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Tuesday, January 28, 2014

CDC Director: China Bird Flu Outbreak Closely Watched

A security guard closes the gate of a live poultry market in Cheung Sha Wan before officials proceed to cull chickens in Hong Kong on January 28, 2014. Hong Kong began a mass cull of 20,000 chickens after the deadly H7N9 bird flu virus was discovered in poultry imported from mainland China, authorities said. (Phillipe Lopez/AFP/Getty Images)

A security guard closes the gate of a live poultry market in Cheung Sha Wan before officials proceed to cull chickens in Hong Kong on January 28, 2014. Hong Kong began a mass cull of 20,000 chickens after the deadly H7N9 bird flu virus was discovered in poultry imported from mainland China, authorities said. (Phillipe Lopez/AFP/Getty Images)

H7N9, a new strain of the bird flu, is spreading through China in advance of celebrations of the Lunar New Year, this Friday. Both travel and chicken sales spike in China around this time.

The strain jumped from birds to humans last year, and according to the World Health organization, 246 people in mainland China have been sickened and 56 people have died since the disease was first reported in Shanghai. Cases have also been reported in Taiwan and in Hong Kong.

Today officials began culling 20,000 chickens after a sample of live chicken imported from mainland China tested positive for the new strain of virus. H7N9 is reportedly less virulent but more deadly than H5N1.

Tom Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC) and administrator of the Agency for Toxic Substances and Disease Registry, tells Here & Now’s Jeremy Hobson that the outbreak is worrisome, but China is being more transparent than ever.

Interview Highlights: Tom Frieden

On the difference between the current bird flu strain and past strains

“There are a few big differences. Probably the biggest is that H7N9 doesn’t make the birds sick — even though it’s highly lethal for people, it’s not lethal for birds, so that actually makes it much more difficult to control. When you have sick birds with H5N1, you can cull the flock and stop the spread. But to track H7N9 is much more challenging because we need to test the birds and track what’s happening.”

On what’s known about the current flu strain and how it spreads

“We don’t understand completely how it’s spreading from birds to humans. We do know that the virus itself has certain genetic characteristics that make it relatively easy for it to spread from the birds to people. Fortunately it does not yet have the genetic characteristics to spread from one person to another person, except if there’s very intense close contact, such as someone who is caring for someone who is very sick, or are close in the family. But it’s not spreading person to person – yet.”

On how China works with the rest of the world in preventing the spread of disease

“Ever since the SARS outbreak hit 10 years ago, we’ve worked very closely with the Chinese government. They came to us and they said, ‘what can we do to strengthen our system,’ and we helped them establish what they call in Chinese the ‘China CDC’ — even though ‘CDC’ doesn’t mean anything in Chinese, that’s what it’s called. And we’ve helped them establish systems to monitor influenza, to track the virus, to test it in the laboratory and to sequence the genome. And because of those systems, within days of H7N9 emerging, they had posted on a site accessible to flu experts around the world and we were able to immediately download the sequence, make a diagnostic test and begin work on a vaccine. So that kind of collaboration over the past 10 years has helped China respond very clearly and effectively and very transparently in this case, and it has also helped us be better prepared.

On the importance of public health action in preventing the spread of disease

“There are always things we can do to reduce the burden of an outbreak. Whether that’s preventing it effectively, finding it sooner, isolating people, supporting people who are affected by it. And what we know is effective public health action can make an enormous difference. Public health investments are a best buy in the health sector because we are able to stop problems before they spread, we’re able to prevent them from occurring in the first place and we’re able to find them quickly, so we’re able to warn people and take appropriate action.”

Guest

  • Tom Frieden, director of the U.S. Centers for Disease Control and Prevention. He’s also administrator of the Agency for Toxic Substances and Disease Registry. He tweets @DrFriedenCDC.

Transcript

JEREMY HOBSON, HOST:

It's HERE AND NOW.

The celebrations of the Lunar New Year get under way this Friday, and health authorities are concerned that the celebrations could increase the spread of the H7N9 virus in China. That's a new strain of bird flu that jumped from birds to humans last year. And according to the World Health Organization, since the disease was first reported in Shanghai, about 250 in mainland China have been affected by it. Fifty-six people have died.

Today in Hong Kong, officials began culling 20,000 chickens after poultry from mainland China tested positive for the virus. Joining us now to talk about all of this is Dr. Tom Frieden. He is the director of the Centers for Disease Control and Prevention. He's with us from Atlanta. Dr. Frieden, welcome.

DR. TOM FRIEDEN: It's great to be with you.

HOBSON: Well, how is H7N9 different from the other strains of the bird flu that we've seen before and talked about before like H5N1?

FRIEDEN: There are a few big differences. Probably the biggest is that H7N9 doesn't make the birds sick. Even though it's highly lethal for people, it's not lethal for birds. And that actually makes it much more difficult to control. When you have sick birds with H5N1, you can cull the flock and stop the spread. But to track H7N9 is much more challenging because we need to test the birds and track what's happening.

HOBSON: So then why are 20,000 birds - 20,000 chickens, to be specific - being culled, we just learned today, in Hong Kong?

FRIEDEN: Hong Kong is quite concerned. They've had a large outbreak of H5 that they had to deal with under great challenge before. So they want to make sure that they're staying(ph) as safe as they can from H7N9. We know that the live bird markets are behind a lot of the spread, that the great majority of people who've gotten the new strain of flu in China have gotten it from contract with poultry. And we have not yet seen a significant or sustained spread from one person to another, but we are seeing it moving toward the south of China.

And of course as we come up to Chinese New Year, that makes us particularly concerned because there's so much movement around China at this time that we anticipate that there may well be an increase in cases in addition to the surge that we're in the middle of now.

HOBSON: Well, tell us more about that because that is the big question. How does it get passed from bird to human or human to human? And what are you most concerned about? Do you have to actually have contact with the bird to be at risk?

FRIEDEN: We don't understand completely how it's spreading from birds to humans. We do know that the virus itself has certain genetic characteristics that make it relatively easy for it to spread from the birds to people. Fortunately it does not yet have the genetic characteristics to spread from one person to another person except if there's very intense close contact such as someone who's caring for someone who's very sick, or close in the family. But it's not spreading person to person yet.

HOBSON: Well, how do you - looking at this from Atlanta and something that is going on, it looks like, only in China, how do you look at it as the head of the CDC and what can you do from here?

FRIEDEN: The health security of the United States is really only as strong as the health security of countries around the world. We're all connected by the food we eat, the water we drink, the air we breathe. And what we try to do is to strengthen other countries' capacity to find, stop and prevent outbreaks where they start. That's the most effective way of doing it. That's the least costly way of doing it. And frankly, that's the right way of doing it.

HOBSON: Sow what do you do when it comes to China? Are you in contact with their health authorities?

FRIEDEN: We are very much so. In fact, ever since the SARS outbreak hit 10 years ago, we've worked very closely with the Chinese government. They came to us and they said: What can we do to strengthen our systems? And we helped them establish what they call in Chinese the China CDC. Even though CDC doesn't mean anything in Chinese, that's what it's called. And we've helped them to establish systems to monitor influenza, to track the virus, to test it in the laboratory, to sequence the genome.

And because of those systems, within days of H7N9 emerging, they had posted that on a site accessible to flu experts around the world, and we were able to immediately download the sequence, make a diagnostic test and begin work on a vaccine. So that kind of collaboration over the past 10 years has helped China respond very clearly and effectively and very transparently in this case. And it's also helped us be better prepared.

HOBSON: Tom Frieden, for those of us who have never firsthand experienced a big outbreak of a disease - we look to movies, frankly. I mean I've seen, you know, "Outbreak," "Contagion," "World War Z" even. When you see those films, if you have, is that realistic of what would happen, how quickly things could spread if something really bad happened?

FRIEDEN: There are a lot of realistic features of many of those movies: the fact that people can be very concerned, the fact that you have to be very upfront and tell people exactly what's happening, what you know, what you don't know, what you're doing to find it out, that we can't always prevent a hundred percent and that can make people very frustrated or anxious. But there are always things we can do to reduce the burden of an outbreak, whether that's preventing and effectively finding it sooner, isolating people, supporting people who are affected by it.

And what we know is that effective public health action can make an enormous difference. Public health investments are a best buy in the health sector because we're able to stop problems before they spread. We're able to prevent them from occurring in the first place. We're able to find them quickly so that we can warn people and take appropriate action.

HOBSON: And your advice to most people listening to this, I assume, for this season would be wash your hands with soap.

FRIEDEN: Get a flu shot, first and foremost. It's not perfect. It's not the best vaccine we have. But it's the best way to protect yourself against flu. And then wash your hands regularly and cover your cough and sneeze. And don't go out if you got fever and cough because you don't want to infect other people.

HOBSON: Should we start wearing those masks when we get sick like many Asian countries do?

FRIEDEN: There is evidence that people who wear masks are much less likely to spread infections that they have. It's not yet culturally acceptable in this country, but there is growing evidence that wearing masks does protect others if it's something that you can tolerate, given how easy it is for you to breathe.

HOBSON: Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, thanks so much for joining us today.

FRIEDEN: Thank you for doing this.

HOBSON: And one other thing the director said, the movie most like a real outbreak is "Contagion." That's the 2011 movie where Gwyneth Paltrow returns from a business trip to Hong Kong with the flu and is patient zero for a global pandemic. Here is a clip from the movie where they're talking about what would happen when people find out about the virus.

(SOUNDBITE OF MOVIE, "CONTAGION")

BRYAN CRANSTON: (As Lyle Haggerty) They're shutting down the board of trade, public transportation, even the Teamsters are pulling their drivers off the road.

LAURENCE FISHBURNE: (As Dr. Ellis Cheever) People are still going to slip through, you know this.

CRANSTON: (As Lyle Haggerty) Yes, they will. The Secret Service is moving the president underground. Congress is figuring out how to work online. When the word goes out, there will be a run on the banks, gas stations, grocery stores, you name it.

HOBSON: Well, I just hope that's not realistic, Meghna.

MEGHNA CHAKRABARTI, HOST:

A mask sounds better and better.

HOBSON: I think so. This is HERE AND NOW. Transcript provided by NPR, Copyright NPR.


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