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The Call-In: All About The Flu


Time now for The Call-In.


GARCIA-NAVARRO: Bad news, everyone. February's almost over, but we're not out of the flu season just yet.

WILLIAM SCHAFFNER: It looked as though we were on a high plateau. So there's still lots of influenza cases occurring, but we hadn't taken, really, a substantial downturn yet. We all wish that would start.

GARCIA-NAVARRO: Dr. William Schaffner is an infectious disease specialist at Vanderbilt University. Last week, we asked listeners for their questions on the flu. And this week, we posed a few to Dr. Schaffner. For starters, why has this flu season been so severe?

SCHAFFNER: The main reason is that it was this bad strain, this H3N2 strain which, traditionally, as we look back over previous years, is one that causes more severe illness. And then this year, it started early and kind of blossomed all over the country. And in parts of the country, it really accelerated, and other parts are now catching up.

GARCIA-NAVARRO: So we have listeners who called in with some questions about the flu and about what to do about the flu. Here's a listener, Andrea (ph) in Nevada, with a question about alternative remedies.

ANDREA: There have been studies on the effect of elderberry versus Tamiflu. So I'm just wondering why we can't have a little bit more discussion about the alternatives to things like Tamiflu or the flu vaccine, which has been very ineffective.

GARCIA-NAVARRO: Is she right? Have there been studies that show that elderberry is as effective as Tamiflu?

SCHAFFNER: I wish we had studies to show that this elderberry or some other product were as good or better than Tamiflu. But in order to do that, you have to do them according to the current standards. And these are small and not very well-done studies. So get your influenza vaccine each and every year. That's been shown to be better than absolutely not getting influenza vaccine. And if you're particularly older, if you have an underlying illness, call your health care provider right away because Tamiflu will actually reduce somewhat the duration of the illness and make it less likely that you will get the complications. And that's the really important part.

GARCIA-NAVARRO: Here's another listener with a question about the flu shot.

JIM: This is Jim (ph) calling from Great Falls, Mont., and my question is regarding the flu. No, I never got a flu shot for over 40 years. And I was healthy while the other people around me would often fall sick. For the last six years, I've worked in a hospital, and I'm required to get a flu shot if I want to keep working here. My question is, what are the statistics of those who have received the flu shot and still get the flu versus those who do not get the flu shot but do end up getting sick?

SCHAFFNER: So two things about Jim's question. The first is, why is it that we as health care providers are obliged to get the vaccine? And that's a patient safety issue, such that if we were to get influenza, we should not give it to the patients to whom we're providing care. Now, apropos of getting influenza despite the vaccine, that can happen. We understand that. But you're much less likely to get the complications of pneumonia, having to be hospitalized yourself or dying.

GARCIA-NAVARRO: Why is the flu shot so ineffective this year, though? I saw numbers - about 30 percent effective.

SCHAFFNER: Well, the reason is, again, this H3N2 strain. Not only does it cause worse influenza, a more serious illness, but, traditionally, the vaccine has been less effective against this particular strain. But remember, when we measure effectiveness, we measure complete protection. We don't measure the ancillary benefit of reducing the severity of the illness. And that's really very important. Indeed, for older people and people with underlying illnesses, the main reason we give influenza vaccine is to try to reduce the risk of those complications.

GARCIA-NAVARRO: I want to look at some legislation. Senator Ed Markey, a Democrat from Massachusetts, has recently introduced the Flu Vaccine Act. And it's a proposal to fund research for a universal flu vaccine. So I guess my question is, how far have scientists gotten with developing a vaccine that would protect against all flus? That seems to be a good idea.

SCHAFFNER: It's a great idea, and scientists are working on that. Actually, there are universal vaccine candidates in early clinical trials already. So let's keep our fingers crossed that they'll be successful. And the more we can prime that pump, the quicker we'll get a universal flu vaccine, one that would protect against a whole variety of strains and perhaps one that only would require us to be vaccinated every, let's say, five or 10 years.

GARCIA-NAVARRO: This bad strain, H3N2 - if we had guessed it correctly, could we have had a vaccine that could have immunized us better?

SCHAFFNER: Actually, the choice of the strains that are in the vaccine are right on target this year. We knew about this H3N2 strain. It's just more difficult to make an effective vaccine against H3N2.

GARCIA-NAVARRO: How prepared are our local health systems to deal with an epidemic or a pandemic? I mean, this flu season has been particularly bad, but it is something that we are familiar with dealing with. But, you know, there have been discussions about how our local health systems have been precarious for many years now.

SCHAFFNER: It's true. Health departments funding has been reduced around the country. And, indeed, the number of beds we have in our hospitals have been calibrated very, very carefully so that if we did have a large pandemic, we would have a lot of work to do to try to manage that in a coherent fashion. My own institution, as I'm sure the vast majority of others, has a pandemic plan that we roll out and practice periodically in the event that such an outbreak would occur.

GARCIA-NAVARRO: What role does the CDC play in that? The Trump administration has proposed cutting the CDC's budget by 12 percent. The CDC's Public Health Preparedness and Response program would have its funding cut in the new budget by 43 percent. Is that significant?

SCHAFFNER: You've just given me a great deal of heartburn because I'm president, if you will, of the CDC fan club. I think the CDC is a national treasure. Reducing its funding really handcuffs its capacity to support state and local health departments and all of us in fighting flu as well as the entire array of communicable and other diseases. That's shortsighted.

GARCIA-NAVARRO: We touched on the antiviral medication Tamiflu in our conversation with Vanderbilt's Dr. William Schaffner, but we wanted to know more. It's the most common virus-fighting medication, and it's prescription-only. NPR's Patti Neighmond reports on when it should be prescribed and how well it works.

PATTI NEIGHMOND, BYLINE: At PM Pediatrics Urgent Care Center in Annapolis, Md., 7-year-old C.J. (ph) sits with his dad...

C.J.: I've been coughing bad, and I've been needing to blow my nose a lot.

NEIGHMOND: ...Waiting to see a health care provider.



NEIGHMOND: The symptoms for this year's flu come on quickly, says PM Pediatrics senior medical adviser Christina Johns.

CHRISTINA JOHNS: Markedly high fever and then kids who are acting like they're absolutely wiped out, just exhausted.

NEIGHMOND: And this year, Johns says, she's seen a huge increase in the number of kids with the flu...

JOHNS: It's been a hanger (ph) honor this year for sure.

NEIGHMOND: ...With symptoms stretching on for as long as two weeks. Sound like time to reach for prescription medication? Maybe, says Johns, if your child is more vulnerable to flu complications like pneumonia and other infections.

JOHNS: For children who have chronic medical problems such as asthma, heart problems, any kind of condition that results in a weakened immune system, those are the patients who are most likely to benefit from getting the Tamiflu medicine.

NEIGHMOND: This is also true for adults with chronic conditions that compromise their immune system. Age makes a difference, too. Children 5 and under who haven't yet developed a strong immune system and adults 65 and older who may have a waning immune system both may benefit from Tamiflu, which has been shown to reduce the duration of flu by about one day. But the key for getting the most out of it...

JOHNS: It must be done within the first 48 hours of symptom onset.

NEIGHMOND: If you wait five days, it's probably not worth it, says Johns. At that point, it's best to rely on tried-and-true symptom relief.

JOHNS: Lots and lots of fluids, fever reducers, rest, chicken noodle soup, all of the feel-good things are really the mainstay. And that's what gets you through.

NEIGHMOND: As with most medications, there are some side effects with Tamiflu. Tanya Altmann is spokesperson for the American Academy of Pediatrics.

TANYA ALTMANN: The more common side effects are stomach discomfort. So vomiting, tummy aches, loose stools.

NEIGHMOND: And there can be some serious side effects.

ALTMANN: Once in a while, you'll have kids that do get bad dreams, maybe hallucinate, act a little crazy. And in that case, you can just stop the medication.

NEIGHMOND: And the symptoms will go away. In 20 years of practice, Altmann says she's only taken kids off Tamiflu two times. Now, the medication's not just used to treat the flu. It's also used to prevent it among people who've been exposed to the virus. Altmann.

ALTMANN: I had a patient whose brother was undergoing chemotherapy for a tumor. So I treated her with Tamiflu. And I also, in that case, put the rest of the family on Tamiflu prophylaxis.

NEIGHMOND: None of the family members got the flu. Tamiflu's been on the market for well over a decade. It can run about a hundred dollars for five days of treatment and possibly less for the generic version, especially if you have insurance. Patti Neighmond, NPR News.


GARCIA-NAVARRO: And next week, The Call-In's on hiatus, but we always love to hear from you on any topic. You can tweet us at @NPRWeekend or head to our Facebook page.

(SOUNDBITE OF CORDUROI'S "MY DEAR") Transcript provided by NPR, Copyright NPR.

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