Why H1N1 Still Matters


Uploaded by CDCStreamingHealth on 17.09.2010

Transcript:
>>> GOOD AFTERNOON, EVERYBODY.
IT'S 12:30 AND LET'S BEGIN.
WELCOME TO THE CDC'S PUBLIC HEALTH GRAND ROUND.
I'M TANJA POPOVIC.
I WANT TO WELCOME THOSE OF YOU WHO ARE HERE AND THOSE OF YOU
WATCHING US EXTERNALLY.
ABOUT A YEAR AND A LITTLE BIT AGO WHEN WE WERE ASKED TO BE
CREATIVE ABOUT DOING ANOTHER SERIES OF TALKS OR SESSIONS, IT
WAS REALLY HARD TO BE CREATIVE AND NOT OVERDO IT.
BECAUSE IT'S THE FIRST ANNIVERSARY OF OUR EVENTS TODAY,
WHAT I WOULD LIKE TO DO IS I WOULD LIKE TO SHARE WITH YOU,
TAKE JUST A FEW MINUTES.
SOME OF THE PEOPLE WHO HAVE BEEN IN THE BACKGROUND BUT WHO ARE
ACTUALLY VERY RESPONSIBLE FOR THE GROUNDS BEING SUCCESSFUL AND
CREATIVE.
THE FIRST OF THESE PEOPLE IS SHANE JOINOR, WHO S
COMMUNICATIONS MANAGER FOR THE ENTIRE ROUNDS AND WHO WORKS WITH
HIS COLLEAGUES ON INTERNAL AND EXTERNAL COMMUNICATIONS AND
OUTREACH AND AMONG OTHER THINGS IS PLACING US ON FACEBOOK,
TWITTERS AND AS OF A COUPLE OF WEEKS AGO, WE ARE ON YOUTUBE.
SO ALREADY HUNDREDS OF PEOPLE HAVE WATCHED CDC GRAND ROUNDS ON
YOUTUBE.
THE REASONS ARE NOT JUST FOR POPULARITY, BUT ALSO FOR THE
POPULARITY OF SYSTEMS THAT ALLOW THESE HUGE TRANSMISSIONS TO BE
VIEWED EXTERNALLY.
HERE IS A GROUP OF PEOPLE.
THOSE ARE THE MOST CREATIVE PEOPLE WE HAVE WHO ARE
RESPONSIBLE FOR THE COLORS, LAYOUTS AND EVERYTHING ELSE AND
ONE OF THEM IS THIS YOUNG MAN, PAUL LEE, WHO DOES MOST OF THE
DESIGN AND IS RESPONSIBLE FOR WHAT YOU SEE ON THE SCREENS.
A GROUP OF WRITERS AND EDITORS AND PRINTERS WHO DO THE EDITING
OF ALL THE MATERIALS.
WHEN WE GET HERE, THOSE OF YOU WHO SIT UP FRONT WOULDN'T HAVE A
GLASS OF WATER IF IT WASN'T FOR ARNOLD AND ALL OF HIS
COLLEAGUES.
JOHNNY LEADS THE GROUP OF PEOPLE WHO WORK ON SCIENCE CLIPS AND
COORDINATION INFORMATION THAT COMES IN ON A WEEKLY BASIS WITH
THE INFORMATION THAT COMES IN THE GRAND ROUNDS.
HERE IS A NUMBER OF EXPERTS WHO HAVE WORKED ON THAT THE PAST
YEAR WITH HIM.
WE ARE ELIGIBLE FOR CONTINUING EDUCATION CREDITS.
TO DO THAT, THERE IS A GROUP OF PEOPLE THAT MAKE SURE
THAT WE DO THIS ACCORDING TO CERTAIN GUIDANCE AND RULES.
EXTREMELY GRATEFUL TO OUR COLLEAGUES FOR PUBLISHING OUR
ANALYTICAL ESSAYS FOLLOWING EACH ONE OF THESE SESSIONS.
THREE IN PUBLISH SO FAR AND ANOTHER ONE IN PRESS.
THE PERSON WHOSE PHONE AND BLACKBERRY RINGS MOST ON
THURSDAYS IS MY ASSISTANT, NELUM GIET.
THIS IS HOW SHE LOOKS EVERY THIRD THURSDAY AT THE END OF THE
DAY.
PEOPLE WHO ARE MOST TO BE CONGRATULATED FOR WHATEVER WE DO
ARE OUR SPEAKERS AND SUBJECT MATTER EXPERTS.
WE HAVE DECIDED THAT WE NEED TO AWARD THE AWARD FOR MORE
ATTENTION GRABBING SESSIONS.
AND THOSE ARE TWO.
WE HAVE HAD ALMOST 100,000 PEOPLE WATCHING OUR SESSIONS FOR
THE PAST YEAR AND THE TOP SESSION IN TERMS OF VIEWERS WAS
CHILDHOOD OBESITY AND EPIDEMIC FOLLOWED CLOSELY BY OUR
CHLAMYDIA COLLEAGUES.
WE WANT TO CONGRATULATE THEM ON THAT SUCCESS.
WE ARE HOPING THAT THE REALLY SPECTACULAR TEAM HERE IS GOING
TO BEAT THAT RECORD.
ALL THIS IS DONE BECAUSE OF YOU.
OUR AUDIENCE INTERNALLY AND STERNSLY.
AND SO WE REALLY WANTED TO KNOW HOW SATISFIED YOU ARE.
WE HAVE RECEIVED COMMENTS FROM DIFFERENT VENUES.
AND ABOUT 90% TO 95% IS REALLY POSITIVE OR EVEN MORE THAN
POSITIVE, THRILLING.
AND SO WE DESERVE SOME PAT ON THE BACK.
WHAT PEOPLE LIKE IS THE PERSPECTIVE THAT THE SESSION
GIVES.
THEY LIKE THEIR TIMELINESS.
THEY LIKE THE FOCUS ON FRONT LINE SCIENCE AND IMPLEMENTATION
IN PRACTICE.
I DO HAVE TO GIVE A LITTLE BIT OF CREDIT TO DR. FRIEDEN FOR
THIS SCIENCE EDGE AND IMPLEMENTATION IN PRACTICE
BECAUSE IT'S ALWAYS THE SAME QUESTION.
WHERE IS THE EVIDENCE DRIVING IT?
WHERE IS THE DATA?
AND WHY ARE WE DOING WHAT WE'RE DOING?
BASED ON WHAT?
SO DR. FRIEDEN GETS SOME CREDIT, TOO.
NOW, WHAT IS IT THAT THE SPEAKERS THINK IS IMPORTANT TO
THEM?
WHY DO THEY DO IT?
IS IT ACTUALLY MARCHING ORDERS OR DO THEY FEEL THERE IS SOME
BENEFIT FOR THEM?
THIS IS FROM SAMMY GOTLIEB WHO IS ONE OF THE MOST WONDERFUL
PEOPLE TO WORK WITH.
SHE SAYS SHE LOVES HIS BECAUSE IT MAKES YOU THINK WHY ARE YOU
DOING WHAT YOU'RE DOING, WHAT ARE THE IMPACTS?
SHE DESCRIBED IT AS SHORT-TERM PAIN FOR A LONG-TERM GAIN, AND I
TAKE THAT AS A COMPLIMENT.
NOW, THERE ARE PEOPLE WHO HAD SUGGESTIONS AND THERE ARE PEOPLE
WHO FOUND IT CHALLENGING TO GET UP AT 4:00 OR 5:00 IN THE
MORNING AND BE WITH US.
SO WE HAVE HEARD YOU AND AS YOU SEE, WE'RE HERE AT 12:30, NOT AT
9:00 IN THE MORNING.
EVEN THOUGH I'M HAPPY TO REPORT THERE WAS A WHOLE BUNCH OF
PEOPLE HERE AT 9:00.
SO WE HAVE ALREADY TRAINED PEOPLE TO COME HERE AT 9:00.
UNFORTUNATELY, NOT EVERYBODY IS AS PASSIONATE AND SOME PEOPLE
DON'T SHARE MY AND OTHER PEOPLE'S OPINIONS THAT THIS IS
REALLY THE HOTTEST THING SOUTH OF BROADWAY.
BUT THEY DID HAVE SOME VERY SPECIFIC AND GOOD SUGGESTIONS.
THEY FELT IN SOME INSTANCES THE FORMAT IS A BIT TOO RIGID AND
PRESENTATIONS TOO SCRIPTED.
TRUE.
SO WE HEARD THEM, TOO.
AND SO WE ARE HAVING A TOPIC THAT IS EXTREMELY DIFFICULT TO
BE SCRIPTED BECAUSE THERE IS 1,200 PAPERS PUBLISHED IN THE
LAST 16 MONTHS SINCE THE FIRST CASE OF H1N1 WAS DESCRIBED AND
IT'S VERY HARD TO SCRIPT.
THE OTHER THING THAT IS VERY HARD IS TO SCRIPT SOME OF THE
PEOPLE SITTING HERE.
AND ONE OF THOSE PERSONS IS STEVE REDD, WHO I THINK HAS A --
YOU KNOW, LIKE TWO OTHER BROTHERS THAT LOOK LIKE HIM
BECAUSE HE IS IN MANY PLACES AT THE SAME TIME.
AND WHO JUST TOLD ME, YOU KNOW ABOUT THOSE NOTES AND SCRIPTS
THAT WE WORKED ON?
I'M NOT QUITE SURE I CAN FOLLOW THEM.
PERFECT TIMING.
THE OTHER ONE IS MICHAEL SHAW, AN OUTSTANDING LABORATORIAN WHO
CAN SPEAK IN A VERY ENGAGING WAY AND YOU WILL SEE THAT IN A FEW
MINUTES.
WE'RE GIVING YOU SOMEBODY WHO CAN HOLD THE ENTIRE CITY OF
CHICAGO WHEN IT COMES TO PUBLIC HEALTH AND SAFETY AND ALSO HAS
TIME FOR PERSONAL LIFE.
AND SO DOES VINCE COVELLO, ONE OF THE MOST RENOWN SPEAKERS IN
RISK COMMUNICATION WHO HAS WRITTEN 25 BOOKS ON THE TOPIC
AND WHO IS GOING TO BE JOINING US REMOTELY.
SO WE ARE TAKING A RISK IN TRYING TO SEE HOW WE CAN ENGAGE
SPEAKERS WHO ARE NOT PHYSICALLY PRESENT WITH US.
BUT I THINK YOU WILL ENJOY A 100% EPIDEMIOLOGY GIST, THOSE OF
YOU WHO ARE EPIDEMIOLOGY GISTS OR NOT, A PERSON CAN BE AN
EPIDEMIOLOGY GIST DURING THE DAY, BUT WHEN THE NIGHT COMES,
THAT PERSON TURNS INTO A SLEEK AND CHARMING, SEEDY PERSONALITY.
SO WITH THAT, WE'RE GOING TO ADD DR. FRIEDEN TO SAY A FEW WORDS
AND WE'RE GOING TO MOVE ON WITH THE PROGRAM.
THANK YOU.
WE ARE GOING -- WE HAVE EXTENDED THIS SESSION FOR 15 MINUTES TO
ALLOW A FEW COMMENTS THAT I MADE ABOUT PEOPLE TO WHOM WE ARE
GRATEFUL AND TO ALLOW A LITTLE BIT MORE TIME FOR THE
DISCUSSION.
>> THANK YOU VERY MUCH, TANJA, AND THANK YOU FOR YOUR
LEADERSHIP OF THIS TERRIFIC EVENT AND FOR AIL OF THOSE WHO
HAVE PARTICIPATED FOR THE PROGRESS IN THE PAST YEAR AND
HAPPY ANNIVERSARY.
THE BASIC CONCEPT HERE IS THE BEST AVAILABLE SCIENCE TO THE
BEST, HIGHEST IMPACT PRACTICE.
AND WITH H1N1, THERE WAS SO MUCH THAT WAS DONE, SO MUCH RIGOROUS
SCIENCE.
AND YET AS WITH INFLUENZA GENERALLY, SO MUCH STILL TO
LEARN AND SO MUCH THAT'S SO IMPORTANT THAT WE NEED TO LEARN.
SO I'M VERY MUCH LOOKING FORWARD TO TODAY'S SESSION.
AND IT IS MORE THAN JUST COINCIDENCE THAT IT CORRELATES
WITH THE BEGINNING OF AT LEAST FLU VACCINATION SEASON IF NOT
FLU SEASON WITH MORE THAN 60 MILLION DOSES OUT THERE TO BE
GIVEN AND THE FIRST YEAR WHERE CDC IS RECOMMENDING VACCINATION
FOR EVERYONE OVER THE AGE OF 6 MONTHS.
SO I ENCOURAGE EVERYONE TO GET A FLU VACCINES RIGHT AFTER THESE
ROUNDS OR ANYTIME AFTER THAT.
I AM A LITTLE CONCERNED BECAUSE IT'S ALWAYS A LITTLE
NERVE-RACKING TO FOLLOW TANJA IN THIS FORMAT.
AND WHEN SHE TALKS ABOUT CHANGING FORMAT AND MAKING IT
MORE FLEXIBLE AND BEING KIND OF LIKE BROADWAY, I'M A LITTLE
WORRIED ABOUT WHAT THE NEXT YEAR WILL HOLD, BUT I'M VERY EXCITED
TO LEARN, AS WELL.
SO HAVE A GREAT SESSION.
>> THANKS, DR. FRIEDEN.
>> HI.
I'M STEVE REDD, DIRECTOR OF THE INFLUENZA COORDINATION UNIT AND
WAS THE INCIDENT COMMANDER HERE AT CDC DURING THE H1N1 RESPONSE.
IT IS A GREAT PLEASURE TO BE HERE TO TALK TO YOU ABOUT THIS
PANDEMIC.
THE FIRST PANDEMIC SINCE 1968 OVER 40 YEARS AGO.
WHAT I'M GOING TO DO IN THE NEXT COUPLE OF MINUTES IS TALK ABOUT
SOME OF THE MYTHS AND MISCONCEPTIONS THAT HAVE CREPT
INTO THE H1N1 NARRATIVE AND TRY TO CORRECT THOSE.
THE FIRST IS THAT THIS WAS A MILD PANDEMIC AND WAS OF LITTLE
CONSEQUENCE.
AND JUST TO FLIP BACK TO GIVE YOU A QUICK REVIEW, THE FIRST
CASE WAS IDENTIFIED ON APRIL 15th, JUST ABOUT 17 MONTHS AGO.
THE ESTIMATED NUMBER OF CASES IN THE UNITED STATES IS IN THE
NEIGHBORHOOD OF 60 MILLION AND THAT INCLUDES 12,500 DEATHS.
MOST OF THESE DEATHS, ABOUT 90% OF THEM OCCURRED IN PEOPLE UNDER
65.
THE REVERSE OF THE SEASONAL PATTERN OF MORTALITY.
AND 190 COUNTRIES HAVE REPORTED CASES OF H1N1 INFLUENZA.
AND, IN FACT, PROBABLY ALL CASES HAVE HAD CASES, EVEN IF THEY
HAVEN'T IDENTIFIED OR REPORTED THOSE CASES.
TURNING BACK TO THE UNITED STATES, AT THE PEAK OF
TRANSMISSION IN LATE OCTOBER, OVER 49 STATES ACTUALLY REPORTED
WIDESPREAD TRANSMISSION.
THE DURATION OF THE SEASON WAS LONGER THAN PREVIOUS SEASONS.
THIS IS A -- THE NUMBER OF CONSECUTIVE WEEKS THAT -- WHERE
MORE THAN 10% OF THE LABORATORY SPECIMENS WERE POSITIVE FOR
INFLUENZA.
AND AS I SAID, 12,500 ESTIMATED DEATHS OCCURRED.
YOU CAN SEE ON THIS SLIDE THAT AT THE PEAK OF TRANSMISSION IN
LATE OCTOBER, THERE WAS A FIVE-WEEK PERIOD WHEN OVER 1,000
DEATHS WERE ESTIMATED TO HAVE OCCURRED.
IN OUR SYSTEM THAT IS USED TO REPORT -- RECEIVE REPORTS OF
PEDIATRIC DEATHS, A MUCH LARGER NUMBER OF DEATHS WAS REPORTED,
AS WELL.
344 COMPARED TO THE NUMBERS THAT YOU SEE ON THIS SLIDE.
THIS IS THE LARGEST NUMBER OF DEATHS BY FAR SINCE THE SYSTEM
WAS ESTABLISHED IN THE '03-'04 INFLUENZA SEASON.
THE SECOND MYTH I'D LIKE TO TALK ABOUT IS THAT BECAUSE WE
PREPARED FOR A MORE SEVERE PANDEMIC, WE WEREN'T READY FOR
THE H1N1 PANDEMIC.
AND IT'S TRUE THAT A NUMBER OF OUR PLANNING ASSUMPTIONS WEREN'T
CORRECT.
WE ASSUMED THAT THERE WILL BE A CASE MORTALITY RATIO OF 2%, THAT
2 OUT OF EVERY 100 PEOPLE WHO GOT THIS NEW PANDEMIC WOULD DIE
WHEN, IN FACT, 2 OF 10,000 DIED.
WE ASSUMED THAT WE WOULD DETECT THE FIRST CASE OUTSIDE OF THE
UNITED STATES WHEN, IN FACT, THE FIRST CASE WAS IDENTIFIED FROM
SAN DIEGO COUNTY.
AND WE ASSUMED THAT THERE WILL BE UNIVERSAL SUSCEPTIBILITY TO
THIS NEW PANDEMIC VIRUS WHEN WE LEARNED FAIRLY EARLY THAT THE
ELDERLY HAD SOME IMMUNITY AND THAT WAS BORED OUT BY THE
EPIDEMIOLOGY.
AND ALL OF THIS LED TO AN ASSUMPTION THAT WE WOULD HAVE
TIME TO CHARACTERIZE THE SEVERITY AND VIRULENCE OF THIS
DISEASE BEFORE IT ARRIVED IN THE UNITED STATES AND THAT WE WOULD
NEED TO MAKE DECISIONS WITH THIS AND WE HAD TO MAKE A LOT OF
DECISIONS EARLY ON WITHOUT ALL THAT INFORMATION.
NOW, THE PLANNING AND EXERCISING AND TRAINING THAT WE DID BEFORE
THE PANDEMICALLIED US TO KNOW WHAT THE DECISIONS WERE THAT WE
WERE GOING TO HAVE TO MAKE AND ALLOWED US TO BE FLEXIBLE TO
ACTUALLY HAVE THE KIND OF RESPONSE THAT WE DID.
THIS IS THE THIRD MYTH.
I'M ACTUALLY GOING TO RETURN TO THIS AT THE AT THE END OF THIS
SESSION.
THE MYTH IS THAT BECAUSE WE'VE HAD THE H1N1 EXPERIENCE, WE'RE
READY FOR ANYTHING AND WE DON'T NEED TO DO ANYTHING ELSE.
WITH THAT BRIEF INTRODUCTION, LET ME INTRODUCE THE REST OF THE
SPEAKERS.
DR. MICHAEL SHAW WILL TALK ABOUT THE LABORATORY WORK THAT WAS
DONE THAT WAS REALLY THE FOUNDATION OF THE RESPONSE.
DAN JERNIGAN WILL TALK ABOUT THE EPIDEMIOLOGY, PARTICULARLY SOME
OF THE NEW WORK THAT WAS DONE.
DR. JULIE MORITA WILL TALK ABOUT THE CHICAGO EXPERIENCE,
ESPECIALLY THE IMMUNIZATION PROGRAM THAT WAS IMPLEMENTED.
AND DR. VINCE COVELLO WILL REVIEW THE RISK COMMUNICATIONS
SUCCESSES AND THE CHALLENGES THAT WERE OUT THERE.
MICHAEL.
>> THANKS, STEVE.
GOOD AFTERNOON, EVERYONE.
I'M MICHAEL SHAW.
I AM ASSOCIATE DIRECTOR FOR LABORATORY SCIENCE IN THE
INFLUENZA DIVISION OF THE NATIONAL CENTERS FOR
IMMUNIZATION AND RESPIRATORY DISEASES.
AND DURING THE RESPONSE, I HAD PRIMARY SPECIALTY FOR THE
OVERALL LABORATORY ACTIVITIES AT CDC.
THERE WERE THREE CLEAR ACTIVITIES THAT PRIMARILY
OCCUPIED US DURING THE ACTUAL RESPONSE.
OBVIOUSLY, DETECTION OF THE VIRUS WAS IMPORTANT FROM THE
VERY BEGINNING.
BUT ALSO, WE'RE VERY MUCH INVOLVED WITH THE SELECTION OF A
VACCINE STRING.
AND ONE OF THE ONGOING THINGS WAS CONTINUAL MONITORING AND
THAT'S SOMETHING THAT ACTUALLY WILL NOT STOP.
BUT FIRST I WANT TO GO INTO WHAT WAS INVOLVED IN THE ACTUAL
DETECTION OF THE VIRUS AT THE VERY BEGINNING.
THIS IS JUST TO SORT OF REFRESH YOUR MEMORY ON THE VERY FIRST
COUPLE OF WEEKS OF THE PANDEMIC WHEN WE FIRST REALIZD SOMETHING
UNUSUAL WAS GOING ON.
THE FIRST CASE WAS A 10-YEAR-OLD BOY THAT WAS IDENTIFIED IN OUR
LABORATORY ON APRIL 15th.
IT'S FROM A SPECIMEN THAT WAS -- CAME TO US AS PART OF A CDC
SPONSORED CLINICAL TRIAL AT THE POINT OF DIAGNOSTIC DEVICE.
THE PROTOCOL, OF COURSE, HAD ANYTHING THAT BECAME UP TO BE
SENT TO US FOR CONFIRMATION, SO THAT'S HOW WE GOT IT.
WE REALIZED QUICKLY IT WAS SOMETHING UNUSUAL.
WHAT WAS -- GOT OUR ATTENTION WAS THAT A SECOND CASE RAPIDLY
FOLLOWED.
A 9-YEAR-OLD GIRL, ALSO SOME CALIFORNIA.
THIS WAS IDENTIFIED ON APRIL 17th AS PART OF THE BORDER
SURVEILLANCE THAT WAS GOING ON IN CALIFORNIA.
QUICK ANALYSIS DETERMINED THAT IT WAS ESSENTIALLY THE SAME
VIRUS THAT INFECTED BOTH OF THOSE.
IN QUICK ORDER, WE SAW THAT THERE WAS ALSO A GENETIC MATCH
WITH CASES THAT WERE POPPING UP IN TEXAS AND IN MEXICO.
SO IT WAS VERY CLEAR THAT SOMETHING UNUSUAL WAS GOING ON.
WE HAD, OF COURSE, REPORTS THAT THE MEXICO CASES APPEARED TO
HAVE MORE SEVERE DISEASE, BUT THAT FURTHER INVESTIGATION
REVEALED THAT WASN'T THE CASE.
BUT A LITTLE LATER, DECEMBER 2009, THE JOURNAL OF SCIENCE
DECLARED THE NOVEL H1N1 INFLUENZA VIRUSES VIRUS OF THE
YEAR AND LOUDED THE SCIENTISTS FOR RAPID CHARACTERIZATION AND
DISTRIBUTION OF TESTS TO DETECT IT AS WELL AS FOR NEARLY
REALTIME SHARING OF INFORMATION.
I'D LIKE TO EMPHASIZE THAT A LARGE PART OF THAT INFORMATION
THAT WAS SHARED VERY QUICKLY AND FREELY WAS GENERATED BY
SCIENTISTS HERE AT CDC.
AND IT WAS BY RELEASING THAT INFORMATION THAT IT ALLOWED
LABORATORIES ALL OVER THE WORLD TO QUICKLY RAMP UP THEIR
RESPONSE TO THIS VIRUS.
THIS IS A PICTURE JUST GIVING A COUPLE OF PEOPLE WORKING ON THE
RESPONSE.
BUT ALSO ON THE RIGHT, IT SORT OF SHOWS YOU JUST A PILOT OF
BOXES FROM SHIPMENTS THAT WE GOT SEVERAL TIMES DURING THE DAY
DURING THIS RESPONSE.
YOU KNOW, IT WAS A NONSTOP EFFORT, 24/7.
AND AS ANYBODY HAS RUN A LABORATORY CAN SYMPATHYIZE,
EVERY ONE OF THOSE BOXES REPRESENTED A CASE THAT THE
SENDER CONSIDERED URGENT, SO THEY WANTED THEIR RESULTS RIGHT
AWAY.
SO WE WERE THE FIRST ONES IN THE WORLD TO IDENTIFY THE VIRUS.
AND FOR A WHILE, WE WERE THE ONLY ONES ABLE TO DO THE
LABORATORY TESTS TO DIAGNOSIS IT.
THIS IS A FIGURE, I THINK, PROBABLY YOU'VE SEEN MANY TIMES
IN ONE VARIATION OR ANOTHER.
IT SHOWS THE GENETIC COMPOSITION OF THE VIRUS, WHICH ILLUSTRATES
THE UNIQUE ORIGIN, WHICH SHOWED THAT IT WAS A COMBINATION OF
JEANS FROM AVIAN, HUMAN AND SWINE INFLUENZA VIRUSES.
THIS PARTICULAR ASPECT OF IT WE DETERMINED WITHIN A MATTER OF
HOURS, ACTUALLY, OF THE VIRUSES ARRIVAL AT CDC.
BUT WHAT WAS SIGNIFICANT WAS THAT THIS PARTICULAR COMBINATION
HAS NEVER BEEN SEEN BEFORE, EITHER IN HUMANS OR IN ANIMALS.
WE ALSO KNEW FROM FURTHER EXTENSIVE ANALYSIS OF THE
GENETIC COMPOSITION THAT THE HEMOGLUTININ GENE, THE HA, WAS A
DIRECT ASCENDANT OF THE SAME MOLECULE THAT HAD BEEN FOUND IN
THE 1918 PANDEMIC STRAIN.
AT THE SAME TIME IT INFECTED HUMANS, IT WENT INTO THE SWINE
POP LAYING AND THEY WERE EVOLVING OPERATELY ALONG
DIFFERENT LINAGES.
SO AFTER 90 YEARS HAD PASSED, IT ESSENTIALLY BECAME DIFFERENT
ENOUGH THAT THE HUMAN HOST RECOGNIZED IT AS A NOVEL STRAIN.
THAT'S WHAT ALLOWED IT TO BECOME A PANDEMIC.
THERE ARE SEVERAL ASPECTS THAT THE LABORATORY WAS INVOLVED IN.
I WON'T GO INTO EACH OF THESE ON THIS LIST.
BUT THERE ARE TWO IN PARTICULAR THAT PAID OFF FOR THIS
PARTICULAR EFFORT.
ONE WAS OUR ONGOING RESEARCH TO DEVELOP NEW DIAGNOSTIC TESTS.
THIS WAS NEGATIVE TO IMPROVE VIROLOGIC SURVEILLANCE.
SO BEFORE GOING INTO THAT, I WOULD LIKE TO FIRST CONCENTRATE
ON DEVELOPMENT OF THE VACCINE.
BECAUSE THAT WAS ONE OF THE ACTIVITIES THAT OCCUPIED A GREAT
DEAL OF VERY FRIENDSIED ACTIVITY RIGHT AT THE VERY BEGINNING.
WHEN SELECTING AN INFLUENZA VACCINE, THE CHALLENGE IS ALWAYS
TO FIND A STRAIN THAT'S REPRESENTATIVE OF WHAT IS
CIRCULATING.
IN THE CASE OF SEASONAL VIRUSES, THIS INVOLVES MONTHS AND MS. OF
JUST WATCHING WHAT'S GOING ON.
IN THE CASE OF THIS NEW PANDEMIC STRAIN, IT WENT MORE QUICKLY
BECAUSE VIRUS WASN'T VARYING THAT MUCH.
IT WAS FAIRLY NEW TO THE HUMAN POPULATION.
THERE WASN'T A LOT OF PRESSURE ON IT.
BUT WE WERE ABLE TO QUICKLY IDENTIFY A STRAIN THAT WE AGREED
WOULD BE A GOOD ONE IN CONSULTATION WITH W.H.O. AND
FDA.
THAT WAS SENT TO THE NEW YORK MEDICAL COLLEGE WHO GENERATED A
HIGH YIELD REASSORTMENT AND THAT IS WHAT WAS DISTRANSCRIPTED TO
THE MANUFACTURERS.
ONE OF THE OTHER IMPORTANT THINGS I WOULD LIKE TO EMPHASIZE
IS THIS IS THE SAME BASIC PROCEDURE THAT IS USED EVERY
YEAR AND IT'S CONSISTENTLY PRODUCED SAFE VACCINES FOR
DECADES AND DECADES.
THE FINAL STRAIN DECIDED ON WAS ONE OF THE FIRST ONES WE HAD
GOTTEN FROM THE CALIFORNIA OUTBREAKS, CALIFORNIA 7, 2009.
AND ON MAY 23rd, THAT VACCINE CANDIDATE WAS SENT TO THE
MANUFACTURERS AND THE MANUFACTURERS ESSENTIALLY TOOK
OVER THE PRODUCTION AND DISTRIBUTION OF THE VIRUS.
NOW, WHILE ALL OF THIS IS GOING ON, WE'RE CONTINUING TO MONITOR
THE PANDEMIC VIRUS AND THIS IS ONE THING WE WILL CONTINUE TO
DO.
WE ALWAYS HAVE TO DO THAT WITH INFLUENZA VIRUSES BECAUSE
THEY'RE SO PRONE TO CHANGE.
THIS INVOLVES IN PARTICULAR TRACKING IT TO SEE HOW IT'S
SPREADING AND ALSO TO MONITOR THE VIRUSES SO WE GET AN IDEA IF
THERE ARE ANY CHANGES IN IT AS IT IS SPREADING IN THE
POPULATION.
AS I MENTIONED, WE HAD A PCR TEST IN PLACE AT THE VERY
BEGINNING FOR DETECTING SWINE LIKE INFLUENZA VIRUSES.
THAT IS WHAT ALLOWED US TO IDENTIFY IT SO QUICKLY.
BUT IT'S ONE THING TO HAVE A LABORATORY IN PLACE FOR RESEARCH
PURPOSES AND IT'S QUITE ANOTHER TO HAVE ONE THAT CAN BE USED FOR
ACTUAL DIAGNOSTIC PURPOSES IN THE CLINICAL LAB.
SO WHAT YOU NEED TO DO IN A SITUATION LIKE THAT IS GET FDA
APPROVAL FOR USE IN DIAGNOSTIC TESTS.
THAT WE GOT WITH AN EMERGENCY USE AUTHORIZATION IN APRIL 28th,
WHICH IS VERY, VERY IMPRESSIVE BECAUSE THAT'S BASICALLY JUST
TWO WEEKS -- LESS THAN TWO WEEKS AFTER WE INITIALLY IDENTIFIED
THE VIRUS.
WE WERE ABLE TO ROLL OUT THESE TESTS AND WE DISTRIBUTED THEM
WORLDWIDE.
BASICALLY, THIS PCR TEST ALLOWS THE LABORATORY TO TELL THAT
THERE IS THE PANDEMIC STRAIN IN THE SAMPLE THAT THEY'VE GOTTEN.
WE ALSO, AT THE SAME TIME, DISTRIBUTED H-I TESTS.
THAT SORT OF ASSAY TELLS YOU A DIFFERENT SORT OF INFORMATION,
IF THE VIRUS IS CHANGING IN THE WAY IT REACTS TO ANTI-BODY AS
IT'S CIRCULATING.
SO THAT LEADS INTO SOME OF THE GENETIC PROPERTIES THAT WE'RE
CONTINUALLY MONITORING FOR THESE VIRUSES.
WE'RE ESPECIALLY INTERESTING IN TRANSMISSIBILITY AND VIRULENCE.
WE ALSO NEED TO KNOW ABOUT THE ANTI-VIRAL SUSCEPTIBILITY.
FROM THE BEGINNING, THE SEQUENCE TOLD US THAT THESE VIRUSES WERE
RESISTANT TO ONE CLASS OF ANTIBIOTICS.
THAT MADE IT MORE IMPORTANT FOR US TO CONTINUE TO MONITOR
RESISTANCE TO THE ONLY REMAINING CLASS.
SO WE'VE BEEN DOING THAT REGULARLY.
AND ALSO, AS WITH SEASONAL INFLUENZA VIRUSES, WE HAVE TO
CONTINUALLY MONITOR TO SEE IF IT'S CHANGING IN THE WAY IT
REACTS TO ANTIBODIS BECAUSE THAT COULD REACT TO THE CHAIN STRING.
DOWN AT THE MOLECULAR LEVEL, WE ARE ESPECIALLY ALERT FOR
CHANGES.
THIS DIAGRAM SHOWS A COUPLE OF AMINO ACIDS UP AT THE TIP OF THE
H-A MOLECULE.
THEY'RE VERY MUCH INVOLVED IN THE ACTIVITY OF NEUTRALIZING THE
ANTIBODY.
IT COULD CAUSE US TO NEED A NEW VACCINE STRAIN.
ANOTHER PART WE LOOK AT VERY CLOSELY IS THE RECEPTOR BINDING
SIGHT.
THIS IS A POCKET ON THE MOLECULE WHERE IT ACTUALLY ATTACHES TO
THE CELL IT'S GOING TO INFECT.
IF YOU HAVE A CHANGE IN AMINO ACIDS THERE, IT COULD POSSIBLY
CHANGE THE LOCATION IN THE BODY WHERE THE VIRUS REPLICATES.
IT COULD GET DEEPER IN THE LUNGS, CAUSING MORE EFFECT.
IT COULD REPLICATE TO HIGHER LEVELS THAN THE NOSE MAKING MORE
VIRUS PRODUCED, MAKING IT SPREAD MORE EASILY.
THAT WAS ANOTHER PART WE WOULD HAVE TO WATCH CLOSELY.
SO WHAT ARE WE SEEING SO FAR FROM THE MONITORING WE'VE BEEN
DOING?
BASICALLY, WHEN WE'VE SEEN CHANGES, THERE HASN'T BEEN ANY
SUSTAINED TRANSMISSION OF THEM.
THIS INDICATES RIGHT NOW THERE ISN'T ANY SELECTIVE ADVANTAGE
FOR THEM.
WE'VE SEEN NO INCREASE IN TRANSMISSIBILITY OR IN
VIRULENCE.
WHEN WE HAVE SEEN MARKERS THAT WE ASSOCIATED WITH VIRULENCE
WITH AVIAN VIRE RUSSS, FOR EXAMPLE, THEY APPEARED TO HAVE
NO EFFECT OR JUST DON'T HAVE THE SAME EFFECT IN THIS PARTICULAR
GENETIC BACKGROUND.
MONITORING FOR ANTI-VIRAL RESISTANCE, MORE THAN 99% OF THE
VIRUSES WE TESTED REMAINS RESISTANT AND BECAUSE THE VIRUS
IS VARYING VERY LITTLE, THE VACCINE STRAIN THAT WAS CHOSEN
IS AN OVERALL GOOD MATCH.
THIS STRAIN IS VARYING LESS THAN THE SEASONAL INFLUENZA VIRUSES
DO.
WE LEARNED SEVERAL THINGS FROM THIS, THREE PARTICULAR THINGS
THAT ARE WORTH EMPHASIS.
THE BASIC LABORATORY SCIENCE IS WHAT ALLOWED US TO RAPIDLY RAMP
UP OUR ACTIVITIES.
TO GET THIS INFORMATION GATHERED AND DISSEMINATED QUICKLY AND TO
RAPIDLY DEPLOY THESE TESTS THAT LABORATORIES NEEDED TO RESPOND.
AND THIS LEADS INTO THE GENERAL IDEA THAT PREPAREDNESS PAYS OFF.
IT'S ALSO HAVING TRAINED PEOPLE.
AND THE STAFF AND FACILITIES ARE INCREDIBLY IMPORTANT.
AND AS YOU SAW FOR RAPID APPROVAL OF THE DIAGNOSTIC TESTS
PARTNERSHIP WITH OTHER AGENCIES WITHIN THE GOVERNMENT,
CLINICIANS, W.H.O., ALL OF THAT WAS INCREDIBLY IMPORTANT TO HOW
THIS WENT SO SMOOTHLY AT THE VERY BEGINNING.
SO AS THE VIRUS IS CONTINUING TO CIRCULATE, SPEC EXPECT IT'S NOT
GOING TO GO AWAY ANYTIME SOON.
ONE OF THE THINGS THAT'S GOING TO HAPPEN IS AS MORE AND MORE
PEOPLE BECOME IMMUNE TO THE VIRUS, THAT'S GOING TO PUT A
SELECTIVE PRESSURE ON IT, IT'S GOING TO START VARYING
AGNOGENICALLY AND WE EXPECT TO HAVE TO REASSESS THE STRAIN
COMPOSITION AS TIME GOES BY.
SINCE WE ONLY HAVE ONE CLASS OF ANTI-VIRAL DRUG, WE NEED TO
CONTINUE TO EXPAND THE TESTING FOR RESISTANCE TO THOSE AGENTS.
NEXT I'D LIKE TO TURN IT OVER TO DR. JERNIGAN.
>> THANK YOU VERY MUCH FOR THE OPPORTUNITY TO SPEAK.
I'D LIKE TO TALK A LITTLE BIT ABOUT A VERY BRIEF PERIOD OF
TIME.
ON THE EPIDEMIOLOGY AND SURVEILLANCE.
WE HAVE SOME EXISTING AND OLD APPROACHES AS WELL AS SOME NEW
APPROACHES.
I HAVE EIGHT MINUTES.
WE'RE NOT ALLOWED TO POINT OUT ALL THE ACKNOWLEDGEMENTS FOR THE
PEOPLE THAT PARTICIPATED.
WE HAVE UP TO 500 PEOPLE THAT PARTICIPATED AT ONE POINT AND WE
ARE EXTREMELY GRATEFUL IN THE INFLUENZA VISION FOR THE SUPPORT
THAT OTHER FOLKS PROVIDED TO US THROUGHOUT AND THE NUMBERS OF
PEOPLE THAT STAYED WITH US FROM BEGINNING TO END.
I HAVE A COUPLE OF THINGS THAT I'D LIKE TO HAVE AS OBJECTIVES.
I'D WANT TO POINT OUT THE CHARACTERISTICS OF THE H1N1
PANDEMIC IN THE UNITED STATES USING SURVEILLANCE SYSTEMS AS A
PROMPT AS WELL AS TALK ABOUT NEW SURVEILLANCE SYSTEMS.
WITH THE IDENTIFICATION OF THOSE FIRST TWO CASES, LIKE MIKE HAD
MENTIONED IN MEXICO AND THEN WITH THE SUBSEQUENT LINKAGE WITH
A SLIGHTLY DIFFERENT APPEARING CASES FROM MEXICO, A LOT OF THE
EFFORT BEGAN TO TRY AND RAPIDLY CHARACTERIZE THE EMERGING H1N1
PANDEMIC.
THERE WERE EARLY FIELD INVESTIGATIONS WHERE THERE WERE
CASE CONTACT STUDIES AND COMMUNITY SURVEYS WHICH HELPED
DEFINE THE TRANSMIGHT TELL MISSBILITY OF THE VIRUS, AND THE
CLINICAL SEVERITY OF THE CASES.
AND THIS IS EXTREMELY IMPORTANT FOR HELPING TO DETERMINE THOSE
POLICIES ABOUT INTERVENTION AS FAR AS WHO SHOULD GET
VACCINATED.
THESE ARE SOME PHOTOS THAT WERE DEPLOYED TO CHICAGO THAT WORKED
WITH JULIE THAT HELPED DEFINE THESE THINGS VERY QUICKLY.
THAT WERE EXTREMELY IMPORTANT EARLY ON.
AT THE SAME TIME, WE ENHANCED OUR EXISTING SURVEILLANCE
SYSTEMS AND WE ALSO DEVELOPED SOME NEW SURVEILLANCE SYSTEMS.
AND SO LET ME TALK A LITTLE BIT ABOUT THOSE SYSTEMS.
THROUGHOUT THE PANDEMIC, WE TRACKED IT WITH BETWEEN 8 AND 10
DIFFERENT SURVEILLANCE SYSTEMS.
FOUR IN PARTICULAR I'M GOING TO MENTION HERE.
AND THOSE TRACKED CLINICS AND EMERGENCY DEPARTMENT VISITS,
THEY TRACKED HOSPITALIZATIONS AND THEY TRACKED DEATHS TO TRY
AND GET TOGETHER A FULL PICTURE OF WHAT THE IMPACT THAT WAS
HAPPENING WITH THE PANDEMIC AS IT WAS GOING ALONG.
THIS IS A GRAPH OF INFLUENZA LIKE ILLNESS VISITS TO
OUTPATIENT SETTINGS AND EMERGENCY DOCTORS, ABOUT 4,800
PARTICIPANTS IN THE INFLUENZA LIKE ILLNESS NETWORK THAT CDC
SUPPORTS.
ANDED IN THE RED BOX, YOU CAN SEE THE PERIOD FROM THE
INITIATION OF THE 2009 H1N1.
THAT LITTLE BLIP OFF THE TO THE LEFT OF THE SIDE OF THE BOX IS A
SPRING WAVE, NOTABLY THOSE CASES IN NEW YORK CITY.
AND THEN YOU CAN SEE THE RAPID INCREASE IN THE NUMBERS OF CASES
AND THE PERCENT AND A VERY HIGH PEAK THERE IN THE MIDDLE OF THAT
BOX, WHICH REALLY DEMONSTRATES AN INFLUENZA SEASON THAT
OCCURRED ABOUT TWO MONTHS PRIOR TO A NORMAL INFLUENZA SEASON
HAPPENING.
AND THAT IS DIRECTLY ATTRIBUTABLE OR DIRECTLY
CORRELATED WITH THE RETURN TO SCHOOL OF KIDS, OF SCHOOL-AGED
CHILDREN.
BUT AS YOU CAN SEE THROUGH THE SUMMER, THERE WAS STILL A LOT OF
DISEASE THAT WAS OCCURRING IN THAT PERIOD BETWEEN THE SPRING
AND THE FALL PIECE.
AND LET ME GIVE A COUPLE OF PERSONAL EXPERIENCES WITH THAT.
THIS PICTURE HERE WAS A PICTURE OF TWO PICTURES THAT CAME IN THE
MAIL TWO MONTHS AFTER MY SON HAD GONE TO CAMP IN NORTH GEORGIA.
AND SO TIMMY IS IN THERE SOMEWHERE ALONG WITH TWO OTHER
FRIENDS OF HIS WITH 25 CAMPERS IN THIS CABIN.
WE PAID FOR BOTH WEEKS, BUT WE GOT TWO PICTURES.
AND SO DURING THE FIRST WEEK, HOWEVER WIN GOT CONTACTED ON
THURSDAY ALONG WITH THE PARENTS OF TWO OF THOSE OTHER KIDS TO
COME PICK UP OUR KIDS BECAUSE THEY HAD INFLUENZA LIKE ILLNESS
WHICH SUBSEQUENTLY WAS FOUND TO BE H1N1 FLU.
BUT DURING THAT TIME, A LOT OF KIDS GOT SICK.
AND THE SECOND WEEK PICTURE YOU'LL NOTE HAD ONLY 11 CAMPERS.
AND SO THIS DEMONSTRATES A GREATER THAN 50% ATTACK RATE,
BUT IT ALSO SHOWS THAT, YOU KNOW, THESE ARE KIDS THAT ARE IN
CLOSE QUARTERS.
IT ALSO SHOWS THAT THIS IS WHAT HAPPENS WHEN YOU HAVE NO
PRE-EXISTING IMMUNITY AND YOU HAVE INFLUENZA CIRCULATING AMONG
THOSE THAT INFLUENZA LIKES THE MOST, AND THAT IS SCHOOL AGED
CHILDREN.
IT SAYS SOMETHING ABOUT THE HYGIENE OF THESE KIDS AND
DISCUSSION WE CHANGE THE TITLE FROM SWINE FLU H1N1 MAYBE WE
COULD GO BACK TO SWINE FLU JUST FOR THIS SUBSET.
>>> MOVING ON TO OUR HOSPITALIZATION SURVEILLANCE,
THIS IS THE EMERGING INFECTIONS PROGRAMS.
21 MILLION UNDER SURVEILLANCE, LOOKING AT DIFFERENT AGE GROUPS
AND THE RATES OF HOSPITALIZATION.
OFF TO THE RIGHT, YOU CAN SEE THE GREATER THAN 65-YEAR-OLD
RATES OF HOSPITALIZATION, THE RED BEING THE PANDEMIC H1N1
RATES FOR 2009.
YOU CAN SEE THAT THEY ARE LOWER THAN THE 2007-2008 H 1 N3 SEASON
WHERE WE SEE A HIGH RATE OF HOSPITALIZATIONS OF THOSE THAT
ARE OLDER.
LOOKING AT THOSE YOUNGER THAN AGE 65, THE RED BARS ARE HIGHER
THAN PREVIOUS SEASONS, INDICATING THAT THERE WAS A
DIFFERENT RATE OF HOSPITALIZATION FOR THOSE
YOUNGER THAN AGE 65.
THIS REALLY UNDERSCORES THE FACT THAT WE FOUND FROM SEROLOGIC
STUDIES THOSE THAT WERE OLDER SEEMED TO HAVE IT AND
THOSE WHO WERE YOUNGER DID NOT.
AUTOS MENTIONED PREVIOUSLY, THIS DEMONSTRATES OUR LABORATORY
CONFIRMED INFLUENZA DEATHS AMONG INDIVIDUALS UNDER 18 YEARS OF
AGE, SO REPORTEDBLE ILLNESS IN THE UNITED STATES COMPARING IT
TO THE PAST TWO SEASONAL INFLUENZA SEASONS.
YOU CAN SEE IN THE SQUARE THAT THERE WERE FOUR TO FIVE TIMES
MORE DEATHS DURING THE H1N1 2009 PANDEMIC SEASON PREVIOUSLY,
INDICATING THAT THERE WAS A LOT OF ACTIVITY AMONG KIDS AND
SUBSEQUENT OUTCOMES AMONG THOSE CHILDREN.
SO LET ME TALK A LITTLE BIT ABOUT SOME NEW SURVEILLANCE
SYSTEMS OR APPROACHES AND SOME METHODS USED TO EVALUATE THE
H1N1 PANDEMIC.
FIRST, THERE WERE A LOT OF PARTNERSHIPS WITH THE SCHOOLS
AND COLLEGES TO MONITOR SCHOOL DISMISSAL AND COLLEGE ILLNESS
WITH THE AMERICAN COLLEGE OF HEALTH ASSOCIATION.
WE ALSO WORKED EMERGENCY DEPARTMENTS AND USED ELECTRONIC
DATA FROM THOSE SOURCES TO MONITOR INFLUENCE LIKE ILLNESS
AND INTENSIVE CARE UNITS TO MONITOR A DISEASE THERE.
WE ALSO DID PHONE SURVEYS TO LOOK AT INFLUENZA LIKE ILLNESS
IN THE COMMUNITY AND VACCINE COVERAGE BY USING THE BEHAVIORAL
RISK FACTORS SURVEILLANCE SYSTEM.
WE LOOKED AT LABORATORY CONFIRMED NOVEL CASE REPORTS AND
EXPAND POPULATION BASED HOSPITALIZATION SURVEILLANCE.
THERE WERE ALSO, ACCOMPANYING THOSE NEW ACTIVITIES, NEW
EPIDEMIOLOGIC METHODS, THERE WERE WAYS OF LOOKING AT
ESTIMATES OF EXCESS DEATHS IN COMPARISON TO PAST INFLUENZA
SEASONS AND INTO PAST PANDEMICS TO TRY AND GET A SENSE OF WHERE
THE SEVERITY OF THIS PARTICULAR PANDEMIC WAS HITTING.
WE ALSO DEVELOPED WAYS TO HAVE NEW WAYS OF VISUALIZATIONS AND
SHOWING GEOGRAPHIC SPREAD USING INFLUENZA LIKE ILLNESS OR
INFORMATION.
ALSO, WE DEVELOPED NEW FRAMEWORKS FOR ASSESSING
SEVERITY AND IMPACTING EMERGING INFLUENZA VIRUSES THAT WE'RE
WORKING ON NOW.
AND A EXPIRAMENT WAS DEVELOPED FOR OUT MODELERS,
INSIDE MODELERS AND OTHER RESEARCHERS.
THIS IS THE OUTCOME OF THAT.
THERE WERE 61 MILLION CASES BETWEEN APRIL 2009 AND 2010.
THIS, AGAIN, JUST POINTING OUT THAT THE RATE OF CASES WAS VERY
HIGH AMONG THOSE THAT WERE -- HAD NO PRE-EXISTING IMMUNITY IN
THE SCHOOL AGED POPULATION.
BUT THE RATES OF HOSPITALIZATIONS AND DEATHS WERE
LOWER THAN COULD BE EXPECTED FOR THOSE THAT WERE OLDER.
AGAIN, POINTING OUT THE DIFFERENCE IN EPIDEMIOLOGY BY
AGE DURING THE 2009 PANDEMIC.
LET ME FINISH BY POINTING OUT A COUPLE OF OBSERVATIONS OF
EPIDEMIOLOGY AND SURVEILLANCE IN ACTION.
FIRST, THE EXISTING SURVEILLANCE SYSTEM IS A SURVEILLANCE BASED
WAS IN PLACE.
THAT ALLOWED FOR US TO HAVE A RAPID SURGE.
SURVEILLANCE INFORMATION THAT PROVIDED A BASELINE SO THAT WE
KNEW WHEN THINGS WERE DIFFERENT AND WE WERE ABLE TO EASILY RAMP
UP FROM THAT.
WE WERE ABLE TO RAPIDLY TRANSLATE THE DATA INTO DECISION
MAKING TWO WAYS, EARLY CASE CONTACT AND COMMUNITY
INVESTIGATIONS HELP DEFINE RISK DIRECTED GROUPS AND DIRECTED
INTERVENTIONS VERY EARLY AND IN THE ONGOING ASSESSMENT WITH
SURVEILLANCE SYSTEMS PROVIDES AS A PICTURE OF SEVERITY THAT
HELPED US TAILOR PREVENTION AND ACTIVITIES AND RECOMMENDATIONS.
WITH THAT, LET ME HAND THIS OVER TO JULIE.
>> THANK YOU FOR THIS OPPORTUNITY.
TODAY WHAT I WANTED TO DO WAS TO SUMMARIZE THE CHICAGO RESPONSE
TO THE H1N1 PANDEMIC.
CHICAGO IS THE THIRD LARGEST CITY IN THE UNITED STATES.
OUR POPULATION IS 2.8 MILLION.
IN CHICAGO, THE FIRST PANDEMIC H1N1 CASES WERE CONFIRMED ON
APRIL 28th, 2009, BY THE ILLINOIS DEPARTMENT OF PUBLIC
HEALTH LABORATORY.
BY MAY 15th, 2010, THE NUMBER OF H 1 N 1/ASSOCIATIONS WAS
REPORTED WAS 35 AND THE NUMBER OF DEATHS REPORTED WAS 30.
CHICAGO'S ALLOCATION OF H 1 N 1/VACCINE WAS BASED ON OUR
POPULATION.
BY MAY 2010, THE NUMBER OF DOSES AVAILABLE WAS NEARLY 1.3 MILLION
AND THE NUMBER OF DOSES DISTRIBUTED WAS 1.1 MILLION.
THERE WAS AN OVERWHELMING NEED FOR BIDIRECTIONAL COMMUNICATION
WITH THE PARTNERS DISPLAYED ON THIS SLIDE.
A SMALL TEAM WORKED AROUND THE CLOCK TO COLLECT INFORMATION
ABOUT CASES, ENGAGE FEDERAL AND STATE PARTNERS TO OBTAIN
INFORMATION ABOUT THE VIRULENCE AND TRANSMISSIBILITY OF THE
VIRUS, PROVIDE FREQUENT UPDATE TO THE MAYOR'S OFFICE, LOCAL
LEGISLATORS AND PUBLIC SAFETY OFFICIALS AND TO PROVIDE
GUIDANCE TO THE LOCAL SCHOOLS, HEALTH CARE WORKPLACES AND
GENERAL PUBLIC.
THE COMMUNICATION CONTINUED THROUGHOUT THE PANDEMIC.
THE GOVERNOR OF ILLINOIS, THE MAYOR OF CHICAGO, STATE AND CITY
HEALTH OFFICIALS AND SCHOOL OFFICIALS WORKED TOGETHER TO
PROVIDE UPDATES ON DISEASE ACTIVITY AND PREVENTION MEASURES
INCLUDING SCHOOL CLOSURES.
OUR PREPANDEMIC SURVEILLANCE SYSTEM CONSISTS OF OUTPATIENT
REPORTING OF ILI AND CASE PEDIATRIC REPORTING.
WE QUICKLY EXPANDED THAT TO INCLUDE LABORATORY SURVEILLANCE,
CASE BASED REPORTING OF ALL HOSPITALIZATIONS.
NONPHARMACEUTICAL COMMITTEE GUIDANCE WAS DEVELOPED.
THEY ADDRESSED EXCLUSION FROM WORK, SCHOOL CLOSURES AND THE
USE OF MASS IN PUBLIC SETTING.
COMMUNICATION ACTIVITIES WERE GEARED TOWARD THE GENERAL PUBLIC
AS WELL AS THE HEALTH CARE COMMUNITY.
THE REST OF MY TALK WILL FOCUS ON MY VACCINATION PLANNING AND
IMPLEMENT AGE AN EXAMPLE OF OUR STRATEGY AND PARTNERSHIPS
THAT WE GUARDED OUR CITY LEVEL RESPONSE.
THIS SUMMARY OF HOSPITALIZATIONS ASSOCIATED WITH THE H1N1
PANDEMIC IN CHICAGO PROVIDES A REFERENCE POINT FOR WHEN OUR
VACCINATION PLANNING BEGAN.
BY THE BEGINNING OF JUNE WHEN H1N1 ACTIVITY WAS PEAKED IN
CHICAGO AND WINDING DOWN IN OTHER PARTS OF THE NATION, WE
WERE CHARGED WITH DISTRIBUTING ALL OF THE H1N1 VACCINATING IN
CHICAGO.
AND CDC QUICKLY ESTABLISHED CONFERENCE CALLS WEEKLY TO GUIDE
OUR PLANNING EFFORTS.
BY THE MIDDLE OF JUNE, OUR PLANNING EFFORTS BEGAN FULL
FORCE.
CHICAGO'S VACCINATION PLAN WAS CONCEIVED BY THE IMMUNIZATION
PROGRAM AND REVIEWED BY MANY STAKEHOLDER GROUPS, INCLUDING
CONTROL, ADVISORY GROUP, OUR CITY BOARD OF HEALTH, STATE
HEALTH DEPARTMENT STAFF AS WELL AS CDC STAFF.
WE FORM SPECIAL TEAMS TO LEAD BOTH ASPECTS OF OUR TWO PRONGED
APPROACH.
DISTRIBUTING VACCINES TO HEALTH CARE FACILITIES FOR THEIR HEALTH
CARE PERSONNEL AS WELL AS PATIENTS.
SECONDLY, INCLUDING LARGE SCALE ASPECTS AND VACCINATION CLINICS.
THIS TIMELINE DEPICTS HOW RAPIDLY WE DEVELOPED OUR
DISTRIBUTION PLAN.
BY THE END OF JUNE, WE HAD ENGAGED HEALTH CARE PROVIDER
TOES A SERIES OF CONFERENCE CALLS, ELECTRONIC NEWSLETTERS
AND BROADCASTS FROM THE VACCINE FOR CHILDREN PROGRAM,
PROFESSIONAL ORGANIZATIONS, HOSPITALS AND LONG-TERM CARE
FACILITIES.
ON AUGUST 5th, THE WEB BASE PREREGISTRATION SYSTEM OPENED TO
DETERMINE THE NUMBER AND TYPE OF PROVIDERS WHO WERE INTERESTED IN
ADMINISTERING VACCINES.
ONE MONTH LATER, OUR WEB-BASED ADMINISTRATION PROGRAM OPENED
FOR PROVIDE HERS TO PROVIDE ELECTRONIC SIGNATURE FOR THE
UNDERSTANDING.
THE NUMBER OF DOSES THEY DESIRED AND THE DELIVERY INFORMATION.
ON SEPTEMBER 30th, WE WERE NOTIFIED BY CDC THAT 21,000
DOSES OF THE LIVE ATTENUATED VACCINE WERE AVAILABLE FOR
CHICAGO.
THEY WERE DELIVERED TO THE CHICAGO FIRE DEPARTMENT FOR
EMERGENCY MEDICAL SERVICES STAFF AND TO CHICAGO HOSPITALS FOR
THEIR HEALTH CARE WORKERS.
THE VACCINES ALL ARRIVED FIVE DAYS LATER.
WHEN WE RECEIVED THE GUIDANCE OR PROJECTIONS FOR VACCINE SUPPLY
THAT WERE MUCH LOWER THAN PARTICIPATED, WE ESTABLISHED
PRINCIPALS FOR VACCINE DISTRIBUTION.
FOR EXAMPLE, WE DECIDED TO DISTRIBUTE THE T VACCINE FOR
PRIORITIES BASED ON THEIR PATIENT PARTICIPATION.
WE DECIDED TO DISTRIBUTE THE ENTIRE AL OCCASION WE RECEIVED
ON THE DAY WE RECEIVED THEM WHEN IT WAS AVAILABLE.
USING AN ELECTRONIC REGISTRATION SYSTEM AND E-MAIL COMMUNICATION,
WE REGISTERED 124 HEALTH CARE FACILITIES TO RECEIVE THE H1N1
VACCINE.
FAMILY PEDIATRIC PROVIDERS REPRESENTED THE HIGHEST FACILITY
TYPE.
ACCESSIBLE TO THOSE WITH DISABILITIES AND BECAUSE CDPH
ROUTINELY USES THESE SIGHTS FOR OUR LARGE SCALE SEASONAL
INFLUENZA CLINICS.
OUR CLINICS RAN FROM OCTOBER 24th THROUGH DECEMBER 19th,
THREE DAYS A WEEK.
IN ADDITION TO CDPH STAFF, WE USED CDC PUBLIC HEALTH ADVISERS
OR CONTRACT NURSING STAFF.
OUR VACCINE DISTRIBUTION SIGHTS INCLUDED FACILITIES INDICATED BY
THE BLUE DOTS AND CDC VACCINATION CLINICS INDICATED BY
THE RED DOTS.
HEALTH CARE FACILITIES WERE DISTRIBUTED THROUGHOUT THE CITY.
OUR GUIDING PRINCIPLES FOR OUR MASS VACCINATION CLINICS
INCLUDED VACCINATING THOSE WITHOUT HEALTH CARE PROVIDERS OR
WHOSE HEALTH CARE PROVIDERS WHO DIDN'T HAVE VACCINE AND FOR
FACILITIES WITH THE TARGET GROUPS.
HOWEVER, WE DIDN'T DENY SERVICES BASED ON RESIDENCE OR TARGET
GROUP.
WE ALSO RESERVED VACCINATIONS FOR PATIENTS WITH
CONTRAINDICATIONS.
OVER 100,000 DOSES OF VACCINES WERE ADMINISTERED AT THESE
CLINICS.
BETWEEN 5900 AND 100,000 VACCINES WERE ADMITTED TO THE
SITES OSTEOPATHY DAYS A WEEK.
PUTTING OUR MASS VACCINATION EFFORTS INTO PERSPECTIVE, WE
DISTRIBUTED THE HIGHEST VACCINE TO PEDIATRIC PROVIDERS AND
HOSPITALS WHILE DISTRIBUTESING LESS THAN 10% TO CDC MASS
VACCINATION CLINICS AND TO ADULT PROVIDERS.
OVERALL, WE DISTRIBUTED A HIGHER PERCENTAGE OF THE VACCINE TO
HEALTH CARE FACILITIES THAN WE ORIGINALLY ANTICIPATED.
CHICAGO'S HOSPITALIZATIONS ASSOCIATED WITH THE PANDEMIC ARE
REPRESENTED BY THE LIGHT BLUE BARS.
OUR CUMULATIVE VACCINE ALLOCATION BY THE BLUE LINE AND
THE CUMULATIVE VACCINE INDICATED BY THE RED LINE.
THE SECOND PEAK OF H1N1 ACTIVITY IN CHICAGO OCCURRED IN EARLY TO
MID NOVEMBER.
LESS THAN HALF OF CHICAGO'S VACCINE SUPPLY WAS AVAILABLE.
SINCE DEMAND DIMINISHED IN LATE NOVEMBER, VACCINE SUPPLY WAS
INADEQUATE WHEN THE DEMAND WAS THE GREATEST.
WE IDENTIFIED THESE SUCCESS NECESSARY VACCINE DISTRIBUTION.
HEALTH CARE FACILITIES PLAYED A LARGER ROLE IN VACCINE DELIVERY
THAN ANTICIPATED.
LESS THAN 10% OF OUR VACCINE WAS ADMINISTERED BY OUR CDHP MASS
VACCINATION CLINICS.
OUR PEDIATRIC ENROLLMENT WAS HIGHER THAN OTHER ENROLLMENT
TYPES.
OUR ELECTRONIC REGISTRATION ALLOWED FOR SUFFICIENT DATA
MANAGEMENT TO PRIORITIZING HEALTH CARE FACILITIES AND
TRACKING VACCINE DISTRIBUTION.
OUR DEDICATED E-MAIL AND PHONE LINES ASSURED HIGH QUALITY
CUSTOMER SERVICE.
CHALLENGES WE IDENTIFIED INCLUDED THE VACCINE SUPPLY WAS
INADEQUATE WHEN THE DEMAND WAS THE GREATEST.
ADULT PROVIDER ENGAGEMENT WAS LESSEE EFFICIENT THAN PEDIATRIC
PROVIDER ENGAGEMENT DUE TO A COUPLE REASONS.
WE HAD MINIMAL PUBLIC HEALTH INFRASTRUCTURE FOR ADULT
VACCINATION ACTIVITIES AND OUR PUBLIC HEALTH RELATIONSHIPS WERE
LESS WELL ESTABLISHED WITH THE ADULT ORGANIZATIONS
WHEN COMPARED TO OUR PEAT ATTIC PROFESSIONAL ORGANIZATIONS.
LASTLY, WE WERE EXTREMELY DISAPPOINTED BY THE INCOMPLETE
REPORTING OF THE DOSES ADMINISTERED.
ONLY 51% OF THE TOTAL VACCINES WERE REPORTED BEING
ADMINISTERED.
WE OFFERED THESE POTENTIAL SOLUTIONS.
IMPROVE VACCINE MANUFACTURING PROCESSES TO INCREASE PRODUCTION
SPEED.
DEDICATE SUSTAINED FUNDING FOR AN ADULT IMMUNIZATION PROGRAM
SIMILAR TO THE CHILDHOOD PROGRAM.
IMPROVE REGISTRIES TO IMPROVE REPORTING OF DOSES ADMINISTERED.
THIS CAN BE DONE BY INCREASING THE RECRUITMENT OF HEALTH CARE
FACILITIES AND BY DEVELOPING INTERFACES BETWEEN ELECTRONIC
HEALTH RECORDS AND REGISTRANTS.
WE CONSIDERED IT A SUCCESS THAT NEARLY 100,000 PEOPLE WERE
VACCINATED IN OUR MASS VACCINATION CLINICS.
THE VAST MAJORITY WERE ETHIC MINORITIES AND MORE THAN HALF
WERE ADULTS.
THE PUBLIC HEALTH EMERGENCY RESPONSE FUNDS WERE ESSENTIAL
FOR US TO CONTRACT WITH THE COMPANY TO MANAGE OUR
VACCINATION SUPPLIES.
THEY WERE USED TO COVER STAFFING.
MASS VACCINATION CHALLENGES INCLUDED, USING A PAPER BASED
SYSTEM FOR TRACKING VACCINE RECEIPT AND ADMINISTRATION.
AS A RESULT, OUR REGISTRATION DATA WERE NOT LINKED WITH THE
STATE IMMUNIZATION REGISTRY.
IN ADDITION, STAFF MOBILIZATION WAS CHALLENGING BECAUSE OF LABOR
UNIT AND CONTRACT PROCEDURES WHICH SLOWED THE PROCESS OF
ASSIGNING STAFF TO THE MASS VACCINATION CLINIC.
HERE ARE SOME PROPOSED SOLUTIONS TO IMPROVE THE FUNCTION OF THE
MASS VACCINATION CLINIC.
DEVELOP A WEB BASED REGISTRATION SYSTEM TO INTERFACE WITH OUR
STATE IMMUNIZATION REGISTER STRER.
ESTABLISH CONTRACTS FOR SERVICES THAT MIGHT BE NEEDED DURING
EMERGENCIES AHEAD OF TIME AND ENGAGE UNIONS TO ESTABLISH
SUFFICIENT PROCESSES TO MOBILIZE UNION STAFF IN EMERGING
SITUATIONS.
IN SUMMARY, CHICAGO HAS A LONG HISTORY OF DEALING WITH
INFLUENZA EPIDEMICS.
AS IN MANY OTHER PLACES, THERE WERE SIGNS OF PANIC.
HOWEVER, OUR PARTNERSHIPS AND PLANNING ALLOWED US TO RESPOND
QUICKLY AND APPROPRIATELY.
THANK YOU.
THE NEXT SPEAKER WILL BE VINCE COVELLO.
>> HELLO, EVERYONE.
IT'S A PLEASURE TO BE WITH YOU TODAY AND I'M VERY EXCITED TO BE
TOGETHER WITH MY DISTINGUISHED COLLEAGUES.
MY NAME IS VINCE COVELLO.
I'M THE DIRECTOR OF THE CENTER FOR RISK COMMUNICATION IN NEW
YORK CITY.
I'D LIKE TO FOCUS ON SUCCESSES AND CHALLENGES.
I ACTUALLY HAVE THREE GOALS THAT I HAVE TODAY.
THE FIRST IS TO SHARE WITH YOU SEVERAL KEY CONCEPTS IN THE RISK
OF LITERATURE.
THAT LITERATURE INCLUDES OVER 8,000 ARTICLES AND OVER 2,000
BOOKS SO I'VE SELECTED OUT SEVERAL.
THE SECOND IS TO VAULT CDC'S PANDEMIC COMMUNICATIONS AGAINST
THE CORE CONCEPTS AND THE THIRD IS TO IDENTIFY CHALLENGES FOR
THE FUTURE.
THE FIRST CONCEPT THAT I'VE SELECTED FOR ATTENTION ARE THE
ONES THAT IN MANY WAYS I BELIEVE PROBABLY THE MOST CHALLENGING,
THAT WHEN PEOPLE ARE STRESSED AND CONCERNED AS THEY ARE IN AN
EPIDEMIC OR PANDEMIC, THEY TYPICALLY WANT TO KNOW THAT YOU
CARE BEFORE THEY CARE WHAT YOU KNOW.
THE SECOND CONCEPT IS WHEN PEOPLE ARE STRESSED AND UPSET,
THEY HAVE GREAT DIFFICULTY HEARING, UNDERSTANDING AND
REMEMBERING INFORMATION.
AND THE THIRD CONCEPT IS SOMETHING THAT PERHAPS IS NOT AS
INTUITIVE AS THE OTHER TWO, WHICH IS THAT PEOPLE TEND TO
TRUST MOST OF THOSE TO ACKNOWLEDGE THE IMPORTANCE OF
UNCERTAINTY.
IF WE COME BACK TO THAT FIRST CONCEPT THAT WHEN PEOPLE ARE
STRESSED AND UPSET, PEOPLE WANT TO KNOW THAT YOU CARE BEFORE
THEY CARE WHAT YOU KNOW.
AS YOU CAN SEE IN THIS GRAPH, THIS PIE CHART, THERE'S A NUMBER
OF FACTORS THAT CONTRIBUTE TO THE PERCEPTION OF TRUST.
DRIVING PEOPLE, MOTIVATIONS, ACTIONS AND BEHAVIORS.
AND AMONG ALL THOSE FACTORS WHICH INCLUDE EXPERTISE,
OPENNESS, TRANSPARENCY, THE RESEARCH NOW INDICATES THAT THE
LIST OF CARING, EMPATHY, COMPASSION DIMENSION PERCEPTION
ACCOUNTS FOR AS MUCH AS 50%.
AND THE STIGZS ABOUT THIS ARE OFTEN -- THE RECOGNITION OF THE
RESPONSE OF THE CARING PRINCIPAL OF RISK COMMUNICATION I BELIEVE
WAS WELL ILLUSTRATED BY MAYOR RUDY GIULIANI.
WHEN ASKED HOW MANY PEOPLE HAVE DIED, HE STATED THE NUMBER OF
CASUALTIES WILL BE MORE THAN WE CAN BEAR ULTIMATELY.
HE WENT ON TO POINT OUT THAT MY HEART GOES OUT TO ALL THE
VICTIMS OF THIS HORRIBLE ACT OF TERRORISM.
THE IMPORTANCE OF CARING PRINCIPAL WAS REFLECTED IN CDC'S
PANDEMIC COMMUNICATION, FOR EXAMPLE, IN THE SPRING OF 2009,
DR. RICHARD BESSERT, THE ACTING DIRECTOR OF CDC AT THE TIME,
I'LL QUOTE HIM AS FOLLOWS THE FIRST, I WANT TO RECOGNIZE THAT
PEOPLE ARE CONCERNED ABOUT THIS SITUATION.
WE HEAR FROM THE PUBLIC AND FROM OTHERS ABOUT THEIR CONCERN AND
WE ARE WORRIED, AS WELL.
THE IMPORTANCE OF THIS CARRYING PRINCIPAL IS REFLECTED IN THE
RISK COMMUNICATION LITERATURE THROUGH A NUMBER OF WHAT ARE
CALL TEMPLATES.
TEMPLATES ARE DERIVED FROM THE RISK COMMUNICATION LITERATURE.
EXAMPLES OF TEMPLATES INCLUDE -- AND THERE'S TWO HERE.
THE FIRST IS REFERRED TO AS THE CCO TEMPLATE.
IT'S THE FIRST MESSAGE IN RESPONSE TO A HIGHLY EMOTIONALLY
CHARGED ITEM TEMPLATE SHOULD BE A MESSAGE OF PASSION.
SECOND IS SOMETHING THAT YOU BELIEVE FIRMLY AND THE THIRD
GOES FOR OPTIMUM.
ANOTHER TEMPLATE MEANS THAT WE BEGIN WITH A STATEMENT OF
COMPASSION, MOVE ON TO A STATEMENT THAT INDICATES WHAT
ACCESS WE'RE TAKING AND SECONDLY PUTTING THE ISSUE INTO
PERSPECTIVE.
WHEN PEOPLE ARE STRESSED AND UPSET, AS THEY ARE IN AN
EPIDEMIC, PANDEMIC WITH A THREAT TO PUBLIC HEALTH, THEY HAVE
DIFFICULTY HEARING AND UNDERSTANDING INFORMATION.
THIS PARTICULAR PRINCIPAL CAN BE TRANSLATED INTO SOMETHING
PRACTICAL, SOMETHING AS PRACTICAL AS WHAT IS OFTEN
REFERRED TO AS THE KISS PRACTICE, KEEP AND SIMPLE BEFORE
STUPID PEOPLE, BUT I REJECT THAT.
PEOPLE ARE OFTEN VERY INTELLIGENT RESPONDING TO
INFORMATION.
I PREFER TO SAY KEEP IT SIMPLE AND SHORT.
THERE ARE SEVERAL TEMPLATES THAT DERIVE FROM THE K.I.S.S.
PRINCIPAL, SUCH AS THE RULE OF OF THREE, WHICH INDICATES THAT
WE SHOULD LIMIT OURSELVES ON AVERAGE NO MORE THAN THREE KEY
MESSAGES.
THE 2793 PRINCIPAL, WHICH GOES FURTHER, SPECIFY THE MESSAGES AT
THE CORE, BUT TRY TO KEEP IT VERY SHORT, SO NO MORE THAN 27
WORDS, EXACTLY THREE MESSAGES.
TIMELY, ANOTHER TEMPLATE IS CALLED THE PRIME AND DECENTLY
TEMPLATE, WHICH INDICATES THAT WE OFFER UP THREE MESSAGES THAT
IS TO YOUR ADVANTAGE, HOLDING CONTENT OF THE VARIABLE TO PUT
THE MOST IMPORTANT MESSAGE FIRST AND THE SECOND MOST IMPORTANT
MESSAGE LAST.
THIS NOTION OF EVERYTHING IN THREES, 27 WORD, 9 SECONDS, 3
MESSAGES, WHICH COULD CAN EXPANDED TO REPEATING THE
MESSAGE THREE TIMES, PROVIDING THREE SUPPORTING FACTS OR
CREDIBLE SOURCES FOR EACH MESSAGE IS REFLECTED IN A
DEVICE, A TECHNIQUE USED BY RISK INDICATORS CALLED A MESSAGE MAP.
A MESSAGE MAP BEGINS WITH A STAKEHOLDER QUESTION OR CONCERN
AND THEN SEVERAL TOP LINE OR KEY MESSAGES THAT WOULD BE REFLECTED
IN APPROXIMATELY NOT WORD ON AVERAGE, BUT EACH OF THE KEY
MESSAGES.
THE CDC MADE EXTENSIVE USE OF THE MESSAGE MAPPING PROCESS AS
EARLY AS 2006 THAT 65 PANDEMIC MESSAGE MAPS WERE PRODUCED BY
VARIOUS WORD GROUPS AND PUBLISHED ON THE CDC'S WEBSITE,
DEPARTMENT OF HEALTH AND HUMAN SERVICES.
YOU CAN STILL FIND THOSE 65 MESSAGE MAPS ON PANDEMICFLU.GOV.
THE MESSAGE MAP TOPICS INCLUDED A WIDE RANGE OF ISSUES OF
CONCERN TO THE PUBLIC.
THEY INCLUDED EVERYTHING TO ANTI-VIRAL MEDICATIONS TO ISSUES
SUCH AS TRANSITION.
AND BECAUSE MESSAGE MAPS CHANGE, THIS IS AN ONGONE CDC ACTIVITY
AND MORE INFORMATION BECOMES AVAILABLE -- AS WELL AS POLICY.
THOSE INTERESTED IN MESSAGE MAP, I PROVIDED THE NEXT SLIDE TWO
REFERENCES WHERE YOU CAN READ MORE ABOUT THIS TECHNOLOGY AND
THE THEORIES IN WHICH THEY DERIVE.
THE FIRST IS CALLED RISK UBFICATION AND MESSAGE MAPPING
TOOLS OR PUBLIC NOTIFICATION.
AND THE SECOND IS A WORLD HEALTH ORGANIZATION DOCUMENTS,
EFFECTIVE COMMUNICATION IN PUBLIC HEALTH.
THE THIRD CONCEPT I'D LIKE TO SHARE IS THAT WHEN PEOPLE ARE
STRESSED AND UPSET, SUCH AS DURING A PANDEMIC, THEY TEND TO
TRUST BOTH THOSE WILLING TO ACKNOWLEDGE THE IMPORTANCE OF
UNCERTAINTY.
I MENTIONED BEFORE THAT THIS IS ONE THAT IS AT LEAST INTUITIVE,
ONE THAT TYPICALLY INDIVIDUALS WILL AVOID BECAUSE OF THE
PERCEPTION THAT THEY PERCEIVED AS LESS THAN COMPETENT AND THE
RESEARCH INDICATES EXACTLY THE OPPOSITE, THAT THEY'RE WILLING
TO ACKNOWLEDGE UNCERTAINTY, TRUST AND CREDIBILITY.
I BELIEVE THAT THE IMPORTANCE OF THIS PRINCIPAL IS REFLECTED VERY
WELL BY DR. BESER IN THE EARLY STAGES, THE PANDEMIC WHEN HE
STATED AS FOLLOWS.
I WANT TO ACKNOWLEDGE THE IMPORTANCE OF UNCERTAINTY AT THE
EARLY STAGES NOW THERE IS MUCH UNCERTAINTY, PROBABLY MUCH MORE
THAN ANYONE WOULD LIKE.
OUR GUIDELINES AND OUR ADVICE ARE LIKELY TO BE FLUID AND
SUBJECT TO CHANGE.
QUITE A STRONG STATEMENT OF UNCERTAINTY THAT PREAMBLED THE
CDC RISK UNIFICATION.
DR. FRIEDEN REFLECTED THE IMPORTANCE OF ACKNOWLEDGING
UNCERTAINTY WHEN HE REMARKED IN SEPTEMBER OF 2009 THAT THE
OPENING OF THE VACCINATION CAMPAIGN FOR H1N1 IS GOING TO BE
A LITTLE BUMPY.
I SHOULD MENTION THAT REFLECTED TO THE NOTION OF UNCERTAINTY,
THAT THERE'S CHALLENGES AND PARTICULARLY I WOULD FOCUS ON
CHALLENGES RELATED TO THE SHARING OF NUMBERS THAT ONE OF
THE KEY PRINCIPALS THAT COME FROM THE UNCERTAINTY OF
LITERATURE IS THAT THAT MESSAGE IS ABOUT NUMBERS OR ESTIMATE TO
BE BRACKETED WITH STATEMENTS OF UNCERTAINTY.
THIS UNFORTUNATELY WAS NOT DONE, I BELIEVE, AS WELL AS IT COULD
HAVE BEEN DONE VERY EARLY THROUGH THE STAGES OF
AVAILABILITY OF VACCINATION STARTS IN AUGUST AND THIS CAME
HOME VERY MUCH IN OCTOBER.
SHARED WITH THE PUBLIC.
CERTAINLY THE BP OIL SPILL HAS ILLUSTRATED THE IMPORTANCE OF
BRACKETING NUMBERS OF UNCERTAINTY IN THE WORLD OF
2010, WE'RE TOLD THERE WERE 5,000 BARRELS ON A DAY AND WE
THEN LEARNED THAT IT WAS 60,000 BARRELS A DAY.
DR. PETER SALMON, ONE OF THE LEADING EXPERTS IN RISK
UNIFICATION OF THE WORLD EMED THE IMPORTANCE FOR PANDEMIC OF
UNCERTAINTY IN THE FOLLOWING QUOTE.
NOTHING IS MORE IMPORTANT IN PANDEMIC RISK COMMUNICATION THAN
PERSUADING THE PUBLIC AND THE POLITICIANS TO THINK
REALISTICALLY THAT PUBLIC HEALTH OFFICIALS NEEDED TO INSIST ON
THEIR UNCERTAINTY.
THE IMPORTANCE OF UNCERTAINTY AS WELL AS THESE OTHER PRINCIPLES
WAS INCORPORATED IN THE TRAINING US OFFERED BY CDC AT ALL LEVELS.
LOCAL, STATE AND FEDERAL.
TRAINING PROGRAMS WERE SPEARHEADED BY DR. BARBARA
REYNOLDS.
OTHERS AT CEC, INCLUDING DR. MARSHA VANDERWURT.
THAT PROGRAM HAD, I BELIEVE, AN INCREDIBLE EFFECT ON THE QUALITY
OF THE COMMUNICATIONS THAT WERE COMING OUT.
FINALLY, I'D LIKE TO FINISH UP WITH THREE CHALLENGES.
THREE CHALLENGES WHERE I THINK THERE'S ROOM FOR IMPROVEMENT.
THREE CHALLENGES ARE FIRST TO ADDRESS THE CULTURE DIVERSITY,
THE SECOND WITH TIMELINESS AND THE THIRD AS THE CHALLENGES
ASSOCIATED WITH SOCIAL.
WE TAKE CULTURAL DIVERSITY FIRST.
IT'S WELL KNOWN THAT WE MUST TARGET OUR AUDIENCES AND YET
THIS IS PROBABLY ONE OF THE MOST DIFFICULT THINGS TO DO, THAT
AUDIENCES ARE VERY DIFFERENT IN THEIR VALUES, VERY DIFFERENT IN
TERMS OF THE MESSAGES THEY WILL ACCEPT, VERY DIFFERENT IN TERMS
OF THE SOURCES OF INFORMATION THEY RELY ON.
IF YOU LOOK AT THE NEXT SLIDE, THAT DEALS WITH HIS PANIC RISK
UNIONFY CAGE.
WE START OFF ON THE LEFT-HAND SIDE WITH A WIDE RANGE OF
VARIABLES THAT AFFECT PUBLIC PERCEPTIONS.
THERE'S ONLY 20 OF THESE PERCEPTUAL FACTORS NOW RANGING
FROM TRUST.
BUT THESE FACTORS GET FILTERED THROUGH A PRISM OF CULTURAL.
THE FAMILY IS A VERY IMPORTANT PART OF THAT CULTURE AND,
THEREFORE, MESSAGES THAT APPEAL TO THE FAMILY OR LIKELY TO BE
MORE EFFECTIVE.
AND THEN IN TURN, IT HAS TO PASS THROUGH ANOTHER FILTER AND THAT
IS WHAT WE KNOW ABOUT HEALTH BELIEVES AND FINALLY IT COME OUT
OF THE END IN TERMS OF OUR MESSAGES WE SHARE.
FINALLY, THE SECOND CHALLENGE IS MESSAGE TIMELINESSTIMELINESS.
AND MESSAGE TIMELINESS, WHEN I STARTED IN THIS FIELD NEARLY 30
YEARS AGO, WE USED TO FIELD THE LUXURY OF THE 24-HOUR NEWS
CYCLE.
WE HAD 24 HOURS BY WHICH TO RESPOND TO AN ISSUE, TO SHARE
MESSAGES.
UNFORTUNATELY BY 2001 WHEN 9/11 HAPPENED, THAT 24 HOURS HAD
SHRUNK DOWN TO FOUR HOURS.
NECESSARY TO RESPOND WHERE THE AIR WAVES WERE ALREADY BEING
FILLED WITH A CREDIBLE SOURCE OF INFORMATION AND MESSAGES.
FINALLY, IN 2010 WITH THE BP OIL SPILL, THAT FOUR HOURS HAD BEEN
REDUCED DOWN TO FOUR MINUTES.
IT BECOMES EFFECTIVELY THE FOUR MINUTE MILE TO GET OUR MESSAGES
ACROSS BECAUSE OTHERS WILL BE SHARING MESSAGES.
CERTAINLY WHEN CDC HAS A MODEL SUCH AS BEING FIRST, IT'S VERY
HARD TO BE FIRST WHEN YOU ONLY HAVE FOUR MINUTES TO GO THROUGH
CLEARING AND ALL THE TYPES OF ACTIVITIES NECESSARY.
FINALLY, I JUST WANTED TO POINT OUT THE CHALLENGE ASSOCIATED
WITH SOCIAL MEDIA.
THIS IS CERTAINLY A NEW TECHNOLOGY.
PEOPLE ARE NOW SHARING INFORMATION.
THEY'RE TALKING TO EACH OTHER THROUGH FACEBOOK, TWITTER, BLOG.
AND WE'RE STILL RAPIDLY LEARNING HOW TO DEAL WITH SOCIAL MEDIA
SUCH AS SECURITY AND PRIVACY.
I'D LIKE TO FINISH UP WITH TWO QUOTES THAT I BELIEVE REFLECT
VERY MUCH THE PREACH TAKEN. THE FIRST IS FROM PRESIDENT
ABRAHAM LINCOLN WHEN HE SAID IF I HAD ALL DAY TO CUT DOWN A
LARGE TREE, I WOULD SPEND MOST OF MY DAY SHARPENING THE AX.
SECONDLY FROM MARK TWAIN SAYING IT TAKES AT LEAST TWO WEEKS TO
PREPARE AN IMPROMPTU SPEECH.
I'LL TURN IT BACK TO TANJA.
>> I THINK THERE IS MAYBE TO SUMMARIZE THIS, WE HAVE TO
BEWARE OF COMPLACENCY OR OVERCONFIDENCE FOLLOWING THE
RESPONSE.
THERE ARE A NUMBER OF AREAS THAT WE NEED TO CONTINUE TO WORK ON.
VACCINE DEVELOPMENT AND AVAILABILITY ARE KEY AMONG
THOSE.
WE'LL NEED TO CONTINUE TO WORK TO ENHANCE SURVEILLANCE TO
COLLECT VIRUSES SO WE CAN START THAT DEVELOPMENT PROCESS THAT
MICHAEL HAS TALKED ABOUT.
THERE HAS RECENTLY BEEN AN IMPROVEMENT IN INCREASING
TECHNOLOGY TO IMPROVE THE VACCINES.
WE NEED TO LEARN FROM THE EXPERIENCE THAT WE'VE HAD IN THE
H1N1 EPIDEMIC TO OPTIMIZE OUR STRATEGIES FROM THE LEVEL OF
ACHIEVING THIS AT COST AND AVOIDING DISEASE.
FROM THE TRAINING AND EXERCISE STANDPOINT, WE NEED TO CONTINUE
TO WORK HERE, AS WELL.
WE HAVE A FULL CALENDAR OF EXERCISES PLANNED FOR THE COMING
YEAR CULMINATING IN A THREE-DAY EXERCISE IN MARCH.
AND WHILE WE'VE TALKED ABOUT H1N1 TODAY, A YEAR AND A HALF
AGO, H5N1 WAS THE THING THAT WE WERE MOST CONCERNED ABOUT.
AND IT IS IMPORTANT TO REMEMBER THAT IS STILL OUT THERE.
IN FACT, DURING 2009, THERE WERE MORE CASES OF H5N1 THAN THERE
WERE IN 2008 AND CASES ARE STILL BEING REPORTED WITH A CASE
FATALITY RATE OF HUMANS OF AROUND 60%.
SO JUST TO WRAP UP, THE H1N1 PANDEMIC HAD A SUBSTANTIAL
HEALTH IMPACT.
YOU'VE HEARD REPEATEDLY HOW PREPAREDNESS HELPED US RESPOND,
BUT WE HAVE MORE WORK TO DO TO BE PREPARED.
SO THANK YOU VERY MUCH.
WE HAVE ABOUT 15 MINUTES FOR QUESTIONS AND LET ME OPEN THE
FLOOR FOR QUESTIONS.
HAROLD.
>> I'D LIKE TO LEARN MORE ABOUT LESSONS LEARNED.
SPECIFICALLY, WHAT DID WE LEARN ABOUT THE IMPORTANCE OF CLOSING
AND REOPENING PLACES LIKE SCHOOLS AND CAMPS?
WHAT DID WE LEARN ABOUT THE USE OF TAMIFLU FOR FAMILY MEMBERS?
HOW CAN WE APPLY WHAT WE LEARNED TO THE NEXT TIME?
>> WELL, A LOT OF THESE LESSONS ARE STILL BEING CAPTURED FROM A
SCIENTIFIC STANDPOINT.
AND I WOULD SAY THAT IN BOTH OF THOSE INSTANCES, WHAT WE ENDED
UP DOING WAS NOT WHAT WE INITIALLY HAD PLANNED TO DO FOR
THAT MORE SEVERE PANDEMIC.
I WOULD SAY WITHOUT DIVULGING ANYTHING THAT'S NOT YET
PUBLISHED, THAT THERE ARE SEVERAL EXPERIENCES OF EXAMINING
THE IMPACT OF SCHOOL CLOSURES, SHORT-TERM SCHOOL CLOSURE ON
DISEASE TRANSMISSION.
FROM THE STANDPOINT OF THE USE OF ANTI-VIRAL DRUGS, THIS WAS
NOT SOMETHING THAT WE RECOMMENDED IN THE UNITED
STATES.
IN THE UK, WE WILL HAVE SOME EXPERIENCE TO REFLECT ON IT.
I THINK THIS RAISES A QUESTION OF THE SCIENCE THAT FORMS THE
BASIS FOR OUR RESPONSE, BUT THE NEED TO ADOPT THAT SCIENCE BASE
TO THE SITUATION THAT IS OCCURRING AND SOMETHING THAT WE
WORKED VERY HARD ON, ESPECIALLY EARLY IN RESPONSE, BUT REALLY
THROUGHOUT THE RESPONSE.
>> THIS IS VINCENT COVELLO.
IF I COULD SAY SOMETHING ABOUT THIS ISSUE.
IS THAT POSSIBLE?
>> YES.
>> IN ADDITION TO WHAT WE JUST HEARD, THAT I BELIEVE THE SCHOOL
CLOSING ISSUE POINTS TO ANOTHER KEY CONCEPT IN RISK UNIFICATION
AND THAT'S THE IMPORTANCE FOR A SHARED RESPONSIBILITY.
I BELIEVE THE CONTROVERSIES ASSOCIATED WITH SCHOOL CLOSINGS
ILLUSTRATE THE IMPORTANCE OF WORKING TOGETHER WITH OTHERS TO
WORK OUT POLICIES IN ADVANCE AND TO MAKE SURE THAT WE HAVE
CONSISTENT IN THE POLICIES.
IF ONE SCHOOL CLOSES AND OTHERS DON'T, AUTOMATICALLY, IT STARTS
RAISING SERIOUS QUESTIONS ABOUT TRUST AND CREDIBILITY.
IT POINTS TO THE NEED TO PARTNER CLOSELY, ESPECIALLY WITH THE
SCHOOLS GIVEN THE IMPORTANCE THAT WE ATTACH TO OUR CHILDREN
AND TO WORK OUT THESE POLICIES BASED ON THE BEST AVAILABLE
NUMBERS.
>> THANK YOU.
I'D BE INTERESTED TO HEAR SOME REFLECTIONS, PERHAPS, DAN OR
JULIE, ON SURVEILLANCE.
I'M FORTUNATELY TO HAVE A STRONG CORE OF SURVEILLANCE SYSTEMS,
BUT WE ALSO EXPLORED A LOT IN NOVEL, INNOVATIVE SURVEILLANCE
APPROACHES.
IN PARTICULAR, AS WE ALL LOOKED FORWARD TO ELECTRONIC HEALTH
RECORDS, YOU HAVE SOME EXPLORATIONS IN POCKETS
ELECTRONIC HEALTH RECORDS.
AND IT DIDN'T SEEM THAT WE GOT MUCH OUT OF THAT.
CAN YOU REFLECT A BIT ON WHERE YOU SEE THAT GOING, WHAT THE
CHALLENGES WERE WITH THAT FIRST ROUND OF EXPERIENCES?
>> SURE.
I THINK WE HAD A NUMBER OF EXISTING SURVEILLANCE SYSTEMS AS
WE, I THINK, HAD THE PROMISE OF A WHOLE LOT OF THE NEWER
APPROACHES TO MONITORING THINGS THROUGH ELECTRONIC HEALTH
RECORDS AND THROUGH AVAILABLE ELECTRONIC DATA.
AND SO ONE MAJOR LESSON THAT IS LEARNED IS DON'T TRY AND BUILD
THE PLANE WHILE YOU'RE FLYING IT.
IT WAS AN OPPORTUNITY WHERE A LOT OF VENDORS OF THESE PRODUCTS
THAT SERVICE THE ELECTRONIC HEALTH RECORDS OR ACTUALLY ARE
THE PROVIDERS THEMSELVES ENGAGED WITH US.
AND WHAT WE HAVE IS ALL AT ONCE FIVE OR SIX DIFFERENT FORMATS,
DIFFERENT APPROACHES, DIFFERENT PURPOSES FOR WHY THEY HAD THAT
DATA.
AND SO IF WE HAD HAD IN PLACE THE RIGHT TYPES I THINK FOR THEM
TO PLUG INTO, THE RIGHT STANDARDS SET UP, IT WOULD HAVE
BEEN A WHOLE LOT SMOOTHER.
WE WOULD HAVE ALSO BEEN ABLE TO, I THINK, HAVE A MUCH BETTER
UNDERSTANDING OF WHAT THAT DATA MEANS.
IT DOES POINT OUT THE DIFFERENCES BETWEEN DATA THAT IS
USED FOR PROMPT VERSUS DATA THAT IS USED FOR VERIFYING.
AND SO SOME OF THESE SYSTEMS ARE REALLY GOOD FOR PROMPTING US TO
LOOK FURTHER AND OTHER SYSTEMS ARE ABSOLUTELY CRITICAL FOR
VERIFYING INFORMATION.
AND SO YOU CAN'T HAVE JUST ONE OR THE OTHER.
YOU REALLY NEED TO HAVE BOTH THINGS.
AND SO FIGURING HOW TO INCORPORATE THOSE KINDS OF
ELECTRONIC SYSTEMS INTO OUR REGULAR ACTIVITY HERE,
ESPECIALLY WITH THE WAY THINGS ARE MOVING WITH ELECTRONIC
HEALTH RECORDS, HEALTH REFORM, ETCETERA, IS CRITICAL.
AND SO WE HOPE TO TAKE THE INFORMATION THAT WE HAVE AND THE
LESSONS THAT WE'VE LEARNED FROM THAT AND APPLY THAT TO BROADER
CONTEXT FOR OTHER ILLNESSES, AS WELL.
>> I THINK DAN'S POINT ABOUT NOT TRYING TO DO -- TO COME UP WITH
RESPONSES IN THEIR NEW SYSTEMS IN THE MIDDLE OF A CRISIS IS AN
IMPORTANT POINT THAT WE LEARNED, LESSON THAT WE LEARNED.
WE DIDN'T TRY TO IMPLEMENT ANYTHING HIGH TECH IN THE MIDST
OF THE PANDEMIC.
WE CAUTIONED EVERYTHING MANUALLY.
RIGHT NOW WHAT WE'RE TRYING TO DO, SINCE THE PANDEMIC, A LOT
MORE HEALTH SYSTEMS HAVE REACHED OUT TO US TO SAY WE HAVE
ELECTRONIC HEALTH RECORDS, WE WOULD LIKE TO WORK WITH YOU TO
BE ABLE TO SUBMIT INFORMATION TO YOU.
AND SO NOW WE'RE WORKING WITH THEM AND HOPEFULLY WE'LL BE ABLE
TO USE SOME OF OUR PANDEMIC FUND TO SUPPORT THEIR EFFORTS, AS
WELL.
>> WE HAVE A QUESTION FROM ENVISION.
IT SOUNDS LIKE WE DON'T, SO FROM THE AUDIENCE IN THE AUDITORIUM
HERE.
>> QUESTION FOR DR. MARIDA.
IN TERMS OF THE ACTUALLY MANY, MANY YEARS TECHNICALLY I SUPPOSE
MANY DECADES OF PREPAREDNESS ACTIVITIES, SOME OF THE FELL
LEVEL, SOME MORE FOCUSED AT THE STATE AND LOCAL LEVEL THAT LED
UP TO THE PANDEMIC, WHAT, IN YOUR VIEW, WHAT ASPECTS OF THAT
PREPAREDNESS AND PLANNING WERE MORE AND LESS HELPFUL?
>> IF WE TALK SPECIFICALLY ABOUT THE VACCINE, OUR VACCINE
PLANNING AND RESPONSE, I WOULD SAY WHAT WAS MOST HELPFUL TO US
WASN'T REALLY A PREPAREDNESS ACTIVITY, BUT OUR VFC PROGRAM.
WITHOUT THE VFC PROGRAM, WE WOULD HAVE REALLY BEEN LOST
BECAUSE OUR ORDERING SYSTEM WAS BASED ON THE SYSTEM, OUR VACCINE
DISBEAUTIFUL WAS BEST TO OUR PROVIDERS AND WE STRUGGLED TO
REACH OUT TO PROVIDERS.
SO I WOULD SAY FROM OUR PERSPECTIVE, THAT PROGRAM WAS
THE ESSENTIAL COMPONENT, WAS THE COMPONENT OF OUR VACCINE
DISTRIBUTION SYSTEM.
THAT WAS THE BEST.
WE DID -- WE HAVE OVER THE YEARS DONE A LOT OF EXERCISING OR
USING SEASONAL INFLUENZA MASS VACCINATION CLINICS AS
EXERCISES.
BUT IT WASN'T A TABLETOP IT WAS DOING THE VACCINE ADMINISTRATION
IN THESE CITY COLLEGES.
SO WE HAD YEARS OF EXPERIENCE IN THOSE SETTINGS AND THAT WAS
INCREDIBLY HELPFUL.
SO I WOULD SAY THAT THOSE KINDS OF EXERCISES, THE VFC PROGRAM
WERE OF THE GREATEST VALUE IN TERMS OF THE VACCINE RESPONSE.
>> IF I COULD ADD SOMETHING ABOUT PREPAREDNESS FOR
COMMUNICATIONS THAT I KNOW THEY RELATED TO THE OPERATIONAL SIDE.
BUT I DO WANT TO FOCUS JUST FOR A SECOND ON THE ADVANCED
PREPARATION IN TERMS OF ANTICIPATING QUESTIONS THAT THE
CDC DID, TO GO BACK TO LOOK AT OLD PREVIOUS EPIDEMICS AND
PANDEMICS, SEE WHAT QUESTIONS PEOPLE HAD ASKED AND TO WORK
TOGETHER WITH BOTH SCIENTISTS AND POLICYMAKERS AND DEVELOPING
ANSWERS TO THOSE QUESTIONS.
I THINK THAT ADVANCED THINKING ANTICIPATED WAS KEY TO THE
EFFECTIVENESS OF THE CAMPAIGN.
>> WHAT A MEDICAL OPINION IS WORKING WITH THE SYSTEM -- CRA
ALSO TRACKED ALMOST LIKE 14 MILLION VACCINES ADMINISTERED IN
THE FIRST EIGHT WEEKS OF THE PANDEMIC INFLUENZA UNTIL
NOVEMBER 21st.
MY QUESTION IS, DR. REDD, THAT YOU VERY NICELY GAVE A
COMPARISON BETWEEN OUR PLANNING ASSUMPTIONS AND WHAT WE REALLY
HAD ON H1N1.
ON THE PLANNING ASSUMPTION, WE ALL RECOGNIZE THAT THE PANDEMIC
IS GOING TO START NOT IN THE I'D, BUT THEN AS A CONTRARY, WE
SAW IT STARTED IN THE UNITED STATES.
WHAT WENT, YOU KNOW, LIKE WHAT WERE THE LIMITATIONS THAT WE
WERE NOT ABLE TO OR EVEN PUTTING THE PLANNING ASSUMPTION THAT IT
IS GOING TO START AND FOLLOWING FOR THIS ARE PREPARED?
>> YEAH.
WELL, I THINK THAT THE QUESTION IS REALLY TO PLAN YOU HAVE
ASSUMPTIONS.
AND THE I THINK THE KEY POINT IS WHEN THE ACTUAL ASSUMPTION
BEGINS, YOU SHOULDN'T NECESSARILY FOLLOW THE PLAN IF
IT DOESN'T FIT -- YOU KNOW, YOU NEED TO CHANGE THE PLAN ON THE
REALITY RATHER THAN ON THE ASSUMPTIONS.
AND I THINK IN THE PARTS OF THE RESPONSE WHERE WE WERE ABLE TO
DO THAT, THINGS WENT BETTER.
IN PLACES WHERE WE DIDN'T DO IT, THEY DIDN'T GO AS WELL.
SO I THINK THE KEY POINT IS FLEXIBILITY AND THE
IMPLEMENTATION.
>> ALSO, I BELIEVE THAT FLEXIBILITY EXTENDED TO THE
COMMUNICATIONS SIDE, TOO, BECAUSE THE ORIGINAL SET OF
ANTICIPATED QUESTIONS, 65 QUESTIONS, WERE FOCUSED ON H5N1.
BUT THEN, OF COURSE, WHEN IT TURNED OUT TO BE H1N1, THERE WAS
THE FLEXIBILITY TO SHIFT TO THAT ISSUE.
>> CAROL.
[ INAUDIBLE QUESTION ].
IN THE POPULAR MEDIA, THIS WAS PORTRAYED AS A VERY SERIOUS
THREAT.
CAN YOU TELL US MORE ABOUT WHAT ACTUALLY HAPPENED?
AND THEN, DR. MORITA ALLUDED A BIT TO THE DIFFICULTY IN
VACCINATING PREGNANT WOMEN.
BUT IF THEY REALLY WERE A PRIORITY, COULD YOU TELL US MORE
HOW THEY COULD BE BETTER ACCESSED FOR VACCINATIONS?
>> LET ME PASS JULIE AND THEN I'LL COME BACK.
>> WE ACTUALLY SAW -- I'M NOT SURE.
WE DON'T HAVE A GOOD WAY TO ASSESS WHAT KIND OF PENETRATION
WE HAD INTO OUR OBSTETRIC AND GYNECOLOGY PRACTICES.
WE ALSO DISTRIBUTED TO HOSPITALS WHO THEN REDISTRIBUTED TO THEIR
PRACTICES, AS WELL.
AND WHAT I WAS IMPRESSED WITH WAS I WENT TO MANY OR MOST OF OF
THEM AND WE SAW HORDES AND HORDES OF THEM COMING TO THIS
CLINIC.
SO I THINK THE MASS VACCINATION CLINICS REALLY DID SERVE ON THAT
SAFETY NET.
BECAUSE WE DON'T HAVE A GOOD DENOMINATOR BECAUSE WE DON'T
HAVE MUCH OF AN ADULT IMMUNIZATION SYSTEM TO TRACK HOW
WILL WE'RE DOING IN TERMS OF DISTRIBUTION, I CAN'T REALLY
TALK ABOUT HOW WELL WE DID.
BUT I DO FEEL LIKE WE TRIED TO GET OUT MESSAGES OUT THROUGH
PROFESSIONAL ORGANIZATIONS, ACOG IN PARTICULAR.
BUT OUR RELATIONSHIPS JUST WEREN'T AS WELL ESTABLISHED AS
THEY WERE WITH OUR PEDIATRIC ORGANIZATIONS.
>> AT THE NATIONAL LEVEL, THIS WAS AN IMPORTANT FOCUS.
THERE WAS A LOT OF ACTIVITY THAT OCCURRED DURING THE RESPONSE,
BOTH TO UNDERSTAND THE IMPACT AND TO INTERVENE VERY GOOD
COLLABORATION WITH THE AMERICAN COLLEGE OF OBSTETRICIANS AND
GYNECOLOGY.
JUST ROUGHLY -- WELL, I THINK THERE'S A -- THERE'S ACTUALLY A
TECHNICAL ISSUE HERE, TOO, IN THAT THE SYSTEMS THAT WERE PUT
IN PLACE DIDN'T HAVE THE KIND OF HISTORY THAT THE SYSTEMS THAT
DAN JERNIGAN DESCRIBED.
SO IT WAS VERY DIFFICULT TO COMPARE PRETO DURING THE
PANDEMIC.
BUT MANY TIMES MORE WOMEN DIED AND WERE HOSPITALIZED DURING
THIS PANDEMIC THAN DURING NORMAL FLU SEASONS.
I WOULD ALSO SAY THAT IT WAS A RELATIVE SUCCESS IN TERMS OF THE
PROPORTION OF WOMEN WHO WERE VACCINATED, MAYBE AROUND DOUBLE
WHAT IS A GOOD YEAR IN A SEASONAL CAMPAIGN.
SO I THINK THIS IS ACTUALLY AN IMPORTANT AREA TO CONTINUE TO
BUILD ON SINCE PREGNANT WOMEN ARE AT RISK FOR FLU EVERY YEAR.
THE BETTER WE CAN DO YEAR IN AND YEAR OUT, THE BEST WE'LL DO FOR
THE NEXT EMERGENCY LIKE THIS.
>> I SHARED A SLIDE WITH CULTURAL DIVERSITY AND
COMPLEXITY OF DIFFERENT CULTURAL GROUPS.
IN MANY WAYS, YOU COULD THINK OF PREGNANT WOMEN AS A CULTURAL
GROUP, A DIVERSE GROUP WITH A SET OF ATTRIBUTES FROM THE
MESSAGES THAT WERE PROPOSED TO SOURCES AND THAT IS THAT WE
REALLY WANT TO EXTEND THE PREPAREDNESS TO THE HIGHEST
LEVEL OF SUPPLEMENTS AND THAT WE WOULD WANT TO EXTENT THAT TO
PREGNANT WOMEN.
>> YEAH.
I WANTED TO FOLLOW UP WITH JULIE ON THE VACCINE DISTRIBUTION.
YOU KNOW, AT CDC, WE STRESSED THE NEED FOR LOCAL DECISION
MAKING AND FLEXIBILITY AND THE ABILITY TO, YOU KNOW, ALLOCATE
VACCINES TO THE PEOPLE THAT WOULD BE MOST EFFECTIVE TO REACH
PEOPLE.
I WAS STRUCK WITH THE INTERDEPENDENCE OF THE CITY AND
STATE AND NEIGHBORING COUNTIES AND WONDERED WHETHER IN
RETROSPECT THERE'S STRATEGIES AT THE CDC THAT COULD HAVE BEEN
DONE DIFFERENTLY OR WOULD HAVE HELPED YOU OR IF THERE ARE OTHER
THINGS THAT NEEDED TO BE DONE BEFORE THE NEXT RESPONSE OR THE
NEED FOR INTERDEPENDENCE.
>> ANN CAME TO VISIT IN THE BEGINNING OF DISEASE AND IT WAS
THAT WEEKEND THAT WE WERE MAKING A DECISION ON WHETHER OR NOT TO
BROADEN OUR RECOMMENDATIONS BEYOND THE INITIAL TARGET
GROUPS.
AND WE HAD DINNER WITH A STATE HEALTH OFFICIALS AS WELL AS
ANOTHER COUNTY HEALTH OFFICIAL AND A NEARBY COUNTY.
WE HAD HEATED DISCUSSIONS.
IN CHICAGO, WE WERE READY.
WE ALMOST FELT LIKE IT WAS TOO LATE THAT WE HAD WAITED TOO LONG
AND THAT THE STATE DID NOT AGREE NECESSARILY.
ANN'S PRESENCE HELPED US TO MOVE FORWARD AND MAKE THAT
RECOMMENDATION ABOUT THE SAME TIME.
I ACTUALLY THINK BY ALLOWING THE FLEXIBILITY IS BECAUSE WE WOULD
HAVE PROCEEDED EVEN IF THE STATE HAD NOT.
IT WAS A GOOD THING THAT THEY JOINED US.
I THINK IT WAS A BETTER MESSAGE TO HAVE.
I ALSO FEEL LIKE IF THEY HADN'T JOINED US, THEY WERE READY.
BECAUSE CDC COULD BE MADE AT A LOCAL LEVEL, WE FELT LIKE WE
COULD MOVE FORWARD.
I THINK IT WAS VERY HELPFUL TO HAVE THAT ABILITY TO MAKE THAT
DECISION AT OUR LEVEL.
>> THIS INCLUDE PUBLIC HEALTH GRAND ROUND, SEPTEMBER 2010.
AND I WANT TO THANK THE SPEAKERS VERY MUCH FOR THE WORK AND THANK
YOU FOR THE AUDIENCE FOR THE QUESTIONS AND THE ATTENTION SEEN
AUDIENCE AND UNSEEN AUDIENCE.
THANK YOU VERY MUCH.
THANK YOU.