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a leader in public health and safety were the last seven decades. we will take a look at cdc operations and the top-health related issues the agency is focused on. after that, a discussion on defense department personnel. and later today's sit-in on capitol hill that was arranged by the protest group democracy spring. >> here on the washington journal we are joined by the principle deputy director at the cdc and admiral of the public health service and led cdc response efforts on health responses from anthrax to sars. she is here for a meeting at the white house about the zika virus. what is happening today? >> it is important for the public stay aware of the zika virus. it is a new infection that is

linked to harm for pregnant women or at least harm for the babies. we are seeing increase in puerto rico and met with over 30 states to help them get ready for the mosquito season. >> who is at the media today? the president? >> no. this is an update for the press. >> the president's budget this year is just under $7 billion. how much will go to the zika virus fight? >> theres wasn't resources programmed in for zika virus within the regular budget but the administration adapted some resources assigned for ebola or the national stockpile or other uses to deal with the emergency right away while congress considers the supplement request. >> the head of the cdc expressed concerns about using ebola funds

to turn to the zika virus fight. why the concern there if there is leftover funding from that public health crisis? >> ebola is not over. there is active disease still with a thousand contacts being followed. we know we will not be lucky enough to have just one problem at a time. there is a yellow fever outbreak in angola. we are concerned we need to be able to address multiple threats at the same time. that said, the zika virus problem is in puerto rico and pregnant woman are terrified there. we are doing everything to protect them. >> as we said, our program today is focusing on the cdc. they have been helpful enough to have three guest with us from the cdc. we are talking about various issues with the agency and with its history. it is celebrating its 70th birthday this year. what were the zika virus and

ebola's back in 1946 when the cdc started? >> the cdc started really out of an agency that was dealing with malaria and that was one of the big concerns but small poxs and typhus was an issue. we eradicated small poxs and you don't hear about typhus every day. >> one article i read called you a virus hunter at the cdc. why do you have that name? >> i have worked for 27 years with the cdc on diseases. lots of work on the flu and unusual viruses like the severe virus that affected china and toronto back in 2003. but really, i am about prevention. so that has been a key part of

my career. >> and dr. ann is with us on the washington junior. if you are in the eastern or central time zone we have a number for you and mountain and pacific time zone number there. with the zika virus, how close are we to a zika virus vaccine? >> people always want a vaccine when something is new and scary but vaccines take a while to develop. they used to take 10-15 years to develop. with some of the new technologies and science we have an opportunity to fast-track that. the nih has candidate vaccines for the zika virus and they hope to begin studies this summer but we will not have a vaccine in general use for at-best case two years after that. >> the house tomorrow taking up a bill that would make the zika

virus eligible for fda priority review. what does that mean? >> it take as while to do studies to evaluate the vaccines but there is a regulatory process and i would say the fda is committed to rapid review of emergency products. last year we were testing an ebola candidate vaccine in west africa and the fda because excellent in looking at the proposals rapidly. but a fast-track review speeds up the time where the materials are being looked at. everybody is keen to get a vaccine for the zika virus but what we need to do is now is everything we can to protect pregnant women in the mean time. reducing mosquito bites with repellent, long sleeves and pants, insect and mosquitos control, and in puerto rico they are beginning that with mosquito control inside and outside of the house. it really means good mosquito

surveillance to know if they are resistant to the different pesticides out there. we are hopeful for a vaccine but have a lot to worry about now. >> in terms of the funding efforts for the zika virus what is the better way to spend the money right now? on the vaccine research or the mosquito bite prevention and monitoring efforts? >> we absolutely need to do both. we will not get a vaccine if we don't invest but the mosquito control is urgent and it is an emergency especially in puerto rico. we need to learn as much as we can in the mean time about the virus as well. >> the latest numbers on the zika virus in the united states is travel associated zika virus there are 346 cases in the united states. cdc with an updated map

president out from last week. explain what a travel associated zika virus is. >> right. you know about 40 million people travel to south america, central america, caribbean, every year from the united states. and what we see is that travelers can get bitten by a mosquito that is infected with the virus and come back and develop symptoms. so far in the continental u.s. the only people developing the virus are people who traveled or a small number of people who had sexual contact with people and got it. so we have not had mosquito transmission in the the states but we have outside of the continental u.s. we know the mosquito that can spread the virus is present in many states.

it is widespread in the southern parts of the united states and that is where we are worried about local transmission this isn't. >> host: we are taking your question and will start inn sioux fallsx, south dakota. >> caller: my question is can a whole group of people get post traumatic syndrome brought on by the federal government because they are taking our pensions away and we are too old or in too bad of health to get a part-time job and many of us couldn't get to if we wanted to. ...

one of our priorities, to strengthen the link between public health and healthcare and to make sure that there is quality services. we do not occur at the hospitals, but we do track things like hospital associated infection and it made real progress in that area. the cdc is part of the executive branch, the

largest part of the federal government, headquartered outside of washington dc. >> how many centers are there? >> ten. we cover the waterfront. communicable disease and now we are the centers for disease control and prevention. what we cover is infectious and noninfectious disease, environmental health, injuries, occupational, illness as well as global health. >> was the role of the principal deputy director? >> are pretty much cover everything around. it is a fantastic job in the privilege. our workforce is truly extraordinary. scientists, engineers, nurses, doctors. >> host: here to take your questions and comments. the next half hour or so.

the phone numbers, 2,027,482,000, mountain pacific tour to 748-2001. >> i just have a few comments. i have cut the budget so much on research and communicable disease, a request for an extra couple billion dollars. and i just, there are so many people, so much money, drug companies. do a lot of research to have you on seven or eight different drugs. once you are on you can't get off of them. they get you kind of hooked. i had a mom that was on 12 or 13.

too many drugs, not enough money for research and for this lady here. people like this lady here, hero. not the trumps in the cruises. people like her, god bless her. >> guest: thank you so much. research and innovation is vital. you know, right now we are tackling a mosquito that is quite difficult to control. without investment and innovation we won't have newer or more effective ways. we also really need to invest in the multi-your multi- your studies that will be so critical to understand the long-term effects when a baby is born. >> host: take us through. the budget request, how does that breakdown in terms of how the cdc uses the

funding? >> guest: we pretty much have infectious disease work , noninfectious disease work which includes environmental, injury, global health and then preparedness. public health preparedness and response. actually predates 911. >> host: it has grown. $1.4 billion of that just under 7 billion. what are the things that go into that? >> a lot of that is helping the states. state and local government to try to make sure that communities are safe, healthy command secure. we have aa program to support the state and local government preparedness which has been vital, whether it is earthquake or hurricane or pandemic or

something like the ebola virus. >> host: tim is up next for michigan. >> caller: yes, i think the major problem with healthcare in today's society is doctors and hospitals kill 440,000 people year, which is equal to the amount of malaria deaths worldwide. >> host: how? >> caller: perhaps they should be sent back to school if they don't graduate in the top half of the class? >> host: you mean mistakes and hospitals? >> caller: yes. >> guest: the quality of healthcare is an important issue. one of the things we need to be focusing on is healthcare associated infection. your new hospital to get well. we have been making progress check lists trying to reduce infections that come when

lines are placed or catheters are placed, working hard to make sure there are routines and protocols in place in intensive care units and other wards on the hospital to make sure people don't get infections that can be prevented. there is more progress we can make. >> host: check is up next in grand junction, colorado. >> caller: good morning. i have been the hiv prevention business for 30 years. what i see happening with this, demanding men wear condoms no matter what. no matter what. i see the sale of condoms go up around the world. condominium machines over 80 countries around the world. >> guest: we were surprised to find that

sexual transmission was more common than we had expected. the early finding as we started to track infections, we saw surprise with a handful of cases. use of condoms to prevent the sexual transmission. they were returning from travel. if women are pregnant, we recommend the partner has been traveling isys history they use condoms throughout. most people who are pregnant very simple disease. can occasionally happen, but the principal focus is

protecting pregnant women. >> host: gene in ohio. not really very percent -- specific. some people don't even have symptoms. coming back from an infected area we recommend they be tested. because the symptoms are so nonspecific.

>> host: why isn't cdc approved the use? >> guest: there are several. we can't eradicated. when mosquitoes. inside and outside the house.

we think this is going to take a very concerted multiple dysentery contact. >> caller: my question goes back to what we were talking about before. i'm a chronic pain patient. right now one morphine and pain management. i do know there are alternatives for pain. creighton is illegal and tennessee. the cdd oil is legal in all

50 states. there going after that now. why is it that the alternative method of pain control are being targeted as well, you know, the chronic pain issue is real. i'm in recovery from alcohol i do watch everything that i take in. what is your opinion about these alternative drugs? >> guest: chronic pain is a difficult issue, as you know from your personal suffering. one thing that we have been seeing at the cdc is a tremendous rise in deaths from prescription drug overdoses, and when we look into this issue, it appears opiate prescribing is really sword. the past 1515 years we have seen a quadrupling of

prescribing for opiates and a quadrupling of accidental deaths from overdoses. recently the cdc issued knew prescribing guidelines for physicians another primary care practitioners intended to help them reassess whether starting a person on opiate painkillers, to think about what the long-term goals are. there is not good data about those types of drugs helping chronic pain. on the other hand some people get started on these medications. we urge clinicians to start low and go slow and to monitor people carefully. there is a small margin between safe and unsafe use of the medicines that unfortunately so many across the country have lost loved ones too. that is what cdc has been focusing on with the prescribing issue. there is more research needed ineffective pain

control. exercise can be promising. >> host: want to get your thoughts on topics. hospital funding is tied to patient satisfaction. no patient will say that they were satisfied. how do you cut down on opioid prescriptions and trying to make that point to doctors with the system in place? >> guest: we hear that so much. if you say yes you get more and more of these medicines. it turns out that clinicians are not really created.

clinicians think they are. we do think that tackling a problem of the surveys and satisfaction surveys for we are working with partners in getting into that. i do think how you measure quality of care can drive care and we don't want those measures to drive care down. >> host: christie in providence, rhode island. >> caller: hi. good morning. i was wondering if that disease we have seen before and the 2nd part of my question is if there is a cure found will there be any push to offer it in schools like middle schools are high schools because it is a sexually transmitted disease? >> guest: it was 1st discovered in 1947, but we did not really see outbreaks until 2007.now.

we have never seen outbreak like what we're seeing right now. we did not realize until this year that the virus appears to be linked.so much att in terms of the teenage population, that is a great question.eing a one vilest -- virus that a similar in terms of being common but occasionally canon cause terrible birth defectsme is rebel him. the way that we have prevented in the congenital or birth defects that that can cause is through vaccination. initially vaccination of teens and now we routinely vaccinate babies at 12 months of life. and so it is possible that the vaccine that gets developed within the pain given to teenagers before there in that reproductive age. but of course quite likely

if we get an effective vaccine it will be recommended for travelers 1st.our area of expe >> host: your area of expertise was immunization. our what do you say to folks who are concerned we overi vaccinate our children, that ongoing discussion that seems to crop up every few months or years.are their childr >> guest: it is so important for a parent asked questions and make sure they are comfortable with the care they are getting. vaccine save lives. we had thousands and thousands of deaths per year. the last 20 years of vaccinations has prevented about three quarters of a million deaths from vaccine preventable diseases and saved about 1.4 trillion. as a physician in public health expert i strongly recommend.ur >> host: how hard is it to

get a new vaccine mandate? >> guest: the outbreak of measles associated really sparked a new dialogue in this country, and we saw a change in the conversation in many states where some states have been pushing the loosen up the requirements. what we saw after the measles outbreak was an outpouring of concern for the bystanders, childhood leukemia couldn't get. really relied on the otherot kids to protect them.alogue so we will continue to have the discussion and dialogue over the years. vaccines are saving lives every day. >> host: klara and murfreesboro, tennessee. >> caller: good morning. appreciate this topic.accinatedo you just said you think all children should be vaccinated. of the that leads me to my question, what arm of the

government to you fall under or are you funded by? with the illegal immigrant problem, i'm going to assume don' quite a few of those people don't have immunizations. how concerned should we be about the illegal population and other diseases and with the government ever step in to stop you? i would like your opinion on illegal immigration and how it affects the health of our population. >> guest: thank you. the centers for disease control and prevention as part of the department of health and human services.um you know, the thing about infectious diseases they know no borders. it is important to protect americans. cdc immunization efforts in

the us and work closely with other countries on global immunization efforts. in fact, it is because latin america to the pan-american health organization was able to control and eliminate rubella that we stopped having problems in the us. measles and rubella have been eliminated. it is important thataddressed ad infectious diseases be addressed around the world. saw that with ebola. of course, the way to keep americans protected against ebola was to tackle the virus. >> host: questions about illegal immigrants without immunization. >> guest: right. the way immunizations are given to children is really about protection.

citizenship, documentation.acci. it is really about protecting the people around them. >> and with the government step in to keep you from reporting on some sort of public health issue? >> guest: it is important that public health conditions that are contagious be reported, and there are ways for that information to be protected. in terms of the health information. so when cdc does diseases geat are nationally notified comeau we are getting the names's >> host: maryland where jay is waiting.ing my >> caller: good morning. are you familiar with doctor gillian mike of its? >> guest: to know, i'm not. the biologist nih in

bethesda. she is currently a whistleblower.wh overwhelming data. she says she had overwhelming data, vaccines cause autism. directly associated.guest: as yo >> guest: thank you for that question. autism is a very difficult question.more we need more research. at exten one thing that has been looked at extensively is the question of vaccines. that a more than a dozen good studies looking at that.

as a dr., public health expert, vaccines are the cause. we do know that vaccines prevent very serious conditions and recommend them strongly. it is important that we monitor them carefully. >> host: a quick follow-up >> caller: i encourage all the listeners to go to cdc truth .org and look at theti interviews. recently bobby kennedy ack acknowledged that the lead scientist for the cdc with the mmr vaccine have been genetically modified. you >> guest: thank you for that comment. i am not familiar with that issue, but it has been used

widely in the us and around the world. and we are seeing huge progress in measles prevention, mainly in africa and asia. measles casee about 20 million around the world every year and need to tackle that. cause it does still cause deaths. about a hundred and 50,000in last year, and so we have our work to do. >> host: we have about ten minutes left. deputy director there. will also be talking about other issues. if you don't get your call and call it will have a few others on our program.tennesseeo good morning. >> caller: hello. i am a chronic pain patient. i went in for minor back

surgery, and the dr. got me confused or something. anyway, i am cut, but to my bra strap. and my regular dr. sent me over to this pain clinic. i can barely walk to the bathroom, to be honest. and i am on pain medicine. and when they sent me over to this pain clinic, well, now i am the mother of four children. everybody likes of me like i'm a drug addict. when i take my prescription to the pharmacy everybody looks at me like i have a drug addict. and i would just like to know, you said exercise does wonders. if you can't walk, you know, how are you going to exercise? the injections don't help. so what are you supposed to do?

you go and take your medicine like you're supposed to. the people out here that is getting this medicine and selling on the streets,ple. those of the people killing the other people. the chronic pain patients have to suffer for what these people -- they need to have a better system. i didn't like the idea have because all of them have a bad name. and i hate to be associated with it because i am a mother. i need help to take care of my children. ho it makes me cry. >> host: let's give her a chance to respond. di >> guest: sorry about the difficulties. points. you talked about training for your clinicians.

we think that is important. most doctors don't get great training on pain management. is not a big subject. we want to reverse that. there are ways to try to actually address. we are not about surgical. more about cancer pain are about end-of-life for palliative care. long-term over several months. the challenges your going through are difficult and i am sorry. we would like to address this. >> host: what is the cdc doing on the stigma issues, something couple of ourom viewers brought up. >> guest: it is a huge issue. a the surgeon general really wants to take that up in a big way.zed they

there are a lot of diseases that used to be stigmatized.ase. we really need to tackle them. so the issue of addiction is widespread, something that can be managed and we're trying to take that on it a out big way. health c i would say look to the surgeon general report about addiction and the future. >> host: what is his relationship? >> guest: as surgeon general he is the leader. so he is a key partner, our director, and independent. caller >> host: richard in wisconsin. >> caller: high. well, my question is, now we

are hearing about this, what caused this? 20 years or so ago we never heard of such a thing. what is the cause? >> guest: that is a great question. the virus has been around for decades, and i have been individual cases on small outbreaks. but it is really when the virus arrived in brazil that we saw this huge spread of the mosquito borne virus. population density, the parts of northeastern brazilco is much more concentrated. biteo this mosquito can bite five or ten people. really spread the virus. so it may be where the virus was present until 2015

mosquitoes and people were living in us closer proximity. we think once the virus made it into south america it spreads pretty rapidly. the mosquito is resident throughout south america and central america. and we are dealing with the challenge. are dealing wit it could be that the viruses the causing birth defects before and we had not recognized it. the numbers were so large. >> host: why has there been a spike in the number of cases? we had it contained at one time.host:

>> guest: we don't have a spike but we are call -- we have a plateau. and so it may be that renewed intent evaluation is going to be important. a large part is occurring is people who were born in other countries. so the best way to really tackle the problem here in the us is to do a better jobe around the world.o we know that it is possible to have strong and effective control. other governments and countries doing a better job of that will be important. the u we have much lower rates than we had 20 years ago. >> host: terry is in kansas city, missouri. wondering

>> caller: if we had knownwn since 1947 and there was an outbreak in 2007, why didn't we start working on a s vaccine in 2007? if we had developed a vaccinea vaccine back then we would not have the problem we are seeing today. >> guest: that is a great question. when the virus was recognized there was a monkey it was being used to see whether there was yellow fever in the area. in 2007 the cdc did go and help investigate the outbreak and developed a lab test. the disease was considered sort of a nuisance. no real severe complications ever recognized. and so it was not a priority for vaccine development.a big pf now of course it is.

it has been known since 1976 the world health organization and leaders around the world are looking at how we can do better prioritizing diseases of epidemic potential vaccine development. we could potentially have a short burst of vaccines. how can we use flexible technology, platform technology where will be speedier to develop a vaccine when we need one.lo one.one. unfortunately the more you suggest you can develop a vaccine overnight, they actually do take time. in north >> host: mike in north carolina. >> caller: yes. another comment on the basis of the lady.

i suffer from a severe injury, the result of an agricultural accident. severe nerve pain. stung like being stung all over. it i the only thing that can calmlm it is through medication. it is getting now to are people who do suffer from severe pain are being scrutinized to the point that they are being drug out over the pace, visits to pain clinics and all of that even though they have an ongoing condition.and all the people out here that are suffering from long-term injuries like cancer and stuff like that having to suffer simply because they cannot seem to come up. there are people out here getting prescriptions and so forth that are going to pain

clinics and so forth that do not have a history that indicates that they should have some of the pain that they have. those people are making it extremely difficult for middle-aged people to give medications. >> guest: the pain problem is a challenge. we do think we need to step back and look at this holistically. we need to be careful about starting people on pain medicines and do a better c job managing pain and need to have a system that will help keep the prescribing asn. safe as possible. >> host: that is our time. thank you so much for your time. we had to atlanta, georgia and cdc headquarters. we are joined by the director of the nationalalte center for emerging and noninfectious diseases.gi

first, explain what emerging and infectious diseases are. >> caller: sure. microbes are constantly changing. a as they change and prevent -- present new challenges. that is what emerging infectious diseases ares about. there are a lot of current emerging infectious diseases on our mind. diseas there are serious diseases that are caused by resistance which is one of the most important and serious public health threats of our time. really modern medicine is at risk. we assume that we can treat infections, treating cancer patients, doing organ transplantation.antibiotic antibody resistance threatens many of the advances of modern medicine

over the last number of decades. those are some examples, and we really need to be very prepared. in any country, no more than a plane ride away from any other country, and so it is easy for infectious diseases to spread which is why we must be aware and prepared and ready to detect and respond quickly to emerging infectious diseases. i was just going to say that it is a funny word but it is connected. infectious diseases are those transmitted from animal to people. and many emerging diseases are also zoonotic. for example, ebola which we think is transmitted probably from that is an example, but foodborne infections are also a

perfect example. were often times infectionaniman in food animals are transmitted to people. this is a very broad range of infectious diseasess discoveg command we are always discovering new ones. we generally discover at least one new infection every year. and it is our job to stay on top of all these microbes so that we can protect americans and people around the world from the threat. >> understand how the center fits in the overall budget requests in fiscal 2017 just under 7 billion. the center for emerging budget requests within that 629 billion. how much of that budget, 629 million is spent on things like ebola and seek out and how much is spent on things like antibiotic

resistance? >> guest: we are very fortunate that this year and the president's fy 15 budget there was a request for $240 million to fight resistance.li and congress appropriated to the cdc particularly in our center 160 billion for the antibiotic solution initiative. this this provides us with an enormous opportunity to really start to get ahead of resistant microbes, to prevent and to much more rapidly detect and respond. we will be using this hundred 60 million in a number of different ways to build up programs and states. as cdc at the federal level levl of the local and statete health department had localities is where the rubber meets the road.hese

if we are going to successfully fight any of these emerging or antibiotic resistant trends we need strong detect, respond, and prevent capabilities at the state and local levels. a large part of the hundred 60 million appropriated will go to strengthen state and local health departments. we are also working to build a laboratory capacity so that we can do a better job of understanding how these organisms move aroundet communities and around the country. that way we can detect clusters and respond quickly and prevent disease. we are also interested in doing a better job of what we call antibody stewardship which means using the right r antibiotics at the right dose at the right time for the right infection. because we know that one of the major drivers of resistances overuse of antibiotics. antibiotic stewardship program that promotes this

idea of using the right antibiotic in the right waycompt is a very important component of the antibiotic solution initiative.ng. finally, thesefinally, these microbes, as i said, are always changing and evolving. so we need to have prevention strategy in placestrn to prevent these infections in the 1st place. that is another bigfi component of the solution initiative. >> and for our viewers, if you wish to ask a question, our lines are split up regionally. we will get right to the phones. marsha from pennsylvania. good morning. >> caller: good morning. i would like them on sent us pray that was used to control the mosquito

population. there was no encephalitis connected with the virus until monsanto at the scene. then they took frankenstein stallman level releasing genetically modified mosquitoes. don't you find this frightening?ing? >> you can address a history here. >> guest: i would be happy to. mosquito borne infections are serious public health problems.oblems. we have dengue, yellow fever , and that we have seen. h and so there are many ways that we are looking to control these infections. this is a good example of an emerging infection and that while we 1st became aware aware many years ago in 1947, we really did not see a lot of the way of a problem, just a

kind of occasional case popping up here and there until an outbreak was detected on the island. and then a large outbreak in french polynesia in 2013 and 14 and then, of course, now we have seen the spread throughout latin america since last may.ho this is an example of how these infections can change and can be unexpected andd the severity with which. "now we are so terribly concerned about the linkage between adverse birth outcomes. so you know, there certainly are lots of ways of working along with our partners at the pan american health organization, world health organization to control, including many ways to

protect pregnant women, to remove sites from mosquitoes to breed and to use well studied and safe methods to control the mosquito population. >> what do you make of this story. researchers treat mosquito as a weapon talking about british biotech company that genetically programmed male mosquitoes to produce offspring of die before adulthood. >> guest: this is one of several new and innovativenew an that is being researched by various companies to be potentially better modalities to combat thesemb mosquitoes which are the vector for these mosquito borne infections. the genetically modified mosquitoes is one command there is an application now with the fda to test

ms. genetically modified mosquitoes in the county of florida. that that environmental assessment is open for public comment and i think now all of us would encourage people to comment if you have opinions on the subject.umber of these i think that there are a number of these innovative strategies, not are ready for prime time right this moment.e and so that is why might the same time exploring modality isy we are focusing on scaling up the tried-and-true strategies to fight now. >> host: let's go to new york. >> caller: great show.er thank you, c-span. she brought up the year 1947. bo at that time there were just coming on board. there were millions being killed.much pain and su we were saving lots of livess,

, and that in the 60slions, wit. the extreme environmentalists, the young lady at the time rachelnm carson. >> i don't know her, but i believe you're right. >> caller: one of the extreme environmentalists. and it became band. all of a sudden the mosquito population expanded, exploded.k in again. malaria came back into being. i understand the dr. before you said the cdc advanced ddt. enough there trying to get back into the good graces. where does the cdc stand on using ddt? >> guest: there are a number of different

mosquitoes that can cause malaria. it is a good question. appreciate your understanding of the history you know, we really are involved using the current tool while at the same time exploring other options.the question of mosquito control is quite complicated. there is a related issue about resistance to pesticide which is another important concern we have. fighting this mosquito which carries a.ka you probably know because it sounds like you're quite educated on the subject. there are many other insecticides currently being used to fight malaria and using different modalities. bed so, i think we are open to considering any option. is whate

and that is what we are doing. i will say in terms of a statement that the cdc is not involved with regulating pesticide. but we certainly are promoting and supporting looking at all kinds of strategies for mosquito control. >> host: virginia is next. >> caller: high. thank you for taking my call. asking questions related airline travel and how airlines are trying between passenger flights. we were told specifically that all of the hand sanitizer's that were alcohol -based would do nothing to stop us from spreading or protect anyone

else. so while the antibacterial prevention methods do not work. it is very, very hardy. outbreaks that you hear about that happened on cruise ships that are so difficult to control. sometimes they have to shut down. it is a tough actor. however, the hand sanitizer's and the antibacterial and antiviral will help. nor

will be transmitted. really the most important strategy for preventing the spread of gastrointestinal illness.utbreaks we he >> host: are there more of them in this day and age? there is less foodborne illness now than there was 15 years ago.but you are but you are right.g more multist we are doing a much better job of detecting foodborne outbreaks and rear seeing more multistate foodborne outbreaks than we did before , probably because of

the way our food is comprised. much of it internationally and distributed around the country.we a we are doing a much better job, and some of that is because the way we have been able to apply cutting-edge new sequencing methods that allow us to really get a very, very precise genetic fingerprint of each of these microbes and therefore really detect clusters quickly.ere is a there is a network of laboratories around the country, and pulse that is in every state health department a number of other laboratories around theou country and the world. using this pulse that network all of the laboratories use the same method to basically get a genetic fingerprint of each of these bacteria. here everybody has a shared

database. every week monitoring somewhere between 40 and 60 potential clusters. much better detecting outbreaks faster and then responding much more quicklyot >> host: director of the national center. my five the legislative regionally. >> i was curious about the varieties. is there a commonality in terms of where they lie in the food chain?

mosquitoes in general. >> host: what kind of dr. are you? >> caller: medical scientists. cancer research, worked on melanoma. that a lot of different things. flow cytometry which i'm sure the dr. is familiar with. >> guest: so, the mosquito we are focusing on is the mosquito that carries, causes transmission of dengue and yellow fever. and it is a particularly difficult skill to control because it is very, very well adapted to living among humans. basically humans are the only host that it likes. many other mosquitoes actually mostly feet on

birds and other animals. but this is exquisitely adapted to biting humans and transmitting infections among them. they live in houses. goodbye during the day as well as the night. they can breed an extremely small amounts of water, for example, what you might find in a bottle.ere there are many breeding sites around human habitation, and they can buy more than one human in the context of one blood meal. so this means it is particularly well adapted to spreading disease among humans, and that is one of the reasons why it has been so difficult to control over the years. >> caller: thank you very much. it is a great program. >> host: carla in atlanta, georgia. >> caller: hello.

last year the mayor of atlanta so there was a tuberculosis outbreak. and the cdc got behind it a few days before. they found no traces. let me to believe they areve political organization. so what happened? it's on private real estate.. so why do they straight out like? they just aren't true.

>> guest: i'm notar familiar. i will say tb continues to be a problem here in thehe united states. and certainly around the world. i am sorry that caller had a bad experience and has those suspicions about public health. i'm not familiar with thatbu particular situation. i will say that you know at cdc we really are focused, laser focused to protect americans. and unfortunately there are many people around thean country and around the world who have lost loved ones because of infectious diseases who are currently living in fear of getting an

infection pregnant who sadly have had babies born with microcephaly who have lost fetuses because of microcephaly. unfortunately and sadly infectious diseases continue to take a serious toll here in the united states andan around the world. this is what we are focused on. i have dedicated several decades of my life i've been with the cdc for 24 years now. you can say it is not an accident that i have this gray hair. there are a lot of serious problems. we really are working 247 to protect americans. we are making progress, but as i said at the beginning

of the microbes are always changing and mutating and there is always a new threat we hust respond to. >> host: baltimore, maryland. >> caller: good morning. africans against malaria. we found in our experiments that ddt was 100 percent effective against the mosquitoes. i understand this is principally transmitted. i am wondering why there is such resistance and not 10 percent of the way we used to apply it.mosq within three months, we didwe it in one area and africa.

>> guest: yeah. you know, i think there is lots of history, both in terms of its effectiveness and also its limitation. and again, i think the important thing to remember here is where most likely going to need a multifactorial strategy to fight vectorborne infections and we have made a lot of progress and are continuing to work toward finding new strategies, perhaps reenergizing all the strategies in order to make further progress.host: >> host: how far along is the process specifically? possibly reenergizing old strategies.

>> guest: it's not something i am intimately involved with.: >> host: monticello georgia.ing. >> caller: good morning.pan. my question is kind of off subject. with the recent contaminant outbreaks i am wondering ifg if there are staffing problems or understaffing or other troubles with the safety protocol being gone over and enforced? >> host: in one specific area. >> it was failures and handling of toxic stuff going on.uff

they have been a couple different stories. i am 60 miles south of atlanta. .. of atlanta. it is a concern to me and my community. a vile cut out of place and was placed in the wrong area. some infectious stuff. the protocol is not handled correctly. guest: you know, laboratory is our highest priority here at cdc. we take the question extremely seriously and we a take this question extremely seriously and we are always looking to improve our laboratory safety. we have a very, very large number of laboratories here and

we've been, as i say, working very hard to improve the laboratory safety. we've made a number of changes with a number of different external groups come in and give us advice. we've responded and basically implemented the suggestions that many of the experts provided to us.us we are continuing to improve the situation, and we really, as i say, take this extremely improved seriously. we are looking at this as our top priority. >> karen is in alexandria virginia. karen, good morning. >> i've been diagnosed with a cabbage and. i can't seem to get rid of it. i was wondering what your familiarity is with it. >> what was the name again?

>> is that something you are familiar with? >> it's not sounding familiar to me. b i do know how difficult it is for people who are sick and get diagnosed with something that is not very well understood. it can be quite confusing and can take quite a bit of time to sort out. i certainly recognize this is an extremely difficult kind of situation. i can't say that kind of pathogen that you are mentioning is sounding familiar to me. >> antibiotic-resistant is a key part of some of the efforts that your area is involved in at the cdc. are there specific drugs that are going to be obsolete soonara because of this emerging problem? where is your top concern here? >> yes, unfortunately there are a number of bacteria that are resistant to most, and in some cases, all antibiotics.

there is one kind of bacteria which is called cre which is what we often refer to unfortunately as a nightmare bacteria because it is developing resistance to almost all antibiotics. what happens and what were most concerned about is that these, this ability to develop antibiotic resistance is carried on a mobile gene element. you could call it like a jumping gene. that means that this resistance, this ability to resist antibiotics can spread from one sort of bacteria to another and cause a whole new type or family of bacteria to develop resistance. the cre is something that we have seen spreading throughout the country it's one of our topu threats that we are focusing on and one of the reasons that we

feel it is so important for communities to improve theirtheq ability to detect so they can quickly detect cre and stop it from spreading before we get large outbreaks that with infections, as i say we are kind of losing our ability to treat with the current antibiotics. >> let's go to georgia where mike is waiting. good morning. >> yes, my question is how come we blame so many of those b diseases on monkeys from africa? monkeys, cows, mad cow, pigs, and my other question is how much of this is real and how much of it is medical?ere are >> zoonotic infectious diseases are diseases that are spread from animals to humans. there are a lot of those.

try mates and monkeys, nonhuman primates, nonhuman primates primates are very close to us genetically speaking and so you can imagine how microbes that are adapted to infecting nonhuman primates might not be a long way to go for them to be able to infect humans. so the whole idea that infections in animals can affect people is a very importantti source of emerging infectious diseases among people, as i mentioned ebola as an example of that, there there are other, mers is another potential example, there are diseases and rift valley fever and many other infectious diseases that travel from animals to people. in terms of bioterrorism, this

is something we take extremely seriously we are always on the alert for bioterrorism and have invested considerably in our ability to detect these types of threats.nts, whi it has the capacity to detect t these threat agents and we are working constantly to identify any potential threats of bioterrorism. >> yes, you had to colors earlier back to back and were not related but i think the subject matter did relate. one was asking if there was any political influence with the cdc and the next was talking about them eliminating the mosquito with zika virus. i know in high school

immediately we had to read silent spring about them killing the birds. i think since then there has been some discrediting of her philosophy but i do think the environmental realm does affect some of the decisions and sometimes that environment comes out on the good end of people and saving them could be just an attempt to eliminate that. i'd like to see your opinion of that. >> you know cdc is a data-driven driven agency. we are staffed with a very large number of scientists that are very committed to the best and the most accurate science, and actually we have extremely strong commitment to providing

the best information and the most scientifically valid information and the most comprehensive information to the american public in a transparent way as soon as we learn itan science is an iterative process. we learn more every day. our commitment is to providing the best information that we have, the most scientifically valid information at any time, sharing that information andme certainly sharing new information as it becomes available.we i think that's a commitment we stand by and i think if we look at cdc history, our website, our response to all of these global emergencies where we send hundreds and sometimes thousands of disease detectives around tht world to address threats and use our scientific tools to get to

the bottom as quickly asossible, possible, you can see that we really do rely on science and we rely on data and that's what we used to stop outbreaks and provide the best guidance that we can to the american people at any given time. >> just a couple minutes left. she is the director. >> good morning. thank you for taking my call. i think i just attract all kinds of interesting bugs and critters that carry diseases but i've lived in indonesia for years and i've contracted many viruses as many times as you can count and have gone through the ringeris with those diseases. after returning back to the united states to try to get some

rest and recovery, i started feeling fatigue again and went to the doctor and i thought, well maybe some of these old illnesses that i have are coming back or maybe it's my immune system. i was shocked to find out that i attracted lyme's disease right here in maryland. i live near lots of woods. now i'm familiarizing myself more so with lyme's disease and realizing that it's just reallyy a growing epidemic here in our country. c it seems to be this really weird dynamic between the cdc and other doctors pi wonder if you would just speak some to why there is such a difference in opinion on limes disease and why many doctors are not educated on it and what can be done, i know some people believe they have chronic lyme disease and all that.. i just wondered if you would speak about all that. >> sure, i'm happy to too. i'm sorry to hear all of your

struggles with all of these infectious diseases. malaria, all of those they're really terrible debilitating diseases and you're right, it does sound like you've been through the ringer. lyme disease is a really serious problem in the united states and were quite concerned about it. it does seem that the incidence is increasing and we've estimated that about 300,000 cases occur every year. it really is a very important and serious problem. there is a proportion of people who appear to have, who don't get better after treatment for lyme disease and have some sort of post infectious condition which is clearly very difficult to live with involving fatigue and a wide array of potential other system symptoms. i this is something we are very concerned about.

i think it's certainly possible that this sort of post infectious fatigue phenomenon can occur potentially with other infectious diseases as well. so we are actually extremely concerned about that and have been working very hard to get the word out to physicians and to just sort of educate the public about what they can do to prevent lyme disease which of course would be the ideal in the first place and that is for people to protect themselves and prevent lyme disease and that's one aspect of education which is on the prevention side. i think on the issue of treatment and disagreements about treatment there are some disagreements and again going back to this question of sciency , we at cdc really rely on the best available science and the best available science

today doesn't really demonstrate effectiveness or efficacy from some of the longer-term antibiotics and other treatments that some physicians have been promoting. we wish we had a solution for people who don't get better after treatment with lyme disease. we certainly support the national institute of health and other groups that are working hard to come up with a better solution and better treatments for people, but at the same time i think it's not responsible for us to promote treatments that as far as our reading of theno science, they're really just is not the science there to support effectiveness and they do have the potential to do harm. >> time for one or two calls. you'll be happy to note that your boss is watching our show today. he tweeted out this morning cdc

works 247 to protect america from threats. will go to hell and who's waiting in tennessee. good morning. >> i'd like to point out a lot of people do not speak out about all the antibiotics in meat today. it's not just the antibiotics that are being prescribed by doctors, but also, what really irritates me is that we know all the data and we know all the guidelines and there's just a lack of adherence to the guidelines. it shouldn't be a first type and third part of problem. people are not adhering to

guidelines, managers and ceos should be discarding them right on the spot. thirdly, and in respect, because of an interest that i have, people don't realize quote unquote that it is supported that lyme disease is transported through sperm of males. there's so many things we just don't know about and it should be communicated to the doctors. we need a system where that information can be communicated from one doctor to another. the sanctions by the state in virginia because she was using antibiotics to treat her lyme disease patients for a year and

it took that long to get rid of lyme disease and she lost her license and regained it again. people, as far as in the medical arena they need to be a little more judicious and learn and listen, and listen to their patients. >> there's a lot there and were running of time in the segment.s i want to give her a chance to respond. dr. bell i give you the last minute. >> thank you, a lot of good points there. it's certainly true that overuse of antibiotics is not good for people whether the overuse is in treating people or whether it's used in agricultural animals. so we are very supportive of the fda's new rules that will really allow veterinarians to adopt some of these stewardship principles that i was talking about at the very beginning and

will make some progress in terms of reducing the use of antibiotics in food animals at the same time as i say that, we reduce the overuse of antibiotics among people. it is important to take a holistic approach and look at reducing antibiotic use across the spectrum both in human health and in the animal sector. >> she's director for the national center of emerging and affection diseases. thank you so much for your time this morning. >> thank you for having me. >> first, late last month president obama participated in a panel focused on the issue of opioid abuse in atlanta. here is some of that discussion. >> when you look at the staggering statistics in terms of lives lost, productivity, impact cost communities, but

most important cost to families from this epidemic of opioids abuse, it has to be something tr that is right up there at the top of our radar screen.n. you mentioned the number 28000. it's important to recognize that today we are seeing more people killed because of opioid overdose then traffic accidents. think about that. a lot of people tragically died of car accidents and we spend a lot of time and resources to reduce those fatalities. the good news is we've been very successful. traffic fatalities are much lower than they were when i was a kid. we have systematically looked at the data and looked at the science and we develop

strategies and public education that allowed us to be saferr drivers. the problem is here, we've got the projector he going in thee opposite direction. 2014 which is the last year that we had accurate data for, you see an enormous ongoing spike in the number of people who are using opioids in ways that aret unhealthy and you are seeing significant rise in the number of people who are being killed. i had a townhall in west virginia where i don't think the people involved would mind me saying this because they're very open with their stories. the child of the mayor of charleston the child of the

minority leader in the house int west virginia, a former state senator, all of them had been impacted by opioid abuse. to give you a sense that this is not something that was just restricted to a small set of communities. this is affecting everybody, young and old, men, women, children rural, urban, suburbano the good news is that because it's having an impact on so many people, we are seeing a bipartisan interest in addressing this problem. were not just taking a one-size-fits-all approach were not just thinking in terms of her mineralization incarceration which unfortunately has too

often been the response that we have had to a disease of addiction, but rather, we have an all hands on deck response that says we have to be stop those who are preying on people but we also have to make sure that our medical community that are scientific community and individuals, all of us are working together in order to address this problem. >> dr. deb serves as director of the cdc's national center for injury prevention and control where one of her major areas of focus is prevention of prescription drug overdoses. first, can can you give us a gi sense of the scope of the prescription drug overdoseprobl problem in the main drivers hear of that? >> absolutely. so in the past 15 years, we've seen the number of deaths from opioids really skyrocket and it has happened lockstep with the number of prescription have gone up.

last year 40 people died a day from an opioid overdose and it happens to neighbors, friends, family members it happens people because people take various addictive medication and can go want to have long-term consequences from it. >> so how much of this is due to availability and access and how much idue to the lethal miss of these drugs getting worse in this day and age. >> so it's really a domination of both. since 1999, we have noticed that the number or amount of opioids prescribed in the united states has quadrupled and the u.s. consumes more than 80% of the opioid in the world. so when you look at the number being consumed in the u.s. it's really gone up. at the same time heroin and fentanyl have been very lethal and potent. the combination of those have

led us to where were at today. so what is your program at the cdc trying to do to help this program? at the cdc we try to protect the public 247 and some of the things were doing specific to opioid include working directly with state health departments. we are working with 29 states to look at how to better monitoring of the program. were looking at different mechanisms to see how we can bet better prescribing interventions to patients. we also developed prescribing guidelines for climate pain. that will give them the tools they need to know how to have those conversations with patients and wenches prescribed opioids. well, >> what happens when the doctors don't follow those guidelines? is there sort of a stick here as well? can they face consequences,

legal consequences? >> so there's no stick and i'm a practicing physician. what i can can tell you is guidelines guide my practice. i like having guidelines because when you have a patient that you're faced with complicated issues, this gives you the tool to know what to do and how to have those conversations but each patient is unique and doctors have the tools they need to decide what is best for the patient and have those conversations with patients. we been thrilled with a number of medical in other areas. >> if you want to join the conversation from yourur telephone, give us a call call. we are talking with doctor deb with the cdc prevention and control. she is the director of that center. e if you're an eastern or central time zone, it's 202, 7,488,000. phone lines are open.

will also look for your tweet. what are some of the other forms of injury prevention that you study in your center? >> our center has a wide range of topics. things like sexual violence and child abuse and were reallygi excited later this month we will be releasing strategies for communities. we also focused on things like car crashes and concussions and suicides in the whole range of violent as well as other types gu unintentional injury. >> we had tweets earlier from massachusetts, a democrat. he wrote last week that gun violence is a public health epidemic and it's time to end the ban on gun violence research at the cdc. what are you currently allowed to study when it comes to gun violence? >> so the national reporting system, we track all sorts of death whether it's stabbing, strangulation or firearms. we report on numbers and look at intervention.

we have also conducted somethinu called an investigation in delaware. there we looked at what are really predictors that lead to youth violence in gun violence so we can determine where to best intervene early. >> if you had congressional backing, if the ban that senator ed markey is talking about were lifted, what would you recommend the cdc study? what would be most effective in your mind? >> so if we were to be fortunate enough to get the 10 million in the fy 17 budget, we would go with the reports that we helped with and some of the things we would look at our risk of protective factors around firearm violence. looking at hotspots and how do we intervene. how can we prevent youth

injuries from firearms? >> another issue that you brought up with sexual violence prevention and that such a big issue, especially with lots of headlines from college campuses. can you talk a little little bi about what you are doing in that area and how you're working with colleges and universities on this topic? >> absolutely. this is something that's personal for me. i worked at university and as a practicing physician, i've seen and conducted rape exams in emergency department. paul: of the things were doing is looking at programs that really allow us to change social norms around sexual violence and engage boys and men as allies to really interrupt the cycle of violence. we've also been part of the white house task force and convene both campus leaders and others to talk about best practices and how to get them integrated into campuses. >> lots of talk pics at the center for injury prevention and control. we can go over any of those issues and explore them more with your phone calls and

questions. so up first in southfield michigan, sonja. >> good morning, how are you question. >> yes, i called on myself but i am not addicted but i have so many friends that really take it to the limit so how can they control it that the people won't be attics? >> that's really an important question. what i would say is for many people they can be maintained on that low-dose, it sounds like your doctors work closely with you on that. others can really push the limit and then the guidelines we talked about really reassessingr the risks and benefits with each patient as you go on higher dosages because the higher the dose you go, the more likely you are to have an overdose which is why we are you say start low and go slow. i think it's also important to realize that just because you're on it opioid doesn't mean you stay on that dose or that opioid

forever. what it means is your doctor needs to work with you or other patients to reassess if this is still working for you or if there's something that could work better. if you're on a really high-dose, is there a way way you could bring it down or help manage your pain and medical issues. >> as we noted, doctor tom has been tweeting at the siu @cspanwj has tagged this. he also wrote prescription drug overdose is a major concern. were talking about these subjects in our last 30 minutes here on our "washington journal". we want to hear your stories. michelle is up next morning. good morning. i had spinal surgery about four years ago. of course i was on high doses of

percocet, muscle relaxants et cetera.pa i had extreme pain. as i was going through my recovery and physical therapy, that brought about more pain and of course the doctors wanted to reduce my painkiller what they wouldn't do, and this this is the problem with the insurance companies, no acupuncture, no massage, no swimming nothing to relieve my pain would be paid for by the insurance companies. i'm four years into this. i'm not on opioids anymore. i'm not on anything. but this is the problem. it takes time and money and as we measure the lack of time that i'm at work, you measure in dollars. i'm measuring it in my health.

so that's really where the concern is. >> thank you for sharing that story. congratulations for being able to manage this successfully. it certainly is a long road as you pointed out.t. the secretary has been very supportive and has had a really conservative effort across the federal agencies about this. we are working with our sister agencies on more access to non- opioid medications andother therapies.ap we believe it is important to have access to these other therapies but there can be access issues and we want to work with medical organizations to increase access to this. we also have a lot of veterans who watch this program. a question for you from one of the folks that's falling along

on twitter. does cdc investigate how many opioids and other narcotic drugs are going out of the virginia hospital? >> so we haven't looked specifically at that, but we work closely with the virginia and they are part of the federal review agreement that looks at our guidelines. we welcome opportunities to work with other federal agencies around this problem. >> do we know if it's worse at virginia hospital's than other hospitals in this country? >> offhand i don't know, but i can tell you across the country in all demographic groups we'vet seen increases in the use of opioids. when it comes to overdoses the highest groups are over the age of 45 and men men so that would be of veteran population but again it's been increasing in all populations. >> talk a little bit about that. one of the demographics of the average opioid user. >> so the demographic of the average opioid user versus the overdose user is a little different.av we see overdoses highest in white non-hispanic men ages 45 w to 64 and when you look at heroin overdoses were seeing

significant increases in all age groups but in the younger age groups we've been seeing the starkest increases. >> some other stats from the cdc, the use of heroin as more than doubled among young and young adults. 45% of people who used were also addicted to prescription opioid painkillers. those are some stats that we will go through in the segment of the "washington journal". i. i want to hear yours calls and yours stories. nancy go ahead. >> my question is really in three parts. one, i'm really concerned about and would like to know what the cdc is doing to track deaths as a result of sports injuries, specifically football, soccer, from concussions resulting in en chronic encephalopathy.

i just recently saw the movie m concussion. i'd like to know what they're doing to track deaths and also to track other problems related to it like memory loss et cetera and is the cdc doing anything to work with the national sports organizations, particularly the high school and college level to change rules so these accidents are less likely to happen? the >> so we have been working toward developing a national surveillance system for concussions. it's in the fy 17 budget request to develop this national surveillance system. you're right, it's really important to be able to track concussions so we know the extent of the problem. so many students, athletes have a concussion and don't tell her parents are coach and we don't even see those in the emergency department. we don't even even know the true

scope of the problem. to develop this surveillance is, we will get to a lot of those questions you're asking about, long-term issues and memory loss and we think it's really important to do that. we've been piloting ways to do that at this time. in regard to working with youth sports leagues, absolutely. we have a program called heads up that's been in existence for more than ten years. we train millions of coaches on recognizing concussions andf on changing the culture so all athletes know the right thing to do is to report concussions. we work with the sport league from youth to the professional sports league and consider them all to be really valuable as partners as we know that athletics and physical activity is really important to our youth. we want to encourage it. we just want to encourage it safely. for finding out more about the heads up program as it cdc.gov/injury? >> yes. thank you. >> will go to linda and lancaster california. >> good morning. i'd like to ask, have there been any cases of people being that

the doctors did not want to deal with because of an opioidhealthc addiction in the past. maybe they had too many issues and couldn't get healthcare atlt all and it developed intod even long-term very serious health problems and even death? is this something you've had experience with someone you know? >> yes it is. >> and what's your story if you don't mind sharing.. >> my story is that i was very sick for a long time and i finally went to usc and a man by the name of john martin they gave me a diagnosis and it was for something called a stealth

virus and i couldn't get help after that. i was with an hmo, i won't mention the name and they gave me a lot of heavy opioids and i had very serious symptoms and i didn't know what this viral condition was and i had been dealing with it for very long time and it made me very sick and the doctors have told me no matter what you do you're notve going to like the outcome. the doctors have said do not come back here and when i tried to get help there was just no one that would help me. my husband and i have been married for 40 years and this has been huge. i was a did to opioids.

off of them completely now on my own. i have very little time now because i can't get any time now. i'm trying to stay very calm and you know, it's just huge. were not very good on computers, but we have managed to not be able to get a whole group of people together but there are many individual people that i have met that have very much this similar program that there shoved under the carpet in the sense because doctors do not want to deal with certain issues and their able to have no understanding because they don't want to see that this disease

even exists in many cases. >> doctor i'll let you jump in. >> 's i can't speak to the disease you're talking aboutre e because i'm not familiar with it as an emergency physician, but what i would tell you is that emergency physicians are the safety net and that's why i loved working in the emergency area because you can take care of patients regardless, that's what's in their heart is taking care of patients. the guidelines that we developdn haven't had a lot of experience dealing with chronic pain. myself included. when i went to medical school, had very little training around pain management and opioids and the risks and benefits. we are hoping that these guidelines give providers twirls to feel more comfortable about knowing about the different options for pain treatment and how to treat patients and help

them get off of them when theyfo need it. >> here's the question, what is the first signal a patient gets that they might be addicted to a medication what other options at that point to solve the problem. >> so i think when you realize that a medication is interferin with your daily life to where you need more and more of that, you can't go without a dose, you start to have withdrawal systems if you stop taking it or if you have things like you try to take other people's medication or borrow people's medication w medication or look for ways tot get it, even to the point of being taking other substances. those are signs of addiction. talk to your family and friends and look at the health services. website where they have resources on addiction. talk to your physicians. there are medications that can help specific with opioid addiction to help people get off medication. >> let's go to greenville massachusetts. joe is waiting. good morning.

>> my basic question is, is there a role for tort reform in dealing with the opioid crisis because my question basically comes from, i went to the doctor over the last four years or so and even my dentist and they would just give me prescriptions for opioids, even my dentist did after i had a wisdom tooth removed. i haven't used any of these pills, but i talked to a relative about it and he said was not really the doctor's fault, patients are going to demand relief from their pain. it just seems to me that in light of that last point, it's not the doctors dispensing too many pills just because they want to it's because they expect patients to demand it, perhaps medical malpractice reform to allow them to more easily say no to a patient's demand might be

in order. that might be a possible solution to this large problem. >> what are your thoughts. >> thank you fat. i think another way to look at it is for patients and providers to really have that conversation around how to manage pain.ed it's not always in opioid and again when i train, i didn't really know the risks tois benefits of opioids. now in the last few years we have a lot of evidence about the risk of opioids. i think one of the things we can do is educate the physicians and patients in the summer we plan to launch a communication campaign around awareness of opioids for the public so the public is aware also of the risk of that medication.. many patients come into a provider and might think that they don't get the opioid that they're not getting their pain treated and i think having better awareness in the community around the risks and

benefits is important as well as educating providers as to what are all the alternate treatments for opioids such as biofeedback physical therapy, some of the neurological medications can help and things like that. i think greater awareness and working really in partnership with our patients. >> about 15 or 20 minutes left. the phone number is eastern and central united states time zones (202)748-8000. good morning.led >> i wanted to say i'm a disabled veteran. i was injured in the first gulf war. i had some massive injuries and internal injuries and it damage to nerve in my leg and it was the image pretty significantly. now they did save my leg but

it's always hurt since then. in the 90s, the virginia just threw me all kinds of pain medicine. the pain medicine eventually would stop working so they would switch to another one. so i've been on methadone for pain and oxycodone and others. eventually i was on it transdermal patch, you wear it every three days. in 2004, they just cut me off.e i guess because the virginia policies have started to change to not give so much pain medicine anymore, but i wentgh through withdrawals and i wasg sick and i started using heroi'' well i have a job so i don't want to stay on heroin. i went to an outside doctor and they got me a dorsal collins stimulator.

it was a surgery done outside of the va because they don't want to do it. so using that and marijuana my pain is very manageable now but the va will not recognize marijuana as a pain medicine. because i have hepatitis, they will not give me the treatment for hepatitis because i continually test positive for marijuana. now i would think that marijuana , i grew up all drugs were bad, but marijuana marijuana isn't that bad between marijuana or fentanyl, i'm much happier on the marijuana because i can function. fentanyl is powerful, powerful stuff. you probably know know anything about va but i do know their policies are changing.

>> doctor on his story? >> so two things, one on marijuana, marijuana, i do think we will have better evidence on how it may or may not be effective for pain.es your story is a great one to share with that. to i think we need better studies to defend the. determine how effective it is. right now it's legal in some state and not another so it's difficult to do the studies. i do think it's something to look further into. you mentioned hepatitis and heroin. indiana had an outbreak about a year ago from injecting prescription opioid. i think that's another aspect of this epidemic when you talk about opioid medication as the injection issue. that in partnership with our center responded to that crisis. it really underscores the importance of safe prescription for opioids and simple things

like not sharing needles. all of that plays into this crisis because you can go from being addicted to in opioid medication to developing hiv or hepatitis, all these things we want to prevent. again, with primary prevention focusing on getting people not addicted to these medications in the first place.aphics, >> on twitter, are we examining opioid use by other nations to determine impact of treatment, velocities, demographics, geographic culture, et cetera? >> so that's one of the thing we are working with our federal partners on and will look at numbers, the united states consumes 80% of the opioids compared to other countries. we are looking at best practices in other countries in our healthcare system is also very different than other countries. they have to keep that in mind. i do think there's a lot that can learned about other treatments and other countries. >> hello.is

thank you so much for everything that you're doing. i want to start out by saying one in three kids in america is abused by the age of 18. you guys are working on trauma in the government as well, and i'm on the diversity board where the sixth-largest district in the country and were seeing something down here in our va hospitals called institutional complex ptsd. it's where you have institutions exhibit very similar to how you have individuals exhibited similar to borderline personality and the black white thinking that is very reactive, self interest versus group interest. what happens is the weakest segment of society, the ones that have the least voice from children to the elderly to the virginiathey all exhibit the

same patterns, it's it's like a fall through the fingers. it's not a matter of one side or another, it's both sides within the system and they're both pointing at each other and not pointing at the person holding the jar. i'm in a back out of that but what i'm looking at here is you coming down here to help this, they're not experts at this.skee they're expecting you to bere there and when i asked them to contact you they're afraid. the reason they're afraid is an the ptsd and there some irony going on here. as a result of everything going on, this is a fantastic t fantastic thing, but the teachers and the students on the

same side of a lawsuit saying we've all suffered the same damage. it's real. it's not something that's just a pat on the head. that's for you come in to educate the people.ic this is the physical reality. it's measurable. because these children are messed with for lack of a better word, there's no way you can do it and we cannot know. >> dr. >> thank you for bringing up child abuse. it is a huge issue in the unitem states and when you look at the long-term consequence of child abuse, it can result in chronic disease like heart disease, diabetes and as you mention things like posttraumatic stress disorder so we absolutely want to look at ways to prevent it. we welcome an opportunity to work with partners and communities. we would love to hear from you or from the county as a way we can help. two things i can tell you about right now that may help is we have a program on our website and it talks about strategies

and policies that can be used in communities around preventingng child abuse as well as measuring it. later this week will be releasing a group of strategies based on the best available evidence on how to prevent or lessen child abuse and neglect. recall that a technical package and that will be coming out later this week.d i think there are ways we can really work with communities and states on how to lessen the burden of child abuse. >> also tracking stats on child abuse, these stats from 2013, about 600 79000 victims were reported to child protective services.se about 1520 children died from abuse in neglect in that year. the cdc is keeping those numbers on their website. you can. you can check out all the work by the center for injury prevention and control at cdc.gov/injury. about ten minutes left in the "washington journal".

lawrence is in pennsylvania. good morning. >> doctor, cannabis has never been a medical problem and i suspect you know that. no one has ever died no one has ever become addicted to absolut marijuana. this is absolute bad science which has led to a drug war fueled by the unwantedknow tha prohibition. e icepack you know all that and if you don't you should educate yourself. sixty years ago they provided over the counter and i suspect you know this too. there is no opioid epidemic at that time. thank you very much. i'll take my answer off the air. >> any response? >> so what i was gonna say is were starting to look at it a lot more as marijuana becomes legal throughout different states and our sister agency is

really one of the key agencies looking at different types of drug abuse within the center for injury control at the cdc.el were looking mainly at overdose deaths, some things like marijuana is something that sits throughout cdc and can impactos other aspects of health. i think it's important to look at it so we can see both the pros and cons but again to datee there isn't a lot of evidence when you look at randomized controlled trials of anything like that around marijuana. we do here patient stories about how marijuana can be helpful but we might not be hearing stories of those who are not having the same benefit. i think we need to wait until there's more information out there. >> ames iowa is out there. your next. >> hello.:: i'm wondering if you have something like information on brain accident. i would suspect the results

would be like having a stroke inside your brain. studying these with mri should be a very useful thing to have a set a date on. then you can see what part of the brain is being injured with each set of bangs are punches on the head. thank you.i ag >> thanks for sharing that. i agree, i think there are different ways we can look at the impact and then the future damage on brains whether it beua mris or virtual reality type helmets. i think there's many ways to diagnose concussion and i think the area is still really early on to diagnose and manage concussions. this is one of the reasons why we think a surveillance system around concussion is important so we have a better sense of how many people have mild to moderate severe brain injuries as a result of other sports and other activities.

>> let's go to ray in little rock arkansas. good morning. >> morning. i'm really starting to get very agitated about all of the fear mongering that's going on regarding opioid pain medication there are people who are truly suffering and unfortunately very little works, very little helps. if they don't do anything except tear the lining in your stomach up, and yet the dea and other federal agencies have absolutely scare doctors to death about prescribing drugs that work,

they work, for all the fear mongering that goes on, these drugs do actually work for people who suffer chronic pain. it's something they live with, day in and day out. it really frustrates me to hear all of the old my gosh these drugs are so horrible and we've got to do something about it.d s what they are not taking into consideration are those people, and i have a dear dear friend who is one of them who need pain medication in order to have some sort of quality of life. >> i've got your point, let's let dr. respond.t >> so what i would say is when we say this drug doesn't have

evidence for long-term use, it's because if you look at the agency for healthcare research and quality, their systematic abuse a few years ago and there's no long-term studies greater than the year comparing it to a placebo or essentially no pain medication. there hasn't been any studies to show long-term effectiveness of it. we do know that opioids can be effective for acute pain for a short time. for longer periods of time, people can be become dependent on it and tolerance of your body may need ten times the amount you originally started on. there can be other medications. i hear what you're saying. there are also other non- opioid medications and therapies that can be helpful for people and that are more effective in the literature around them.or kidne

what i would say is it's up to the patient and provider to have these discussions. the risks and benefits are different for each patient depending on what their medical condition is in the other issues they might have like renal or kidney disease, long-term illness and all of that needs to be discussed between the provider and the patient really balancing the risks and the benefits. >> let's go to hendersonville tennessee. >> good morning. >> go ahead. yes, my question is your regulay dr., for like a person who had back surgery, they go to the regular doctor and then theyin wind up sending them to a pain clinic. i'm not exactly sure how long the pain clinics have been in effect but it's been a few years once they go to a pain clinic, what they do is they start out with two or three high-powered pain medications and i had a

friend who was on morphine and it used to be that morphine wasn't given until it was somebody with cancer and then they keep switching him around like the two or three didn't work and they build up a tolerance. then they put a month something else. it is a problem, but it's the prescriptions that are doing it and it's also the doctors that are doing it to the people instead of giving them one medication or something to see how that works and then build them up or switch them over to a different one. their doing so many all at one time. then you have all these people who are addicted and everybody'. wondering what's going on in these people are dying. i have a dear friend that's actually addicted now and just a matter of how can they get off

of it, can they get off of it? i just like to know as far as the doctors prescribing them and the people that are already addicted. : treatment is really important for pain and including opioids the milano purex, physical therapy. we did not get here overnight. for the past 10 years, we have seen the number of prescriptions increasing with a number of overdoses increasing lockstep. one of the things we can do is say for prescribing and having conversations with patients and physicians and patients informing themselves more and we can turn the epidemic around. host: dr. debra houry is the director of the cdc prevention center for injury and control. thank you so much for your time this morning. guest: thank you. we look forward to hearing all of you.

please check out our website for all of the resources on the topics we mentioned today. host: things to all of our guests and the cdc for allowing us to bring you this program today. was the right b >> had the great monday.

[inaudible conversations] good afternoon. has advertised we will do a follow-up note from the briefing here a couple of months ago when from the national institutes of

health and the cdc kang give you an update on what we have learned about this virus and but it poses to the american public and also the funding request to the estates congress as we discussed last week we have not seen the response from congress that we would expect and frankly we haven't seen the response from congress in the interest of the safety and well-being of the american people. so both doctors should provide some insight into how this resource is to make brief opening statements and questions and then he will let them go and then discuss other topics dr.?

>> thanks. it is the pleasure to be here today since the last discussed the zika virus we are learning every day most of what we are learning is a reassuring. we have learned the viruses linked to our broader set of complications of pregnancy not just micra supplely but i problems, the prematurity and other conditions the mesquita a factor to this present in the of a broader range of states in the continental u.s. some instead of 12 states we believe it is 308 states have the mosquitos present. also the virus is likely to be a problem during much of the pregnancy period not just the first trimester but throughout the pregnancy. this information is of

concern and the cdc is working 24/7 two protect pregnant women that are the front line to learn as much as we can about the mosquito and with other countries to learn what we may see in the continental u.s. faugh we're quite concerned about p.r. where the virus is spreading there could be hundreds of thousands of cases ted perhaps hundreds of affected babies we know pregnant women are keen to protect themselves and we are working closely with authorities there to support their response with mosquito control and distribution of the zika provincial kids for pregnant women. mosquitos transition but it

is also spread through sexual transmission so we had to do updated guidance. there is a resounding interest in preventing this disease. last week on april 1st this cdc convened zika action plan summit in atlanta with more than 30 states or territories joining in to do the action planning there is a lot to do to increase laboratory diagnostic testing in humans surveillance and birth defects tool improve communications to have the best information so that is what is going on since we

talked a couple weeks ago. >> similarly there has been at us and it did a research meeting that to underscore we are learning more and more i will give a very brief summary but the more we learn the more we are concerned about the scope the bottom line is he's still have a lot to learn. but with a very important study at the molecular level to see if there is any difference if it is transmitted blood is the difference between zika and others that looks as a molecular the except with a short amino acids that is

part of the virus that binds the cells so that is the clue of why it acts different to be narrow topic or to have the propensity to affect tissue but we have two models since we spoke last in day underscore what the doctor said because it can affect neurological tissue we have that monkey model because now you can get a monkey pregnant and let's get the difference between the virus and the pregnant monkey and one that is not pregnant. what we have seen is the virus stays around the blood significantly longer in the pregnant monkey. we had a case here every washington resident that affected the fetus and they had weeks which is unusual

because only last a couple of days. neurological issues of in vitro studies show it has said very strong propensity to destroy tissue with the development of a fetus to directly attack brain tissue even later in the period of gestation. continuing with the vaccine studies but the candidate in phase one it looks like it is on time outside of bethesda and processing to get it to the fda and finally we have a screening program for drugs. we have now screamed this -- screened 62 that have some degree of activity it

doesn't mean they will turn out to be good but they do have activity so a lot of things have gone on according to serious issues to address that we do need to learn a lot more. that we cannot either pretend we don't ever think about it the. >> dr. you expected hundreds of thousands of cases importer rigo? how many do expected united states broadly. >> led to the of predictions come from the viruses that are spread from the same virus a range between 25 and 80 percent of the population over the course of one or multiple seasons in the

continental u.s. we have seen travel cases but not large numbers of locally transmitted diseases we have seen dozens but as a doctor was saying everything seems to be scarier than what we initially thought so that we don't see widespread and that is what the summit was about to with mosquito control what do we know or not? and how to get ready for mosquitos season how to look around for mosquitos year by the one that travelling public to use repellent for a couple weeks after they returned if they have zika and missed it then that

mosquito can spread the virus so i don't expect there to be large outbreaks in the continental u.s. and but we cannot assume we will not have a problem with the other viruses we had bigger problems than we expected some retaking it seriously to. >> what we know is 25 for 80 percent of the population we go right now it is more difficult to keep out fever and rash so i would say they're at risk for very high tax rates. with pregnant women we don't know yet if you have zika during pregnancy but% it is totally dermal or a complication. that is an important

question for us to the answer and teams are working to answer that question it is the most important question for pregnant women. >> tell us about the prevention kit and but that entails and also in working on something specifically. but are you confident you have what you need to maintain? >> the insert is a don't have what i need right now but what i have done is take money from other areas of the non it zika area we couldn't just opted way we had to go ahead but if you

don't get the money the president has asked for you cannot take it to the point where we have accomplished what we need to do so we really don't have what we need but we're going full blast by throwing money from other areas. those that were trees from ebola will bring us further but not what we wanted. we needed 1.9% billion with the president asked for 1.9% billion dollars period the prevention kids are he given to pregnant women in the areas where the of irises already spreading. with 9,000 kits distributed so far. they include insect repellent how women can protect themselves and with condoms because we know it can be spread sexually not just through mosquitos. to make sure they stay

outside the home. we were considering putting in some treated clothing but then some surveillance resistance revealed we didn't include that debt essentially there is materials to help them protect themselves with athletes we note the olympics is a wonderful event we wa to make sure people know if they are pregnant they should defer travel and travel to the area may indeed to infections with symptoms and following infection it is important to take precautions during sex not to spread the virus. that has been shared with the olympic committee and cdc is working closely about further advice.

>> are you concerned by transferring the money from the appropriated funds with the urgency of congress? >> it shouldn't because it isn't enough for us to get the job done. it is a temporary stopgap. look at what we need to do with the cdc and nih we have a lot of work to do and that may lessen the intensity but we still don't have enough to do what we need to do. >> we also feel a sense of urgency of ebola and many of those countries in africa are having outbreaks right now. so we have to be ready to support response more than one of breaking a time so

we're working as quickly and as deeply as we can while continuing to support ebola of response recovery. >>. >> is there any type of mosquito forecast if that will be worse than usual or in general? and were you telling travelers if they are returning and should they be tested? >> the issue of mosquitos surveillance is a great question. one of the problems is we have let mosquito control efforts wither away so we don't hound that great misinformation or we need to do better mottling where the problems will be and where they will occur. so strengthening surveillance is a priority.

so that is something we are working on and but we can do a better job copper co we do think if you come back from an area where zika is spreading we recommended you were tested symptomatic or not. in terms of peoplehood they don't need to be tested if not pregnant but they do need to have precautions with sexual contact in terms of sex with a pregnant woman. a lot of couples were asking i am not pregnant but i want to be how long do i have to wait? we put out guidance waiting eight weeks following travel before trying to conceive or longer if you have symptoms

there is the potential they could have persisted virus in the season -- semen xx have a projection of the spread of the virus in what happens with the stopgap? >> yes we do think the prevention in kits may be helpful in a lot of interest from those that attended the summit. today have screens or air-conditioning so that idea of protecting yourself may be relevant here. >> we have a team tracking

where the mosquitos are that are potentially of concern and then in multiple parts of the island and it the be those cases are just a small percentage because they could be a symptomatic the only people tested right now are coming in with symptoms we are worried as it gets warmer. >> but to be honest i cannot imagine that we would not be given the money when we tell you things that our more serious. we reached the point of the stop-gap budget hopefully that will never happen that with very important research

to suffer badly by almost can't imagine because as we keep talking we spoke about the interesting issue i'm not an alarmist but as to learn about those neurological aspects to say this is very serious we know you have a case of the acute encephalitis then then you saying that was just recently described that is multiple sclerosis type of involvement thankfully it tends to resolve that we see more and more selling context cannot imagine that all of a sudden we will not get the money.

>> if they catch us by surprise. >>. >> handed the sense we should have known since the virus was first recognized in 1947 in the human cases was 1952 it was inconsequential in the sense a rather mild illness no mortality no hidden source signals of other things that we see now like the micro supplely -- micro insightfully but when had its first outbreak of the islands is when things started to explode and only when the head a vulnerable big population to be start

to see the unfolding of the scenario every week every month will surprise us but there was no reason to be suspicious it was of virus that even a mild illness. >> what the health chairman said they continue to monitor and fund as needed why do you need that up front verses getting as it progresses? when is it too late is a first bite? >> i fink we haven't been waiting for the money because it is so serious eric is a of a backlog of our laboratory testing to scale up takes time knowing

their resources are coming helps there's a lot of commercial partners he did it will they help without knowing if resources are coming in rehab vector control but that is expensive and we are learning not all chemicals are pesticides will work there are multi-year studies that will be needed for these babies widow of a tile that looks healthy will have the effect so there is longer-term studies that will be needed. those attracted intensively right now we can use those additional resources we cannot commit to to though long-term in the places the resources were taken is where important work was going on in we are foldable of we can beat to the abrupt

ebola response and recovery. >> also wouldn't mention the last time is we have the very important partnership and if they don't perceive us as a reliable partner they tend to back off to develop those counter measures we need to partner with them. to say trust us we give it later that doesn't work. >> the answer is think believe not yet but i have considerable experience when we were building countermeasures to get back seasons for anthrax to bring companies in the end of last we have the money upfront

then many of the important companies don't want to see that now. >> when will it be too late? >> we held our segment -- -- summit with the season was coming that there is the need to develop mosquito control efforts and difficult tasks so no there is some resources is helpful they are frustrated because it is coming from other programs that they have. and then it is several months when the baby is born. then you see the horrible effects on the child. we need to act before then.

>> spee vicki said you are moving money around with the

appropriate way to message. >> for women that become pregnant tell us more about the neurological disorder. and at what point i will adjust the part of recommendations the oecd's case reports with others

similar viruses i imagine 81 year-old man it could develop encephalitis now the two cases we don't know the denominator. that is the reason why he do surveillance studies. but what is the extent of that? or are you look carefully will you see a lot of them? at the same time you see that clinical manifestations with that in vitro wind to put the zika virus they have these things that are completely destroyed by the zika and those that are

related to the neurological system that appears to be in neurotropic how that relates to the clinical cases. >> in terms of the additional travel guide at this point we have enhanced travel recommendations that they defer travel. i cannot promise we would not have broader recommendations but based on what we have. with the general population is fairly rare. it is truly causing an increase it is relatively uncommon. dead-end not for us to say don't go.

>> there are reports from haiti it is growing seriously and the problem is compounded for those they say with medical centers. and given that proximity to the united states. >> a key country working with authorities with intensive support me share a concern about haiti that of virus is there the population is vulnerable region of a country office working with the authorities with those same principles that people need to be protected and the care will not be as strong the view

that the syndrome in haiti it would be difficult so we share with our counterparts there