Media Briefing: A(H1N1) Influenza

Media Briefing: A(H1N1) Influenza

(Conducted by Dr. Jon K. Andrus, Pan American Health Organization, May 3, 2009)

Media Briefing: A(H1N1) Influenza
(Conducted by Dr. Jon K. Andrus, Pan American Health Organization, May 3, 2009)

Good afternoon. Welcome all members of the Press who are on the line, and thank you for taking the time to listen to this briefing of the Pan American Health Organization on the Influenza A (H1N1) epidemic that is currently ongoing.

•  I want to take a moment to introduce myself before we begin. I am Jon Andrus, a senior medical epidemiologist and technical advisor for immunization at the Pan American Health Organization. My 24 years in global health has largely been dedicated to the control and elimination of vaccine preventable diseases in developing countries around the world.  I have been asked by the Director of the Pan American Health Organization, Dr. Mirta Roses, to convene a daily press briefing starting today.
• The main purpose of these briefings will be to keep you updated with the best available information to the extent possible on the current situation, particularly as it evolves in our Region of the Americas. We also want to share with you any new scientific information that will ensure we are implementing the best strategies to control the outbreak, as well as the work we doing to support countries. Finally, we want to re-emphasize what individuals can be doing to protect themselves.
• This time together will provide you an opportunity you to address any questions that you may have. We are all dedicated to keeping the public informed with the best and most current information that we have available. This will ultimately help people ensure the safety and health of their families and their communities where they live across the world. At PAHO, we are particularly dedicated to ensuring that resources are equitably distributed among countries, particularly among people who are most in need.

Let's start by providing you with a quick update on the epidemic:

• Globally, the latest data show 820 confirmed cases due to the new Influenza A (H1N1) virus from 17 countries (Austria (1), Canada (85), China, Hong Kong Special Administration Region (1), Costa Rica (1), Denmark (1), France (2), Germany (6), Israel (3), Mexico (506), Netherlands (1), New Zealand (4), Republic of Korea (1), Spain (13), Switzerland (1), United Kingdom (15), and USA (226)). 
• Globally, there have 20 deaths (19 in Mexico and 1 in the USA).
• Costa Rica and Colombia are new countries since yesterday with cases. El Salvador is in the process of investigating two probable cases.
• In our Region of the Americas, we now have X cases (Canada 51, Costa Rica 1, Mexico 506, and USA 160 cases).
• With the data we have available, most experts would agree that the Influenza A (H1N1) outbreak that we are experiencing is mild to moderate in terms of severity. Of the cases in the US, for example, 5 cases have been hospitalized. The vast majority of cases recover fully.
• However, that is not to say that things cannot change very quickly and very dramatically. What we know about influenza and RNA viruses in general is that they are predictable in their UN-predictability. The rapid and fairly aggressive response by PAHO and WHO has been appropriate given this completely novel strain of new influenza A(H1N1) virus. Thank God that we are not encountering more deaths. We need to be vigilant, but calm so as not to create panic and loss of public confidence.
•  I think at this time, it behoves us to remind ourselves of the 1918 Spanish Flu outbreak. It started in the Spring, much like the outbreak we are currently experiencing with mild to moderate cases. Over the summer months transmission diminished because ecological conditions of the winter are much more favorable for influenza transmission. With the onset of the Fall and Winter, seasons much more favourable for influenza virus transmission, the virus came roaring back with a vengeance, most likely mutating to a more virulent form, killing 40 million people globally. So again, we must be calm, but we definitely cannot let up or drop our guard on vigilance.
• Before going further, I would like to share with you a special perspective we have here in the Americas. Some of us here in this room at PAHO have spent most of our professional lives fighting killer diseases like yellow fever and cholera.  Others have fought hard to eradicate polio, a well-known crippler of children. More recently countries have been working on the measles and rubella elimination initiatives in the Americas, also killers and cripplers of children. When you work in disease eradication, every day is an emergency. Every day that passes means more children are being paralyzed. This is unacceptable, so every day has to be an emergency if the job is going to get done. In the Americas, countries have been highly successful with achieving these disease elimination efforts.
• You may recall in the early 1990's how cholera swept across the hemisphere, causing a million cases and 10,000 deaths. There was wide-spread public panic initially. In the 20th Century, it was the largest cholera epidemic on the planet. From a historical perspective this cholera outbreak in the Americas has been referred to as the 7th global cholera PANDEMIC. Countries with support from PAHO responded extraordinarily well. Using the polio eradication machinery in place we stopped transmission with mass campaigns for improving education, water and sanitation strategies.
• So, I think it is safe to say that countries will respond similarly to control this new Influenza A (H1N1) outbreak, especially when we have more tools at hand. So, the message is: the countries know what to do and they will do it, particularly when the vaccine becomes available. 
• To that end, WHO in collaboration with PAHO, has established an Influenza A (H1N1) Vaccine Task Force which is meeting on a daily basis beginning last Sunday, 26 April. I am a member of this Task Force. The Task Force is also composed of experts from WHO Geneva, PAHO, and EURO.
• This Task Force on Influenza A (H1N1) vaccine strongly recommends that seasonal influenza vaccination should continue particularly in the southern hemisphere countries who are about to enter winter and their own seasonal influenza season period. We know in the U.S. seasonal influenza kills on average 36,000 people annually. So, it will be imperative for the southern hemisphere countries to vaccinate with seasonal influenza vaccine currently available.
• WHO has already sent the new Influenza A (H1N1) wild-type virus to WHO-affiliated labs and to some pharmaceutical companies to start producing candidate vaccine virus strains and ultimately the vaccine. (This is the appropriate virus that would used for the creation of a new vaccine.)
• Aside from the traditional cell culture approaches to influenza vaccine production, other newer technologies are being used, like reverse genetics, to generate a new H1N1 vaccine. This technology uses what we know about the genetic sequence of the virus to produce the wild virus surface antigens (H1N1). The antigens produced are used in a vaccine to illicit the proper immune response of the individual being vaccinated. This and other novel technologies are exciting areas of work because they provide hope and great optimism that if the severity of this epidemic gets worst, vaccine will become available.
• Initial data suggest that despite the composition of the last season's seasonal influenza vaccine (including Brisbane H1N1 strain) that this year's seasonal vaccine offers no protection against the currently circulating H1N1 strain. Additional investigations are ongoing on this point. They include the testing of sera of patients who participated in the clinical trials, as well as animal studies in ferrets.
• So in essence, the vaccine manufacturers are pursuing several different technologies, each having their own specific timeframes. Hence, there is a range of estimates when the vaccine will be ultimately available for community vaccination programs. Right now as we speak, our best estimate is within the next 4-6 months.
• Since our best estimate is 4-6 months, what can we do in the meantime. All our efforts should be highly focused on mitigating disease spread (hand washing, personal hygiene, social distancing). We really cannot over-emphasize these interventions. 
• PAHO and WHO are not imposing any travel restrictions, but if you do become ill, do NOT travel, and if you are returning from travel and become ill, go see your doctor.
• I should say something about all the work that went into pandemic preparedness plans these last few years. There is no doubt that all this work, including the work that went into vaccine development, is currently paying us dividends in terms of the rapidly of the national, regional, and global response to this current crisis. In addition to the new vaccine production technology mentioned, there have been substantial advances in the development of surveillance tools, such as new rapid test kits for diagnosis of new Influenza A (N1H1); these are currently being distributed to countries by the Centers for Disease Control and Prevention of the United States as we speak. 
• WHO will guide manufacturers on the signal, when needed and if appropriate, to switch from seasonal vaccine production to new Influenza A (H1N1) vaccine production. This will depend upon many factors, including the relative disease burden and severity of the current Influenza A (H1N1) outbreak.
• Equitable distribution of vaccine to developing countries is an absolute top priority for PAHO. As it stands, several manufacturers have pre-production contracts with certain countries which could impose some barriers to vaccine access for the poorest of the poor in the Region. We need to keep the advocacy and dialogue going to prevent a humanitarian crisis in lieu of possible vaccine shortages, particularly if this current outbreak were to become more severe, with increased mortality rates.
• Once Influenza A (H1N1) vaccine becomes available, by all accounts, most likely the global supply will be limited. Globally, perhaps 1-2 billion doses will be become available, falling far short of the 6 billion people living on the planet. Vaccination strategies will need to target those individuals are higher risk. The data coming out of Mexico determining risk factors for morbidity and mortality will be critical not only for Mexico, but for the rest of the world.
• So, we are working hard with all our partners to fill gaps in information that will help ensure we are providing the best outbreak response. An excellent example is what happened last night. Last night, Canada notified WHO of some 220 pigs on a farm in Alberta, Canada, infected with the same Influenza A (H1N1) virus circulating in Mexico and the USA. We have been told that the farm has approximately 2200 pigs resulting in a 10% attack rate among those pigs on this farm. The farmer had a travel history to Mexico and returned home on 12 April. Two days later he had contact with his pigs and they have subsequently have become ill. Experts say this is not surprising and that the appropriate steps have been taken by placing the farm under quaranteen. There is no evidence of other neighboring farm involvement.
• With the data and knowledge we have available, there is no risk to purchasing pork in stores and eating properly cooked pork meat. So, no one is saying stop eating pork. The food industry with support from the public health sector should also be on the look out for illness among pig farms. Farm workers who are involved in slaughtering pigs may have increased risk because of exposure to secretions from pigs they are slaughtering. But the virus can only survive a short period of time and by the time the pork meat has been processed, and by the time it reaches the store, viral transmission is a non-issue.
• This is just an example of how we must be ready to react appropriately to a situation that is rapidly evolving.
• PAHO is also working very hard to ensure there is equitable distribution of antiviral medications for the treatment of acute infections. Oseltamivir has been stockpiled by PAHO in its Panama office and WHO also has global stockpiles. In both cases, the medicine is being distributed to those who need it most. In fact, WHO yesterday rolled out a logistics plan for distribution of 2.4 million treatment courses to 72 countries in need, including Mexico. PAHO is taking similar steps with its stockpile.