"Since 95 percent of flu outbreaks start in mid-December, it’s best to get the flu shot in early to mid-November."

"There's no one study that's going to be the Holy Grail. But there are going to be key studies upon which others can build. And this is one of them."

"Frankly, I'm much more concerned about people coming in and out of JFK or Chicago-O'Hare [than disease from immigrants]. Somebody exposed to the MERS virus on the Arabian Peninsula, who's going to check them? Nobody. If somebody picks up a drug-resistant infection while on some exotic tour, it gets to their community before they ever get screened. "

"You think of San Diego as a vacation destination and now, suddenly, you're hearing about hepatitis and unsanitary conditions. That contrast is going to get more media attention, sort of like a measles outbreak at Disneyland is going to get more attention than one at a school in a metropolitan area, even if they have the same number of cases."

"We have a number of indicators right now showing that our ability to quickly detect cases and follow up on their contacts has been seriously challenged by the safety issues. [Vaccine] can't be given to people you don't know exist."

"As far as the past year, clearly the Chinese began a very aggressive and comprehensive program to vaccinate poultry against H7N9 [avian flu]. That is by far the most likely explanation for what happened [to dramatically lower human cases], but even there we can't be certain."

"We have no sense of why the fifth [wave of H7N9 avian flu cases] was so high. There was just no reason that we can come up with beyond the spread in poultry."

"These kids are largely recovering. It’s not like a life-threatening bacterial infection. . . . Second, there is, in a sense, a treatment. We know that early and aggressive physical therapy intervention can actually be very, very important."

"[Seek medical care] if you start to sense any neck weakness or stiffness in the neck, which could also be signs of meningitis. You start to really get into [AFM's] clinical symptoms when you get drooping eyelids or facial droop, as well as difficulty swallowing or slurred speech. And, finally, [look for] a weakness in any of the limb."

"The risk is really low. Remember, it's still less than one in a million in terms of individuals. And we don't want people to change their everyday activities."

"It's likely being caused by an infectious agent, much like the polio model. And we think an enterovirus is likely causing it. One — [EV-D68] — has been identified in some cases, but not in the majority of them."

"When we put out that report, it was like shouting into the Grand Canyon. Now we're seeing substantial investments in both money and intellect."

"We don't have stockpiles of anything beyond a limited supply the US government has of some medical products, which would be quickly exhausted if we are in a real pandemic. We have to anticipate these things, and we have to have plans."

"We used to talk about vaccine hesitancy where people were reluctant to get vaccines. Today it's much greater than that. It's a hesitancy to adopt any kind of science-based approach."

"There's reason to believe we can find a combination [flu] vaccine that would be much more effective. But I would say we're at least 5 to 8 years off.

"We are extremely vulnerable today to any disruption in international trade in lifesaving medicines and medical devices. Look no further than what happened last fall when a Category 5 hurricane hit Puerto Rico, an island where about 80% of IV (intravenous) bag manufacturing worldwide was concentrated."

"We are much more vulnerable today to a catastrophic influenza pandemic than we were in 1918. That may seem counterintuitive, but today there are about 7.6 billion people on Earth, more than 3 times the population in 1918."

"We have to adjust the practice of medicine to the science of medicine, and the science of medicine right now says get your flu shot as late as possible before the flu season."

"From the time you get the flu shot, every month after that the actual protection is reduced over time."

"While there are some differences, they’re not demonstrably different between a cell culture versus an egg-based, versus which kind of [flu] vaccine you get. I think the key thing is getting vaccinated."

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