Native Americans Hit Hard By H1N1

Earlier this month, the Center for Disease Control and prevention announced that the current wave of the pandemic H1N1, or swine flu, virus appears to have peaked in the U.S. But despite the decrease, the outbreak is continuing to take a heavy toll of hospitalizations and deaths, especially among children. The virus has also been found to hit Native American communities particularly hard. Dr. Matthew Davis, associate professor of pediatrics, internal medicine and public policy at the University of Michigan, and Dr. John Redd, chief of the Infectious Diseases Branch of the Indian Health Service Division of Epidemiology and Disease Prevention, discuss why Native Americans are up to four times more likely to be hospitalized with the virus.

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JACKI LYDEN, host:

This is TELL ME MORE from NPR News. I'm Jacki Lyden filling in for Michel Martin.

Coming up, we talk to humorist Gene Weingarten about why he hates office parties. That's in a few minutes.

But first, for a few months earlier this year, the biggest health story was the H1N1 virus and not the health care bill. Public concern and interest in the virus has waned, though, almost as quickly as it began.

Earlier this month, the Centers for Disease Control and Prevention announced the current wave of the H1N1 pandemic appears to have peaked in the U.S., but there's no reason to be complacent about the H1N1 virus. The outbreak continues to produce a heavy toll of hospitalizations and deaths, especially among children. There's another community the virus has hit especially hard. And we're going to take a look at that today. Native Americans are up to four times more likely to be hospitalized than other Americans.

Joining us now is Dr. Matthew Davis. He's an associate professor of pediatrics, internal medicine and public policy at the University of Michigan. Welcome, Dr. Davis.

Dr. MATTHEW DAVIS (Pediatrics, Internal Medicine and Public Policy, University of Michigan): Good to be here, Jacki.

LYDEN: And also joining us is Dr. John Redd. Dr. Redd is chief of the infectious diseases branch of the Indian Health Service Division at Epidemiology and Disease, and he joins us from Santa Fe, New Mexico. Welcome, Dr. Redd.

Dr. JOHN REDD (Chief, Indian Health Service Division at Epidemiology and Disease): Glad to be here.

LYDEN: So, let's get a little background first about the broader look at the H1N1 now. Dr. Davis, in a nutshell, what's the status in the outbreak?

Dr. DAVIS: Jacki, the status of the outbreak is that we're seeing a lot less influenza activity and the vast majority of the influenza activity this season has been from the H1N1 virus, whereas we had all the states at a very widespread level of activity earlier this season, just a month ago. Right now, we're seeing the states reporting much lower levels of activity.

LYDEN: And why is that? I mean, when it first appeared, there were accusations that this might be sensationalized. Why did it turn out to be less fearsome than it had been expected?

Dr. DAVIS: Well, there are a couple of aspects of your question. One is why is it acting the way it is? And what we've seen from past outbreaks of the H1N1 is that tends to come in waves, perhaps even two or three waves through the population. So, it may be that we've just seen the first wave and that there are other waves to come.

The other question is to what extent were our fears realized or not? And I would argue actually as a pediatrician that our fears have been realized with this virus. As you pointed out, the rate of hospitalizations among children has been particularly high with H1N1, and there are particular communities like the Native Americans, who have been particularly hard hit.

LYDEN: Let's take a look at that. Dr. Redd, how much more likely are Native Americans have suffered and died from this illness than others?

Dr. REDD: Well, at the current time, it appears that American-Indians and Alaska Natives are approximately four times more likely than other Americans to die from H1N1. And that was shown in a publication that we did with our colleagues from the State of New Mexico (unintelligible) epidemiology centers and the Centers for Disease Control. We showed that the death rate, which is the proper measure in a consortium of 12 states that contain about 50 percent of the American-Indian, Alaska Native population in the U.S. had a death rate that was about four times higher.

LYDEN: Now, you're working in New Mexico. Have you been able to visit any populations, reservations and look at what sorts of precautions are being taken?

Dr. REDD: Well, sure. I work for the Indian Health Service. So, I work in Albuquerque, but our - my program covers the entire country, wherever American-Indians, Alaska Natives are. And so, we've done a lot of investigations. In fact, our term, you know, is going out to the field, and we've done quite a few field investigations over the course of the outbreak. American-Indians, Alaska Natives, it's been clear that they have been more affected since very early on in this H1N1 outbreak, which was consistent with what we expected to be based on prior pandemics.

LYDEN: Why is that? Is that because of underlying poor health or are there other factors?

Dr. REDD: Well, it looks as if there are several factors that contribute to the elevated mortality. And I'll answer that in two ways. First, in the MMWR that we just published, we saw that of the 42 American-Indian, Alaska Native deaths, 81 percent of people were in any category that CDC calls high risk. And that's high risk for complications from flu compared to 78 percent of other racial and ethnic groups.

But if you look very specifically at what the people who died in this had had, it was really notable they had - 31 percent of the people had asthma, and that was around twice as many as American-Indians and Alaskan Natives, and 45 percent of the decedents in this study had diabetes. And that was also about twice as many as in the rest of the group.

But when we look at health of indigenous people around the world, there are common themes. So, we've been following this pandemic with colleagues in Australia, New Zealand, and Canada from the very beginning, and those countries, which also have indigenous populations, also have seen an elevated death rate in their indigenous population. So, we don't feel that the difference is made strictly by being American-Indian, Alaska Native.

LYDEN: I just want to point out your reference saying the morbidity and mortality report from the CDC. Also, Dr. Davis, you know, it's fascinating to see how much attitudes have changed about the vaccine for this virus. There's been an anti-vaccine backlash. Why is that?

Dr. DAVIS: Well, Jacki, before this season, this fall season began, we measured in the national population that about 40 percent of parents wanted to get their kids vaccinated against H1N1. That proportion is lower than the proportion reporting their intent to vaccinate their kids against the seasonal flu. And I would say, as a pediatrician and as a public policy researcher, that what we're seeing here is a reluctance that naturally happens in the U.S. population with a new vaccine.

What I emphasize to my patients is that actually this vaccine is rather familiar to us because it's the same vaccine structure that we've used for the seasonal flu vaccine for many years, and it's paring out over the last few months that the side effects from this vaccine are very similar to the ones that we're seeing with the seasonal flu vaccine that is to say very few side effects, and very mild side effects, especially among children who are a high risk population.

LYDEN: Dr. Redd, are Native Americans and Alaskan Indians able to get the same kind of vaccines as everybody else?

Dr. REDD: Oh, absolutely. And we keep track of how many doses have been given in our facilities, and we've given approximately 130,000 doses already, and that's increasing every week. So, in our population, as in others, the availability of the vaccine is increasing all the time. And we still very much encourage our patients to go to their Indian Health Service facility and to receive their vaccine. It's extremely important.

LYDEN: And do you think that complacency is creeping in the greater population, Dr. Davis?

Dr. DAVIS: Well, I am concerned about that in my clinic and in clinics, more broadly. I think that the general U.S. population expects when January and February come around to decrease our interest in flu vaccination, and that's something that we've gotten used to as seasonal flu.

But what I emphasize to my patients is that H1N1 is different. We don't know what's coming next, and we don't know what pattern the future outbreak will take. So, while we have the supplies of vaccine, like Dr. Redd was talking about, it's important to go ahead and get vaccinated and get the protection that the vaccine offers.

LYDEN: Well, thank you both very much for joining us. Dr. Matthew Davis is an associate professor of pediatrics, internal medicine and public policy at the University of Michigan, and he was kind enough to join us from WURM located on that campus. And Dr. John Redd is chief of the Infectious Diseases Branch of the Indian Health Service Division at Epidemiology and Disease Prevention, and he joined us from his home in New Mexico. Thank you both for speaking with us today.

Dr. DAVIS: My pleasure.

Dr. REDD: It's a pleasure.

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