H7N9美国CDC的访谈
OPERATOR: Thank you for standing by.During the question and answer session of today's call, you may ask a question by pressing star one.Today's conference is being recorded.TOM SKINNER: Thank you, Shirley.Thank you all for joining us today for this telebriefing that we're having on an update of the situation around H7N9 infections in China.With us today is the director of the CDC, Dr. Tom Frieden who is going to provide some opening remarks and then we'll get to your questions where we'll be joined by Dr. Joe Bresee, a medical epidemiologist in our influenza division.With that, Dr. Frieden.
TOM FRIEDEN: Good afternoon, everyone.Thank you for joining us today.What we'll do is update you on the current situation with H7N9 in China. We're getting a lot of calls from the media, so we felt it would be most efficient for everyone to hold this telebriefing.We first want to update you about the situation in China and describe the steps that we at CDC are taking to protect health here in the U.S.We also want to put the outbreak in China into context and finally, of course, answer as many questions of yours that we can get to.I will provide an overview of the situation and of our response and I’d also like to just mention to you how CDC's relationship with the Chinese public health authorities is paying off in response to this outbreak for us and for people around the world and then I’ll be joined by the director of our influenza epidemiology unit, Dr. Bresee, who along with me will answer your questions.
As of April 5th, 2013, Chinese public health officials have reported 16 cases of human infection with a novel avian influenza A, which is called the H7N9 virus, from four different provinces in China.Patients were hospitalized and six of them have died.These are the first human infections with this particular strain of H7N9 that have been identified.15 of the cases are among adults ages 27 to 87.The one child is age 4 and apparently had mild illness.All cases had onset between February 19th and March 31st, 2013.There has been no person-to-person transmission and no epidemiologic link between any of the cases so far.There are two families where there was illness in a family around the time of a confirmed case and those two family situations are being investigated by Chinese authorities to see if there was person-to-person transmission in those cases.I would say that with other avian influenza strains we sometimes see limited person-to-person transmission within the close contact of a family or health care but only one generation of spread or two generations of spread, not multiple generations of spread.So when we speak of person-to-person transmission, we really are looking at whether it's spreading widely.
Now, at this point, we are -- there are several things that give us some confidence that it's not spreading widely from person to person.One is that more than 100 contacts have been assessed and monitored by Chinese public health authorities and none of them have developed illness.In contrast, in influenza, you would expect at least 20 to 30 percent of family members to develop illness.So the fact that there are that many contacts and no illness has been identified is encouraging.In addition, many or perhaps most of the cases in the investigations are still ongoing have direct contact with live poultry.We also have reports from the Chinese Agricultural Authority that there are positive cultures for a similar strain of H7N9 from both chickens and pigeons and that further testing is under way.At this time, no cases of human infection with avian influenza A H7N9 have been detected in the United States.
CDC is working to address this situation as part of a coordinated international effort.First, today we issued a health advisory to inform clinicians and public health specialists throughout the U.S. of what is happening and what they should do if they have a suspected case in a traveler who is returning from China, what they should do in terms of testing, infection control, and care.We also have developed a test currently being used at CDC so that we can test specimens from travelers returning from China who have severe illness that might be this influenza and determine whether or not they have it.We will be taking further steps to develop a diagnostic test kit that we can send to states throughout the U.S. and to China so that we can have rapid diagnosis of infections going forward.The information coming out of China suggests that the virus is susceptible to two of the main antiviral agents we use, Oseltamivir and Zanamivir and we will be confirming that in the coming days, but that's what it looks like.Throughout the U.S. government and with pharmaceutical companies, the vaccine manufacturers out of an abundance of caution were developing a candidate virus that could be used to produce a vaccine if one is needed.This would only be produced if there were evidence of widespread transmission from person-to-person.That's not something that we are seeing at this time. We are not issuing any formal travel advisories.As I said earlier, a source for these infections has not been identified but we do know that the Chinese health authorities are starting to cull birds in live markets as a precautionary step and for about a decade we've already recommended to people in China to Americans traveling in China to avoid contact with birds and other animals.That's been in place since both SARS and the spread of another strain of influenza called H5 nearly a decade ago.
I want to take a moment to talk about CDC's relationship with the Chinese equivalent.The Chinese equivalent is called China CDC.And we have a very robust, long-term relationship with them.It got much stronger after SARS when China recognized that it needed to strengthen its public health system and we have an office that CDC maintains in China to collaborate. Over the course of many years our scientists have helped the Chinese public health doctors effectively monitor for influenza throughout the vast population of China, improve their laboratory testing for influenza, learn how to do genetic sequencing of the influenza strains that they identify, become a World Health Organization collaborating center for influenza and because of that, the Chinese government is able to track where influenza is spreading but we may not well have learned of these isolated cases and because of that, the Chinese government has posted publicly the full genetic sequence of the H7N9 strain that is affecting people in this cluster.In fact, I have a long -- a long-standing series of annual meetings and periodic updates with the director of the Chinese CDC and we had a long conversation late last night about this situation to ensure that we are providing any assistance that we can.We are working in concert against this to quickly identify the situation and take all appropriate steps.
Before I turn the call over to Dr. Bresee to answer your questions, I wanted to put this into perspective.Two questions that CDC is frequently asked are, how concerned are we and how concerned should the public be about the situation?And I’ll say this.We at CDC work 24/7 to protect people's health, including from threats such as emerging influenza viruses.We work to have the public's back.It's our job to be concerned and to move quickly whenever there's a potential problem, such as the one in China.And that's what we're doing.As far as should the public be concerned, there is no evidence at this point that the virus is being transmitted from one person to another or that the virus has caused any infections in the U.S.
There are no specific steps that people in this country need to take to protect themselves.People can go about their daily lives.Information can be a powerful anecdote for people who are worried or concerned.So what we're doing here is to communicate as much as we can of what we know when we know it completely openly.For many years, we have encouraged people in China, Americans in China not to have contact with live markets because influenza and other infections can spread and we continue with that recommendation.We will continue to provide updated information through our website as soon as we have it.We'll also continue as needed to update as there are developments.Thank you.
TOM SKINNER:Shirley, I believe we're ready for questions, please.
OPERATOR:Thank you.We will now begin the question and answer session.If you would like to ask a question, please press star 1.You will be prompted to record your name.Again, press star 1 to ask a question and one moment for our first question.Our first question comes from Elizabeth Weiss with USA Today go ahead with your question.
ELIZABETH WEISS:Thanks for taking my call.I wanted to ask a bit about the work on the seed strains for the virus.Can you talk a bit about when that was started and what -- where it stands currently?
TOM FRIEDEN: Because the genetic sequence is available, we're able -- and manufacturers are able to do reverse engineering to develop a potential vaccine strain.The Assistant Secretary for Preparedness and Response, Dr. Nicki Lurie and BARDA are in contract with pharmaceutical manufacturers who are also working in this area so that a seed strain can be available, if needed, as quickly as possible and the contracts that HHS, BARDA ASPR, as it's called, has with the manufacturers make sure that what they do is open source .In other words, it would be available to anyone.I'd like to turn it over to Dr. Mike Shaw who is director of our influenza laboratory to address further issues.
MIKE SHAW: Right.Under this contract, the synthetic genes were created for BARDA and they are being shared.We are using them to try to develop a candidate vaccine strain as are companies.There are many different approaches to this.Many different companies and organizations are trying to work as quickly as possible to get the strain that would be shared as widely as possible to make sure that the vaccine production could receive it as quickly as possible.
TOM SKINNER: Do you have a follow up?
ELIZABETH WEISS:No that should do it.
OPERATOR:The next question comes from Miriam Falco, with CNN Medical News.You may ask your question.
MIRIAM FALCO: Hi, doctor.Thank you.I'm a little confused because according to the WHO press release, they say an additional five laboratory confirmed cases, including one death due to human infection with influenza A H7N9 virus and you've said twice now there hasn't been human-to-human transmission and one possible situation.I know you don't speak for the WHO but you guys obviously talk to them.Which one is it?
TOM FRIEDEN: So let's be clear.What we have is 16 reported, confirmed cases.All of those cases are isolated cases.There are no epidemiologic links that have been identified between the 16 different people.There are two of those 16 had other people ill in their families and that's continuing to be assessed to see if there was transmission within the family.And one thing to try to be clear about, we look at two things when we look at influenza.First, how virulent is the strain and second, how readily does it spread among people.In terms of that first question, how virulent or how deadly it is, we won't know until we are able to test a larger number of people and see if more than 16 people had it.It could be that hundreds of other people have mild infections and these people were the tip of the iceberg or it could be that it was a rare event that it passes from animals to people and that for those few people who are unfortunate enough to contract the infection from an animal, it's a very severe illness.The second question is, does it spread readily from one person to another?And everything we're seeing at this point suggests that at this point, that is not happening.
MIRIAM FALCO: So it's still accurate to say no human-to-human transmission?
TOM FRIEDEN: …has been documented, as of now.Correct.
MIRIAM FALCO: As of now.And then the other question I have is about this particular virus.It's the first time we've seen it in humans ever.Is there something about this virus that you think might make it more eligible to change quickly and quickly change to become more easily transmissible?
TOM FRIEDEN: One of the unusual characteristics of this virus is that in animals, it generally causes mild illness.So it's unusual, though not unheard of, for a virus to cause mild virus in animals but severe illness in people.And one possibility -- and we'll know this within the next week or so -- is that it's fairly widespread among animals.Sometimes when there are things like outbreaks of H5, you have a clue because there are bird die-offs or sick flocks.That may not be the case here.It's something we may find with time.
OPERATOR:Thank you.Our next question comes from Mike Stobbe with the Associated Press.You may ask your next question.
MIKE STOBBE: Thank you for taking my question.I apologize.I missed the first couple of minutes.Could you say a little more about the 16 cases, how old they were, what sex they were, and do they have any shared characteristics that might predispose them to more severe illness?And I had a follow-up question which was about, could you tell me about what the flu surveillance system is in China in is it a Marshfield Clinic type model or what is it that you have helped them develop there?
TOM FRIEDEN: Dr. Bresee will take the second part of that.Fifteen of the cases are in adults ages 27 to 87.One case is in a child, age 4.We do not have full information on predisposing medical conditions but it appears that many, if not most of the individuals, did have an epidemiologic link with live markets, with poultry. Dr. Bresee, on surveillance?
JOE BRESEE: The surveillance system in China has really dramatically improved over the last decade or so since the introduction of H5, the catalyst for that.They do a couple of things that is important.One is, they have a wide dispersion of labs that can detect flu, generally speaking, using the best methods, called PCR.They have well over 400 of these labs around the country that have grown up over that last few years. They really do have the ability to look for flu, wherever it is, in the country.They also have about an equal number of sites that looks for flu disease that tests people and count people, including both hospitalized people and people that come to clinics.If you think about China's ability to detect cluster of illness, to detect new illnesses, and to see how this potential outbreak may or may not spread, I think they are well positioned to do that.
TOM SKINNER: Mike, do you have a follow-up?
OPERATOR:One moment, please.Go ahead, Mike.
MIKE STOBBE: No.No.I don't have a follow-up.
TOM SKINNER: Next question, Shirley?
OPERATOR: The next question comes from Richard Knox with National Public Radio.You may ask your question.
RICHARD KNOX: Even though there isn’t any clear evidence of human-to-human transmission and I gather no signal of influenza-like increase in the area, Nancy Cox was telling me that genetic analysis indicates this virus might infect mammalian cells more easily than H5N1 does and I wonder how you can reconcile those two kinds of information and how heavily the genetic analysis of that weighs in your current threat assessment.
TOM FRIEDEN: So we always have to analyze the genetic sequence in concert with the epidemiologic pattern.It is true that some aspects of the genes of this organism are partially adapted to mammals, suggesting that they may have spent time in swine or other populations.But ultimately the fact that we haven't seen cases in contacts, that we haven't seen widespread cases in children, that we haven't seen a spike are all reassuring.And that most of the cases or many of the cases have had direct contact with the likely vector, I think all of that is reassuring.But, of course, one of the things that we look at very carefully is the continued evolution of influenza.Even if this organism ends up not going further than people who had a direct contact with animals, there's always the risk that it would continue to evolve in swine or other populations and become more transmissible in the future.And that's just to say we are at no larger risk today than we were two weeks ago before we all knew about it.But we always have to be prepared for emerging threats and that's why we monitor for them and that's why we respond very quickly when they may be emerging.
TOM SKINNER: Next question, Shirley?
OPERATOR: Next question comes from Richard Besser with ABC News.You may ask your question.
RICHARD BESSER: Thank you for taking my question.I have two.The first is, is there any way to tell how novel this virus is and whether there would be any population immunity?Have there been H7's or N9's that have circulated before?And the second is a follow-up to Richard Knox’s question.Is there any way to look at the virus to tell how many mutations would be needed to be spreadable from person-to-person?
TOM FRIEDEN: So because this virus has -- is not related to previously circulated influenza virus, there is not population immunity as far as we know to this particular strain of H7.Since it doesn't affect people, people haven't developed the immunity to it.And there is no specific way to say exactly what it would take to become better adapted to be able to spread person-to-person.
RICHARD BESSER: Thanks very much.
OPERATOR: Thank you.Next question comes from Eben Brown with Fox News Radio.Go ahead with your question.
EBEN BROWN: Thank you very much.Appreciate the time, doctors.You had mentioned that there had been no cases in the United States reported.Are there any chances of this coming to somewhere else in the Western Hemisphere that could eventually then find its way into the United States?
TOM FRIEDEN: This is why we work with countries throughout the world to have a flu monitoring system and it's certainly possible that it could spread to countries neighboring China or to countries that have travelers to and from China who were in live markets.At this point, it looks like direct contact with live poultry in China is the main risk factor.But because flu can emerge anywhere in the world, it's in all of our best interests that there are good flu monitoring systems around the world and that's why when we do produce diagnostic kits, we distribute them to more than 100 countries and we help countries around the work to do their own flu surveillance.It protects them and it protects us.
TOM SKINNER: Next question, Shirley?
OPERATOR: Next question comes from Maryn McKenna with Wired.com.Go ahead with your question.
MARYN MCKENNA: Thank you very much for this call.Can we hear a little bit more about what surveillance is like on the animal side in China?I think that Dr. Bresee was describing the human surveillance but I'd be interested in what is going on beyond the call of chicken in looking for this virus as it's moving through chickens or pigeons or whatever the suspected reservoir is.
JOE BRESEE:Thanks Maryn, this is Joe.I will say that the animal health authorities in China have issued guidance now for surveillance for this virus among poultry population, duck populations, and any bird populations that exist in markets in that area of China.They've engaged now in a very systematic surveillance system over the next week or so that intends to figure out what the scope of this virus is and what populations it might exist in.And so I think we can expect, as Dr. Frieden says, in the next week or two, some additional data to try to better to find the animal host of the virus which we think will be important in identifying prevention strategies for humans.
MARYN MCKENNA: Can I ask a follow-up to that?
JOE BRESEE:Sure.
MARYN MCKENNA: Can you -- is there anything else you can say about where that surveillance is taking place by which I mean, is it in people facing areas such as live markets, is it more out in the countryside?Are they looking at small farm holdings, the big new mega farms?
JOE BRESEE:That's a good question.What we're told by the Chinese authorities is that the extenuated surveillance will focus on those provinces that currently have human cases of the disease but be directed at both markets, industrial farms, and small holding farms.
MARYN MCKENNA: Super.Thank you.
TOM SKINNER:Next question?
OPERATOR: Thank you.Next question comes from Betsy McKay with the Wall Street Journal, you may ask your question.
BETSY MCKAY:Just a quick question about surveillance.I wondered what you all might know about what level of heightened surveillance there might be going on in other neighboring countries in Asia because of this.
JOE BRESEE:That's a good question.What we know now is that several of the countries in Asia, especially several of the bordering countries from China have been doing extenuatedsurveillance either in the community where they’re testing severely old people to look for the introduction of this virus or occasionally in airports where they’re screening for fevers, for instance, of incoming passengers.I can't say that I know the exact scope of the extenuated surveillance going on, but we have heard from colleagues in Laos, Cambodia, Thiland, Taiwan and Vietnam that they’ve all heightened their surveillance in looking for this virus as have countries around the world, I might say.
BETSY MCKAY:Okay.Thanks.
OPERATOR: Thank you.Next question comes from Bob Roos with CIDRAP News.
BOB ROOS:Thank you.A couple of questions about the vaccine seed strain.I'm wondering if you have any existing vaccine seed strains for other H7 sub type viruses and if so if you plan to test those to see if they offer cross-protection and I wondered if this is the first time that you're trying to make a seed strain just from the DNA sequence without using an actual isolate?
TOM FRIEDEN:We do have strains of H7 but because this strain is so different, we don't expect that they would be protective.We have done reverse engineering to produce vaccine strains previously.
BOB ROOS:Thank you.
TOM SKINNER:Next question?
OPERATOR: Thank you.Next question comes from Jonathan Serrie with Fox News.You may ask your next question.
JONATHAN SERRIE: Good afternoon.If it becomes necessary to manufacture an H7N9 vaccine, how would its manufacture impact production of seasonal flu vaccine or would it become one in the same?
TOM FRIEDEN:If it became necessary and we should be clear that at this point that is not what appears to be happening, we do not think it would interfere with the ability to make seasonal vaccine.There are new technologies for vaccine production.We've been adding regularly BARDA has new manufacturers under way.We expect cell-based vaccine it to be available this year.We don't think it would affect availability of seasonal flu vaccine. At this time, we don’t think it would affect availability of seasonal flu vaccine.]
OPERATOR: Thank you.Our final question comes from Donna Young with Script News.Go ahead with your question.
DONNA YOUNG: Thank you.I just was looking for a little bit of clarification again on this seed -- the seed virus that you're working on.Are the manufacturers working on that with you right now or is it strictly the government that's working on that and then you'll turn it over to the manufacturers?
TOM FRIEDEN:It's a joint project.The manufacturers are working – Novartis , J. Craig Venter Institute, ourselves, manufacturers are on contract with BARDA, the U.S. government.We're doing it as a team in concert.Dr. Shaw, do you want to add anything to that?
MIKE SHAW: Right.It's a very wide effort right now looking at several different possibilities.There's the new recombinant vaccine that was recently approved that’s also an alternative.We’re not investing on a single pathway. There’s several different groups going at this.
TOM FRIEDEN:Thank you all for joining.Sunlight is the best disinfectant and there are concerns when we hear about people becoming severely ill and have died in China, the information we have so far suggests that all of the cases have been isolated, that they are mostly associated with spread of this virus in animals, likely poultry, chickens, ducks, geese, pigeons, perhaps.And we're in close collaboration with authorities in other countries, including China, so that we can rapidly learn more about where it's coming from and how -- whether it has spread from person-to-person.This is an example of why we need to keep our guard up and make sure we're prepared to detect and respond to threats as they emerge whether in this country or around the world.So thank you very much for joining.
TOM SKINNER: Thank you all for joining us.If you have the need for follow-up information, please call the CDC press office 404-639-3286.Thank you for joining us.
OPERATOR: Thank you.This does conclude today's conference.We thank you for today's participation.At this time you may disconnect your line.
音频地址：http://www.cdc.gov/media/releases/2013/t0405_h7n9_influenza.mp3 有中文的翻译吗？谢谢！ 老师，拜托有翻译中文的吗？我们{:1_10:}{:1_10:}{:1_10:} 辛苦楼主了，内容很丰富，就是看不懂。
拜托那位老师帮翻译一下，也让我们看看国际形势。 老师，看不懂，有翻译吗？ 看不懂，但又很想懂。拜托了 佳蕙淼淼 发表于 2013-4-7 12:41 static/image/common/back.gif
有中文的翻译吗？谢谢！
接线员：谢谢你站在。在今天的呼叫会话的问题和答案，你可能会问一个问题，按明星之一。今天的会议记录。
汤姆斯金纳：谢谢你，雪莉。谢谢大家参加我们今天的这telebriefing，我们有一个更新的情况下，围绕中国H7N9感染。我们今天是导演，汤姆·弗里登博士的CDC谁去提供一些开场白，然后我们会得到您的问题，我们将加入由乔·伯瑞斯博士，在我们的医疗流行病学流感师。 ，弗里登博士。
TOM FRIEDEN：大家下午好。感谢您参加我们今天。我们要做的就是更新你对当前形势的H7N9在中国。我们得到了很多媒体的电话，所以我们认为这将是最有效的，大家有这telebriefing。首先，我们要更新你关于中国的情况，并在CDC，我们正在采取的保护健康，在美国这里描述的步骤，我们也希望把在中国爆发的来龙去脉和最后，当然，回答尽可能多的问题你的，我们可以得到的。我会提供一个概述的情况和我们的反应，我也想向您提CDC的关系，如何与中国的公共卫生当局还清响应这次爆发对于我们和世界各地的人们，然后我会加入由董事流感流行病学单位，伯瑞斯博士，谁跟我一起会回答你的问题。
截至2013年4月5日，中国公共健康官员已经报告了16例人感染一种新的禽流感A，这就是所谓的H7N9病毒，从四个不同的省份在中国。患者住院治疗，其中6人已经死亡。这是第一个已经确定这个特定菌株的H7N9人类感染。 15例成年人年龄在27至87之间。一个孩子4岁，显然有轻微的疾病。所有病例发病在2月19日和2013年3月31日之间。一直没有人对人的传播之间的任何情况下，到目前为止并没有流行病学联系。有两个家庭围绕一个确认的情况下，这两个家庭的情况下，中国当局正在调查，看是否有在这些情况下，是人对人的传播时间是在一个家庭的疾病。我会说，与其他禽流感病毒株，我们有时会看到在一个家庭的密切接触或保健有限的人对人的传播，但传播只有一代或两代人的传播，而不是多代的传播。所以，当我们说话的人对人的传播，我们真的是看它是否广泛蔓延。
现在，在这一点上，我们是 - 有几件事情，给我们一些信心，它不是从人到人广泛蔓延。一个是已超过100个联系人的评估和监控，由中国公共卫生当局和他们都没有开发的疾病。流感，相反，在你所期望的至少20％到30％的家庭成员发展疾病。因此，有许多接触，也没有疾病已经确定的事实是令人鼓舞的。此外，许多或者大多数的情况下，在调查仍在进行中与活家禽有直接接触。我们也有从中国农机管理局的报告，有鸡和鸽子，并进一步测试正在进行类似的H7N9菌株培养阳性。在这个时候，任何情况下，人类感染禽流感H7N9已在美国发现。
作为协调一致的国际努力的一部分，CDC正在努力解决这种情况。首先，今天我们发出了健康咨询，告知临床医生和公共卫生专家，在美国各地正在发生的事情，他们应该做的，如果他们有一个疑似病例的旅客返回中国，他们应该做些什么方面的测试，感染控制和护理。我们也开发了一个测试，目前正在使用的，使我们可以在CDC测试标本从中国有严重的疾病，可能是流感，并确定他们是否有返回的旅客。我们将采取进一步措施，以开发一种诊断检测试剂盒，我们可以发送到整个美国和中国的国家，使我们可以快速诊断感染前进。来自中国的信息表明，病毒是我们使用的主要抗病毒药物奥司他韦和扎那米韦敏感，我们将确认，在未来的日子，但是这是什么样子。纵观美国政府与制药公司的疫苗生产商开发丰富的谨慎，如果需要的话，可以用来生产疫苗的候选病毒。这只会产生，如果有证据广泛传播从人到人。这是没有的东西，我们看到在这个时候。我们没有发出任何正式的旅游警告。正如我刚才所说，这些感染源尚未查明，但我们知道，中国卫生部门开始扑杀禽鸟市场，作为预防措施，在现场的大约十年中，我们已经建议中国人民美国人在中国旅游时，避免接触鸟类和其他动物。这在自SARS和另一株流感的传播称为H5近十年前的。
我想花点时间谈谈相当于中国疾病预防控制中心的关系。相当于中国被称为中国疾病预防控制中心。我们有一个非常强大的，与他们的长期合作关系。它得到了更强大的SARS之后，中国认识到它需要加强公共卫生体系，我们有一个办事处，在中国疾病预防控制中心保持合作。在过去的许多年的历程中，我国科学家已经有效地帮助中国公共卫生医生为流感监测整个中国庞大的人口，改善他们的实验室测试的流感，学习如何做他们确认的流感病毒株的基因测序，成为世界世界卫生组织合作中心的流感，正因为如此，中国政府能够追踪流感蔓延，但我们可能没有得到很好的了解到这些孤立的情况下，正因为如此，中国政府已公开发表的全基因序列H7N9株，影响着人们在这个集群。其实，我有很长 - 一个长期存在的一系列与中国疾病预防控制中心主任的年度会议，并定期更新，我们进行了一次长谈，昨晚深夜，以确保我们所提供的任何援助，我们可以对这种情况。我们正在人士反对这种迅速查明情况，并采取一切适当步骤。
在我把呼叫转移到伯瑞斯博士回答您的问题，我希望地理解这一点。 CDC常见的两个问题是，我们如何关注和公众应该如何关注有关情况？我会这样说。我们在疾病预防控制中心工作24/7，以保护人民的健康，包括如新出现的流感病毒的威胁。我们工作有市民的背部。这是我们的工作予以关注，并迅速采取行动，只要有一个潜在的问题，如一个在中国。而这正是我们正在做的。至于公众关注，在这一点上没有证据显示该病毒正在从一个人传染到另一个或病毒已经在美国造成任何感染
有没有具体的步骤，在这个国家的人需要好好保护自己。人们可以去了解他们的日常生活。信息可以是一个强大的担心或关注的人的轶事。所以我们在这里做什么是我们所知道的，当我们知道它完全公开，我们可以尽可能多的沟通。多年来，我们一直鼓励中国人，在中国的美国人不是有接触带电市场，因为流感等感染，可以传播，我们将继续与建议。我们将继续通过我们的网站，只要我们有提供最新资讯。有发展，我们还将继续需要更新。谢谢。
TOM斯金纳：雪莉，我相信我们很愿意回答大家的提问，请。
接线员：谢谢。现在，我们将开始答问。如果您想请教一个问题，请按星1。系统将提示您录制您的姓名。再次，按星1问一个问题，一个时刻为我们的第一个问题。我们的第一个问题来自伊丽莎白·魏斯与“今日美国”继续你的问题。
伊丽莎白WEISS：感谢我的电话。我想问一些关于病毒种株的工作。您能否谈了一下，什么时候开始的，什么 - 它代表目前在哪里？
TOM FRIEDEN：由于遗传序列是可用的，我们能够 - 而且厂家能够做到逆向工程[编者按：“逆向工程”，更准确地表述为“合成生物学技术”开发一个潜在的疫苗株。防备和应对的助理秘书长，博士本站Lurie和巴尔达与制药厂商，谁在这方面的工作，使种子株是可用的，如果需要的话，尽快和合约的合约HHS，巴尔达ASPR，因为它是所谓的，与制造商确保他们做什么是开源[编者按：由于开发候选疫苗病毒会被自由共享]。换句话说，这将是提供给任何人。我想，把它交给博士进一步解决的问题是我们的流感实验室主任麦克·肖。
MIKE SHAW：没错。根据这项合同，巴尔达创建合成基因，他们正在共享。我们使用的是他们尝试开发一种候选疫苗株的公司。有许多不同的方法。许多不同的公司和组织都在努力工作，尽可能快地得到应变，将尽可能广泛地共享，以确保疫苗的生产可以尽快收到。
汤姆斯金纳：你是否有跟进吗？
伊丽莎白WEISS：不应该这样做。
接线员：下一个问题来自法尔科仪，CNN医疗新闻。你可能会问你的问题。
仪FALCO：你好，医生。谢谢。我有点困惑，因为根据世界卫生组织新闻稿，他们说，五个实验室确诊病例，其中一人死亡，由于人感染A型流感H7N9病毒，你说现在的两倍并无人对在人与人之间传播，一种可能的情况。我知道你不说话的世卫组织，但你们显然他们交谈。哪一个是什么？
TOM FRIEDEN：因此，让我们清楚。我们拥有的是16日报道，确诊病例。所有这些案件是孤立的案件。有已确定的16个不同的人之间没有流行病学联系。有两个这16个家庭中有其他人生病，继续进行评估，看是否有家庭内传输。尝试要清楚的一件事，我们来看看两件事情，当我们看流感。首先，是多么恶毒的应变和第二，如何容易，它是人与人之间的传播。 ，第一个问题而言，剧毒，致命的是，我们不会知道，直到我们能够测试更大数量的人看到，如果16人以上的有。这可能是数以百计的其他人有轻度感染，这些人只是冰山一角，或者它可能是，这是一个罕见的事件，它通过从动物到人，那几个人谁是不幸收缩从动物的感染，这是一个非常严重的疾病。第二个问题是，它很容易传播从一个人到另一个？而在这一点上我们看到的一切表明，在这一点上，是不会发生。
FALCO仪：所以它仍然是准确的说，没有人对人的传播？
TOM FRIEDEN：...已经被记录在案，截至目前。正确。
仪FALCO：截至目前。然后，我的问题是关于这个特殊的病毒。这是我们已经看到了它在人类有史以来的第一次。您认为可能使更多合资格的迅速改变，迅速改变变得更加容易传播这种病毒是不是有什么吗？
TOM FRIEDEN：这种病毒不寻常的特点之一是，在动物，它通常会导致轻微的疾病。所以这是不寻常的，虽然不是闻所未闻的，针对病毒引起轻度病毒动物，但在人们的严重的疾病。一种可能性 - 我们会知道这在未来一周左右 - 是，它是在动物中相当普遍。有时，当有H5暴发的事情，比如，你有一个线索，因为有鸟相继死亡或生病的羊群。这可能不是这里的情况。这件事情，我们可能会发现随着时间的推移。
接线员：谢谢。我们的下一个问题来自迈克·施托贝与美联社。你可能会问你的下一个问题。
MIKE施托贝：感谢您对我的问题。我向你道歉。我错过了第一对夫妇分钟。他们多大年纪，你能不能多说一点有关的16例，他们是什么性别，做他们有什么共同特征，这可能会使他们更严重的疾病吗？我有一个后续的问题有关，你能告诉我什么的流感监测系统是在中国，它是一个Marshfield诊所类型模型或它是什么，你已经帮助他们开发？
TOM弗里登博士伯瑞斯将采取的第二部分。十五的情况下，是在****年龄27到87。一种情况是在孩子4岁。我们没有诱发医疗条件的所有信息，但它似乎有许多，如果不是大多数的个人，也有与现场市场，与家禽有流行病学联系。伯瑞斯博士，监视？
JOE伯瑞斯：监控系统在中国已经真正显着提高H5，引进的催化剂，因为在过去十年左右。他们做的事情，重要的是一对夫妇。一个问题是，它们具有很宽的分散液，可以检测出流感实验室，一般来说，使用的最好的方法，被称为PCR。他们有这些实验室已经长大了，过去几年全国各地的超过400。他们真的有能力寻找感，无论它是在国内。他们也有大约同等数量的网站，寻找流感的疾病，测试人员和计数人，其中住院的人民和来诊所。如果你认为中国有能力，检测疾病群集，发现新的疾病，怎么看这个潜在的爆发可能会或可能不会蔓延，我认为他们是作好准备，做到这一点。
TOM斯金纳：迈克，你有一个后续？
运营商：请稍等，来吧，迈克。
MIKE施托贝：我没有后续。
TOM斯金纳：下一个问题，雪莉？
接线员：下一个问题来自理查德·诺克斯与全国公共广播电台。你可能会问你的问题。
RICHARD KNOX：即使没有任何明确的证据的人到人的传播，我收集流感样增加在该地区没有信号，南希·考克斯告诉我，遗传分析表明，该病毒可能更容易感染哺乳动物细胞比H5N1确实，我不知道如何可以调和这两个种类的信息，以及如何严重的遗传分析，重当前威胁评估。
TOM FRIEDEN：所以我们总是要在演唱会的流行病学模式的基因序列进行分析。这种微生物的基因的一些方面部分适于对哺乳动物，这表明它们可能在猪或其他人群中已经使用了一段时间，它是真实的。但最终的事实是，我们没有见过的情况下接触，我们还没有看到普遍的情况下，儿童，我们还没有看到一个尖峰都让人放心。大多数情况下还是很多的情况下有过直接接触的可能的载体，我认为所有这一切都让人放心。但是，当然，一个很仔细看的东西，我们是流感的持续发展。即使结束了这个有机体不会有直接接触动物的人相比，总是有风险的，它会继续发展，在猪流感或其他人群，在未来变得更具传染性。而这仅仅是说，我们今天是在没有较大的风险比我们之前两个星期前，我们都知道它。但我们总是要准备新兴的安全威胁，这就是为什么我们监视他们，这就是为什么我们非常迅速地回应时，他们可能会出现。
TOM斯金纳：下一个问题，雪莉？
接线员：下一个问题来自贝瑟（Richard Besser）与ABC新闻。你可能会问你的问题。
贝瑟（Richard Besser）：感谢您对我的问题。我有两个。首先是，有没有办法告诉新型病毒是如何，是否会有任何人群免疫力？是否有过H7或N9之前已经流传？第二个是后续理查德·诺克斯的问题。有什么办法看病毒的告诉将需要多少突变涂抹从人到人吗？
TOM FRIEDEN：所以，因为这种病毒有 - 是不是此前流传的流感病毒，有没有人群免疫力，因为我们知道这个特殊的H7菌株。因为它并不影响人，人们还没有发展到它的免疫力。有没有具体的说，到底是什么将成为更好地适应人对人的传播方式。
RICHARD BESSER：非常感谢。
接线员：谢谢。下一个问题来自埃布朗与福克斯新闻电台。来吧，您的问题。
BROWN EBEN：非常感谢你。欣赏的时候，医生。你曾提到，一直没有案件在美国报告。是否有任何机会，今年在西半球到别的地方，最终可能找到自己的方式进入美国？
TOM FRIEDEN：这就是为什么我们与各国合作，在世界各地有流感监测系统，它肯定是可能的，它可能蔓延到中国邻近国家或国家和来自中国的旅客谁在现场市场。在这一点上，它看起来像直接接触活禽中国是主要风险因素。但是，由于流感可以出现在任何地方在世界上，它在所有我们的最佳利益，有良好的流感监测系统在世界各地及，为什么当我们不生产诊断试剂盒，我们分配他们到100多个国家和我们帮助的国家周围做自己的流感监测工作。它可以保护它们，保护我们。
TOM斯金纳：下一个问题，雪莉？
接线员：下一个问题来自Maryn麦肯纳与Wired.com。来吧，您的问题。
MARYN麦凯纳：非常感谢你为这个呼叫。我们能听到一点点像中国在动物方面的监控是什么？我认为伯瑞斯博士描写人类的监控，但我有兴趣在鸡在寻找这种病毒，因为它是通过鸡或鸽子或任何涉嫌水库是超越了通话是怎么回事。
JOE伯瑞斯：谢谢Maryn，这是乔。我会说，在中国的动物卫生当局已发出指引监视这种病毒在家禽中人口，鸭种群，中国在这一领域的市场中存在的任何鸟类种群。现在他们已经从事一个非常系统化的监控系统在未来一周左右，打算弄清楚这种病毒的范围是什么，它可能存在什么样的人群英寸，所以我认为我们可以期待，弗里登博士说，在接下来的两个星期，一些额外的数据，为了更好地发现宿主动物的病毒，我们认为将是重要的识别人类预防策略。
麦凯纳MARYN：我可否跟进？
JOE伯瑞斯：当然可以。
MARYN麦凯纳：你 - 还有什么你可以说，监控的地方，我指的是，它是在直播市场等领域面临的人，它是在农村更多吗？他们在看小农场控股，新的大型农场大吗？
JOE伯瑞斯：这是一个很好的问题。中国当局告诉我们的是，监视extenuated将集中在这些省份，目前有人类病例的疾病，但冲着这两个市场，工业农场和小农场。
MARYN麦凯纳：超级。谢谢。
TOM斯金纳：下一个问题？
接线员：谢谢。接下来的问题是从贝特西麦凯华尔街日报，你可能会问你的问题。
贝特西麦凯：只是一个快速的问题关于监控。我想知道，你可能了解什么水平，加强监测，可能会在其他亚洲邻国，因为这个。
JOE伯瑞斯：这是一个很好的问题。我们现在知道的是，一些亚洲国家，特别是一些从中国接壤的国家已做extenuated监控无论是在社会上，他们正在测试严重老人寻找引进这种病毒或偶尔在机场他们筛选发烧，例如，传入乘客。我不能说，我知道的确切范围extenuated监控，但我们听到同事老挝，柬埔寨Thiland，台湾和越南，他们都在寻找这种病毒提高他们的监视有国家在世界各地，我可能会说。
贝特西麦凯：好吧。谢谢。
接线员：谢谢。下一个问题来自鲍勃·鲁斯与CIDRAP新闻。
BOB的原产地规则：谢谢。一对夫妇的问题疫苗种子株。我想知道，如果你有任何现有的疫苗种子株其他H7子型病毒，如果是这样，如果你打算测试看看他们是否提供交叉保护，我想知道，如果这是第一次，你想使菌株的DNA序列，而使用一个实际的隔离？
TOM FRIEDEN：我们有H7菌株，但因为这株是如此的不同，我们并不指望他们会保护。我们已经做了逆向工程以前生产疫苗株。
BOB的原产地规则：谢谢。
TOM斯金纳：下一个问题？
接线员：谢谢。下一个问题来自乔纳森Serrie与福克斯新闻。你可能会问你的下一个问题。
JONATHAN SERRIE：大家下午好。如果需要制造的H7N9疫苗，如何将其生产的影响生产的季节性流感疫苗或将成为在同一个吗？
TOM FRIEDEN：如果它成为必要，我们应该清楚，在这一点上没有什么发生，我们不认为它会干扰的能力，使季节性流感疫苗。有新的疫苗生产技术。我们一直定期添加巴尔达有新的厂商正在进行。我们预计，基于细胞的疫苗，它是今年。我们不认为这会影响季节性流感疫苗的可用性。 [编者按：在这个时候，我们不认为它会影响可用性的季节性流感疫苗。]
接线员：谢谢。我们的最后一个问题，来自唐娜年轻的脚本新闻。来吧，您的问题。
DONNA杨：谢谢你。我只是一直在寻找一点点澄清再次上seed - 种子病毒，你的工作。是制造商工作，现在和你在一起或者是严格的政府工作，然后你就会把它交给厂家？
TOM FRIEDEN：这是一个联合项目。制造商正在努力 - 诺华[合成基因疫苗协同工作，公司，J. Craig Venter研究所，我们自己，制造商都在巴尔达，美国政府合同。我们正在做的是作为一个团队在演唱。 Shaw博士，你要不要添加任何？
MIKE SHAW：没错。这是一个非常广泛的努力，现在看几个不同的可能性。有新的重组疫苗，这也是另一种最近被批准。我们不投资的单一途径。有打算在这几个不同的群体。
TOM FRIEDEN：谢谢大家加入。阳光是最好的消毒剂，并有顾虑，当我们听到有关的人变得病重，已经死亡，在中国的信息，我们迄今已表明，所有的情况下，已被隔离，他们大多与这种病毒的蔓延动物，可能家禽，鸡，鸭，鹅，鸽子，也许。而且我们在其他国家，包括中国与有关当局密切合作，使我们可以迅速了解更多关于它的未来和如何 - 无论是从人到人传播。这是一个例子，为什么我们需要保持我们的后卫，并确保我们准备检测和应对威胁，因为他们的出现是否在这个国家或世界各地的。所以，我非常感谢你的加入。
汤姆斯金纳：谢谢大家参加我们的。如果你有需要跟进的信息，请致电404-639-3286 CDC新闻办公室。感谢您加入我们的行列。
呵呵，谢谢！还是能看懂部分的。{:1_14:}{:1_14:} 谢谢老师的翻译，看懂了一部分，继续学习
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