Thursday, 10 January 2013

Flu Epidemic? Worst Outbreak in 10 Years/Centers for Disease Control and Prevention ; White House Explains, Advises; full text

National Swine Flu Alert

Hospitals are struggling to keep up with the patients that are coming in with the flu and some hospitals are having to turn people away.

In an interview today with American Urban Radio Networks in the Oval Office, the President made clear that the time for adults to get their H1N1 shots is now and that it is safe.  From ABC News' write-up of the interview:

"People need to understand that this vaccine is safe," Obama said. "Michelle and I just got the shots ourselves... we wanted to make sure nationwide that children were getting it before adults did. And now there's enough vaccine so that adults should get it as well."
The President spoke about how his daughters received the vaccine in October, when it was first being made available to school-age children. He said that it’s important for parents to vaccinate their children.

"That's the most important population because this flu, unlike seasonal flu, disproportionately affects children and young people -- healthy children and young people as well as people with underlying conditions like asthma or neurological diseases. So it is so important and, frankly, the African American vaccination rate has been lower, substantially lower so far than the general population," he said. "I think people just need to understand: If I had the two people that are most important in my life, my two daughters, get it right away -- and they've been just fine with it and in fact haven't gotten sick this entire flu season -- then you need to know that you need to make sure your children get it as well."
As always, learn more about H1N1 and your family at

Listen to conversation on radio as the media staff cant come to work , everyone is getting sick.
A White House nurse prepares to administer the H1N1 vaccine to President Barack Obama at the White House December 20, 2009. (Official White House Photo by Pete Souza)

Flu Epidemic? Worst Outbreak of Influenza in 10 Years!

CDC announces early start to 2012-2013 flu season

The Centers for Disease Control and Prevention held a teleconference Monday to announce that flu cases are on the rise around the U.S. CDC Director Thomas Frieden called this start of the 2012-2013 flu season “the earliest regular flu season in nearly a decade,” adding, “This could be a bad flu year.”

The conference call was held to kick off the start of the 2012 National Influenza Vaccination Week, observed the first week of December every year. National Influenza Vaccination Week was established in 2005 to highlight the importance of continuing influenza vaccination in December and beyond.

The most recent CDC FluView surveillance shows high levels of influenza-like illness activity in five U.S. states:  Tennessee, Alabama, Louisiana., Mississippi and Texas.  Frieden added that he expects it is “just a matter of time” before activity increases in other states.

In the past, flu seasons have been more severe when the influenza A virus subtype H3N2 is in wide circulation. Melinda Wharton, acting director of CDC’s National Center for Immunization and Respiratory Diseases, reported that so far this year there has been a predominance of this influenza strain.

However, Frieden suggested that there is some good news: “This year’s strains look to be a great match for the influenza vaccine.” Based on early testing of flu specimens, the composition of the 2012-2013 seasonal influenza vaccine is a 98 percent match for the flu viruses that are circulating in the population. “The vaccine is still the best tool to protect against the flu,” he said.

During the teleconference, CDC also announced that flu vaccination rates have been increasing over the past few years, especially among vulnerable populations such as pregnant women, children and health care workers. Newly-released mid-season influenza immunization rates indicate that between 80-90 percent of pharmacists, doctors and nurses have received the flu vaccine this year.

CDC officials stated that there is plenty of influenza vaccine still available for those who have not been vaccinated yet, and that it’s not too late to get the seasonal flu shot. Frieden encouraged people to get vaccinated before holiday get-togethers, adding: “Spread good cheer and give presents; don’t spread infections and give the flu.”

For more information about CDC’s seasonal influenza surveillance,

Flu Season Has Boston Declaring Health Emergency

WBUR-Jan 9, 2013
BOSTON — Boston declared a public health emergency Wednesday as the city tries to deal with a harsh early flu season, and the state has ...

Pregnant woman have a weaker immune system puts pregnant women at higher risk for more severe illness as well as birth complications when they give birth .Pregnant women are among the groups considered the most vulnerable for catching the flu. So how can we protect ourselves while being pregnant , experts say there’s no need to panic since there are many ways to protect against the flu.

Many immunologists say something is better than nothing ,Get the flu shot. It’s not too late.

Flu Epidemic Obama White House explains, advises; full text
Full text of the White House 

Homeland security Secretary Janet Napolitano

Full text of the White House emergency swine influenza
briefing by Homeland Security SecretaryJanet Napolitano (above); John Brennan, assistant to the president for Homeland Security and Counterterrorism; Dr. Richard Besser, Centers for Disease Control and Prevention; and Robert Gibbs, presidential press secretary.

The president spent Sunday golfing near Washington.:

MR. GIBBS: Good afternoon, guys. Thank you for taking some time out of your Sunday afternoon. We wanted to bring together many of the people that have the primary governmental responsibility in dealing with the situation and to discuss the government's capacity and capability to discuss the steps the government is taking to address this.

Three people we'll hear from today and then we'll take some questions:  First, John Brennan, Assistant to the President for Homeland Security and Counterterrorism; Dr. Richard Besser, the Acting Director of the Centers for Disease Control and Prevention, and Janet Napolitano, the Secretary of Homeland Security. So with that I'll turn it over to Mr. Brennan.

MR. BRENNAN:  Thank you, Robert. And thank you, everyone, for coming here today. Obviously, President Obama is very concerned about the recent cases of swine flu that have been identified in the United States, as well as the outbreak in Mexico. The President's thoughts are with those who have been affected by this illness. He is monitoring the situation very closely and has supported a very active, progressive and coordinated response by his administration.

The President wants Americans to be fully informed of the situation, which is why we have convened this press briefing today. The vast majority of these cases have occurred in Mexico. Building on the close bilateral cooperation that President Obama advanced during his recent visit to Mexico, he has asked me to publicly convey his full support to President Calderón, the Mexican government and the Mexican people in their efforts to contain the outbreak.

Both the U.S. and Mexican governments are taking steps to reduce the potential for further transmission.  Our goal is simple: to communicate information quickly and clearly for our citizens, to rapidly address any new cases that emerge, and to have the capacity to effectively limit the spread.

At this point a top priority is to ensure that communication is robust and that medical surveillance efforts are fully activated. This will enable both the rapid identification and broad notification of any new cases that may occur in the U.S., as well as in Mexico.

We believe that our increased surveillance efforts have resulted in the identification of new cases over the last 24 hours.  Early identification is vitally important to the overall effort.  In the event that....

...additional cases or sites of infection occur within the United States we want to recognize them quickly and then respond rapidly with appropriate guidance for the public health community and the general public in the infected area.

We also want to ensure medical surveillance and testing and the provision of medications and medical supplies are distributed where necessary.

I would like to share with you some of the steps the administration has taken to ensure that information about this evolving event is flowing swiftly among federal, state and local partners, between U.S., Mexican, Canadian and other governments and with the World Health Organization.

First, the President is receiving regular updates and briefings on the situation.  I updated the President earlier today.  The President has reviewed our national capabilities to mitigate the effects of a broader outbreak in the United States and the steps we are taking to support state and local governments and their public health experts.

I am consulting closely with Secretary Napolitano, who is the principal federal official for domestic incident management with responsibility for spearheading our efforts. The Homeland Security Council has convened an interagency body of senior federal experts to facilitate coordination among the federal departments and agencies that have a role in recognizing, responding to, and communicating with domestic and international partners regarding health incidents that have the potential for significant impact to our nation's well-being.

This group has been conferencing daily to share updates and to identify actions we can take now to respond to developments in an accelerated and effective manner.  The information and decisions of the group are reported daily to senior leaders in the federal government and throughout the White House.  Additional reports are provided as new information of significance becomes available.

While the President and his administration are actively coordinating the overall government response, individual departments and agencies with specific responsibilities as well as unique expertise and experience in dealing with public health risks are leading key elements of the effort.

For example, the Department of Health and Human Services is responsible for the overall effort to coordinate disease surveillance, medical preparedness, and guidance to public health professionals in the event that further cases are detected.

The Departments -- Centers for Disease Control and Prevention has responsibility for identifying and tracking the spread of the disease and for communicating health-related information to the government, media, and public. To this end, the CDC has held regular public briefings since Friday.

In a moment, Dr. Richard Besser, the Acting Director of the Centers for Disease Control and Prevention, will provide an update on the situation in the United States and Mexico, as well as where health professionals and the public can go for reliable information and guidance on swine influenza.

As I mentioned, Secretary Napolitano and the Department of Homeland Security have the overall lead for coordinating the federal response to an influence epidemic in the United States.  The department is closely coordinating with Health and Human Services and CDC to monitor the situation.

After Dr. Besser speaks, you will hear from Secretary Napolitano, who will update you on the department's efforts to coordinate response preparations and actions to date.  The Secretary also will describe actions that are underway to ensure communication of timely and accurate information at land borders and at ports of entry as well as to travelers who seek additional information.

Clearly we all have individual responsibility for dealing with this situation.  We should all be practicing good hygienic practices, such as hand-washing on a regular basis; if you feel sick, it makes sense to stay home; and then also following the other practices that are common sense when we deal with an outbreak of flu every year. I would ask that you hold your questions until after Dr. Besser and Secretary Napolitano have finished their remarks.

DR. BESSER:  Thank you, Mr. Brennan. First, I want to say that our hearts go out to the people in Mexico and the people in the United States who've been impacted by this outbreak. People around the country and around the globe are concerned with this situation we're seeing, and we're concerned as well.  As we look for cases of swine flu, we are seeing more cases of swine flu.

We expect to see more cases of swine flu.  We're responding and we're responding aggressively to try and learn about this outbreak and to implement measures to control this outbreak.

Let me provide for you an update in terms of where we are today and what kinds of public health actions are being taken here as well as abroad. Today we can confirm that there are 20 cases of swine flu in the United States.  We have five affected states: There are eight cases confirmed in New York City, there's one case confirmed in Ohio, two in Kansas, two in Texas, and seven in California.

And again, as we continue to look for cases, I expect that we're going to find them.  We've ramped up our surveillance around the country to try and understand better what is the scope, what is the magnitude of this outbreak.

The good news -- all of the individuals in this country who have been identified as cases have recovered.  Only one individual had to be hospitalized.  But I expect as we continue to look for cases, we are going to see a broader spectrum of disease.

What we know about this virus is it looks to be the same virus as is causing the situation in Mexico. And given the reports out of Mexico, I would expect that over time we're going to see more severe disease in this country.

There are some things that it's important people understand:  Flu viruses are extremely unpredictable and variable; outbreaks of infectious disease are extremely unpredictable and variable.  And so over time what we say about this and what we learn will change.

Expect changes in terms of the number of cases.  We're going to try and give you consistent information and have it on our web site once a day, so that we don't get into the situation where you're hearing different numbers of cases throughout the day -- we're going to report that daily.

We expect that we're going to be changing our recommendations over time based on what we learn. And that's an important thing.  You'll start to see different activities taking place in different parts of the country, depending on the local outbreak picture -- and that's good.  You want people to respond based on what the situation is in their community, based on what situations are in particular countries.

Because of this speed in which things are progressing, you will at find -- at times find inconsistent information, and we're going to work really hard to make sure that that doesn't stay up for long.  But as we're updating recommendations and they're going out through various sources, you may find some inconsistency and we will work to minimize that.

This is moving fast, but I want you to understand that we view this more as a marathon.  We do think that this will continue to spread, but we are taking aggressive actions to minimize the impact on people's health.

It's important that people understand that there's a role for everyone to play when there's an outbreak going on.  There are things that individuals do, there's things that families do, communities do to try and reduce the impact. At the individual level, it's important people understand how they can prevent respiratory infections. Very frequent hand-washing is something that we talk about time and time again and that is an effective way to reduce transmission of disease.

If you're sick, it's very important that people stay at home. If your children are sick, have a fever and flu-like illness, they shouldn't go to school. And if you're ill, you shouldn't get on an airplane or another public transport to travel. Those things are part of personal responsibility in trying to reduce the impact.

It's important that people think about what they would do if this outbreak ramps up in their community.  We understand that in New York City there's a cluster of disease in a school and New York City has announced that they're not having those children come back to school on Monday, so that they can understand better about transmission in that school.

There's a similar situation in Texas. Those are very smart public health decisions.  If there are other communities where we saw cases in a school, we would be recommending that they take those actions as well.

So it's time for people to be thinking -- forward-thinking about, well, if it were my child's school, what would I do, how would I be prepared for that kind of an event.  We view the public as partners in the efforts to try and control what's going on.

There are a number of sources of information. I want people to know that the CDC web site -- has our latest information on swine flu. There's a link from there to very current information and there's a link there to a Spanish language site as well.

So let me talk about some of the public health actions that are going on.  We are working very closely with state and local public health on the investigations going on around the country.  We're providing both technical support on the epidemiology as well as support on the laboratory in terms of confirming cases.

We're also doing a lot of work with the World Health Organization, the Pan American Health Organization, and the governments of Mexico and Canada on this outbreak. There's a tri-national team that is working in Mexico to try and understand better the spread -- why are they seeing more severe disease in Mexico than we are here?  That's a critical question.

We're working to assist Mexico in establishing more laboratory capacity in-country.  That, again, is very important because when you can define someone as a truly confirmed case, what you understand about how they acquire disease takes on much more meaning.

We issued two days ago an outbreak notice on our web site regarding travel to Mexico.  It indicated that if you are traveling to Mexico, that you look at that to see what precautions could you take as an individual to reduce the likelihood that you became ill.  We're going to continue to evaluate the situation in Mexico, and if need be we will increase the warnings based on what the situation warrants.

Later today we're going to be putting out some additional community guidance so that public health officials will know what our general recommendations are should they see cases in schools or additional cases in their community.

And I think that the last thing I want to mention is that whenever we see a novel strain of influenza, we begin our work in the event that a vaccine needs to be manufactured.  So we've created that seed stock, we've identified that virus, and discussions are underway so that should we decide to work on manufacturing a vaccine, we can work towards that goal very quickly.

Our support to the states and locals will continue. We provide epidemiologic support, laboratory support, and we provide them support in terms of their medications and other material that they need to work on this outbreak.So thank you very much, and I'll turn it over to the Secretary.

SECRETARY NAPOLITANO: Thanks, Dr. Besser. A number of things going on and the purpose of today, this briefing, is to give you the most current information about what is happening.  And as has been mentioned before, this is a changing picture. And so we intend to conduct these types of briefings daily for a while so that, you know, it can help up communicate to the public what is happening and so that with knowledge people know what kind of issue we're dealing with.

The first thing I want to announce today is that the Department of Health and Human Services will declare today a public health emergency in the United States. That sounds more severe than really it is.  This is standard operating procedure and allows us to free up federal, state, and local agencies and their resources for prevention and mitigation; it allows us to use medication and diagnostic tests that we might not otherwise be able to use, particularly on very young children; and it releases funds for the acquisition of additional antivirals.

So you'll see those declarations coming out today. And when I say "standard operating procedure," that's exactly what I mean. We issued similar declarations for the recent floods in Minnesota and North Dakota and for the inauguration.

Second, I want to give you some information about where we are with respect to antiviral drugs.  These are the kinds of things you would take should you get sick with this strain of flu.  We have 50 million treatment courses of antiviral drugs -- Tamiflu and Relenza -- in the strategic national stockpile.  We are releasing 25 percent of those courses, making them available to all of the states, but particularly prioritizing the states where we already have confirmed incidents of the flu.

In addition, the Department of Defense has procured and strategically prepositioned 7 million treatment courses of Tamiflu.

The United States Department of Agriculture is heavily involved in monitoring and testing to ensure that there is no issue with our food supply, and everything looks fine. I want to underscore that you cannot get the swine flu from eating pork. So that's very important.  And we're screening and testing livestock to monitor any developments there.

Next, in the Department of Homeland Security, we have a number of components with direct responsibility here. The CBP is inventorying for every duty station and every employee our resources, personal protective equipment, and so forth, to make sure that we have adequate supplies on hand at the borders themselves.

Secondly, we have implemented passive surveillance protocols to screen individuals who may arrive at our borders.  All persons entering the United States from a location of human infection of swine flu will be processed through all appropriate CBP protocols. Right now those are passive.

That means that they're looking for people who -- and asking about, are you sick, have you been sick, and the like; and if so, then they can be referred over for further examination.

Travelers who do present with symptoms, if and when encountered, will be isolated per established rules.  They will be provided both with personal protective equipment and we will continue to emphasize universal health measures like hand-washing and gloves. And if and when the situation develops all CBP sites can implement and we can deploy additional personnel to the borders.

In addition, at the TSA, many of the similar measures are being implemented there with respect to the protection of our TSA workers and also their experience with travelers.  To date, the State Department has not issued official travel advisories for particularly Mexico, but again, as I said earlier, these situations are very fluid and so you need to keep up to date on that.

In addition to the CDC website, the Department of State has a website that will keep travelers posted on what the situation is not only with our neighboring countries, but with countries around the world.

As I said earlier, our intent is to update you daily on this situation so that you can know what is happening within the federal government. State and local governments obviously now are in the loop.  State and local public health authorities obviously are working very hard and will be working hard, because as the doctor said, this will be a marathon, not a sprint, and even if this outbreak is a small one, we can anticipate that we may have a subsequent or follow-on outbreak several months later, which we will be prepared for.

And again, the government can't solve this alone. We need everybody in the United States to take some responsibility here. If you are sick, stay home. Wash your hands, take all of those reasonable measures; that will help us mitigate, contain how many people actually get sick in our country.Thank you.

MR. GIBBS:  With that, let's take a few questions.

Q    Thanks, Robert.  Are there any U.S. clusters that suggest this is easily spread?  Have we seen any pockets of suspected cases in the U.S. that suggest this could be on the scale of Mexico?  And you say it's a marathon.  How long is this marathon going to be?

DR. BESSER:  Thanks for those questions. In terms of duration, my comment earlier about every outbreak is unique is really important to remember. And so it's very hard to say. There's one thing in our favor; we're nearing the end of the flu season, we're nearing the end of the season in which flu viruses tend to transmit very easily.  And so we would expect to see a decline in cases, just like we're seeing a decline in cases of seasonal flu, at some point.

The issue of clusters is an important one, and New York City earlier talked about their school cluster, and that's important. Some of our early epidemiologic investigations are showing that contacts of people who have been diagnosed have a significant rate of respiratory infection -- not confirmed to be this; we only have one documented by viral isolate case in this country of person-to-person spread -- and that was an individual who had gone to Mexico and came back, and then there was a spouse who was diagnosed as well, and both are doing well.

Q    Robert, how concerned are you about the potential for this outbreak to set back the hopeful economic recovery both here in the United States and globally?  And secondly, what if anything are we meant to read into the fact the President Obama decided to go golfing today?  Is this part of your effort to reassure Americans that there's no need to panic?

MR. GIBBS:  I'm not sure I would draw a direct conclusion between the news today and the President's golf.  (Laughter.) I think as Mr. Brennan said, the President has been updated regularly on this and we'll continue to do so as we will continue to regularly update you.

In terms of anything that is affected economically both here and worldwide, I think it's probably far too early to determine whether that will be a case or whether that will have some factor.  We just want to ensure that people understand the steps that are being taken both here and throughout government to address the situation, as well as, as each of these speakers have said, understand the individual responsibilities that people have.

If you have questions, go to the CDC website at  And as the doctor mentioned, there's also a Spanish version of that site.

Q    First to you, Robert.  Why was it necessary to have the President checked this morning?