Thursday, October 10, 2013
ROCHESTER, Minn. — Flu season is under way, but how many Americans have been hit so far, how badly, and which influenza bugs are to blame is unclear. That information is important to prevent and manage outbreaks, and it is crucial for creation of the next batch of influenza vaccines. But this flu season, the nation is flying (and coughing, and sneezing, and maybe worse) blind. That's because the agency that normally keeps the country on top of influenza outbreaks — the Centers for Disease Control and Prevention — is largely out of commission due to the federal government shutdown. Mayo Clinic infectious diseases expert Gregory Poland, M.D., explains what the CDC normally does and what federal furloughs mean to efforts to protect people from contagious illnesses.
MULTIMEDIA ALERT: Video of Dr. Poland is available for download from the Mayo Clinic News Network.
What does the CDC normally do to track outbreaks?
Dr. Poland: "The CDC has as one of its seminal missions infectious disease surveillance globally and nationally, and they're the only entity in the U.S. that tracks these things nationally. So now you've got a week, two weeks, who knows how long, where there's no one really responsible for watching what's happening nationally. What kinds of diseases are we looking at? We're starting influenza season, there are measles and rubella outbreaks occurring in the world, polio, enterovirus, the coronavirus that we've seen out of the Middle East, avian influenza. There are an endless number of infectious disease threats that, as we often say, are an airplane ride away from us. Who's going to monitor this over this time period?"
Does it matter if no one keeps track for a few weeks?
Dr. Poland: "The issue is this happens in real time. Think back to February 2009 when we were beginning to get the sense of a pandemic virus arising out of Mexico. Well, there were some unusual respiratory diseases in Mexico; CDC is aware of it, the World Health Organization is aware of it, then spotty cases occurring in the Southwest and then a bunch of cases in the Northeast part of the United States. Who put that together into understanding, we've got a transmissible infectious disease, it's respiratory in origin, looks and acts like influenza? CDC receives the virus, sequences it and voila, we understood that we had an influenza pandemic on our hands. All of that inside a couple of weeks. So that's how fast these things can move and why you need somebody really doing that real-time surveillance."
Why can't states just band together and do it?
Dr. Poland: "The state public health departments can look at what's happening in their state, if they have the resources, but nobody can piece together what's happening across states, across countries, and develop a comprehensive collage of what the threat might be for the American citizen. CDC has mechanisms to incorporate data from all of the states simultaneously. They have personnel who can actually go into the states and investigate outbreaks. They have personnel who are authorized to go outside the continental U.S. and look at outbreak investigations and piece all that information together. No state has that capability or authority."
Why can't the World Health Organization do it for the U.S.?
Dr. Poland: "They can do some of it, but their responsibility is not the United States. Theirs is a global mission. The CDC's responsibility is the United States. That is the federal entity that has stood up to protect the average American citizen against these health threats, particularly infectious diseases."
What does the government shutdown mean this flu season?
Dr. Poland: "Normally what would happen is CDC is gathering respiratory specimens from around the world, getting hundreds of thousands of respiratory specimens in and then screening those to determine what viruses are causing disease. When they understand it's influenza, they actually do genetic sequencing of those viruses to determine does this pose a unique threat, is it a potentially pandemic virus, is it resistant to antivirals, so a lot of valuable information, in addition to tracking what's happening. It means what we don't have, whether it be for influenza or any infectious disease, we do not have a key ingredient with which to protect ourselves, and that's situational awareness."
What does the government shutdown mean for the next flu season?
Dr. Poland: "All of this season we will collect influenza respiratory specimens, they'll be sent to CDC, and other countries too, but to CDC, they'll be sequenced, we'll understand what kind of viruses or bacteria are causing disease. To the extent that they're influenza virus, we will understand which strains of influenza virus and by February, no later than this February, determine what's going to be in the vaccine for 2014-2015. We're behind the curve this year."
Dr. Poland serves on the CDC's Advisory Committee on Immunization Practices and the Defense Health Board. At Mayo Clinic, Dr. Poland heads the Vaccine Research Group and the Program in Translational Immunovirology and Biodefense and is the Mary Leary Professor of Medicine. To arrange an interview with him, please contact Sharon Theimer in Mayo Clinic Public Affairs at 507-284-5005 or email@example.com.
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