Transcript for CDC Update on Widespread Flu Activity

OPERATOR: Welcome and thank you for standing by. At this time, all participants are at a listen only mode. During the Q&A session, if you’d like to ask a question, please press star 1 on your phone. Today’s call is being recorded. If you have any objections, please disconnect at this time. I’d like to turn the call over to Mrs. Kathy Harben. You may begin.

KATHY HARBEN: Thank you, Ted and thank you all, for joining us today. There continues to be great interest in influenza. We called this briefing to get you the latest FluView numbers and to provide advice on preventing the flu and information about what people can do to reduce the risk of flu or serious illness. We’re joined by CDC Director Dr. Brenda Fitzgerald and Dr. Dan Jernigan. He is Director of the influenza division in CDC’s National Center for Immunization and Respiratory Diseases. Dr. Jernigan will address questions following our briefing. I’ll turn the call over now to Dr. Fitzgerald.

BRENDA FITZGERALD: Good morning, everyone. Thank you for joining us. This is clearly a topic of much interest. We appreciate you being here. We look forward to answering your questions so you have information that you can act on. CDC is the common defense of the country against health threats and clearly one of the threats facing us right now is influenza. We are currently in the midst of a very active flu season. With much of the country experiencing widespread and intense flu activity. Many of you may be have been directly impacted by this. You may have been sick with the flu yourself or caring for loved ones who are sick. I also know that many of you have received — may have received the flu vaccine this season, but you got sick anyway, or you tried to fill a prescription for medicines to treat the flu, and it was difficult to do. We are here today to discuss these issues and our latest information with you. So far this season, influenza A, H3N2, has been the most common form of influenza. These viruses are often linked to more severe illness, especially among children and people age 65 and older. When H3 viruses are predominant, we tend to have a worse flu season with more hospitalizations and more deaths. While our surveillance systems show that nationally the flu season may be peaking now, we know from past experience that it will take many more weeks for flu activity to truly slow down. We also know that you can reduce your risk of getting the flu through everyday good health habits like covering your mouth when you cough and frequently washing your hands. You need, of course, to limit contact with others who might be sick and if possible, stay home when you are sick to help prevent the spread of germs and respiratory illnesses like the flu. These are the most important measures that we all should be doing. We also continue to recommend the flu vaccine. While our flu vaccines are far from perfect, they are the best way to prevent getting sick from the flu and it is not too late to get one. As of this last month, manufacturers reported that they have shipped more than 151 million doses of flu vaccines, so it should be readily available. Someday, of course, we hope to have a universal flu vaccine, one that attacks all influenza type viruses and provides protection that lasts for years. But until that day arrives, we will continue to improve the vaccines that we have and find ways and tools to help Americans reduce their risk of getting sick. Now, I’ll turn it over to Dr. Jernigan, who will talk about the activities we’re seeing this season and answer questions. Again, thank you for being here. We appreciate your interest.

DAN JERNIGAN: Thank you, very much, Dr. Fitzgerald for the opportunity to go into more depth on some of the information that will be available today in our CDC FluView document that you can get from the CDC website and from other sources. What I’d like to do is talk about three things in particular, talk about where is the flu right now, talk about what that experience of flu is in the outpatient setting where there’s clinicians seeing the patients in doctors’ offices and finally, what’s happening with hospitalizations and get a sense of the severity of illness that occurring out there. First, is with the geographic spread or where is flu happening, and I think the simplest way to describe it is that flu is everywhere in the U.S. right now. There’s lots of flu in lots of places. Our team that does this kind of surveillance studies has been doing this particular thing for 13 years and this is the first year we had the entire continental U.S. be the same color on the graph meaning there’s widespread activity in all of the continental U.S. at this point. It is in a lot of places and causing a lot of flu. So I think the sense that the nation has right now is that a lot is happening and we’re seeing that across different media that is being reported. Second thing is what’s happening in the outpatient setting. CDC works with 2,000 or more providers who provide us information about what’s happening in the clinics What we can see is that there’s been a very rapid increase in the numbers of people coming in to see their doctors or health care providers. What we’re seeing is the season has started early and that it’s probably peaking right about now. If we were to compare this to that kind of activity that occurred in the past, it’s looking a lot like the activity from 2014-2015 and from 2012-2013. Both of those seasons were seasons where the strain H3N2 was the predominant strain, a strain that’s, like was mentioned, is going to be associated with more cases and it’s going to be associated with more hospitalizations, and it is associated with more deaths. In terms of the numbers, we are, again, having a slight increase this week. We’re up at 5.8%, which is slight increase from last week. It’s not quite as high as the 6% that was seen in 2014-2015, but, still, early season peaking now. Finally, in terms of the hospitalizations, we have a number of hospitals that participate in a network across the U.S. where we count numbers of laboratory confirmed influenza hospitalizations, and what we see there is also that rapid rise in the numbers of people that are being hospitalized with laboratory confirmed flu. In terms of the numbers, this week in the FluView we’ll report there’s 22.7 hospitalizations per 100,000 people in the United States. That’s up from 13.7 last week, so that’s almost doubling in terms of the numbers, just in the last week. If you were to look at who is being hospitalized, clearly, the highest rates are among those that are over age 65 and even for those that are age 50-64, in that sort of baby boomer generation. They are seeing high numbers, and they are increasing over last week. The other area that we are, of course, following closely is the children younger than 5 years has also increased or almost doubled in the last week. The people that we see affected with H3N2, that is the very young, the very old, and those with underlying conditions clearly are showing up in the hospitalization data showing up as being the most affected. One other thing that we’ve been monitoring is mortality. We are — it’s — we’re sad to report this week that there are an additional seven flu associated pediatric deaths bringing the number of pediatric deaths reported so far to CDC to 20. In addition, many people I think have been following anecdotes and reports in the media of young, otherwise healthy adults who have been admitted with very progressive influenza disease, then died because of that. Reports are out there. It’s just a reminder that flu, while causing mild disease in a lot of people, can also cause severe disease and death in others. A little bit of context around what’s happening this season compared to others –when we look at all the different indicators and surveillance data that we have, this season seems to be tracking the two more previous H3N2 years, the 2012-2013 year, and the 2014-2015 year. Many remember 2014-2015, a season with a significant drift in the vaccine effectiveness was low that year, and we had a lot of cases, perhaps, upwards of 700,000 hospitalizations during that year. Right now, while we’re tracking the first part of the season, we can’t say for certain what it looks like for the remainder, however, it is looking like our season now seems to be tracking somewhat worse than 2012-2013, perhaps not as bad as 2014-2015. We actually published recently a paper looking at how to characterize influenza seasons into levels of severity and over the last 13 years there have only been two seasons where we have what’s called high severity. The first was 2003-2004. The other was 2014-2015, which both of those were H3N2 predominant years. Whether we reach that level this season, we don’t know, but we think it’s somewhere between those two, 2012-2013 and 2014-2015. The hospitalizations also that we’ve been tracking is likely for them to be hitting somewhere between those two seasons as well. If we then look at the timing of the season, even if we have hit the top of the curve or the peak of the seasonal activity, it still means we have a lot more flu to go. We’re currently in the seventh season right now and in the past, if you look at seasons like this one that we’re having, there’s at least is 11 to 13 more weeks of influenza to go. In addition, there’s other strains of the flu that are still to show up to be a major cause of disease. We always know that B viruses, which the vaccine also covers, will be showing up later in the season. Another reason why it’s good to go ahead and get vaccinated now if you have not gotten vaccinated. We are seeing H1N1, which is one the other influenza viruses starting to show up in states that have already had H3 activity, so it’s possible we may have a pretty robust season, not just with H3, but with the others as well, and, therefore, a good reason to go ahead and get vaccinated if you have not. A lot of that information, those numbers, those graphics on the CDC website that you can actually play with those numbers and make graphics as well. Let me switch now to the use of antiviral drugs. While influenza vaccination is the best way to prevent influenza infection, antiviral treatment with antiviral drugs, these are approved and recommended to treat influenza illness. These drugs can lessen the symptoms and shorten the duration of illness and there’s observational studies and other studies that have shown they prevent serious flu complications. During influenza epidemics, with widespread and intense flu activity, flu antivirals can reduce the burden of illness in a community. Most people who get the flu have mild illness and they don’t need medical care or antiviral drugs; however, some people are more likely to get very sick from flu. We’ve seen that some states have even had states of emergency called because of the influenza in their states right now. For that reason, not everyone needs to get antiviral drugs, but there are certain people that should. CDC recommends that people who are very sick or people with flu symptoms who are high-risk for serious flu complications should be treated as soon as possible with flu antiviral drugs. Who are those people? That means people that are 65 and older. It means young children. It means people with chronic conditions like diabetes, heart disease or asthma. It means pregnant women and others more vulnerable to serious flu illness. Clinicians should not wait for confirmed testing, but they should begin treatment if they suspect flu in a severely ill or high-risk patient. For more information, go to our website. All of this antiviral guidance is there. In addition, a health alert notice was sent out to health care providers. That’s on our website as well, with guidance on use of antiviral drugs. There’s been a lot of interest in antiviral drug supply. CDC has been in regular contact with influenza antiviral manufacturers regarding supply and other issues. While the total reported national supply of influenza antiviral drugs should be sufficient to meet this high seasonal demand, some manufacturers are reporting delays in filling orders and CDC is aware of spot shortages of antiviral drugs in some places that have high influenza activity. There are number of new manufacturers on the market because of the new formulations. Generic formulations that are available. There are more people making the drugs; however, it may be that pharmacies need to check with different manufacturers to make sure they can get those drugs. We are working closely with the manufacturers to address any existing gaps in the market. Additionally, pharmacies and others that are attempting to make bulk purchases of influenza antiviral drugs may need to call more than one distributor or more than one of these manufacturers to locate medications available for purchase in the short term. CDC has updated the antiviral drug supply web page with manufacturer information and phone numbers for inquiries related to antiviral purchases and availability. One thing for patients that are trying to find these drugs, individual patients seeking to fill an influenza antiviral prescription may want to call ahead to their pharmacy and make sure the product is on the shelf and if not, find alternative pharmacies or other ways to get that medication. The final thing with antiviral drugs is that they work better the earlier you begin to take them, so getting them as quickly as possible is best because their action is better when taken earlier. A little bit now about vaccination. Vaccination is our main tool to prevent influenza infection, and CDC recommends that vaccination efforts continue as long as influenza viruses are circulating. It about takes two weeks for protection from vaccination to set in, but as I said, we have a lot of flu season to get through still. We will see other flu viruses start to circulate later during the flu season and most flu vaccines protect against all four of those circulating viruses. The B viruses are still to really show up and take off. So getting a vaccine would help cover them as well. The manufacturers are reporting that they’ve shipped more than 151 million doses of flu vaccine so there should be product available to folks. One tool you can use is to go to the CDC website and look up the vaccine finder. This is a tool you can put your zip code in and it will help find where there are vaccines near you. I just want to make a quick point about vaccine effectiveness this season. In addition to being associated with increased severity, H3N2 seasons also are associated with vaccine effectiveness that is lower than what we usually see against H1NI or influenza B viruses. The preliminary vaccine effectiveness data from studies ongoing this season will not be available until at least mid-February. We’re still enrolling patients in our study sites and at this time, we’re using laboratory data to try to suggest how well our vaccines may work. Our information so far suggests that vaccine effectiveness against the predominant H3 viruses will probably be somewhere around what we saw in the 2016-2017 season, which was in the 30% range. While this is better than the 10% that has been reported from Australia in one study, it still leaves a lot to be desired and we’re very well aware we need to have better flu vaccines. There are many steps that have been taken in the past few years to make our vaccines supply more robust and more effective. I’m happy to address that in the Q&A period if interested. We need better technologies and there are some new technologies that are out there, but getting better vaccines is a great thing. So in summary, we’re seeing a very active flu season and early signs that the season may be severe. Right now, our most important tool for treatment is influenza antiviral medications. Our main tool for ongoing prevention should be flu vaccines, and of course, do not forget to take the everyday common sense behaviors that your mother taught you, stay away from people who are sick, stay home from work or school if you get sick, and cover your cough, wash your hands often. These actions can reduce the spread of respiratory illnesses like flu in the community. So thank you very much for that and happy to take questions at this time.

KATHY HARBEN: Thank you, Dr. Jernigan. Ted, we are now ready for questions, please.

OPERATOR: The phone lines are now open for questions if you’d like to ask a question over the phone, press star 1, and record your name. If you want to withdrawal your question, press star 2, thank you. First question in the queue from Maggie Fox with NBC News, your line is open.

MAGGIE FOX: Thanks very much. I want to make sure we’ve got this message clearly.  There have been some very wrought headlines out there but you are saying “calm down”, the farthest we have to go back to see if flu season is bad is just 2014/2015. Is that right? And I have a follow up.

JERNIGAN: Yep. Flu seasons every year are bad so there’s never a mild flu season. This season is on that more severe side. We don’t know exactly where it’s going to end up, but the indicators from 2014-2015, we have not quite reach those yet, but it’s going to be — this is a bad flu season. We don’t know if it will be a high severity season or not, but all the more reason to take those precautions like we just talked about. Get your vaccine. If you are sick and certainly, if you have underlying conditions, be sure to talk with your doctor about anti-viral drugs.

MAGGIE FOX: And there’s no indication there’s been unexpected mutation of this strain of H3N2 that is circulating? No indication of inhibitors resistance, correct?

JERNIGAN: Right. With regard to the antiviral drugs and resistance, we are not seeing really any of these viruses that are currently circulating that will not work with the antiviral drugs. Currently, there’s also Oseltamivir, there is also Zanamivir which is an inhaled drug, there’s a new drug called Peramivir which can be given through an IV and it can be given to children now. In severe cases, there’s more options than we had before and that’s a good thing. We’re not seeing any of that resistance develop right now.

KATHY HARBEN: Next question, please.

OPERATOR: Next question is from Brenda Goodman with Web MD, your line is open.

BRENDA GOODMAN:  Hi, Dr. Jernigan, I just wanted to get a clarification on the 30% estimated vaccine effectiveness. Was that for — is that your early estimate for overall vaccine effectiveness or is that against H3N2 specifically?

JERNIGAN: Yes. That was the H3N2 specific – the low 30s. The overall for 2016-2017 was 39, so almost 40% overall looking at the effectiveness of the vaccine against all the different circulating viruses that year. When we look at just for the H3 component, which was the predominant virus that year, last year, it was in the low 30s.

BRENDA GOODMAN: Thank you.

KATHY HARBEN: Next question, please.

OPERATOR: Next question’s from Lena Sun with The Washington Post, your line is open.

LENA SUN: Hi, Dr. Jernigan, thank you for taking the call. I was looking at the FluView that was just posted, and I just wanted to double check something about severity this season versus 2014-2015. On the chart that looks at percentages of influenza-like illnesses, you know, the red line. It looks like it’s continuing to go up, but the previous seasons by this point the number of cases had already fallen rapidly. I want to make sure I’m looking at this map correctly, this chart correctly, the red line versus the pink.

JERNIGAN: Right. So the red line with the triangles is the current season like you mentioned. I think one important point is when you see one flu season, you’ve seen one flu season. So exactly what happens to the red line with the triangle over time, we expect it will drop similar to the pink and blue lines which were the2014-2015 season and the 2012-2013 season. That’s what we expect to happen, but you — we never know. I would say that, yes, it’s likely to start dropping. The fact that it is slightly different than those other two seasons, hard to make any really determinations about what that means. We follow it in this way. We follow it in other ways and, in general, we see things peak about now, but, again, that means there’s a whole lot more flu to go this season.

KATHY HARBEN: Next question, please.

OPERATOR: Betsy McKay with the Wall Street Journal, your line is now open.

BETSY MCKAY Hi, Dr. Jernigan. Thank you so much for all of the helpful information. I had just a couple of questions. One is that you mentioned that hospitalizations increased in the last week and have been increasing in general among the 50-64 year-old baby boomer age range. I wondered if you have specific numbers, do you know how high the numbers are, how much they are increasing, and how concerned you are about this? I wanted to ask what new flu vaccine technology is close on the horizon being in development for so many years. It would be helpful to hear what you think is coming along and could be available soon.

JERNIGAN: So the actual numbers of people hospitalized, we — I don’t have with me here. We do things in terms of rates, which can drive some people crazy because of the way we present that information, but the rate per 100,000 people for those aged 50-64 in the previous week was 15.4 and then for this most recent FluView is 24. So it went from 15.4 to 24 for that 50-64-year-old age range. So one thing, too, is that these hospitalization numbers are based on a lot of data that’s collected at hospitals and so these numbers do get back filled some, and so they are likely to go up some as the season progresses, and more information is collected, and able to fill in prior weeks information. In terms of the technologies – most of the vaccines that are made in the United States are made using eggs. That’s something that we’ve all known about and it’s been in production for many, many years. You can get very high yield, and that’s how we are able to get upwards of 151 million doses per year. There are some newer technologies that have been coming out. One is in the form of a recombinant vaccine with the protein in the vaccine. That one is called Flu Block. The other is one that is grown in mammalian cells that is called Flu Sell VAX. Both the recombinant protein vaccine and the cell-grown vaccine don’t have to use eggs to grow and therefore, it’s possible that those vaccine viruses may look more like what’s actually circulating out in the community than the egg-based one. It just varies per year. That’s with regard to the H3N2 viruses. For the other viruses, H1 and B viruses, the egg and the cell look a lot more similar. Our problem is has been with H3N2. Those are some of the new technologies. Ultimately, a broadly-protected, longer lasting vaccine, one that you would get once or twice in life and it would cover every flu. We’d love to see something like that that, but I think it’s going to be several years before we’ll have something that’s like that, so in the interim, we’re pleased to see there are these new technologies, and ways of increasing the antigens like a high dose vaccine for senior citizens and then also using antigens as well. There are technologies out there. We look forward to seeing improvements from manufacturers.

KATHY HARBEN: Next question, please.

OPERATOR: Hellen Branswell from STAT, your line is now open.

HELLEN BRANSWELL Hi thanks for doing this and for taking my question. Dr. Jernigan, something you could sort of talk to us a bit more about, how you determine whether or not a season is severe? I mean, the ILI chart that — or graph that Lena Sun was just  referring to, that really only talks about how much flu is out there and as I watched FluView over the last few weeks, I mean, even those — pediatric deaths are starting to tick up a bit. It’s still low. I know those tend to come in late, but low in comparison to other seasons, and I think this week is the first one where the pneumonia and influenza mortality, chronic diseases specific threshold — might be wrong about that — but how do you determine whether a season is severe or just very active?

JERNIGAN: That’s a great question and one that plagued us for many years. There was a period of time when every season was referred to as moderately severe. A few years ago, we decided that we needed to have a much more objective and formal approach to determining how we categorize the influenza seasons and not one that’s just for seasonal flu, but also one that could help categorize a pandemic when it shows up. I’ll have to direct you to a paper by Matt Biggerstaff. I forget the journal it’s in, but it’s from — just this last year? From 2017. Where we look at all the flu indicators, hospitalization information, outpatient information, mortality data from NCHS and put those into a frame work where we then look at intensity thresholds and then from that, we are able to then categorize intensity thresholds into moderate, high, and very high severity, so that we can begin over time seeing how these different seasons compare to one another. As I mentioned, the two seasons in the last 13 years were overall severity was high with the 2003-2004 and 2014-2015. That information is from the paper by Matt Biggerstaff. I’ll take your comment to mean that maybe we should be more clear at putting that into the Flu View as such that that categorization scheme can be more timely for folks who want to know that information.

KATHY HARBEN: Next question, please.

OPERATOR: Rob Stein from NPR, your line is now open.

ROB STEIN: Yeah, hi, thank you very much for taking my question. I just was wondering about the latest numbers on the hospitalizations, the 22.7 per 100,000. How that compares to previous years like the last, you know, the last couple of H3N2 seasons we had. Is that as bad as you were seeing at this point during those years, not as bad, worse? Any context for the number?

JERNIGAN: Right. So we have a couple comparisons. One is just the comparison to last year, which was, again, a pretty similar virus but occurring over a much longer period of time. At the same time, for instance, those who are over age 65-98 last year, was 56.6. If you compare it with 2014-2015, they are slightly higher than what we are seeing right now for the same time period. Now, the question is, whether or not we would actually see back filling of that information that may make this season worse or not, but more comparison, the overall hospitalization rate for week one, that is the week that ended last Friday, the 2017-2018 overall hospitalization rate was 22.7. For 2014-2015, which was the severe season, the H3 season that had high severity, the hospitalization rate was 29.9. Again, there may be an increase in the number for this season, but that’s the comparison that we have right now, so 2017-2018 is a severe season. We’ll know a little later exactly how severe, but that does not, at this point, appear to be as severe as the 2014-2015 season.

KATHY HARBEN: Next question, please.

OPERATOR Mike Stobbe with the Associated Press, your line is now open.

MIKE STOBBE Hi, thank you for taking my call. Dr. Jernigan, do you mind talking for a second about expectations or fears going into this season as you alluded to; there was a lot of discussion about what Australia saw, 10% effectiveness. Did you all think that you might have a high severity season, if so, is there any relief or, no, you didn’t have an expectation and do you mind talking about that? I have a follow-up too?

JERNIGAN: Sure. If you actually go back to the 2016-2017 season last season, we had a lot of influenza illness that year, upwards of 600,000 hospitalizations just last season. That was an H3 year, not so different that what we’re seeing with the virus this year. The thing about that season, it was extended over time and so you didn’t have this all at once phenomena that we’re getting now where hospitals are having lots of cases all at once all across the U.S. It was distributed over time. I think Australia probably had a much more peaked season where there was lots of cases at the same time. They also vaccinate less there. They vaccinate older individuals and so they did have a very notable season. Question is, did Australia determine what we have this season or what we are seeing is actually just a continuation of what we had last year? Those things we don’t know for certain. It’s really hard to predict influenza and so we are always expecting there to be an unusual season. We’re always prepared to monitor for any severity and, also prepared with messages and other tools to help folks respond to whatever kind of influenza season we end up getting.

MIKE STOBBE Okay, so you are not necessarily thinking it was high severity, you just didn’t know for sure?

JERNIGAN: I think that for most of us in the division and elsewhere in the influenza community, we are rather humbled by this virus. We are always prepared for a severe season and welcomed a less severe season, but it’s difficult to predict what will happen.

KATHY HARBEN: Was that your follow-up, Mike? Okay. We have time for one more question.

OPERATOR: Nancy Burton from the Weather Channel, your line is now open.

NANCY BURTON: Yes, hi, thank you, Dr. Jernigan. Is this outbreak being called an epidemic and if not, how close is it to being called an epidemic, like, what’s your criteria for calling something like that?

JERNIGAN: Well, epidemic really just refers to an impact upon the people of an infectious disease. Each year in the United States we have an epidemic of flu, so, clearly yes, this is an epidemic. We have very specific criteria where we can say the epidemic is beginning and ending based on when flu activity goes above a certain baseline. So we’ve clearly passed that baseline back in November and we’re at the peak of it now, and we’ll probably see it go below the baseline in several months. So, yes, definitely in an epidemic, but that’s happens every year in the United States and in the northern hemisphere with influenza.

NANCY BURTON: Okay. Very good, thank you.

KATHY HARBEN: Okay. Thank you, Dr. Fitzgerald and Dr. Jernigan for joining us today, and thank you to the media who have joined us. For follow-up questions, you can call 404-639-3286 or e-mail us at media@CDC.gov. Thank you for joining us, and this concludes our call today.

OPERATOR: This concludes today’s call. Thank you for your participation. You may disconnect at this time.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES