NEAL CONAN, HOST:
This is TALK OF THE NATION. I'm Neal Conan in Washington. This year's flu season started early. Eight states already report widespread flu activity, and doctors say it's a nasty strain this year, too. The good news is this year's vaccine is a good match. But even so, the flu will kill thousands more, probably tens of thousands of Americans, before it runs its course. Why? And what more can we do to reduce that number?
In a few minutes, we'll be joined by Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. If you have questions for him about the flu, give us a call, 800-989-8255. Email us, firstname.lastname@example.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.
Later in the program, today's obituaries universally described Ravi Shankar as a master of the sitar. What made him so good? But first the flu, and we begin with NPR science desk correspondent Rob Stein, who is with us here in Studio 3A. Good to have you with us again, Rob.
ROB STEIN, BYLINE: Hi Neal, nice to be here.
CONAN: And a nasty strain of the flu this year?
STEIN: Yeah, that's right. That's one of the reasons why federal health officials are trying to get the word out that this could be a particularly nasty year for the flu. They're not saying it's going to be, but they're saying there are some early signs that are making them a little bit nervous that it might be. And one of the reasons for that is the predominate strain that's circulating right now is known as an H3N2 strain.
And the last time that that kind of a strain was the predominate strain was back in the 2003-2004 flu season, which turned out to be a particularly nasty year.
CONAN: And the vaccine, though, is a good match.
STEIN: Yeah, that's the good news. As opposed to that year, 2003-2004, when they didn't have a good match, this year they do have a good match. The vaccine that's out there should protect most people from the predominate strain that's circulating.
CONAN: How do they develop a - I mean, they have to develop the vaccine long before the flu shows up.
STEIN: Yeah, that's one of the big problems, actually, with fighting the flu is that the technology that they use predominately to develop the flu vaccine is pretty antiquated. It's based on trying to grow up the flu strains in eggs, actually, which takes a long time, which means they have to really kind of do guesswork, educated guesswork way back early in the year to try to guess what strains might be circulating the following winter.
CONAN: Well, how do they arrive at that, and then how do they arrive then at the strains that they put into those chicken eggs?
STEIN: Yeah, basically they're just trying to look at the historical record, see what kind of strains have been circulating in the previous year, what strains are circulating in other parts of the world already. And they - you know, basically based on that and based on past experience, they try to come up with formulas they think might work.
And a lot of times it doesn't quite match, and many times it does. And this year it looks like they're a good match.
CONAN: Did they put in protection against one particular strain, or is this sort of a rainbow?
STEIN: Oh, usually it's two or three strains, usually two that they use as the predominate strains that they're trying to protect people against.
CONAN: Is there any hope that they may come up with a universal vaccine?
STEIN: Yeah, yeah, that's the great hope and ambition is that one day they'll be able to come up with a vaccine that would work against all strains, and there's some promising research that hopefully may someday lead to that, but they're not there yet. We don't have that quite yet.
CONAN: Well, that's the vaccine news. There's also - is there any progress towards updating that procedure, where you don't have to grow it in eggs?
STEIN: Oh yes, and in fact yes, there's a lot of work going on to try to develop alternative methods of developing the flu vaccine, specifically to try to develop what they call a cell-based technique, which would involve using cells instead of chicken eggs. And the FDA in fact this year proved that for the first time in this country.
CONAN: All right, we've also seen activity earlier, I guess it's been about 10 years since there's been a flu season that's started this early.
STEIN: That's right, the last time a flu season started this early was back in the 2003-2004 season. Usually the season doesn't really get going until about a month later, like January, February. But back in 2003-2004, it started to pick up early, like this year, and that's the year that it was particularly bad.
There was - a lot of people got really sick, there were more deaths than usual, especially more deaths among kids, and that's the thing that really has people worried, that they don't want to see a repeat of that.
CONAN: Eight states already, where is most active?
STEIN: Well, it seemed to start mostly in the southern states and south, southern-central states. And there were four states initially where there was widespread flu activity. In the following week, that doubled, up to the eight states that you mentioned. And those included Alabama, Mississippi, North Carolina.
And then they added states like New York and Alaska, Ohio, Rhode Island and South Carolina.
CONAN: How many people, on average, and every flu season is different, but on average how many people die from this every year?
STEIN: Yeah, the average - I mean, it does vary from year to year, but on average it tends to be around 36,000 Americans will die from the flu. So it's a significant public health problem.
CONAN: So during flu season, that's over 100 a day.
STEIN: I guess if you average it out that way, I guess it could - yeah, and now usually most people, it's important to note, you know, they get pretty sick, but they do recover. It's really people - the people who are most vulnerable to it are older people or elderly people, young kids and people who have other health problems, and they're the ones who are most susceptible to the severe complications that can result in death.
CONAN: And we keep hearing about the best way to prevent the flu, of course wash your hands frequently and of course get a vaccine.
STEIN: Yes absolutely. The best way to protect yourself against the flu is to get the flu shot. It's highly effective, it is very safe, and that's certainly the best way to do it. And there's a big push on - especially to get health care workers to get vaccinated because they can be people who can spread the virus around.
CONAN: And there's some hospitals and facilities that require their employees to get flu shots, and, well, there's some pushback, some employees really, really object to that.
STEIN: Yeah, yeah, that's something that really picked up back in 2009, when we had the H1N1 pandemic. There were - a lot more places started requiring their doctors or nurses, the nurses' aides, the nursing home employees to get vaccinated against the flu. That didn't make a lot of people happy, but the result was that the vaccination rates have started to increase significantly.
CONAN: There also seem to be available, just in the past few years, every drug store seems to offer flu shots. That's relatively new.
STEIN: Yeah, you can get it at most drug stores. Many more employers are offering it, and that's also a really big way of getting people vaccinated, when their employers offer it for their employees.
CONAN: Well, joining us now is Dr. Thomas Frieden, who is the administrator of the Agency for Toxic Substances and - excuse me, I'm just getting the sheet of paper here - director of the Centers for Disease Control and Prevention, administrator of the Agency for Toxic Substances and Disease Registry, with us from a studio at the CDC down there in Atlanta. And doctor, good of you to be with us today.
THOMAS FRIEDEN: Great to be with you.
CONAN: And we mentioned that average of, what, about 36,000 people a year who die from the flu. Are those preventable deaths?
FRIEDEN: Flu causes a lot of illness. In an average flu season, tens of millions of Americans get sick from flu. And as with many biological phenomenon, it's essentially a bell curve. So you will have people who will get a flu infection and won't even know it, even though they might be able to spread it to others.
On the extreme other end, people who may die from flu, particularly the elderly or people with underlying health problems. But most people will get a little bit sick or sick for up to a week. Flu can be pretty severe even in an average case. It can knock you out, miss a few days of work and feel pretty miserable.
CONAN: Yet again, are those preventable deaths?
FRIEDEN: The vast majority of flu deaths could be prevented if we had widespread vaccination, not all of them because the vaccine isn't perfect, particularly for people who have weakened immune systems. And the best way we can protect those people is for others to get vaccinated.
So we found for example that if the health care workers in nursing homes get vaccinated, then the residents of nursing homes are less likely to get severely ill in that flu season.
CONAN: And how critical is it, the guesswork that goes into the creation of that vaccine, and I don't mean to slight it, it's very educated guesswork?
FRIEDEN: It's definitely an educated guess, but it's also a tribute to a wonderful global collaboration. Countries all around the world track the flu virus. They get specimens from sick people, they send them to standardized laboratories that we at the CDC and the World Health Organization ensure are doing quality work, and then they check what happens in different parts of the world.
And you see the migration of flu across the world, and you - at a certain point in time you have to pull the trigger and make a guess of which three strains to include in this year's flu vaccine.
Now interestingly we're going to be able to add a fourth strain in future years, one of the incremental improvements in flu vaccine technology. But as it happens, this year the three strains that are include match about 90 percent of the circulating strains of flu, the three most common strains.
So it was - the pick was - did as well as it could possibly have done this year.
CONAN: Rob Stein is with us, science correspondent and senior editor on NPR's science desk. Also with us, you just heard Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. If you have questions about the flu, give us a call, 800-989-8255. Email us, email@example.com. And Mike(ph) is on the line calling from Madison, Wisconsin.
MIKE: Not to sound insensitive, but it seems like a pretty disproportional response to say, you know, I'm supposed to go get an injection because 36,000 out of 300 million people are, you know, falling to this disease, to the flu and, you know, most of those being people who are already immunocompromised, like infants or elderly or related to other diseases.
So to be frank, it seems more about making some money for health companies or pharmaceutical companies to generate this stuff.
CONAN: Is there a necessity for people who are healthy and not elderly or infants to get the shot, Doctor?
FRIEDEN: Only if you want to be less likely to get the flu. The flu vaccine works. It reduces the risk that you'll get sick. A lot of people are going to get the flu in an average flu season, tens of millions of Americans so not just the people who die from it. But tens of millions of people who will be off from work, feel miserable, go through something that you really wouldn't want to go through.
Remember that flu isn't the common cold. Common cold, you may feel bad for a day or two, sore throat, but the flu makes you really quite sick, with high fever, body aches, lots of feeling miserable. So even a garden-variety flue case is very unpleasant.
So getting vaccinated reduces your risk. It also reduces other people's risk, and that's a reasonable thing to do, as well, especially if you've got a young child in your home that you're concerned about or an elderly person.
CONAN: Rob Stein, the other part of Mike's question, is this a big profit center for vaccine manufacturers?
STEIN: Yeah, I mean, drug companies certainly do make money from manufacturing the vaccine, but they don't - it's not a hugely profitable product for them. And in fact it's been a real problem in making sure that the United States does have the facilities to produce enough vaccine for the country.
You might remember back in the pandemic year, when that was a real problem, making sure that there was enough vaccine available quickly enough.
CONAN: Thanks very much for the call, Mike.
MIKE: Thank you.
CONAN: We're talking about the flu. It's arrived early this season. It's believed to be a very nasty strain of the bug, and, well, the good news is the vaccine is a good match. Nevertheless, a lot of people are going to get sick, 800-989-8255 if you've got questions about the flu. Email us, firstname.lastname@example.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.
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CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan. Flu season is here, and the early returns suggest it could be a doozy. The Centers for Disease Control recommends everyone six months or older get the flu vaccine. Thus far, only about 37 percent of the population has gotten the shot.
That's a serious concern because the flu causes a couple of hundred thousand hospitalizations each year and tens of thousands of deaths. Dr. Thomas Frieden, director of the CDC, is our guest, along with Rob Stein from NPR science desk. If you've got questions about the flu, give us call, 800-989-8255. Email email@example.com. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.
Dr. Frieden, if the main problem is getting more people to get the vaccine, what kind of campaign can the CDC or the government or doctors do to convince more people to get the shot?
FRIEDEN: What's interesting is that probably the single most important thing we need to do is make it easier for people to get the flu shot. If you look at health care workers, for the first time we broke down the different types of health care workers and different places where they're practicing.
For pharmacists, doctors and nurses, 80 to 90 percent have been vaccinated already this year. That's much higher than I would have imagined before we did that test, before we did that survey. But in nursing homes, a much lower proportion of health care workers and for allied health workers who have less access to health care, a much lower proportion are getting vaccinated.
Similarly, we looked at the group of pregnant women. Flu can be very serious in a pregnant woman, and with H1N1, we increased the awareness of the importance of vaccinating pregnant women and increased the number of obstetricians who provide the flu vaccine in their offices.
We find that although overall about 50 percent of pregnant women have been vaccinated this season, if the obstetrician offers the flu vaccine, that nearly is nearly 75 percent. So making it easier for people is important, and that's one reason we're so encouraged that more and more pharmacies and workplaces are providing the vaccine.
In fact, more than a third of everyone who was vaccinated this year was vaccinated either in a pharmacy and/or in a workplace; that is among adults.
CONAN: Let's get another caller in on the conversation. Derek's with us from San Francisco.
DEREK: Actually, my question ties in quite a bit to your comment. So I'm a big believer in flu vaccine. I've been getting them every year for a long time. My wife has never gotten a flu vaccine. She's pretty skeptical about recommendations from mainstream medicine.
She's pregnant, and I tried to convince her that she should get a shot. We went to the CDC site on pregnancy and flu vaccines, and she saw the recommendations but said I need more information. What are the links to these actual studies? So I guess what I'd try to encourage is be even more transparent about how you come to your recommendations.
Link to the studies and have a link to OK, here's what we saw, and here's why we're making this recommendation.
FRIEDEN: I agree with you 1,000 percent, and I would encourage you to get on the site of the Advisory Committee for Immunization Practices, also known as the ACIP. We think it's really important that the information that we use to come to recommendations is entirely transparent. The ACIP is the non-governmental body, coordinated by the CDC, with the world's experts in the different diseases that makes recommendations for vaccination, whether it's influenza or any other vaccine that we recommend.
Every meeting of the ACIP is an open meeting, it's webcast. It's available for people to see. Every paper that's provided to the ACIP is entirely open and in the public domain, and all of the articles, all of the scientific research that we base our decisions on, that's all available. We would rather overcommunicate than undercommunicate the bases of our decisions because we know there are people who are suspicious.
And we think the best disinfectant is sunlight. So we want to provide the maximum information that's available so that people can make informed decisions. The issue with pregnancy is that when you're pregnant, women who are pregnant actually down-regulate their immune system a bit because the body doesn't want to reject the fetus.
So the immune system of pregnant women is a little less effective than immune system of the same woman who is not pregnant. In addition, simply having the large uterus compresses the lungs some and makes the lungs a little bit more susceptible to severe infections. And that's why we saw some deaths from influenza among pregnant women during the H1N1 pandemic.
CONAN: And just following up on Derek's question, publishing those papers, providing links, that's obviously one level of, well, of information. What about public service announcements? What about ads on TV?
FRIEDEN: CDC funds state and local governments, and we work with broadcasters and producers and others to provide information about influenza. It's something that we do especially for communities that have traditionally been more resistant to vaccination. So we see lower vaccination rates, for example, in the African-American community, and we've done more outreach through churches and the media to try to increase vaccination rates in communities that have traditionally had lower rates.
CONAN: Email question from Jim: Does repeatedly - does repeated yearly shots of different strains build a more robust defense from various flu strains?
FRIEDEN: Yes, in fact it does seem that although you need this year's flu vaccine to protect you against this year's flu, there is some benefit to prior years' vaccinations but only if you get a similar flu strain in that year. And the flu has a tremendous variability.
So you can shift or drift from one type of flu to another, and that's why you need to get the vaccine each year, but doing that may have some cumulative benefit.
CONAN: And another email question: What's the incubation period from the time someone's exposed, infected to the virus to the time they begin to show symptoms? And how long is an infected person contagious?
FRIEDEN: You can actually be contagious with the flu from before you show symptoms, by a day or two, and you generally would stop shedding large amounts of flu when you no longer have a fever. Though you can still grow it from people from sometime thereafter, we think generally to spread it to others you've probably more likely got to be coughing and ill. But that's one reason we really encourage hand-washing regularly.
The vaccine itself takes about 10 to 14 days for the immunity to kick in after you get the vaccine.
CONAN: Let's go next to Marsha, Marsha with us from Oklahoma City.
MARSHA: I want to know the difference between the shot and the flu mist, and, you know, what are the pros and cons.
FRIEDEN: So the flu mist is a live, attenuated virus. It's a virus that's grown in the laboratory until it can't make people sick, but it can only be used on certain people. So it is only approved for people up to the age of 50, and it's not approved for people who have certain counter-indications such as a weakened immune system just 'cause we're not 100 percent certain that it would be safe in that environment.
But it's not a shot. So kids who prefer the mist may prefer the mist to a shot. And one of the things that we like to see is more options. So this year there was an intra-dermal vaccine in addition to the usual flu shot, so two different ways of giving shots. One of them were shallowly in the skin. And then the flu mist is a way for people who don't like needles to get a flu shot if they're under the age of 49 and otherwise can take it.
CONAN: Marsha, do you prefer the mist?
MARSHA: I prefer the mist, and so does my 12-year-old son, who is just horribly afraid of shots.
CONAN: I was afraid of them, too, when I was 12. I didn't have any choices, but I was afraid of them.
MARSHA: That's right. Thank you so much.
CONAN: Thanks very much for the phone call, appreciate it. Let's go next to Brian(ph), and Brian's on the line with us from Charlotte.
BRIAN: Yes hi, thank you for taking my call.
CONAN: Go ahead.
BRIAN: My family, we've all gotten the flu shots, with the exception of my 18-year-old, 17-year-old daughter. She's a vegan, and she is really adamant about it. And so our question is, in trying to be preventative about this: Are there any alternatives for someone who's vegan? Because as I understand, the vaccine is derived from eggs.
CONAN: It's grown in eggs, yes. Doctor, is the mist also developed that way?
FRIEDEN: You know, I would have to check on that. So we could check to see how the flu mist is grown. It's a live, attenuated vaccine, and I'm not certain of whether or not eggs are made - are used in the process. There are other ways to protect yourself against the flu, although the vaccine is the best tool. Washing your hands, covering your cough and ensuring that people who are sick with fever and flu stay home, can protect others.
CONAN: And I wonder, Rob Stein, the - that new technique you were talking about earlier that doesn't use eggs, is that coming online anytime soon?
STEIN: Well, it was approved by the FDA. So it is available to be used. It was approved too late, really, for this year's flu vaccine, but it would be available if, for example, another strain suddenly emerged, like a pandemic strain suddenly emerged. They would be able to sort of put that into action and try to produce extra vaccine if they needed to do that.
CONAN: And the benefit would be not merely that vegans could use it too, but also that it would be a little quicker than the current technique.
STEIN: Yes, exactly. It would save time. So you'll be able to produce vaccine more - shave some time off the production period.
CONAN: Brian, we wish you good luck.
BRIAN: OK. Thank you.
CONAN: Doctor, you're about to say?
FRIEDEN: We do expect that by the next flu season, if all goes well, the cell-based vaccine should be available on the market.
CONAN: And would it completely replace the previous egg-grown vaccine?
FRIEDEN: No. Probably both will be on the market. They both have different characteristics. And there wouldn't be enough of the cell-based produced vaccine for the entire country, but it'll be another option for people, just as FluMist is another option for people now.
CONAN: Let's get C.C. on the line. C.C. is with us from Green River in Utah.
C.C.: Yeah. Hi. I have a question and also a comment. My question is in terms of rural versus urban living. I'm curious what's been discovered in terms of strains of illnesses and also the likelihood that you will or won't get sick if you're living in a big city versus a small town.
And I also wanted to recommend to your listeners a documentary film called "The Greater Good," which looks at the vaccine issue and vaccine safety, and it follows three families that are affected by vaccination. It's a fabulous film. But I'm curious about this rural-urban question, if you guys have thoughts on that.
CONAN: Well, is there any difference, rural or urban, Doctor?
FRIEDEN: There's variability. So even among urban areas and among rural areas, we may see very different levels of flu activity for reasons that we don't completely understand. One of the things that we saw in the past year in many rural areas related to 4-H clubs and work with county fairs was spread of a certain strain of swine flu or swine-origin influenza to kids and others who had close contact in county fairs with swine, what was called H3N2 variants.
So we had a strain of swine flu that had picked up one of the genes from the H1N1 pandemic influenza virus, and then it had come back into people, and we've seen several hundred cases of that. As we worked with some of the agricultural groups in the Midwest to reduce the human-swine contact, we saw fewer cases.
So there are different kinds of patterns of flu disease. What we do sometimes see in cities, in schools, are large outbreaks of influenza. And during the H1NI pandemic we had schools that had hundreds or even over a thousand cases of influenza spreading very rapidly. But of course you can have a crowded school even in a rural or semi-rural area.
CONAN: We're talking with Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. Rob Stein is also with us from our Science Desk. You're listening to TALK OF THE NATION from NPR News.
And Rob, I wanted to follow up. A couple of years ago, during that H1N1 pandemic, we saw new ways of tracking the outbreaks of flu using Google Maps. Is this working out?
STEIN: Yeah. Well, I mean that's one of the methods, new methods that have come along where they're using tools like Google to track outbreaks of various diseases, and actually they have these crawlers. The World Health Organization has a similar system now where they have these Web crawlers out there that are looking for all sorts of signs of anything that might indicate that there's a disease that is cropping up. They look for runs on certain drugs and stores and people going to the doctor for certain things more often and developing lots of new tools. It's really interesting stuff.
CONAN: Not just Tamiflu but other drugs...
STEIN: Right, exactly. Right. People going in for, you know, just regular cold medications or going to see their doctors for various things.
CONAN: Oh, by the way, just to answer another earlier call, the FluMist website says you should not get FluMist if you have a severe allergy to eggs, gentamicin, gelatin or arginine. And that would, I guess, suggest that it is derived from eggs. So take that information to your vegan daughter and avoid the mist, I guess, as well.
Several years ago - this is an email from Leanne(ph) - Pates(ph), one of my clients - a healthy, robust 50 athletic-something male - contracted a flu on Tuesday, went to a doctor on Thursday, hospitalized and was dead by Saturday, completely unexpected, a shock to everyone who knew him, a reminder that anyone has the potential to die from the flu.
And so, Rob, yes, those most at risk are the very young and the very old, but that's not everybody.
STEIN: Yeah, that's right. And that was especially apparent, again, during the H1N1 pandemic that it seemed to be hitting healthy, young, relatively young people really hard for reasons that were really hard to understand.
CONAN: Let's see if we get Peter on the line, Peter with us from Fayetteville in Arkansas.
PETER: Yeah. Hi. Thanks for taking my call. I'm calling because a friend of mine was recently - had to - was mandated by our employer to take the flu vaccine and was within hours struck down with just a full-body multisystem - they don't know what's wrong with her yet.
But I do know that - or at least I've been told that they use mercury to make the vaccines and that there is mercury in the vaccines themselves, and that there are some people in the population who have a terrible reaction to the mercury in the vaccine as well as whatever other toxic chemicals they use.
CONAN: Yeah. I don't mean to cut you off, Peter, but I wanted to give Dr. Frieden a chance to respond. We just have a couple of minutes left.
FRIEDEN: We check every possible reaction to the flu vaccine. We have not seen reactions like the one that you describe to any of the components in the flu vaccine or to the flu vaccine itself. But one of the reasons that we track things like this is to know if anything like that happens.
And again, as with the information I shared earlier about the ACIP, we provide all of that information publicly on the Internet, not with people's names, of course, but with the frequency of different adverse events. And we have not seen anything like that as a trend, but it's something that we would absolutely look at. And I certainly hope that she does better.
CONAN: And is mercury part of the vaccine?
FRIEDEN: For some of the strains - some of the vaccines on the market, the multi-dose vials, continue to be made with thimerosal, a form of mercury, in minute quantities that are necessary to act as a preservative for the vaccine. It's not present in the single-use vials and it's not present in the flu mist either.
CONAN: And just to back that up, Rob Stein, my understanding is this is, by all accounts, an exceptionally safe vaccine.
STEIN: Oh, yeah. It's been studied extensively, and you know, nothing is 100 percent safe. There are some complications that can occur. They are extremely rare though. And when all is said and done, the benefits seem pretty clearly outweigh the risks.
CONAN: Well, Rob, thanks very much for joining us, and we appreciate your time.
STEIN: Nice to be here.
CONAN: And Rob Stein from NPR's science desk. And Dr. Frieden, thank you very much for your time as well.
FRIEDEN: Thank you. Stay healthy this flu season.
CONAN: Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, with us from a studio there in Atlanta.
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