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CDC Telebriefing Transcript

SARS: Latest regarding the Lab Investigation of SARS Virus

March 24, 2003

DR. GERBERDING: I'm here today to give you an update on the evolving investigation of SARS, the Severe Acute Respiratory Syndrome, that has been an emerging problem over the last several weeks.

We are continuing to collaborate with WHO and the other international investigators to understand the modes of spread, the causes of illness and what really is the best way to prevent spread and treat the patients. Of course, our greatest concern is for the family members and the individuals who are suffering from this illness or worried about this illness, and we have you in our hearts and are doing everything we can to solve this epidemic for you.

Today, we are reporting an update from WHO that indicates there have been 419 global cases of SARS, plus 39 cases that have been identified in the United States. You can kind of get an impression here from this map that shows increasingly this is truly a global problem. There are more and more countries affected and more and more states within the U.S. who are reporting individual cases.

Of the 39 cases in the United States, I think it's important to point out that we still are seeing a pattern that's been very consistent. Thirty-two out of thirty-nine of these individuals have traveled to parts of the world where cases are prominent. The others are either health care personnel or close family members who have been in direct contact with a suspect case. So we are not seeing spread in the community at this point in time.

And again it emphasizes how important it is, when individuals present with a febrile illness and respiratory syndromes, that a history of travel or history of contact with someone who has recently traveled to these areas be taken. And if there's any suspicion of SARS, that the individual be immediately put into respiratory isolation until additional findings are available.

We are also here today to tell you a little bit about what is happening in our laboratories and in the laboratories of our collaborators internationally with respect to the viral cause of this infectious disease. We are reporting today that our evidence indicates that Coronavirus, a new Coronavirus is the leading hypothesis for the cause of this infection.

You've heard reports from other laboratories internationally that are also concerned that Coronavirus may be an etiology. Coronavirus is not a Paramyxovirus, it is not a Metapneumovirus. It is a family of viruses that traditionally have caused common illnesses like colds and upper-respiratory tract infections and can be quite contagious.

But the information we have today suggests that this virus could, in fact, be a part of, if not the entire cause of SARS, at least contributing to the SARS, and let me tell you what the evidence is to support that from our laboratory.

We, as you know, have been gathering specimens in conjunction with our collaborators around the world, including tissues from patients who have died of this disease, blood specimens, so that we can measure their antibodies and various other fluids and secretions that they become available.

We have been able to culture Coronavirus from two of the patients that we've evaluated so far of the four that we have tissue from. In one patient, the tissue is culturing virus in our laboratories, but in addition we can see the virus, and you can see here pictures of what this virus looks like in tissue cultures. What you see is a circular virus that looks like it has a corona or sort of a crown effect, and that is basically little spikes and protein globules that surround the virus so that it gives it that very characteristic appearance.

This is the enlarged picture, and then over here on the left we see many virus particles as they've been growing in tissue culture, and on a lower power magnification some sense of the size of these particles in the context of an overall cell.

I think the important message here is that we've grown it out of two of the patients that are affected. That, in and of itself, does not imply causality because we have many common respiratory viruses that could be cultured out of patients. But what's interesting to us is not only are we culturing it, but we're finding evidence of it in actual affected tissues.

In one patient, we see the virus in kidney specimens very clearly on the electron microscope. We also have done PCR, which is a way of probing for the genetic material of the virus, and we're finding virus PCR, very specific evidence of that, in lung tissue, as well as the kidney in this individual patient.

Also, this patient, when tested with an antibody, in an antibody test to the virus, had a negative antibody test at the very beginning of the illness, and by the end of the illness that antibody test had become positive. So, in other words, the patient seroconverted using a very specific assay for this new Coronavirus.

We have evidence of an infection in seven other patients that we've evaluated so far. The evidence is in a variety of forms. A total of three patients have seroconverted, meaning they had a negative test and then a positive test in paired serum later in their illness, and we're actively getting late serum now from many of the suspected cases so that we can see if others will seroconvert as their illness progresses as well.

We also are finding evidence of the virus genetic material in lung secretions, in lung tissue and in many, many other samples. So as the day progresses, and as the week progresses, we will be looking at more specimens with more tests. And in collaboration with our partners in the global arena, we hope to be able to ascertain whether this really is related to the onset of disease and, if so, what is the relationship.

This, in scientific terms, is very strong evidence supporting Coronavirus as an etiology, but we know from sequencing pieces of the virus DNA that it is not identical to the Coronaviruses that we've seen in the past. So this may very well be a new or emerging Coronavirus infection, but we also are very respectful of the findings of other laboratories that are collaborating in this investigation, and it's very premature to assign a cause or to make dogmatic statements about the etiology. We're still learning as we go, and we will maintain that spirit of collaboration.

Just to give you a sense of what that collaboration involves right now, we communicate through the WHO's collaborating group on a daily basis, through a secure Internet site, and the scientists from the various laboratories in Asia, in Europe, in the United States and elsewhere are sharing their scientific information.

They're posting these pictures on their secure Internet so that they can understand each other's work. They are exchanging reagents, sharing specimens and tissues, and really I think doing an exemplary job of how the global scientific community can come together to combat a global epidemic.

But in addition, we're collaborating with academic partners. Earlier this week, we sent DNA out to a laboratory at the University of California, San Francisco, so that they could do the absolute state-of-the-art probe for virus genes and help us identify the cause.

We are also collaborating with the Department of Defense, who has agreed to, on a very rapid track, set up some capacities to develop testing reagents so that we can get these materials out to the state local laboratories and the medical community and get better tests for diagnosing these conditions. The Department of Defense has also agreed to test the virus against various anti-viral* drugs to see if we can identify a drug that might be effective in treatment.

So the epidemic is characterized by global expansion, but our response to it is characterized by global collaboration, and I think on the fastest possible track we are scaling up, and speeding up and doing absolutely everything we can to get to the bottom of this so that we can prevent spread and treat the affected people.

So let me just stop there and take whatever questions you may have.

QUESTION: Diana Davis from WSB in Atlanta.

Following up on what you just mentioned about a way to test for the virus, if this is in fact a virus, and also a drug to treat patients. I know you really have no way of knowing, but people will still ask what's the time line? How soon might there be a test? How soon might there be a drug?

Can you give the public any words of encouragement on those issues?

DR. GERBERDING: Well, I think a number of laboratories are very encouraged that we are getting close to having a test that could be used clinically, but testing really does depend on accurate understanding of what is causing the problem and then some knowledge about how sensitive the test is and how specific it is for this particular illness.

So in order to translate what we're doing in the research laboratory into a clinical environment, it's going to take some time and some patience as we understand the accuracy of what we have available. So I would predict that would be weeks, certainly not days. And in order to get a commercial available test, of course, that will take much longer. But we are doing it as fast as we absolutely can.

Maryn?

QUESTION: Maryn McKenna, Atlanta Journal Constitution.

Could you be a bit more specific about the number of specimens you have and the type of specimens you--so many tissues, so many sera, so many antibody studies, and also from where in the world those samples came?

DR. GERBERDING: Maryn, I'm not going to be able to give you that specific information in this context, but we can work with you on getting a little more specificity there. We have samples that have come in from various patients in Asia, including Hanoi, Hong Kong. I believe we have an isolate from a patient in Singapore.

And we're working very hard domestically to get at least blood specimens from all of the patients in the United States so that we can do that antibody testing here, and we don't have them all yet. In particular, we're looking for the follow-up specimens because that would be the way we would be able to identify seroconversion.

So getting specimens is always the challenge, but we, compared to just earlier this week, we've come a long way and are much more optimistic that we have the materials and are being able to share the materials that we need.

We have tissue specimens from four patients at this point in time.

Do I have a phone question, please?

AT&T OPERATOR: Yes, our first question comes from the line of Jennifer Wagner with WebMD. Please go ahead.

QUESTION: Actually, that's Jennifer Warner from WebMD.

I was wondering if you could compare the significance of this finding to the excitement that was expressed last week regarding the other group of viruses, and can you compare how damning this is compared to the earlier findings and how this might affect the development of treatments for this.

DR. GERBERDING: I think that any time you make a discovery in the context of such a serious problem, there's great excitement and great enthusiasm to take it to the next step.

We always debate whether it's appropriate to provide information and at what point do we have enough confidence that it's safe to bring it out in the open or is it too preliminary. We scientists like to dot our "I's" and cross our "T's" and get as much information together before we make it public.

On the other hand, this is an evolving problem, and I think different laboratories have had different thresholds for what they want to bring out, but certainly the more we know and the more we exchange information, the faster we will be able to either confirm or refute a given hypothesis.

Right now, for us, this is a hypothesis. It is our leading hypothesis based on careful science that has been conducted by some of the world's best scientists and our collaborators around the world, but there are a lot of other potential explanations for what we're finding here, and we are exercising caution and not being dogmatic that we have the answer here, and I think the other laboratories have said the same thing.

Everyone is keeping an open mind, and we understand that the challenge here is we've got a pretty nonspecific illness, and we're dealing with families of virus, whether we're talking about Coronavirus or Paramyxovirus or Metapneumovirus that are ubiquitous, and finding them in tissues is not the same thing as saying that they're causing the disease.

Having said that, I think we've gone a bit further and are being able to localize the virus in affected tissue using some pretty sophisticated probes and tissue techniques and our confidence is building.

A question from the floor over here.

QUESTION: Dr. Gerberding, from the Wall Street Journal, just a clarification question, just for clarification.

Since the Coronavirus has not, as it seems, been known to be deadly before in humans, could you give us any information on what is different about this virus, maybe the origins of it, you know, anything you can tell us on that.

And, secondly, given the fact that there are tests going on for a drug, what advice do you have for treatment at this point?

DR. GERBERDING: Let me ask Dr. Anderson to answer the first part of this question. He's an expert on respiratory viruses, and he may have some context on this particular question.

DR. ANDERSON: It's true that the known Human Coronavirus, the only clear link to the disease has been respiratory, really, the common cold virus. There has been suggestion, but it's kind of a hypothesis, that it's related to gastroenteritis and even some neurologic disease.

In animals, it's been associated with more severe disease. So there's a range of illness associated with Coronavirus, but not really in humans.

The source of this virus, we have no idea. We just don't have enough information. We'll be getting more information as we get more sequence data, but right now we don't know.

QUESTION: [Off microphone.] [Inaudible.]

DR. GERBERDING: Dr. Larry Anderson, chief of the Respiratory Pathogens Branch at the National Center for Infectious Disease. We all have very long titles here.

Go ahead.

QUESTION: Sabrina Gibbons from WSC(?) Radio. I wanted to ask you about the 39 cases here in the U.S. You said 32 of 39 traveled to affected areas. I want to ask about the other seven. Were they in close contact with those people? And are there any cases in Georgia?

DR. GERBERDING: The patients who are not travelers to the affected areas of the world are people who either have lived in the home with a case patient and had very close face-to-face contact or health care personnel who had very close contact without using respiratory precautions. And I'm not going to comment on the specifics of the location of any of the cases, but you know you can follow that up with the state health offices.

I want to get back to the second part of your question which we didn't answer which had to do with treatment recommendations. And let me just say that we're not aware of any specific treatment for coronaviruses that would be relevant to this particular situation, so we're not recommending specific therapy for individuals, but that is part of why we were so fortunate that the Department of Defense has agreed to step up and evaluate all of the known, relevant antiviral compounds against this family of viruses to see if we'll be able to find anything that works. We'll actually be able to at least test against this specific coronavirus in those assays. So if they find something, that might give us a clue to where we could go next for treatment.

Is there a phone question?

AT&T OPERATOR: Yes, we have a question from the line of Lisa Kreeger (ph) with San Jose Mercury News. Please go ahead.

QUESTION: Yes, thank you. This may be a question for Dr. Anderson, actually. I wonder what PCR tells you about where this--what you're announcing today, where this fits in with what we know about the family of coronaviruses. Is this some sort of out--way outlier genetically? What can PCR tell us about it?

DR. ANDERSON: Well, the PCR per se just tells us that it's coronavirus, and then we sequence it to get more information. Based on the sequence studies--and it's limited sequence studies in one gene of the virus--it suggested different--about equally different as the three kind of antigenic groups within coronavirus that have been characterized so far. So it's different than the other ones that we know about from that--

DR. GERBERDING: Just to clarify, I think that what Dr. Anderson was talking about, that there are three sort of groups of coronaviruses, and this one, if the sequence data pan out as more of the viruses like that, would really fall into a fourth group.

Can we take another phone question, please?

AT&T OPERATOR: Yes, our next question comes from Erica Nadowski (ph) with the Baltimore Sun. Please go ahead.

QUESTION: Can you update us, Dr. Gerberding, on the quarantine efforts and what's being done here in this country to prevent the transmission and spread?

DR. GERBERDING: Let me separate that into quarantine, meaning how are we handling ill people who are arriving into the country, and I'll ask Dr. Cetron to address that, as opposed to isolation, which is how we handle a situation where someone presents to a health care facility with what might be the illness. And right now the isolation recommendations are the same as we would use for someone with tuberculosis. In other words, the patient is put in a respiratory isolation room that has negative air pressure so that the air does not penetrate into other parts of the health care facility. The health care personnel in contact with that individual wear a respirator, N95 fit-tested respirator, to protect themselves, and then they also use precautions to avoid direct contact with body fluids and mucus membranes with the virus. So they would wear a face shield, for example, if they were doing a procedure where splatter was apparent. And, of course, they would wear a gown and gloves and use appropriate hand hygiene to avoid cross-contamination.

Do you want to take the other part of the question as it relates to incoming passengers?

DR. CETRON: As I mentioned previously, we're continuing to alert all inbound arriving passengers from the affected areas using passenger alert cards. To date, this amounts to about 62,000 passenger alerts cumulatively since it began on the 15th. And it's roughly 65 different internationally arriving flights that are being met at the ports of arrival. All passengers are being given a card, the health alert card that we passed out at the last conference.

DR. GERBERDING: That was Dr. Marty Cetron, C-e-t-r-o-n.

Can we have another phone question, please?

AT&T OPERATOR: Yes, our question comes from John Lollerman (ph) with Bloomberg News. Please go ahead.

QUESTION: Hi. Thanks for taking my call. Could you tell us a little bit more about finding the coronavirus? That is, could you be a little bit more specific about how and where you found it and why that makes you suspect this is the cause? And also tell us--I understand other labs have the ability to use PCR. Was your use of PCR somehow unique or did you have--were you using tools not available in other labs? Give us more idea, a better idea why you're looking at coronavirus as opposed paramyxovirus. Thanks.

DR. GERBERDING: I'm going to answer this question in the microscopic view, and then I'll ask Dr. Anderson again to provide some specific details for a more scientific explanation.

I think what we're really saying is that it isn't enough to just find virus in one patient and one tissue. What we're looking at here is the conversion of a variety of different methodologies. We can culture it. We can see it on electron microscope in respiratory fluids. We have now very specific PCR assays that are picking it up in a variety of different tissues and specimens. We see that patients have antibodies that react to it over the course of their illness. And we're looking for it in a variety of affected lung tissues and getting some immunologic evidence that it's probably there.

So we're getting information in from a variety of different kinds of testing, all of which are pointing us in this direction right now at this point in time. But maybe you can speak a little bit more technically to the causality issues here.

DR. ANDERSON: Well, there are a couple of issues. One is identifying the agent in the affected tissue, and we've got some evidence of that. The histopathology results are showing it by pictures in the tissue. It's pending, other than EM and some bronchio-alveoli lavage specimens.

Sequence data that we don't have yet but suggest it's exactly the same virus in all the patients and from multiple sites would be helpful as well to say that this virus, in fact, started at one place and spread globally. We don't have that information, but that's some of the data that we're working on.

DR. GERBERDING: I think it's also, you know, important to put out what some of the hypotheses are here. It's certainly within the realm of possibility that this still could be an incidental finding, although that's looking increasingly doubtful. It could be part of a co-infection where perhaps more than one agent is necessary to cause disease in individual patients. Or, of course, it could turn out to actually be the cause.

When you see patients as distributed widely across the world as the patients involved in this epidemic, there are going to be other viral infections circulating in the communities. And so we have to make sure that we're sampling patients from all of the affected areas and finding the same thing, or we could get confused by some other problem that's going on in a particular location.

I might ask Dr. Hughes here to just put what's happened in the last ten days or so in the context of other emerging infectious diseases, because I think one of the things that is so remarkable about what's happening right now with this community of collaborating scientists is the speed with which our biology has really come together.

Dr. Hughes, Dr. James Hughes is the director of the National Center for Infectious Diseases.

DR. HUGHES: Thank you, Dr. Gerberding.

I hope all of you appreciate how significant this is as an illustration of the global sort of threat that infectious diseases can pose. This is most reminiscent in my experience of the hantavirus pulmonary syndrome episode that was recognized back in 1993. If you recall, that was an illness recognized in the Southwestern part of the United States that was very severe and killed previously healthy young people. And we brought a broad range of laboratory procedures at the time together to sort out that cause and were very surprised to find a previously unrecognized hantavirus as being responsible, using many of the same techniques, which are more--the techniques today are more sophisticated than the ones we had in 1993, but many of the same people who are working on this investigation are exactly the same ones who worked on hantavirus in 1993.

The thing that's really remarkable about this and unprecedented is the extent of the international cooperation and collaboration which Dr. Gerberding mentioned. But you should follow this. I would say this is historic. The laboratories around the world who at other times might be competing with each other to be first to sort this out are sharing all their information on a daily basis as it's developing, and that's why we're able to make as rapid progress as we have made.

But stay tuned. There's more coming.

DR. GERBERDING: If we can take a phone question, please?

AT&T OPERATOR: Thank you. Our question comes from Elizabeth Caldon (ph) with CBS News. Please go ahead.

QUESTION: Good afternoon. Dr. Gerberding, back to this issue of treatment, I'm just wondering if you're not making any recommendations at this point, are there drugs out there that have traditionally been successful dealing with the coronavirus? And are the 39 cases in this country being treated in any uniform way, or is it just sort of hit or miss on the part of the physicians?

DR. GERBERDING: Well, first of all, remember that up until now coronaviruses have been causes of the common cold, and there is no specific treatment for the common cold. We wish there was, but that just hasn't been something that has been successfully developed. So, no, there is no on-the-shelf medication that we know has activity against this particular family of virus. That's why we've asked the Department of Defense to put drugs through the screening with this new virus that we have provided them.

But the patients who are ill with pneumonia and other components of this syndrome in the United States are certainly getting medical care. They're getting the recommended treatment for community onset pneumonia in their appropriate age group, and there are very specific treatment guidelines that have been promoted by the Infectious Disease Society and others to help guide the treatment of pneumonia when you don't know what the etiologic cause is. And so the patients are receiving antimicrobials, usually antibiotics, because sometimes it's difficult, at least up front, to rule out a bacterial cause, and they're all getting appropriate levels of supportive nursing care and so forth.

So we don't have a specific treatment targeting this virus or any of the other viruses that are under investigation, but the patients are in good hands and receiving good medical care. And the fact that many of them are improving both here domestically and internationally suggests that the majority of people will be able to survive this illness if they are in good medical care, and we're optimistic that will be the case for most people.

Can I have another question from the floor?

QUESTION: I have two follow-up questions, and I think one's for Dr. Anderson and one's for Dr. Cetron.

The quarantine and isolation question first. Has any more patients been met by the Quarantine Division at planes, at flights or boats or anything like that and taken into isolation? You said on Friday that five had been at that point.

DR. GERBERDING: Marty, do you want to come to the podium and address that?

DR. CETRON: The stations continue to follow the protocol of meeting arriving ill passengers, whether that be by air or by sea. As far as--since Friday, there have been no new meetings of flights for arriving ill passengers by plane. We did have--we did meet a cargo ship and it turned out that the folks on board across the long journey from Hong Kong to the West Coast were well by the time our team boarded with the health department, state and local, and so that situation went quite smoothly.

QUESTION: So they were not taken into isolation?

DR. CETRON: There was nobody ill that needed to be placed in isolation, and the cargo ship was not put under any quarantine.

QUESTION: Okay. Thanks. So part two of my question, which I think is for Dr. Anderson, is: I realize that this finding of coronavirus is still quite new. But I'm wondering whether in this collaborative network that the WHO has set up, have you gotten any reactions back yet from the Far Eastern labs that said they had found paramyxo--I'm sorry, the German labs and Far Eastern labs that said they'd found paramyxovirus and the Canadian lab that said they found human metapneumovirus? And have they had any comments on your results?

DR. ANDERSON: Well, as Dr. Hughes commented, and Dr. Gerberding, we've had updates daily with the WHO collaborating laboratories working on this outbreak. And what we did yesterday, once we had primers for PCR developed and confidence that they worked, made sure that others could access that. And other laboratories have used those and identified some positive results for coronavirus in tissue culture isolation material. They haven't sequenced yet because there hasn't been time to be sure it's the same virus. So I think we've gotten at least suggestions that other laboratories have identified a coronavirus as well.

DR. GERBERDING: Any questions from the floor? Then let me take the next question from the phone.

AT&T OPERATOR: Thank you. We have a--we have a question from Larry Altman with the New York Times. Please go ahead.

QUESTION: Yes, in pursuing that, the other labs identifying the coronavirus, can we back up to Friday, Dr. Gerberding? At that time you were, I guess, a bit skeptical of paramyxovirus findings, and now you have put into the equation as the leading hypothesis the coronavirus. Is it because CDC has isolated this virus that you've apparently shifted your view? Or can you just clarify that and also clarify what other--I wasn't quite sure from Dr. Anderson what other laboratories had confirmed the finding of coronavirus. My understanding is many labs are getting paramyxo and other labs are finding corona. So could you just put that in some perspective, please?

DR. GERBERDING: Thanks, Larry. I would, first of all, be the first to say that we have an open mind here and we know that the collaborating laboratories, many of these scientists are just absolutely world class. And so if they're saying paramyxovirus, we take that very seriously, just as they're taking very seriously that we're finding coronavirus. And I think the mystery here is how do we make sense out of all of this information and really relate it to the epidemiology and the large number of affected people that we're seeing.

It's one thing to find a virus in a few patients. It's another thing to find evidence of it in the more than 400 people who have been suspected of having this disease.

At CDC we have not identified as of this point in time a paramyxovirus in the patients, and we have looked with the same rigor and the same tools that we have used to identify the coronavirus. So the fact that we've been looking in many, many patients and looking as aggressively as we know how to look and not finding it argues against its presence in at least the specimens that we see. But we also know, as we pointed out from the very beginning, we have limited tissue specimens. The specimens generally come from patients who have died, and, therefore, this is at a very end stage of the illness, and often by the time a person has been on a ventilator for several weeks or been ill for several weeks, the virus itself is no longer in the tissue. The immune system has cleared it. And what we're left with is the damage that the virus has done and perhaps some antibody evidence of its presence.

So these are all clues, and we just have to patch it together as we go forward.

Another question from the floor?

QUESTION: Yes, (?) Wall Street Journal. Just a clarification on timing. When did you arrive at this hypothesis about coronaviruses? Yesterday? Saturday? Friday?

DR. GERBERDING: Well, arriving at a hypothesis is not really a fair statement of how the process works. I think when we started out, we had heard information about paramyxovirus. We were in contact with the other collaborating investigators, and we're culturing non-specifically, meaning taking tissue and putting it into a variety of different cell lines and mechanisms to try to see if we can find any virus in there. And when the virus that showed up--and the most conspicuous virus was the coronavirus--that was a hint, well, let's take a look at this. And then that leads to the next step and the next step and the next step. So you find it in one patient. You characterize what you see. You look at it under the microscope. You develop some probes to identify its--in this case, it's looked at the sequence of a polymerase chain in the virus and so forth, and it's like detective work. Each step leads you closer to where you want to be. So then you look in more patients and try harder to find it. Once you have an antibody to it, then you can use that antibody to probe other tissues, and it becomes kind of an iterative process.

So I don't know. Larry, if you had to say what day was it that we identified this as a hypothesis, when in your mind was it a potential candidate?

DR. ANDERSON: Well, the sequence of events was as Dr. Gerberding noted. We got cytopathic effect in tissue culture. Then our electron microscopy labs looked at that and identified coronavirus-like particles. That gave us the clue to use probes or PCR primers to look for a coronavirus. And then we sequenced that and we had that information Sunday morning. And we provided information to WHO and proceeded from there.

QUESTION: I have another follow-up question. Are any of the labs, yourselves included, working on split samples, or are you all working on samples from different sets of patients [inaudible]?

DR. GERBERDING: In general, the samples are shared, meaning that they are split. For example, if a patient was in Hong Kong, some of the tissue is in Hong Kong, some of the tissue is here. In Canada, some of the materials are in the Canadian Health Canada Laboratory system, some of them samples are here. So we are in some cases looking at the same tissue and in other cases we're not because not all--there's not enough of everything to share with everyone.

I think we have time for one more question, and let me take a phone question.

AT&T OPERATOR: Thank you. This question comes from Mandy Gardner with Health Scout News. Please go ahead.

QUESTION: Hello, thank you. I'm changing tracks a little bit. I'm wondering what the status is of the CDC team going to China, if it's there or what's happening in that arena.

DR. GERBERDING: Yes, the CDC is participating on the WHO team that has been invited by the Chinese Government to evaluate the epidemic of respiratory illness in Guangdong Province earlier this year. The CDC team is there. The individuals are beginning to look at what the experience was over the last several months, and they're just in the very beginning phases of that so we don't have any information or anything to report at this time, other than the fact that the investigation has started.

With that, let me just thank everybody for being here. I really appreciate the opportunity to give you this update, and as always, we'll tell you as we know more, and we'll do everything we can to keep you up to date, and we'll be letting you know tomorrow morning if there will be an advisory or press conference tomorrow or not, depending on what we know. Thank you.

AT&T OPERATOR: Ladies and gentlemen, this concludes our conference for today and thank you for using AT&T Executive Teleconference. You may now disconnect.

*Correction: please note anti-retroviral has been corrected to "anti-viral."

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