H1N1 Vaccine Supply Delayed, But Coming

GUESTS:
Rob Stein, national science reporter for the Washington Post
Dr. Jonathan Fielding, Los Angeles County Health Commissioner

President Barack Obama has declared swine flu a national emergency. Thousands of Americans have stood in long lines, hoping to receive the vaccine, but it is in short supply. Still, some parents question the vaccine's safety, and whether their children need it.

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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington.

With H1N1 now widespread in 46 states, President Obama declared a national emergency this weekend, while thousands stood on long lines at clinics around the country to get the H1N1 vaccination, but many places just don't have it yet.

Reality has fallen far short of estimates that 40 million doses of vaccine would be available by the end of this month. Health and Human Services Secretary Kathleen Sebelius made the rounds on the morning talk shows today, this from CBS TV's "The Early Show."

(Soundbite of television program, "The Early Show")

Secretary KATHLEEN SEBELIUS (Department of Health and Human Services): What we were doing was relying on the manufacturers to give us their numbers, and as soon as we got numbers, we put them out to the public. It does appear now that those numbers were overly rosy, that the projections were too high a couple of months ago, and we got updated projections as recently as Columbus Day.

Having said that, I want to remind folks that I know there's frustration of people waiting in line. I don't want to minimize the anxiety of a lot of parents who want to get their kids vaccinated, but we do have a vaccine that works. It works with everybody over 10 years old with one dose, and the immune response hits more quickly than we anticipated.

So actually, as of today, we'll have about 16.5 million doses available throughout the country.

CONAN: As the vaccine slowly rolls out, many parents have questions about why availability is so limited, and some continue to ask if it's safe or even necessary. So parents, what's happening where you live? Give us a call, 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION.

Later in the program, on the opinion page, a skeptic considers the hidden cost of the perspective deal on Iran's nuclear fuel, but first H1N1, and we begin with Rob Stein, national science reporter at the Washington Post. He joins us today from a studio at that newspaper. Thanks very much for being on the program.

Mr. ROB STEIN (National Science Reporter, Washington Post): Hi, Neal, it's nice to be here.

CONAN: And let's begin with President Obama's declaration over the weekend. What's a national flu emergency?

Mr. STEIN: This is a step that the administration was taking really as a precautionary step. It's - a couple people I talked to likened it to when you know a big storm is coming, and you make sure you have all your snowplows ready, and you have all your salt piles ready to go.

They really - what this does is it enables the federal government to waive certain requirements that could get in the way of treating large numbers of patients in hospitals if that should occur, and hospitals get overwhelmed, they have to satellite centers to treat patients. It's basically aimed at clearing away some of the administrative and bureaucratic hurdles that could get in the way of treating patients.

CONAN: In the event, but the event seems to be here.

Mr. STEIN: You know, the numbers of cases, yes, they've definitely started to increase, and at least 46 states are now reporting widespread flu activity around the country. A lot of hospitals are reporting that they're seeing a lot more patients coming in. There's even been a couple of hospitals, at least one in Texas and one in Memphis, where they got so crowded in the ER that they had to set up tents in their emergency - in their parking lots outside the emergency rooms because they were getting too crowded.

But most hospitals are so far dealing with it okay, and their ERs really haven't gotten overwhelmed, their ICUs haven't gotten overwhelmed, but that's a possibility, and they just want to be ready for it whatever might happen.

CONAN: And then there's the question of the availability of the vaccine. We were promised 40 million doses by the end of the month. We're getting about a third of that.

Mr. STEIN: Yeah, that's been a real disappointment. You know, the administration back in the summer was predicting that they were hoping to have at least 120 million doses of vaccine available by now. They had to cut that back to 50, then to 40, and then a couple weeks ago, they said well, you know, it looks like we're only going to have about 30, and that's been - that's been a real problem now because a lot of people built up expectations. People are anxious. A lot of parents are anxious. Pregnant women are anxious to get vaccinated, and so far, not a lot of vaccine out there and available.

CONAN: Is there any way to gauge the gap between the availability of vaccine and availability of demand?

Mr. STEIN: It's clear right now that there is a gap, that there's more demand than there is vaccine available right now. You know, that said, there's a lot more vaccine coming in the pipeline. A couple weeks from now the situation could be a lot different. Administration officials are predicting now that they'll have about 50 million doses available next month, and by December 150 million doses available. So it's ramping up a lot slower than they had hoped, but they think they're going to get there. And they are promising still that everybody that wants to get a shot or get a FluMist vaccine that squirts up their nose will be able to get it.

CONAN: And who decides this shipment goes to Memphis, that one to Seattle?

Mr. STEIN: Yeah, the way that works is that each state gets allocated a certain amount of vaccine based on a population, and then each state puts in its order to the CDC and says yes, we'll take 10 million doses, please ship it out, and then they designate certain sites around the state where the vaccine should be shipped to. And that's actually one of the complications here is that it's - these decisions are fundamentally being made on a local basis so that in some places, where the - you know, where everywhere the vaccine is short, so they have to make priority groups.

In some places, they're vaccinated health care workers first. Other places, they're putting kids or pregnant women at the top of the line, and so, you know, it's hard to know where you are, whether you're going to be first in line or whether somebody else is going to be first in line. That's contributed to some of the confusion and frustration and confusion out there.

CONAN: Well, we want to know what's going on where you live. Give us a call, 800-989-8255. Zap us an email, talk@npr.org. You can also join the program via our Web site. Go to npr.org. Click on TALK OF THE NATION.

And Rob Stein, there are conflicting messages here. At the same time people are worried about the high, you know, widespread in 46 states sounds pretty scary. Nevertheless, they're also saying well, the good news is it's pretty mild.

Mr. STEIN: Yes, and it is pretty mild. For most people, this flu is pretty much like, you know, any old flu you get any old year. You know, you're pretty miserable for a few days, but then you get over it, you're fine, and you don't even need to see a doctor. The difference here is that the groups that are being affected is very different.

Most years, the people who get the sickest and are most likely to end up in a hospital or even dying tend to be older people, elderly people who are maybe in the hospital already because they're already sick from something else. This year, those people are pretty much being spared, and it's younger people that are being affected: children, young adults and sometimes young, healthy adults who really are otherwise fine - and that's what has gotten people concerned.

CONAN: Here's an email question we have from Jennifer in Bend, Oregon. I am quite sure the four people in my family had H1N1 this past week. Our symptoms match what everybody's deciding, but I can't know 100 percent for sure because our local clinics aren't testing for it. Question: Should we get the vaccine anyway, or since it's in short supply, save that for the high-risk folks?

Mr. STEIN: Yeah, you know, the CDC medicine made a decision not to - to stop testing people routinely, because they pretty much assume that if you get the flu this year, especially right this time of year, the only flu virus that's circulating out there really is the H1N1 virus. So if you've gotten the flu, you probably have gotten swine flu.

That said, you know, you can't be sure. So once the vaccine becomes available, officials are still recommending that everybody get vaccinated as soon as the vaccine is available to them. You may have immunity from being exposed or have gotten sick, but, you know, it can't hurt to get vaccinated just to be on the safe side.

CONAN: Let's get a caller in on the line. This is Laura(ph), Laura with us from Lakefield in Massachusetts.

LAURA (Caller): Hi, Neal, how's it going?

CONAN: Very well, thanks.

LAURA: Good. I have a question. My children, both just got vaccinated for H1N1 today.

CONAN: Congratulations.

LAURA: Thank you. Yeah, I feel very lucky. They are three and five, and our doctor is recommending that after 28 days, they get another shot, like a booster, of the H1N1 vaccine, and I was wondering if that's necessary.

CONAN: Rob Stein, we heard in that clip from HHS Secretary Kathleen Sebelius, that kids under the age of 10 might need more than one shot?

Mr. STEIN: Yeah, and that - again - that's typical, even for the regular seasonal flu shot. Younger children tend to need a shot and then a booster to make sure they build up enough immunity to fight it off. Older people - kids ten and older and young adults - one shot works, and that actually was the good news. 'Cause at one point they thought everybody might need two shots.

CONAN: And, Laura, could you describe what the scene was like today?

LAURA: Well, I know that there were other children in the office who actually had swine flu. So, you know, kids, don't touch anything, we're leaving right now.

CONAN: And to think this was a doctor's office?

LAURA: Yes.

CONAN: And was the waiting room crowded?

LAURA: No. They were ushering healthy people into room ASAP so that nobody would be waiting in a room full of sick people.

CONAN: Except people sneezing at them, yeah.

LAURA: That's right.

CONAN: Okay. Laura, again, congratulations and good luck.

LAURA: Thank you.

CONAN: Appreciate it.

LAURA: Bye-bye.

CONAN: Here's an email question from Judy in Edmond, Oklahoma: I think my daughter should have her two-year-old vaccinated for H1N1. Her pediatrician says no. Why is there no consensus on this?

Mr. STEIN: Yeah, well, you know, there really is consensus among all the major health groups and health authorities that a child like that should get vaccinated. I have been hearing reports like that myself. There are some doctors out there that have been expressing some skepticism and hesitancy, and they're the outliers for the most part.

And the CDC, all the major doctors' groups - American Academy of Pediatrics -are all recommended that people get this vaccine. It's a safe as any other seasonal vaccine you get any year.

CONAN: Let's get Sandy on the line. Sandy with us from Philadelphia.

SANDY (Caller): Yes. Hi, how are you?

CONAN: Good, thanks.

SANDY: I wanted to say that I think this is the first vaccine that I've heard of that all the mothers, parents, everyone is on board, and I don't think it's an issue of safety this time around with this particular vaccine; it's just availability.

CONAN: And have you tried everywhere that you know of Philadelphia?

SANDY: Yes. I actually have a son who has a history of asthma and would've been a priority, but, you know, it's not available. We tried to get it through his health care professionals, through our pediatrician and also through the school. And, you know, while they expect doses at some point it's not here yet, and you wonder if this wave of delivery of vaccines will just come a little too late, after, you know, we've seen epidemic proportions of H1N1 already.

CONAN: And Pennsylvania is one of those 46 states where it is widespread. Have you seen any examples of other kids your son's age who have seemed to have had it?

SANDY: Yeah. I mean, I would say, you know, 50 percent - some days in the past two weeks - 50 percent of his class has been absent. And at the high school over the weekend, they cancelled the homecoming dance because of, you know, the high absent rates for students.

CONAN: Well, Sandy, how old is your son?

SANDY: He is 11 years old and he is home from school sick today with flu-like symptoms.

CONAN: Oh my gosh. Well, I hope he feels better.

SANDY: Yeah. The other point that I just wanted to make is that my husband works for - in manufacturing of vaccines and, not the flu vaccine but…

CONAN: Darn it.

SANDY: I know. But he had said months ago, back in September when the government was releasing, you know, numbers for expected doses, he said this is a little unrealistic. The general public does not understand the complexity of manufacturing live vaccines.

CONAN: Well, we heard Kathleen Sebelius say she got the number from the manufacturers. That's where the numbers she went with. But, anyway, evidently, somebody's estimate was wrong. Sandy, good luck and I do hope your son feels better.

SANDY: Thank you so much.

CONAN: Bye-bye.

Coming up, more about H1N1 and how parents are dealing with it. What is happening where you live? Give us a call, 800-989-8255; email us: talk@npr.org. We'll be talking with the Los Angeles County health commissioner as well. Stay with us.

I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington.

The H1N1 virus has hit. With vaccine in shorter supply than expected, anxiety has hit too, especially among parents. Our guest is Rob Stein, national science reporter at the Washington Post. We want to hear from parents in our audience. What's going on where you live? 800-898-8255; email is talk@npr.org. You can also join the conversation online. Go to our Web site, NPR.org, and click on TALK OF THE NATION.

And joining us now is Los Angeles County health commissioner, Dr. Jonathan Fielding. The Los Angeles County Health Department served in the L.A. area at H1N1 vaccine clinics over the weekend. Nice of you to be with us today.

Dr. JONATHAN FIELDING (Health Commissioner, Los Angeles County): Thank you, Neal. Glad to be with you.

CONAN: And did you get all the vaccine you'd hope to?

Dr. FIELDING: No, of course not. Nobody has. We have about five-and-a-half million people in the high priority groups and we have about 300,000 doses countywide in a county of over ten million people.

CONAN: And how did you prioritize?

Dr. FIELDING: Well, what we did was most of the vaccine went to private providers. But only about 400 of the 3,000-plus that ordered it have received any and most have not received enough. We've had vaccine clinics that have been set up primarily for those that didn't have other forms of health care 'cause the rate of uninsurance is very high here.

And we've had 25 of those this last weekend and another one today. And we've had a very high demand but we've been able to meet the demand in virtually every case. So, we've given about 50,000 doses of vaccine over this period of time and not just people who don't have insurance but others who have been very frustrated because of the increased concern about this flu and then not being able to find it through their usual source.

CONAN: And I assume among those a lot of parents and kids.

Dr. FIELDING: Among those, a lot of parents and kids, that's absolutely true. One of the groups that we've focused on as well, of course, are pregnant women. Because last year nationally only about 15 percent of pregnant women got a flu shot, and they're six to nine times as likely to have a severe case, compared to non-pregnant women this year. So, we want to make sure that they get it as well.

As, of course, health care workers and those who take care of kids under six and all children six, seven months to 24 years.

CONAN: And I heard a report on MORNING EDITION today of a clinic in Encino, which is in your area, and long lines there. But if somebody was waiting on line and they're not on the priority list, do you say, I'm sorry, you have to come back another day?

Dr. FIELDING: Well, we've been fortunate. We've been able to reallocate the vaccine, so of the 26 clinics we've held, one we had to curtail in part because of traffic and other concerns. But in the others, we've been able to reallocate enough vaccine so that we've had enough to provide everybody with vaccine who wanted it.

CONAN: Here's an email question we have from Lisa, who's a doctor in Las Vegas: I wish there was a state or a federal Web site that could direct patients to a provider who has the vaccine. Nevada has a link on its flu site but it's not a comprehensive list of providers. We currently have 30 doses of the nasal spray for those in high-risk groups but no easy way to get the word out besides some signs in our office.

Is there a Web site there in Los Angeles?

Dr. FIELDING: Yes, there is. People in Los Angeles can go to publichealth.lacounty.gov, and we have all the listings for the public sites. I think this is very similar to the situation a few years ago when we had a shortage and all the vaccine therefore came to the Department of Public Health and we held large clinics.

And when you don't have it widespread in the private sector, that's an opportunity for the public sector, because our job is to assure that everybody gets protected. And everybody who works in public health, they can be sexually transmitted diseases or epidemiology or smoking control, whatever, but in this kind of situation they become emergency service workers and help us mount this clinics.

CONAN: All right. Here's an email question from David in Fremont, New Hampshire: I'm curious: what are the four states not affected by the H1N1 flu thus far? And I think widely affected is probably the better usage. Rob Stein, I think I looked at a map and I saw that among them were Hawaii and New Jersey.

Mr. STEIN: Yeah. I think D.C. might be another - well, that's not a state - but another area…

CONAN: Depends on who you talk to, Rob.

Mr. STEIN: That's right. That's not reporting, quote-unquote, "widespread activity." But the point is it's everywhere; it's just a question of sometimes is the reporting live from some of these localities. But really the CDC was saying last week they've never seen this much flu in the country at this time of year. It's extremely unusual.

CONAN: Let's get Doug on the line. Doug calling us from St. Louis.

DOUG (Caller): St. Louis Park actually.

CONAN: Go ahead.

DOUG: I, according to a previous caller, I'm the one parent who is not looking for the flu vaccine. I don't really know a lot of folks in our neighborhood that are looking for it, and I don't know what sort of scientific correlation there is. But the only people I ever know that get the flu have gotten the flu shot. So, that almost discourages me from getting it, thinking that I'm going to get sick.

CONAN: And do you have kids?

DOUG: I do have a six-year-old and a three-year-old. He's at home with mom but she is in afternoon kindergarten.

CONAN: And they're not getting…

DOUG: And there has not been a breakout at the school.

CONAN: Okay. If there were to be one, would you reconsider?

DOUG: Not likely. I might keep her home for a couple of days so she wouldn't get it. But, I mean, I like to think we're pretty good parents. We've got the hand sanitizer everywhere and keep hand-washing during flu season and that sort of thing.

CONAN: Well, those are wise, those are wise precautions. I wonder, Dr. Fielding, if you have any advice for Doug?

Dr. FIELDING: Well, I do. This is a different type of flu in terms of who's affected. As Rob Stein said, the people who seem to have gotten the worst of this, even though the average case is no worse than the average flu, are young people - the highest hospitalization rates in the zero to four group in Los Angeles County. The average rate for, the average age for hospitalization is in the teens with a lot of younger people.

There have been over a hundred children that have died victims of this disease since it started, which is twice the number that we usually have die in the flu season. So, I think there's good reason, even if you haven't done it in the past, to get children immunized.

The other point I'd make is that flu is contagious before you have symptoms. So, you can have a child who infects a lot of people and the next day they're out school 'cause they became symptomatic but your child was infected in the process. So, get the vaccine.

CONAN: Doug, good luck. I mean, you could never tell where the flu outbreaks are going to be but there's no reason to believe Los Angeles is going to be any different from St. Louis Park.

DOUG: That's true.

CONAN: All right.

DOUG: Have a good day.

CONAN: You too. Bye-bye. Let's see if we can go next to…this is Joy. Joy with us from Live Oak in Florida.

JOY (Caller): Yes.

CONAN: Go ahead, please.

JOY: We're in a very small community. It's rural. We have limited health care for a lot of people. And we're having really widespread illness. Lots of kids are out of school; my two daughters have both been sick and it's seeming to hit Friday. One got sick one Friday, the next one was next Friday and now my husband's home sick. And…

CONAN: How are they feeling?

JOY: The first one - she's still off and on; extremely tired, still coughing. The older one is on her second week out of school.

CONAN: So, this is no joke.

JOY: No, it's not. She's still having fevers and now she's having problems with digestion. So, she's having some stomach problems also. And they…

CONAN: And when you talk about fever, how high?

JOY: Hers has stayed low - a hundred the whole time; the younger child was about 104. But she had more severe symptoms but seemed to recover more quickly.

CONAN: Yeah, I guess, Dr. Fielding, every case is different.

Dr. FIELDING: Well, every case is different. One thing that is a little different with this flu is there's more likely to be gastrointestinal problems, nausea and vomiting, than with other types of flu, not just for children, which for some times it happens with seasonal flu, but for older people who get this as well.

So, you can't always tell. You can have a very mild cases without fever, you can have very serious cases. And, of course, there'll always be some of these that won't be flu. That's why Rob Stein is absolutely right in saying that everybody, you know, even if you think you've had it, if you haven't been specifically diagnosed you should still get the immunization when it becomes…

JOY: Oh good.

Dr. FIELDING: …available.

CONAN: Yeah.

JOY: That was my question. We're having…next week they're starting vaccinations in the school, and free for all kids and anybody who has children and school workers. So, I'm planning on having both of them immunized just in case.

Dr. FIELDING: I think you're smart.

JOY: And so…

CONAN: And one other question on this. Joy's call raises a question, Dr. Fielding, a kid with 104, well, gee, 104 can make a parent very nervous. At what point should you think about taking your kid to a hospital?

Dr. FIELDING: Well, I think, you know, the flu is no different than anything else. So, if there is something, if there are a set of symptoms for which you would normally seek medical care, either on a regular or on an urgent basis, I would do the same thing. Certainly for very young kids, if they start to turn blue, if they have a fever that comes with a rash, if they're non-responsive and if they don't want to be held.

I mean, there are a bunch of these criteria. But those are the kind of things that you would be calling about, you know, in any case. So, I wouldn't treat this any differently. But in most cases, you're going to be able to take care of it just as you have at home with good hydration, with over-the-counter medication for fever and for aches, which are three characteristics - although, not aspirin. Don't use aspirin. And simply try to manage this symptomatically.

JOY: That's what we've done.

CONAN: Good luck.

JOY: Thank you very much.

CONAN: Good luck, Joy. Thanks very much for the call. Rob Stein, I wonder -we're hearing from a public health official here from Los Angeles County, this is a wake-up call for public health officials all over the country, and a good look at how systems work.

Mr. STEIN: Yeah. It really is. It really is. This is really testing our public health system, which, you know, has suffered a lot of difficulties in recent years, and especially this past year. There's a lot of - because of the economic troubles, a lot of public health departments have had to cut back, they've had to lay off people, and they're stretched as it is.

And, you know, in the wake of 9/11, there was a lot of investment in the public health system because of fears about bioterrorism and, you know, anthrax attacks and that sort of thing. And that helped. It built things back up after the system has been neglected for a long time. But it's still - this is the sort of situation that really puts a strain on the system.

Dr. FIELDING: It does, but I also think that, just as you say, since the bioterrorism concerns and how are we going to get, you know, antibiotics to enough people if we had anthrax attacks. The other situation was SARS that never actually materialized here, but which we had to be prepared for, the H5N1, the shortage of vaccine - all those have led us to be much better prepared than we were and have everybody trained in incident command structure and emergency response. And that's why everybody is dual role.

But you're right, we've been cut back as most other health departments. And I think we need to have a core federal funding. My hope is that the reform bill going through will include that, so there can be at least a base that everybody will have, because local health departments have been losing significant numbers of staff, and they're not going to be as ready for these kind of problems if that continues.

CONAN: Email question - my name is Meghan(ph). I live in the Central Valley, California. I'm seven months pregnant and have a home daycare. I know we should all get the vaccine, but I'm concerned about the risks to my unborn baby, being that the vaccine is a live virus. Is that a valid concern, Dr. Fielding?

Dr. FIELDING: No, it's not. I understand the concern, but if you're pregnant you should get the killed virus, the shot, rather than the inactivated - than the attenuated virus, which is a live virus, although it doesn't proliferate in the body, just in the nose. But you want to get the shot, and that - and it's very important that you do get it.

CONAN: And most people will, as I understand it, get the shot rather than the mist.

Dr. FIELDING: Well, for pregnancy, yes. You want to definitely get the shot. Now, the mist is a very good option for those aged two to 49, not pregnant, otherwise healthy, no respiratory problems. And it's interesting, we've been really pushing it. And there are some cultural biases. There are some cultures that feel if you haven't gotten a shot, we'll you haven't gotten, you know, good remedy.

CONAN: The real deal, yeah.

Dr. FIELDING: The real deal. So trying to push back on that and do some health education has been a challenge in some cases.

CONAN: Are guests are Dr. Jonathan Fielding, the Los Angeles County health commissioner. With us by the phone from his office there. And Rob Stein is national science reporter of the Washington Post. You're listening to TALK OF THE NATION from NPR News.

And let' talk with Jessica(ph). Jessica with us from Summerville in Massachusetts.

JESSICA (Caller): Hello.

CONAN: Hi.

JESSICA: Hi. My question in general is, are the CDC guidelines mandatory or can a doctor's office decide whether or not they're going to file - follow the specific guidelines for who has priority? Because my husband and I have a four-month-old daughter. And when I called my doctor's office - and I've called them repeatedly - they say that most of the other people that I've read are in the -they keep saying high risk…

CONAN: Mm-hmm.

JESSICA: …and not - she's not listing us and she can't confirm whether we're going to actually get priority or not.

CONAN: Rob Stein, can you help us out here?

Mr. STEIN: The CDC guidelines, our guidelines, are not mandatory, so doctors can really decide for themselves, bust most people are following them. But anyone who's taken care of a baby like this, is considered in the priority group. And so the parents should be high in the list to get the vaccine.

CONAN: So Jessica, that's the priority. Is there anywhere to go see this priority list, Rob, is there a Web site?

Mr. STEIN: Yeah. If you go to the CDC Web site - you just go to Google, Google CDC H1N1, and you'll find all the information you could possibly want, including a list of all the priority groups. Now that being said, as I said earlier, you know, different localities are prioritizing within these five high-priority groups - some are putting health care workers at the top of the list - some are putting pregnant women at the top of the list. So it really does depend on where you live.

JESSICA: There's really no way to make my doctor's office give me the vaccine first if they decide that that's kind of the bottom of the priority list?

Mr. STEIN: Well, you know, you should contact your local public health department and find out who else has vaccine and what kind of prioritizing they're recommending.

JESSICA: Okay.

CONAN: Good luck, Jessica.

JESSICA: Thank you very much.

CONAN: Bye-bye. Let's go next to Mary Sue(ph). Mary Sue in Charlotte.

MARY SUE (Caller): Hey, Neal. Thank you for taking my call.

CONAN: Sure.

MARY SUE: I was just wondering if there is any indication that there's a higher level of influenza or seasonal virus, or other viruses - seasonal flu or other viruses that might be confused with H1N1? I know my son had flu-like symptoms -high fever, body aches, pains, but he also developed a rash. And when I took him into the doctor's office, he had what's called hand, foot, and mouth virus. Is there any indication that there's a spike in other kinds of seasonal flu?

CONAN: Dr. Fielding, can you help, sir?

Dr. FIELDING: No, there's none. In fact, if you - there's two issues. One, a lot of things that give you, quote, "flu-like" symptoms aren't necessarily flu. There are other viruses around: the respiratory syncytial virus, pear(ph) influenza, a bunch of others. But among - when you have flu, influenza, the only virus that really circulating to any significant degree as the H1N1 - is the novel H1N1 99 percent of all the isolates that have tests to do that.

Of course, one of the other complications however is that there's a kind of quick test for flu type A. And if you get a positive test, though, the chances are very, very, very high that it's an H1N1. But it's not a very sensitive or specific test, so that your chance if you get a positive, you know, it's probably good but not necessarily. And if you get a negative, it doesn't mean you don't have it. So…

(Soundbite of laughter)

Dr. FIELDING: So unfortunately, the very simple test also is not terribly accurate. And the other one is expensive and takes time and (unintelligible)…

CONAN: Which is why they stopped testing everybody.

Dr. FIELDING: But the other point I'd make is - early on, if you really feel you have the characteristic symptoms, you can talk to your doctor and see whether an antiviral medication would be appropriate. It can be helpful if given within the first 48 hours to lessen the time you have it and lessen the symptoms and lessen the risk of complications.

MARY SUE: Thank you.

CONAN: Thanks, Mary Sue. We just have a few seconds left, Doctor. But when can we expect the seasonal virus season to begin?

Dr. FIELDING: Well, we don't know if we're going to have it. And, you know, we'll just have to see. I think that one of the questions is when is this going to peak? And I would point out that even after this peaks - and some people think it's going to peak this month, some - most of us really don't know. Even if that happens, there's going to be a lot of flu after the peak. So it's really important that everybody, when it's available, get immunized. And there's going to be plenty of vaccine to go around.

CONAN: Dr. Fielding, thanks very much for your time today. Appreciate it.

Dr. FIELDING: My pleasure.

CONAN: Good luck there. Dr. Fielding is the Los Angeles County health commissioner, former health commissioner from Massachusetts, with us today by phone from his office. Rob Stein, nice to have you on the program as always.

STEIN: Nice to be here, Neal. Thanks a lot.

CONAN: Rob Stein, a science reporter with the Washington Post where he has been covering the H1N1 virus. And he joined us today from a studio at the newspaper.

Coming up on the Opinion Page, Michael Singh on the recently concluded talks between the United States and Iran, and looking at the hidden costs of the projected nuclear fuels deals. Stay with us.

This is the TALK OF THE NATION from NPR News.

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