by being protected before flu activity picks up. Getting vaccinated now also means you'll have some protection against flu before the holiday season, before you get on that airplane, train, or bus to spend time with family, or before you open your home to others. Getting sidelined by the flu or passing it along to loved ones is something nobody wants on their holiday wish lift. I want to share with you quite a bit of data we're happy to have now about how we're doing with the influenza vaccination season so far. Dr.  Koh already shared some results about vaccination in health care workers, but I′m going to talk about two other surveys. Keep in mind the results I′m going to share are estimates of the mid–fall vaccination coverage. They provide us with a helpful post check but our final coverage estimates for this year won′t be released until the influenza season is finished. There is still time for us to improve the numbers that I′ll be reporting. There's time to protect more people. And of course in past seasons many more people did get vaccinated in December and beyond. And we hope this year will be no different. First, let me share results about the general public and remind you that this is the second year of our universal influenza vaccination recommendation. So we recommend everyone six months and older receive a flu vaccine.

The first results I′ll share refer to the general population. That′s the 305 million Americans six months of age and older. And these results come from our national flu survey, which was carried out between November 1st and November 13th, 2011 to provide us with national estimates. The estimates will apply then to the first week of november. Interviews were carried out by land line or by cell phone with just over 16,000 adults and with over 4,000 parents. And that's the source of this coverage data. So by early november, we estimate 36% of people six months and older had been vaccinated. That translates to about 111 million people. That′s a bit higher than our estimates for the same time in 2010.

It's actually about 3.5percentage points ahead of our early november 2010 result. Compared to last year, flu a vaccination uptake by the first week of november this year is about the seam for adults.36% this year versus 44% in adults last year. Buff it's a bit higher for children this year. Almost or about 37% this year versus 31% last year. So that's good news for children. And of course the season is not over and we can still do better. Last year people are taking advantage of the many places vaccines are being offered. Doctor offices and medical settings are still the most common place people go to get vaccinated against influenza but there are other sites where adults are getting flu vaccines this year. For adults, medical settings like doctor offices or clinics accounted for 55% of all doses given. Commercial sites like supermarkets, pharmacies and other stores are where 21% of adults got their vaccine. And workplace, 16% of adults, myself included, got their flu vaccine. Most children were vaccinated at medical settings; about 90%. But about 5% were vaccinated at school.

Next, I want to mention high risk groups because they off have the hardest toll of influenza complications. This year, like past years, the highest uptake of flu vaccines so far has been in seniors and people 65 years of age and older. This year by early november about 62% of people 65 and over have received the flu vaccine. People with chronic conditions like heart or lung disease or diabetes are at especially high risk for complications due to influenza. By early november, only 42% of people 18 to 64 years who had chronic conditions had been vaccinated. And that's very close to what we had seen last year at about 39%.this is an area where we have lots of room for improvement and we hope we can do better through the rest of this season. Next I want to provide some encouraging data about racial and ethnic patterns. There′s good news for children here

For the second year in a row, our mid–season survey found no disparities in influenza coverage among minority children. In fact, coverage was actually the highest in Hispanic children at 43%.coverage was similar for non–Hispanic, white and black children at 33% and 35%.it's so important we address influenza vaccination of minority populations. We know that in the 2009pandemic we had much higher rates of complications among flu in minority populations. So we're glad that parents at least are stepping up to get their children vaccinated. Unfortunately we continue to have disappointing results for adults where major disparities in flu vaccine uptake persist between racial and ethnic groups. Coverage was higher for white adults at about 40% compared to Hispanics at 26% and black′s at28%.i is next going to turn to results in pregnant women. And of course many of you will remember the heartbreaking stories we heard about in the2009 pandemic where pregnant women had very severe complications from influenza. That can happen every year. And so we've been tracking influenza vaccine in pregnant women more closely since the pandemic. The results that I′m going to share come from a different type of survey. These are from an internet panel survey in pregnant women carried out between november 1st and november 13th, 2011.there was 2,000 women who participated in this survey.

As of early november, nearly 43%of pregnant women had been vaccinated. That number is very similar to the number that had been vaccinated in the previous year. Of those vaccinated, about half the pregnant women were vaccinated by their OBGYN or midwife office and 33% a family physician or other doctor's office. We hope more people who are pregnant will be taking advantage of the flu vaccine in the weeks ahead to protect themselves and to protect their newborns from influenza and its complications. So at this point in the season we're cautiously optimistic about the number of people who have already received the flu vaccine. But there are still so many others who need to be protected. And I would hate for complacency among these people to lead to regret when they or a loved one comes down with a serious illness over the winter months ahead. Even healthy people can get the flu and it can be serious. As we head into the holiday season, it's especially important for those at high risk of serious complications and their close contacts to be vaccinated. This of course includes pregnant women, people with chronic heating conditions like asthma, diabetes and heart disease. Health care workers, parents and caregivers of children under six months of age too young to be vaccinated directly themselves. Our hope every year is we′re going to use all the flu vaccine that′s distributed and it would be terrific if all the doses that are available do get used up and we're able to protect as many people as possible.

Again, by early november it looks like as many as 111 million people had been vaccinated. What we know about vaccine supply right now is that about 129 million doses of flu vaccines have been distributed so far this season. And we know some people were vaccinated between the time we did the survey and today. So we believe that supplies are still ample around the country, but we really don't know how long that's going to last. And so we hope that people will be able to find flu vaccine easily in the weeks ahead, but we hope that you can act soon. The supply of flu vaccine at this point in the year is pretty much fixed. And as more people get vaccinated vaccine will likely be harder to find and get. So this is a really good time to get vaccinated because there′s still supplies left.

We also know from our national flu survey that there were a lot of people who planned to be vaccinated who had not yet been vaccinated by early november. If all of those people do follow–up, supplies could be quite short. Now, there's always –– or almost always an increase in flu cases after the holidays. So people should try to put getting vaccinated on your holiday to–do list. And we really want parents also to know if you have children younger than 9 years of age they might need to get two doses to be fully protected. So you can ask your provider whether that child needs to comeback for a second dose. Also, if you're a parent and you′re worried about being able to afford vaccine, I want to make sure everybody knows that the vaccines for children program provides free vaccines to children who are uninsured, Medicaid eligible or other financially vulnerable children. And if you have questions about that you can call1–800–cdc–info.people can also visitcdc.gov/flu or flu.gov for more information about influenza, including nearby locations for vaccine. And you can visit CDC's website for a much more detailed summary of the vaccine coverage reports that I′ve provided. So I′m going to close with reminding you to celebrate the national influenza vaccination week and turn things back over to glen for questions.

Glen Nowak: Thank you, Dr.  Koh and thank you Dr.  Schuchat. Operator, we're ready to take questions. If reporters have a question they would like to direct to a specific person, please let me know and we will do that. Otherwise, we will do our best to direct the question to whoever we think can answer it′s we will take questions.

Operator: If you would like to ask a question, please press star 1and record your name clearly. To withdraw your request, press star 2.once again to, ask a question, please press star 1 and record your name. Our first question comes from Mike Stobbe with the Associated Press. Sir, you may begin.

Mike Stobbe: Hi. Thank you for taking my question. Two questions, actually Dr.  Schuchat, do you know why we think there's been an increase in vaccination rates this fall as compared to last year, especially among the kids. You said it went from 31% to37%? And the other one was what's the pattern in terms of vaccination? Is there a particular month when most people get their vaccinations? Is that changing anything recent years as we have seen flu vaccine become available earlier and earlier in the year and pushes us to get vaccinated extend later?

Anne Schuchat: Thanks, Mike for the great questions. You know, we are pleased that we′re seeing increases in children and we think there are multiple factors involved. I don't think years ago parents realized that influenza could be so serious in children. We′ve had required reporting of deaths in children. You know, last year, even with influenza vaccination, more than 100 children died from influenza. So we think that groups like families fighting flu have done great job getting the word out. Because the last thing a parent wants is to lose a child and the regret of not having done everything you could to protect that child. We also know we've been working quite a bit with partner groups who can reach some of the minority populations. There′s some great community groups and faith–based groups that have been getting out there as trusted local messengers who help parents who have questions about vaccines and ways they can keep their kids healthy. Now, in terms of timing, for years influenza vaccination would be something in the fall and would come to a complete stop at thanksgiving. But for the past several years we′ve been really trying to promote vaccination throughout the season, in December and beyond. And that's when we've started having the national influenza vaccination week celebration toss really promotes the idea that it wasn't too late to be vaccinated. As you know, influenza is unpredictable. And we have had years where there′s a lot of disease in the fall. But most of the time disease picks up in January and February. Some years it goes on into may. And so it's not too late to be vaccinated. And we have been seeing the past couple years continue vaccination in December and beyond. We hope we can break the patterns we've had in the past and do a bumper job this December and January in using up all the remaining doses.

Mike Stobbe: Do you have any numbers that could expand on that a little bit? Like it used to be like only 3% or 4% of the vaccinations happened after thanks giving but now it's 15%? Anything to help?

Anne Schuchat: I can give you some numbers for the 2010–11 seasons anyway. The majority of vaccinations given out last year, 58% had been given out before the week of november. Then 23% of vaccinated people got their vaccines in november last year. And then another 19% were vaccinated from December to may. So that 19% was better than we had done in years before. But you can see still the majority last year anyway were done earlier in the season.

Glen Nowak: Thanks. Next question?

Operator: Our next question from Elizabeth Weise of USA Today.

Elizabeth Weise: Thanks for taking my call. How good a match is this year′s vaccine for the flu that you′re seeing in the 30 states where it′s shown up so far?

Anne Schuchat: Yes, thanks. That′s an important question. Because of course the influenza vaccine ability to protect depends on how close the match is. So far we don't have a lot of influenza strains that are circulating. Of the strains that have been characterized they appear to be very good match with the vaccine. So we don't have evidence of a mismatch at this point. I do need to caution that it′s early in the year and we haven′t seen a lot of influenza yet. So that's why our laboratories are busy characterizing the strains that occur and trying to keep on top of that. We do know that the best way to protect you from influenza is with a vaccine.

Glen Nowak: Next question, operator?

Operator: Our next question comes from David Brown of the Washington Post. You may begin.

David Brown: Thanks a lot. Dr.  Schuchat, does it appear that the dominant strain this year is still going to be the 2009 Novel H1N1? And if so, how much residual immunity do you think people have who have gotten that vaccine now for two years in arrow?

Anne Schuchat: We don't have evidence right now that there's going to be a single dominant strain. In fact, last year we did see a mix of H1N1, the same that had occurred in the pandemic, H3N2 the other group we see and influenza B. This year so far we're seeing all three types circulate. So in terms of how much protection would you have from last year's vaccination or from disease the year before, it′s very unpredictable. We do know, though, that multiple strains are circulating right now and the best way to assure you're protected against all the circulating strains is to receive an annual flu vaccine.

Glen Nowak: Thank you. Operator, next question?

Operator:  Our next question comes from Timothy Martin with the Wall Street Journal. Sir, you may begin.

Tim Martin: Hi. Thanks for taking my call. Are there any factors that you will be looking at which might signal an uptick in flu? It is tough to put a project on it. Secondly, can you address children′s rates that gone up. But you said there is a disparity between adults and minorities. Can you explain the factors behind that and if anything can be done. Thank you.

Anne Schuchat: Two important questions. We work with the clinical community and the public health community to track influenza around the country and each week update what activity levels are in flu view that's posted on third website. This will include the trends that we're seeing and influenza–like illness and thousands of provider′s offices or emergency departments as well as the strains that we′re characterizing through our laboratory system. And we also include a map of the state epidemiologist of what′s going on in their state. So those metrics help us know when things are getting hotter in a particular area or generally. Also, additional things that we can look for that sometimes signal a difficult year. For instance, outbreaks in nursing homes which can sometimes mean that the strain is out there and causing the most vulnerable people harm. Now, of course we do recommend people in nursing homes, including their health care workers, all be vaccinated against influenza. But those are sometimes early warnings that it's going to be a bad year.

The second was about disparities in adults. This has been a real big challenge for us. I think there are probably a number of factors and there′s probably no single factor that explains everything. I also think there are differences region to region and in different minority groups. We know that there are some ways that we can address this. And one of the key approaches we′re trying to use across the department with Dr.  Koh's leadership is to work through community groups, faith–based groups, trusted local groups that really are out there to help their communities improve their health in general, not just out there trying to promote influenza vaccine, to try to understand where the concerns, questions, and issues and how can we overcome some of the barriers. We know that a lot of adults in the past in minority groups have not had insurance and that that has been one limiting factor but we know there are other questions, sometimes trust in government, trust in health care programs. So we feel our trust –– working with local leaders, community leaders can be important in addressing particular group's concerns.

Howard Koh: I can add to that, because we are hardened, that as Dr.  Schuchat pointed out for second year in a row there are some disparities in flu vaccination for minority kids but we are concerned about the disparities for flew vaccination in adults. Six months ago they put out a very aggressive action plan to eliminate health disparities and flu vaccination in adults is one of our big targets. We have had a lot of attention to outreach with community groups, as Dr.  Schuchat has mentioned. There's more attention to efforts with collaboration with pharmacies, through community health centers and also increased attention to advancing so–called an effort to advance health in community through entrusted locals. So we hope that such approaches will narrow disparities in adults in the future.

Glen Nowak: Thank you. Operator, next question?

Operator: Our next question comes from Lisa Schnirring with CIDRAP News. You may begin.

Lisa Schnirring: Hi. Thanks for taking my question. You mentioned the number of doses that have been rolled out this year. And I was just wondering – I think if I′m remembering correctly, the projection from industry was about 166 million. I just wanted to check in to see is everything on track with production, any concerns about any distribution glitches or anything? Just checking in on how all that′s going.

Anne Schuchat: Thanks for that question. I don't actually know how many doses were produced. I believe the number that the manufacturers were predicting was lower than that, but you could check with them for the latest. Here in Atlanta we haven't heard about any manufacturing challenges. And as you know, quite a bit of vaccine was released earlier than ever in terms of august and large amounts in September. So there′s been a pretty good distribution of vaccine. I think the companies always make decisions about their final production based on market issues. And I think probably they would have the best sense on how much they produced until they're finished. I don't have those details.

Glen Nowak: Thank you. Operator, next person?

Operator: As a reminder if you would like to ask a question, please press star 1 and record your name. Our next question comes from Michelle Merrill of Hospital Employee Health Newsletter. You may begin.

Michelle Merrill: Hi. Thank you very much for taking my question. I actually have a couple of questions about health care worker vaccination. First of all, do you have number on how many additional health care workers said they intend to get vaccinated? And my other question is about mandatory vaccination. Do you have any sense that the increase in health care worker vaccination is due to an increase in requirements at hospitals around the country? And conversely, do you feel this shows health care workers are getting the message about vaccination and so maybe mandatory vaccination policies are, in fact, not necessary to increase vaccination rates?

Anne Schuchat: Well, we're very encouraged that the health care worker vaccination rates appear to be rising through 2009 and beyond. And as you pointed out, there′s much discussion about the best strategies to keep those rates going. We have health people 20/20 goal of some 90% of health care workers being vaccinated for the flu. So we want to reach that goal as soon as possible. And as you pointed out, there′s lot of discussion about a wide variety of approaches, particularly at the state and local level. So at this point we′re interested in hearing about best practices and encouraging what works in a particular state or community and we're very pleased that the numbers overall appear to be increasing up to the 63%figure for now as I mentioned earlier, which is an increase of7% from last year. We should also stress that when we say a health care personnel, that′s physicians, dentists, nurses, physician assistants. Also long–term care facility workers and people in that last setting traditionally have some of the lowest vaccination rates. So we're trying to advance the message for all these groups.

Michelle Merrill: Did you have a number on how many intend to get vaccinated?

Anne Schuchat: You know, I can try to address that on that survey we did not include the question of are you planning to get it this year? But I can tell you about what happened last year when we compared the November survey results with a follow–up done in April. And it turned out that an additional 8% of health care personnel were vaccinated between the november and end of season April timing. So it's possible that there are additional health care workers that were planning to be vaccinated but, unlike the national flu survey, we didn′t include it on that panel as far as I understand.

Glen Nowak: Thanks, Anne. Operator, our next question?

Operator: Our next question comes from Stacey Singer from the Palm Beach Post. You may begin.

Stacey Singer: Hi. Thanks for taking my call. When I started our coverage of this swine flu epidemic a couple of years ago the first two cases in our community involved the death of a pregnant woman and the extremely severe illness of pregnant woman who lost her baby. So I wondered if you had any data –– you mentioned how many pediatric deaths there were. Do you have any data about deaths or severe illnesses in flu for pregnant women and their unborn babies?

Anne Schuchat: You know, we don't have data that′s comparable to what we have in children. One thing that has been carried out, though, is some surveys among obstetric caregivers about their influenza vaccination practices. And one of the questions that have been asked in some of those surveys is whether you have personal experience with patients with influenza, including severe or very complicated presentations. And I don't have the statistics from that survey, but there were an impressive number of respondents who described having personal experience caring for a woman such as you've described. I think the 2009 pandemic really shined a spotlight on how bad influenza can be when you′re pregnant and really hopefully tipped the scales in favor of people being –– in favor of providers strongly recommending flu vaccines and women wanting to get them. But I think of course different women are pregnant each year and it′s a message that we have to give out strongly every single year.

Glen Nowak: Thank you. Operator, next question?

Operator: Our next question comes from Miriam Falco with CNN Medical News in Atlanta. You may begin.

Miriam Falco: Hi, Dr.  Koh and Dr.  Schuchat. I appreciate you taking the time. I′ve got one very simple question. Can you clarify which statistic you′re going with for the number of people who die from the flu each year? And then I was interested in hearing Dr.  Schuchat talk about the possibility that you could be running out of –– or find it difficult to find flu vaccine eventually when at the same time you′re trying to get people to get vaccinated. Are you putting the cart before the horse a little bit? Are there production problems? Maybe I missed something, but I was just curious to hear that.

Anne Schuchat: Thanks, Miriam. Nice to hear from you. Influenza deaths are estimated through a variety of models, and we have recently updated our estimates what the annual toll that influenza takes on the whole population in the use is. It's incredibly variable. If we go back a couple decades worth of data we estimate that the range of influenza deaths vary from around 3,000 to 4,000up to 49,000 year to year. So there's not really an average because it's such a huge range.

Your second question is whether put the cart before the horse, and I hope I didn't do that. So I think just to simplify my answer, I think our current data suggests that there is influenza vaccine in doctors′ offices, in work places, in pharmacies, in health departments, in commercial stores, and people looking for it right now should be able to find it, and we strongly recommend that they seek it out. Whether that will still be the case a month or two from now when you see a lot of influenza in our community I can't guarantee so I think my key message is don't put this off forever because you may find yourself or your family quite ill if you do. So hopefully there's not going to be any kind of supply problems based on what's been produced and distributed. What we would like to see, though, is an incredible increase in demand the next couple weeks to really protect people before the season picks up in the winter.

Glen Nowak: Operator, we'll take two more questions. Next question, please.

Operator: The next question comes from John Reichard of Congressional Quarterly.

John Reichard: Yes, thank you. You mentioned that the pandemic of a couple years ago generated great deal of public awareness of vaccination. I wondered, how is the general public vaccination rate now compared to, you know, pre–2009?

Anne Schuchat: Thanks. It′s actually –– the short answer is we're doing better, but the long answer is that we have new systems. One of our challenges before2009 was that we usually got good estimates of influenza coverage about two years after the season. And the pandemic really increased all of our search for more timely information. So we have come up with systems that were piloted during the pandemic, and we've been using since then to get information closer to the time that the vaccine is being used. We do believe that no matter how you look at it coverage in children is greatly increased and that we're seeing improvements in health care workers and pregnant women even though the systems are not exactly the same. In other adults and the elderly, we may not have as much progress but your year–to–year pair sons are challenging because of the delays of the system that had been in place year in and year out. So in general, better, but not good enough.

Howard Koh: Just to stress again for several populations for pregnant women we have seen increasing coverage for kids and particularly with respect to eliminating disparities for minority kids. That′s a very positive trend. And also for health care workers, as I mentioned before. But as Dr.  Schuchat has stressed and we have stressed, the flu remains so serious and unpredictable and we need to continue this progress now and in the future.

Glen Nowak: Thank you. Operator, the last question?

Operator: Our last question comes from Helen Branswell of the Canadian Press. You may begin.

Helen Branswell: Oh, hi. Thanks very much for taking mycelia wanted to follow–up on david brown′s question of earlier. He mentioned the fact that the vaccine contains the h1n1component that's been in the vaccine the last two years. In fact, this year's vaccine is the exact same composition for all three strains as last year's shot. How much is known about durability of immunity and if people got shot last year, is it really crucial for them to get one this year?

Anne Schuchat: Thanks, Helen. That's a really good question. We think it's still important to get vaccinated this year even if you were vaccinated last year. The duration for durability of protection is variable. There are some people who got vaccinated last year who may still have protection right now but I can't guarantee it. And the best way the make sure you′re protected against the strains that are targeted by the vaccine is to get another vaccine this year. Based on everything I know, I got vaccinated again this year, and I strongly recommend others do so.

Glen Nowak: Dr. Koh, your closing thoughts or comments?

Howard Koh: Well, we want to thank your attention to this. We want to stress we're trying to build a system of vaccination year in and year out. We′re very pleased that the results that we have unveiled today reflect some sustained progress, but we have a lot more work to go. So we want to thank you for your attention and keep stressing the message that it's not too late to vaccinate.

Glen Nowak: Thank you. And I thank all reporters who took time–out today to join us. The transcripts will be posted in the next few hours, and we will be posting them on the website. The urls will take you to the data that Dr. Schuchat referred to in this press briefing. So thank you and we'll talk to you soon.

Operator: That concludes today's conference. Thank you for your participation. You may disconnect at this time.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES