Health Officials Brace For Fall Flu Season

Experts met this week to decide who should receive the first available swine flu shots this fall. Dr. Anne Schuchat of the Centers for Disease Control and Prevention and University of California, Berkeley epidemiologist Dr. Arthur Reingold discuss public health preparations.

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IRA FLATOW, host:

It's still summertime here in the Northern Hemisphere. But, of course, in a few months, fall is going to be here, bringing those colder temperatures and temperatures that are more flu-friendly. So public health officials are keeping a careful eye on the swine flu to see what happens over the next few months.

In the meantime, pharmaceutical companies are working to develop an effective vaccine, and that development has not been without some problems, though. And with setbacks we've had so far, will we have enough of the vaccine when we need it? And even if we have lots of the vaccine on hand, is the swine flu threat serious enough now that we should all consider getting the shot? And if everybody's making swine flu vaccine, what about the regular flu we get every year? Who's making those - the vaccine for that regular flu, the seasonal flu?

So that's what we're going to talk about for the next part of the program. Our number is 1-800-989-8255.

With me now is Dr. Arthur Reingold. He's co-director of the California Emerging Infections Program, a professor and head of the Division of epidemiology at UC Berkeley. Welcome to SCIENCE FRIDAY.

Dr. ARTHUR REINGOLD (Co-Director, California Emerging Infections Program; Epidemiology, UC Berkeley): Thank you very much.

FLATOW: What's happening with the swine flu this season? You're down there in Sao Paulo, Brazil, where it's wintertime, right?

Dr. REINGOLD: I am in Sao Paolo, where it's wintertime. And I can tell you both what's happening in California and in Brazil. And I think it's safe to say we have a quite a bit of influenza. So back in California in our Emerging Infections Program, we're seeing unprecedented numbers of influenza cases in the summertime. In fact, we've seen more in the last couple of months than we saw all of last winter.

FLATOW: Wow.

Dr. REINGOLD: Pretty much all of them caused by the new - novel H1N1 virus. And here in Sao Paolo, there are large numbers of cases. So far, here in the city, there have been almost 30 deaths. And they're, in fact, about to close - or actually keep schools closed for an extra two weeks rather than restart them on time after their normal winter break in order to…

FLATOW: Mm-hmm.

Dr. REINGOLD: …try and reduce transmission. So there's definitely a lot of this new flu virus around.

FLATOW: Well, would you call it a new outbreak of just a continuation of the old one?

Dr. REINGOLD: Well, I think what's going on in California now and in other parts of the United States and what's happening here in Brazil, Argentina, other parts of the Southern Hemisphere, is all part of the same outbreak or epidemic or pandemic, as WHO has properly called it. It's the same virus. And it's basically the same outbreak.

FLATOW: I want to bring in Dr. Anne Schuchat, the director of the National Center for Immunization and Respiratory Diseases at the CDC in Atlanta. Welcome to SCIENCE FRIDAY.

Dr. ANNE SCHUCHAT (Director, CDC's National Center for Immunization and Respiratory Diseases): Thank you.

FLATOW: How are we doing with flu vaccine preparations for the year?

Dr. SCHUCHAT: The vaccine production is going forward. We actually have the seasonal flu vaccine well underway and available very soon, but the preparation for the H1N1 vaccine is in progress. There are five companies that are producing vaccine for the U.S. And there are clinical trials that have begun already in some other countries and that are beginning here in the U.S. very soon.

FLATOW: Dr. Arthur Reingold's on the phone with us, also now. He's in Sao Paolo, Brazil, and he says there's a lot of flu out there. Would you agree with that?

Dr. SCHUCHAT: Yeah. That's right. It's the very usual year. Of course, we had that early experience in the spring with this new virus really detected in April and increasing in many parts of the country in May and June. And we've had continuing transmission through the summer with outbreaks in camps and 40 states. And, of course, many other countries now seeing increases in their winter flu season in the Southern Hemisphere.

FLATOW: Do you have two different recommendations for the swine flu and the seasonal flu virus vaccine recommendations with different populations? Or are they the same people who should get both of them?

Dr. SCHUCHAT: They're somewhat different - many overlaps. But the seasonal flu vaccine is recommended for most Americans, and it's really a good idea to get it to reduce your risk of influenza. There are new recommendations that have just been made by the Advisory Committee for Immunization Practices for the H1N1 vaccine, particularly at the beginning where we might not have as much as we would have later.

And there, we're focusing on five groups: pregnant women, households, and caregiver contacts with children under six months, health care workers, people who are six months of age up through 24 years of age, and then older adults, 25 through 64 years of age with underlying conditions.

FLATOW: Yeah. Dr. Reingold, why should older folks, who were usually at the top of a flu list, be at the end of this swine flu list?

Dr. REINGOLD: Well, I think that's a reasonable recommendation. What we know so far - although it's still somewhat early days - is that this new virus primarily is affecting people under the age of 60. And that may be because those of us over the age of 60 have seen a virus like this before somewhere, perhaps back in the 1950's, and have some residual immunity. So at least the epidemiologic data so far suggests that there may be less of a need for the vaccine in the elderly for this particular virus.

FLATOW: Mm-hmm. Dr. Schuchat, when you make recommendations about certain groups that should receive priorities for the vaccine, isn't there some danger that, for example, many pregnant women won't show up to get the vaccine allotted to them and then you'll be denying the vaccine to people who want it but are not on the list or high up on the list?

Dr. SCHUCHAT: We're very keen to respond to demand and be able to fill it. We don't want vaccine to go to waste. And so these focus groups that are part of the earlier recommendations are really a signal to the states and providers to out and find these people, make sure they have access to vaccine. We don't want people to be turned away, but we also don't want those at highest risk to not have access. And so it's a balance. But it was very important to the committee that we do all we can to be able to increase demand and meet with our supply.

Pregnant women really need to know this is a serious virus. We've had deaths here in the U.S. and in other countries. And influenza vaccine's been used for years in pregnancy. We really think that…

FLATOW: Mm-hmm.

Dr. SCHUCHAT: …pregnant women need to have that in their minds.

FLATOW: 1-800-989-8255 - Anne in Boston. Hi. Welcome to SCIENCE FRIDAY.

ANNE (Caller): Hi. Thank you. I have a six year old and a three year old. And my three year old has a minor egg allergy. So with seasonal flu, what we typically do is vaccinate everyone around her to protect her from seasonal flu because the seasonal flu vaccine is egg-based. But what I'm hearing is that she would be in the groups that would be - they would want to have vaccine, but she has an egg allergy.

And I'm wondering if the swine flu vaccine has egg and whether, you know, with her minor allergy, is it more of a risk for us to not vaccinate her when we can vaccinate everyone around her? Or, you know, what the recommendation would be in that situation.

FLATOW: Good question.

Dr. SCHUCHAT: Yes, these are egg-based vaccines. So, unfortunately, we aren't recommending them for those with egg allergies. And that idea of protecting those around you is a general principle for influenza. We think that's a good idea for the seasonal influenza vaccine. And part of our recommendations for babies under six months is about that idea, protecting those around, those who can't get vaccine themselves.

FLATOW: All right, Anne?

ANNE: If my kid is not able to get vaccine, but the rest of us are not in those high-risk groups that have identified as ones who should get vaccine, then, you know, how do we protect her?

Dr. SCHUCHAT: Yeah, that particular circumstance would be a good one to talk with your provider about, because it would really be analogous to the baby under six months.

ANNE: Okay, great. Thank you.

FLATOW: And there…

Dr. SCHUCHAT: Sure.

FLATOW: Thank you. And there's enough vaccine to go around, Dr. Schuchat?

Dr. SCHUCHAT: The U.S. government's been preparing for this kind of problem, and we're optimistic about the vaccine supply. We're expecting a supply to come online in October. And, of course, with influenza vaccine production, it can be unpredictable. So far, our targets are being met, but we really need to remain flexible as a country. So we'll be keeping people up to date as we hear changes in the projections.

FLATOW: Dr. Reingold, based on your experience down there in South America, do you think we're - our staff up here is able to handle what you see as a large outbreak?

Dr. REINGOLD: Well, I think that - I would say two things. First of all, I think state and local health departments are certainly going to have their hands full this coming flu season, by all accounts. And I think that one of - there is an expectation that there will be some federal resources going to the states and counties to help them, and that will be extremely important.

One has to recognize it's against the backdrop in which many state and local health departments have actually been laying people off in response to state budget problems, so I think they're going to have their hands full. On the other hand, I do think Americans generally need to appreciate the fact that they are better off, will have better access to a vaccine than people in poor countries around the world, where in fact vaccine probably won't be available at all for most people.

FLATOW: Would you agree, Dr. Reingold - oh, Dr. Schuchat? I'm sorry.

(Soundbite of laughter)

Dr. SCHUCHAT: You know, the international aspects of a new virus like this are immense, and I think the U.S. government really is committed to working with partners around the world to help ease the challenges that we're going to face. It's a very - you know, it's very early days to know the full extent that we'll see when this virus is transmitted widely in many countries. But I do feel that Dr. Reingold makes good points there.

FLATOW: There are many people who still rightly or wrongly are fearful of the thimerosal that's in some of the old vaccines. I - there is an option for a non-thimerosal version, is there not?

Dr. SCHUCHAT: The preparations that are being developed include nasal spray that is - does not include thimerosal, and also some product that will be produced with needle and syringe, individual formulations that would not have thimerosal. It's important for people to know that the thimerosal issue has been looked at extensively, and we don't think that there are safety risks associated with that. But as I said, there will be some formulations without thimerosal that are being produced.

FLATOW: Mm-hmm. Dr. Reingold, what about the trial vaccines? Are you - how many trials do you think we need?

Dr. REINGOLD: Well, I think - and Dr. Schuchat may be in a better position to talk about how many trials are going on. There's a trial going on currently in Australia, and a number have recently started at sites in the United States. But, typically, in an annual influenza year, when we're preparing annual influenza, we rely on testing a vaccine in a modest number of people, typically, the numbers in the thousands, because we have relatively little time. We need to collect the data quickly.

And what we're trying to establish is that the vaccine is immunogenic, that it makes antibodies, and that it appears safe when given to thousands of people. So, I think there are an adequate number of trials proceeding now, and at least my understanding is we will have that kind of information basically within the next six to eight weeks.

FLATOW: Mm-hmm. Dr. Schuchat, you would agree, I imagine.

Dr. SCHUCHAT: You know, there are a number of studies that are going on. They've begun in Australia and Costa Rica, and they're going to begin here in the U.S. fairly soon. Manufacturers are doing studies, and the National Institutes of Health is coordinating a number of studies with their vaccine treatment and evaluation units.

There'll be different kinds of information coming from the trials. I think it's important to - for people to know that the type of vaccine that's being made is really exactly like the influenza vaccine that's made every year in the United States or in other countries. These are vaccines that we have years of experience producing, and they have a pretty good safety profile.

FLATOW: Mm-hmm. I want to thank you both for taking time to be with us today. Dr. Anne Schuchat is the director of the National Center for Immunization and Respiratory Diseases at the CDC in Atlanta. Dr. Arthur Reingold is the co-director of the California Emerging Infections Program and professor and head of the division of epidemiology at UC Berkeley School of Public Health. Thank you, again, for taking time to be with us today.

Dr. REINGOLD: Thank you, Ira.

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