Press Briefing by Mr Michael D. Malison, M.D. MPA
Director
Thai Ministry of Public Health — U.S. Centers for Disease Control and Prevention Collaboration (TUC)

Thank you Mr. Chairman for inviting me to join this press briefing today, and I would like to also thank the members of the press for their willingness to help us convey important health risk information to the public about the recent H1N1 flu outbreak, both about the situation and what individuals can do to protect themselves.

I’ve been asked to share U.S. experience on the outbreak, but before I do that, I want to take a moment to commend my colleagues in the Ministry of Public Health of Thailand (MOPH) for their extraordinary efforts and dedication in doing the best they possibly can to contain this outbreak during the early stages, and more recently, to reduce transmission and minimize mortality among high risk populations. Thailand has gone to extraordinary lengths to detect and track the early cases of H1N1, to mobilize partners in academia, NGOs, and in local government, to engage the Ministry of Education on school closures and health screening, and to serve as a regional leader in helping other governments coordinating their responses by hosting the ASEAN +3 Health Ministers meeting on H1N1 a few months ago in Bangkok.

Thailand is also a leader on H1N1 vaccine development. As we have already heard from Dr. Birmingham, the World Health Organization (WHO) Representative, Thailand is rapidly scaling up vaccine production capacity in collaboration with WHO and we fully expect Thailand will become an important regional vaccine production center in the near future.

We heard a few a moments ago an update on the current H1N1 situation in Thailand – 6,776 cases and 44 deaths. The numbers in the U.S. as of last week were approximately 40,000 cases and 263 deaths. Even with the recent increase in deaths in Thailand, we see a consistent pattern of low mortality (< 1%), a pattern similar to that in the U.S. as well as other countries in the region. It’s important for the media and the public to note that as the number of cases increases and we can no longer count each individual one, our case detection will increasingly underestimates the total number of persons who actually have H1N1. This said, we are continuing to monitor the number of deaths from H1N1 very closely, but this create a disproportionate sensitivity between case and death counts, and that means that we are very likely to see an artificial rise in case-fatality rates due to underreporting, not due to an increase in the severity of the virus.

We also need to keep this outbreak in perspective. While there is not very good background data in Thailand on seasonal flu in most provinces, in the U.S., seasonal flu affect roughly 20% of the population each year — that’s roughly 40 million people. This results in 200,000 hospitalizations for pneumonia, and approximately 30,000 flu-related deaths. As I’ve mentioned, so far, the H1N1 outbreak has only affected a small fraction of this number and fortunately, there have only been a few hundred deaths. But flu is much more seasonal in the U.S. than it is in a tropical country like Thailand. Our peak transmission season is during the winter months — just a few months away. It’s quite possible that we will see a large increase in H1N1 transmission this winter in the U.S., and may well see many more deaths.

Remember, this is a global pandemic of flu, and in the absence of huge quantities of a highly effective vaccine, the best we can do is to slow, but not totally prevent transmission.

The U.S., like Thailand, has urged people to exercise good hygiene including frequent hand washing, use of hand sanitizer, covering their mouth with a sleeve when they cough or sneeze. We are also encouraging people who have influenza-like illness to stay home from work or school for 7 days. School closure has been implemented in some locations in the U.S. and other countries, but it’s not yet clear whether school closure alone dramatically affects transmission, especially in an urban setting where children have many other places where they can gather and spread illness. Mexico, you will recall, closed not only schools at the height of their outbreak, but businesses, churches, and all public transportation as well. This may have been an effective step in a crisis situation, but it came at considerable economic and social cost. The point is there’s no easy answer about when to take drastic action like this — it’s only partially a public health decision. It also requires elected officials and the business community to weigh in on the costs versus the potential benefits.

In closing, I’d just like again thank and commend my Thai MOPH colleagues for their hard work and dedication to protecting the public’s health. The U.S. CDC and WHO stands by your efforts, and we are here ready to assist in whatever way we can to help reduce the health threat posed by this or any other disease outbreak.

Thank you for your attention, and I’ll be happy to answer any questions.