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NEAL CONAN, host:

An op-ed in yesterday's New York Times cited some scary numbers. Since April, more than a million Americans caught H1N1, more than 10,000 hospitalized and about a thousand dead, including 76 children, and it's just the beginning of October. Still, more than 40 percent of adults tell pollsters they will not get the swine flu vaccine. Many believe the vaccine is riskier than the disease.

Dr. Paul Offit's article is titled "Nothing to Fear but Flu Itself." If you have questions about safety, testing or risks, our phone number is 800-989-8255. Email: talk@npr.org. You can also join the conversation on our Web site at npr.org, click on TALK OF THE NATION.

Joining us now from Audio Post studios in Philadelphia is Dr. Paul Offit. He's chief of infectious diseases at the Children's Hospital of Philadelphia. He's also the co-inventor of a rotavirus vaccine called Rotateq.

And Dr. Offit, pleasure to have you on the program today.

Dr. PAUL OFFIT (Chief of Infectious Diseases, Children's Hospital of Philadelphia; Author, "Nothing to Fear but Flu Itself"): Thanks, Neal.

CONAN: And why do people believe the flu is - the vaccine is unsafe?

Dr. OFFIT: I think we're not very good at determining where the real risks lay. You know, here, you have a vaccine which is quite well tested, which is tested certainly as well as any seasonal flu vaccine. The technology's 60 years old, yet still, mis - you know, surrounded. And there's, you know, there's nothing theoretical about the disease. It's out there spreading across the country and killing people.

CONAN: But people say, hey, it's very mild.

Dr. OFFIT: Well, it's probably no more virulent than the typical seasonal flu that spreads through our country every year. But remember, flu, you know, kills about 35,000 to 40,000 people ever year. And this virus, because no one has immunity to it, it is much more likely to spread broadly and infect many more people than are typically affected by seasonal flu. So the fact that you already have, you know, about 10,000 hospitalizations, about a thousand deaths, including 76 deaths in children, tells you that this is not so mild.

CONAN: Seventy six deaths of children amongst a thousand - is that significant?

Dr. OFFIT: Yes. I mean, if you look over the last three years, we've had, sort of between 40 and 80 children that have died of influenza for the entire year. 76 have already died, and it's only mid-October. This is a virus which is a winter virus for a reason. It's actually transmitted much more easily under conditions of low temperature and low humidity. So I think you can expect those numbers only to increase, and I suspect we'll see three or four times more deaths this year from novel H1N1 than from previous seasonal influenza outbreaks.

CONAN: Some people say, wait a minute, there was a swine flu scare back in the '70s and the vaccine then did cause a lot of problems.

Dr. OFFIT: Well, it's - there are couple of things that are unfortunate about that. First of all, this particular virus is unfortunately named swine flu. Unlike that virus - which did infect pigs, did cause disease in pigs and was transmitted from pig to pig - that's not true of this virus. It's really - most of its genes are not from swine, they're from birds and humans. And so, it's unfortunately named swine flu. That's too bad.

Secondly, the issue of whether that vaccine in 1976 caused something called Guillain-Barre syndrome, an event that was claimed to have been affected about one per hundred thousand vaccine recipients, I think is still under question. Certainly, no influenza vaccine before that did that, no influenza vaccine subsequent to that has done that. So I think people can be reassured that this particular vaccine is not going to do that for many reasons, one of which is it's not a swine flu.

CONAN: Let's see if we can get some callers in on the conversation. Let's turn to Jonathan(ph). Jonathan with us from Muncie, Indiana.

JONATHAN (Caller): Hi. Thank you for taking my call.

CONAN: Go ahead, please.

JONATHAN: Okay. Yeah. I was just telling the screener about - there's a large population of my students that actually tell me about their parents who have, you know, some of the same fears that you have been describing on the show. And I've told them that it's not even that the swine flu is necessarily more dangerous, it's just that it won't - 30,000 people die every year from the flu in general, and it's just that the swine flu is transferred so much more, you know, readily and easily that, you know, it's important that they get the vaccine.

CONAN: And what do the parents tell you, Jonathan?

JONATHAN: Well, you know, I haven't actually talked to any of the parents about it. This is just, you know, anecdotal conversations that I've had with students in the classroom. But…

CONAN: And are they going to get it at school?

JONATHAN: No. They're not going to get it at school. They are offering it to the staff, and they're encouraging the staff to get the vaccine. But my concern, really, is just the students. I wonder why the parents would avoid getting the swine flu vaccine for any of their kids when they are in, you know, a really dense group of people every single day.

CONAN: Well, Dr. Offit, schools certainly seem to be a place where the disease spreads.

Dr. OFFIT: Absolutely. I mean, if you look at the - a recent pandemic, say, or a pandemic that occurred 1957, about 50 years ago. It was the last time we actually made vaccine in advance of a pandemic. When you start to see that pandemic take off in the United States, it's when in September and October kids got together for school, because they're principally the reservoir of this infection, and they're the ones who transmit to others. I mean, for example, when Japan, when they instituted a school-wide vaccination program, it was really a mandatory program, they find not only a decrease in hospitalizations and deaths in children, they found a dramatic decrease in hospitalizations and deaths in the elderly because that's where the elderly is catching the virus from, from young children.

CONAN: Let's go next to Dave, Dave with us in Dayton in Kentucky.

DAVE (Caller): Yes. Hi.

CONAN: Go ahead.

DAVE: I was just calling - my two nieces just had swine flu. They were -they're 12 and 13, I believe. And their pediatrician said, oh, don't worry. It's no big deal. They're better in a couple of days. He said the real flu is a lot worst.

CONAN: And…

DAVE: (unintelligible).

CONAN: …where they better in a couple of days? I hope so.

DAVE: Oh, yeah. Yeah. And then I've also got a one-year-old and a four-year-old niece and nephew, and they had it. And he was just saying - their pediatrician acted the same way. No big deal. Take Tamiflu. You'll be fine. So, as far as the vaccination, I'm just rolling the dice of my own kids.

CONAN: So, you're not going to get the vaccine?

DAVE: No. Uh-uh. I'm just going to - if it's - as much as he's blowing it off as don't worry about it and I've seen them, all four of them get better in a couple of days, and it's, like, well, they've been worst than that with strep. So, I mean…

CONAN: Dr. Offit, do you have any advice for Dave?

Dr. OFFIT: Well, you know, the odds are that if you get influenza as a child that you're going to survive. I mean, certainly, that's true. And - but remember, every year about 200,000 children are hospitalized. And every year, you know, between, you know, 50 or 60 children die from flu. This year is going to be worse, because no one has immunity to this virus. Now are the odds that if your children get influenza, that they will survive that? Yes. But why take the risk when you know that every year, there are children that die?

You know, if you talk to advocacy groups like, for example, Families Fighting Flu, which are groups of parents whose children have died from influenza, they all tell the same story, which is that, you know, I can't believe my child died from influenza. I just never thought it was that serious. And they become passionate advocates for the vaccine because they saw what the disease could do. Why, you know, put a gun to your head even if it's got a million chambers, you know…

DAVE: Right.

Dr. OFFIT: …and put a few bullets in there when you don't have to?

DAVE: Yeah. That makes senses.

(Soundbite of laughter)

CONAN: Okay.

DAVE: But my kids are 18 and 14, and I - hopefully, they'll be fine, like you said. I don't know. Maybe I'll change my mind if I keep listening to you.

CONAN: All right. Thanks.

Dr. OFFIT: Well, my kids are 17 and 14, and they're getting this vaccine.

DAVE: All right. Okay. All right. Thanks.

CONAN: Good luck, Dave.

DAVE: All righty.

CONAN: Email from Julie in Kansas City: My son was diagnosed late last spring with Influenza A. The test to determine if he had H1N1 was never performed. His symptoms seemed to mimic H1N1. Can the vaccine adversely affect him if he had the flu? Also, which do you recommend to receive first, the seasonal flu or H1N1? I understand you have to wait a month between vaccines.

Dr. OFFIT: Well, it's - you actually - it depends on the kind of vaccine you get as to whether you have to wait a month. I mean, if you're getting the seasonal flu vaccine shot and you're getting this - the H1N1 shot, they can be given at the same time. Similarly, if you're - if one of them is just the nasal spray and the other one's a shot, that you can get at the same time. The only ones you have to wait a month between are if you're getting the nasal spray vaccines for both.

Which one would I recommend first? The one you can get first. I mean, right now, you know, distribution of that vaccine has been difficult. As a general rule, the seasonal vaccine is far more available, so I would get that one, you know, while you can. And then, get the N1N1 - H1N1 vaccine when it becomes available.

CONAN: Okay. Let's go next to Karen, Karen, from Portland.

KAREN (Caller): Hi. Well, first, I'd like to speak to the gentleman who's not concerned about the flu and not going to get the nasal spray for his children. Well, that's all well and good if his kids are not adversely affected by a flu. But as a mother whose daughter was hospitalized with the flu five years ago -and I guess my children would have died off as pioneers, they don't have a great immune system - the more people who feel that way, the greater risk my children are taking. So, if you don't feel the concern for your kids, great. But as social responsibility, you know, help the rest of us out here.

And then, here's my other concern. I recently moved to Portland. I have Blue Cross Blue Shield, but Portland is almost ruled by Kaiser here. And I called around. I called about 20 different clinics and told them about my kids' susceptibility to the flu, and they wouldn't see me because I wasn't with Kaiser or I didn't already have a primary care provider established. I couldn't get any information, and I spent a day on the phone and on the computer trying to get this for my nine-year-old son. And so I have no idea where to get it, when to get it because I'm not in the system. And probably…

CONAN: Well, Karen, I'm not sure the H1N1 vaccine is available in most parts of…

KAREN: It is. Well, when I listened to NPR, I heard that they had 2,000 doses available. So I'm assuming it went to Kaiser or whatever…

CONAN: In Portland?

KAREN: Yes. Yep.

CONAN: Okay. I'm just saying, that's not true of every place in the country.

KAREN: Right.

CONAN: Okay. But…

KAREN: But in Portland - you know, I'm an avid NPR listener, so I thought I have an in because I knew when it was arriving and how much was here and who it was going to. But apparently, without the right kind of insurance, I'm not going to get it. Maybe it will help the economy. Maybe it will…

CONAN: But…

KAREN: …kill off to all the poor people.

CONAN: I don't think that's quite the way it works. Dr. Offit, do you have any information on distribution?

Dr. OFFIT: I think Karen makes two points. One is the distribution question. We - I think for the first time really in decades, we've been able to make a lot of vaccine quickly and well. That's good. I mean, it took, I think, a lot of money, frankly, to build up the infrastructure to do that. But I think what we're not very good at yet is being able to distribute it through networks that can give a lot of it fairly quickly, like schools being probably the best example.

It's very hard to do all this through the pediatricians or family practitioners office. The second point that Karen made that I think was really important is the notion of the social responsibility. I mean, there are certainly people in this country who can't get vaccines because they're getting chemotherapy for their cancer or they're getting immunosuppressive therapy for their transplants or they're on long-term steroid therapy for their asthma.

They depend on living among a group of people who are going to be relatively highly vaccinated. And that's that social contract that, I think, at some level has broken down.

CONAN: Mm-hmm. We're talking with Dr. Paul Offit, chief of infectious diseases at the Children's Hospital of Philadelphia and author of an op-ed, "Nothing to Fear but the Flu Itself."

You're listening to TALK OF THE NATION from NPR News.

And here's an email from Lisa Ann(ph) in San Mateo. I've only had one flu shot in my life, and immediately afterwards, I was the sickest I've ever been in my life. I'm an extremely healthy person. When I do catch cold symptoms, I'm able to fight them off with vitamins before I get really sick. Is it really necessary for me to get the shot? I have a feeling it's going to make me sick.

Dr. OFFIT: Right. You know, and this is a story that you occasionally hear. It's, you know, we give our flu vaccines in the winter. That's when a lot of other viruses, including, you know, flu viruses are circulating. And the question is, you know, can the flu vaccine cause flu? The answer to that question is clearly no.

I mean, the vaccine is - it comes in two forms. One is as a shot, in which case the virus is completely inactivated with a chemical, so it can't possibly reproduce itself and cause respiratory symptoms. The second vaccine is a so-called nasal spray vaccine, which is a highly weakened form of a natural virus which can't possibly grow at body temperature, therefore it can't possibly reproduce itself in the lungs and cause illness. So I think those things are coincidental, but obviously those anecdotes are very powerful and influential for many people.

CONAN: Email from Sydney in Berkeley: Being from Hong Kong, we are more concerned with H1N1 because of SARS. Also, a good friend of mine in his late 30's just died from the flu in less than five days. I wish the media would do a better job describing the disease, the targeted population and the speed with which it kills. When you get it, five days, is that unusual?

Dr. OFFIT: No. You know, there's an old saying for medical students, which is that every medical student should get influenza so they can know what it feels like to be really sick. You know, the symptoms invariably start with high fever and shaking chills to the extent that you can actually remember the hour when it started. Then it progresses to respiratory symptoms.

I think the - what people tend to do, and it's understandable, is they tend to use the term flu to describe a variety of respiratory illnesses, some of which can be quite mild. But true influenza infection is something that you remember.

CONAN: I thought I'd had it many times, then I did get it a couple of years ago, and it is - you don't mistake it for anything else ever again. It is really, really bad. Let's talk with Graham, Graham with us from Highway 26 in South Carolina.

GRAHAM (Caller): Hey. How's it going?

CONAN: Very well. Thanks.

GRAHAM: Listen, I have a 14-year-old son and a nine-year-old daughter and, well, you know, they've gone - we're firm believers in chiropractic and, you know, take our vitamins and the whole nine yards. I've never gotten them flu shots or anything of the sort.

And when all this topic has come up in the last, you know, few months here, I just feel this overwhelming scare tactic running in. It's just this feeling that I have that's, you know, coming from the government saying, oh, do this, do this, do this, do this.

And it just - it's not feeling right. In that manner, I feel like that if you take care of your body, you know, you're going to get sick. You're going to get, you know, things, but I just don't feel like - the one caller earlier said that it was irresponsible of other parents not to get the flu vaccine. I just think that was irresponsible of her to even say that because, you know, she -there's no real…

CONAN: Graham, we just have a few seconds left. What's the risk? What's the cost?

GRAHAM: Well, what is the cost? Exactly. That's the question, you know? You know, there's two sides to each coin here.

CONAN: Dr. Offit, I'll give you the last minute here.

Dr. OFFIT: You know, when chiropractic broke from traditional medicine in the late 1800s, right around the time of the proof, frankly, of the germ theory, which is to say that specific germs can cause specific disease, in this case influenza virus causes what we know as influenza disease.

And so, there is this belief, and it's an unfortunate one, that if one simply maintains, you know, sort of good, you know, good nutrition, that you can avoid infections. I mean, you know, I think probably Franklin Delano Roosevelt is the best example of why that's not true.

He was a patrician, well-nourished, who suffered, you know, a bout with polio which affected him for the rest of his life. You know, all I can say is that vaccines have caused us to live much longer. Because of vaccines, our lifespan has increased by about 30 years over the last 100 years. They've performed tremendous service for us, and I think we shouldn't be scared of them.

CONAN: Graham, good luck.

GRAHAM: All right. Thanks, guys.

CONAN: Bye-bye. And Dr. Offit, thanks very much for your time today.

Dr. OFFIT: Thank you, Neal.

CONAN: Paul Offit joined us from a studio in Philadelphia. He's chief of infectious diseases at the Children's Hospital of Philadelphia and co-inventor of RotaTeq, a vaccine for the rotavirus. His op-ed, "Nothing to Fear but the Flu Itself," appeared in yesterday's New York Times. You can find the link at our Web site. Go to npr.org/talk.

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