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Unusual Lull In Flu Season, Explained


Right now, flu season, and most years we'd be right in the thick of it between the regular seasonal flu and the H1N1 pandemic. Officials worried this winter could be very, very bad indeed, but that's not the way it's turned out. So far, about 12,000 deaths are attributed to the flu. And while that seems like a lot, it's less than half what you'd expect most years. After eruptions of H1N1 prompted school closures and quarantines last fall, we seem to be in a low now. So what happened?

Nurses, doctors, teachers, what kind of flu season have you experienced? 800-989-8255 is our phone number. Email: [email protected]. You can also join the conversation on our Web site. That's at and click on TALK OF THE NATION. NPR's Joanne Silberner joins us from the studios of Georgia Public Broadcasting. Joanne, always nice to have you with us.

JOANNE SILBERNER: Good to be here, Neal.

CONAN: And you're near the Centers for Disease Control there in Atlanta. I'm sure people there are relieved, but do they know what happened?

SILBERNER: Not really. And something happened. The flu peaked very early for the flu. Flu usually peaks, as you mentioned, around now. This one peaked in late October. It also showed up last April in the spring - late spring is a very odd time for flu to show up. So this one is not - it's not following the rules in the book.

CONAN: Some suggestions that there could be a third wave. You mentioned the one last April, the one this fall. That doesnt look like it's happening either.

SILBERNER: No, it doesnt. And there's a pretty good reason to think that it won't happen, and that is a lot of people have been vaccinated. A lot of people have gotten sick, so there's a lot of people who are now immune. So there's -it's less likely to spread when it - because it'll encounter people who can't get it, so it can't spread to the next person through that person. So the third wave idea, I think, is dying down.

CONAN: Yet, we're talking about the H1N1. What happened to the regular, standard seasonal flu that we get every year?

SILBERNER: Another great question. It could be that this one out-competed, that their bodies' reaction to this one either through the vaccine or through the flu itself was enough to scare the other flu viruses off. There might have been enough of an antibody reaction. But that's a great question. When they figure that one out...

(Soundbite of laughter)

SILBERNER: ...they're going to know a lot.

CONAN: And are people worried that there's going to be concern that they seem to have cried wolf, that they were very, very worried. I don't think anybody suggested they were worried for no reason. Nevertheless, the effect is, well, next time they say you need to get a shot, people are going to say, so what?

SILBERNER: You know, that is a real concern, and it very well could happen. And that's pretty sad, because flus do kill people - 20 to 40,000 people a year usually. This one was a mild flu, but it infected a lot of people. It made about 57 million people sick. I think those people may remember having had the flu and they may be a little more concerned and get the vaccine next year because you're not completely protected even if you have the flu. But there will be others who'll say, well, I didnt get it. And then they won't get the vaccine and then they'll get the flu.

This will be part of the flu shot next year, so there's not going to be two flu shots next year like there was this year. There'll be just the one. So you will be vaccinated against this if you're vaccinated against the seasonal flu. But again, I think you're right, there are people who are going to say, well, you know, it wasnt as bad. And of course, you can't, you know, win for losing. If they had under-predicted it, you know, there would have been just as much criticism.

CONAN: And after all that concern about the amount of H1N1 vaccine that was available and how quickly it was available, it turns out a lot of it didnt get used.

SILBERNER: A lot of it didnt get used and it expires. The government paid for about 229 million doses. I think the total now is about 95, 97 million doses used, so there's a lot of it sitting around. One thing that is clear is that the manufacturers are capable of producing large amounts of vaccine, not as quickly as anyone had hoped with this one. This one was a little bit tricky in its biology. So it's now known the manufacturers can do it, the manufacturers who've been, you know, happy about getting the money to do it.

CONAN: Sure.

SILBERNER: They've got the facilities now, so that's a good thing. But it's a bad thing that a lot of vaccine was wasted.

CONAN: And as you suggest, this H1N1 is going to be incorporated and become -well, is that next year going to be the regular seasonal flu?

SILBERNER: Yes, and there'll be two other strains in it as well. What scientists do is they look and see what's showing up in the southern hemisphere because, of course, their winter - their flu season is six months ahead of ours. They look at what's going around there. They put that in. And in this case, they're adding in the H1N1, so they've already got the vaccine designed and they'll start making it fairly soon.

CONAN: And of course, one difference between this H1N1 and the standard, if you want to say, seasonal flu, was who it affected. The victims tended to be younger than normal.

SILBERNER: Yes. And this was very disturbing to a lot of the epidemiologists and the scientists who study flu because that's not been seen for a long time. And to see children and babies dying of the flu was just incredible. And old people didn't seem to be getting it. There were deaths among the elderly. Of those 12,000 deaths that you mentioned, about 1,500 of them were over 65. But that's very low. Usually, they are the ones who are dying. They didn't seem to be getting the flu as often because chances are they saw a flu like this maybe 30, 40, 50 years ago...

CONAN: But...

SILBERNER: they were somewhat protected.

CONAN: But does that mean next year they're not going to know who to prioritize? Basically everybody should get a shot?

SILBERNER: Yes. And that's what they're saying already. In fact, they said regular seasonal flu. It used to be - you know, way back when, they just wanted the risk - the really high risk groups: the older people, people with immune systems that were weak for one reason or another. Those are the only ones. But as vaccine capacity expanded, the only reason that there were limits was because there were limits to - how many vaccines there were in this country. But as more and more vaccine got available, they've now expanded it. And last week, authorities - officials came out and said everybody should get it.

CONAN: We're talking with NPR's Joanne Silberner at Georgia Public Broadcasting down in Atlanta about well, what happened to the pandemic? What was your flu season like, doctors, nurses, teachers? 800-989-8255, email us [email protected]. Jodie(ph) is calling from Baton Rouge.

JODIE (Caller): We had a really mild flu season as far as the severity of the symptoms. But a lot of people have had H1N1. I'm a home-health nurse, and really, I see mostly premature babies who have gone home, and those premature babies who got the H1N1 were very sick. But my children - I have two two-year-olds - they both had H1N1. They both had the vaccine in November but they both developed the virus at the end of January beginning of February - you know, they spiked a temp, felt bad for a couple of days. But one got an ear infection a few days later and the other got bronchitis a few days later, which they attributed to the flu. But the flu itself was nothing like the seasonal flus that we've seen, the severity of the symptoms.

CONAN: And again, a lot of people think they've had the flu until they actually get it and then you never mistake it again. You know what it is.

JODIE: I've had the seasonal flu and was much sicker than my children (unintelligible).

(Soundbite of laughter)

SILBERNER: But it is hard to tell that's truly H1N1 without a lab test. It costs about 250...

JODIE: They did take (technical difficulty). But it was too late...

SILBERNER: They did the lab test?

JODIE: treat with Tamiflu. But they tested positive for type A, which they said was H1N1.


CONAN: Okay. Jodie, I'm glad everybody's okay.

JODIE: Yeah. Thanks.

CONAN: Appreciate the phone call. And that, again, was characteristic of this season. A lot of people got sick but not that sick.

SILBERNER: Absolutely. So that's, you know, the good news is, people didn't get that sick. The bad news is a lot of people got sick. I mean, usually, they track something where you go when - from doctors' offices, there's a survey of doctors. And one of the questions - a regular survey - and they say, how many people came in with flu-like symptoms?

And, you know, normally it's maybe one to two percent or during the flu season, it's normally two to four percent. In late October, when H1N1 was really out there, it was 7.8 percent of people going to doctors' offices had flu-like symptoms. That's three or four times higher than in a regular flu season.

CONAN: Yeah. Except, again, now when we're usually at the peak of the flu season, apparently very few people are going to doctors' offices.

SILBERNER: Right. Right.

CONAN: Yeah. Let's get another caller in. This is Kirk(ph). Kirk with us from Detroit.

KIRK (Caller): Hey. How are you doing?

CONAN: Very well. Thanks.

KIRK: I just - I'm an ER doctor here in Detroit. I was going to mention, you know, you talk about crying wolf. I think that actually, the public outcry did a lot of good for a lot of people because people came in this season, they knew they had to keep hydrated. They knew they had to have their Motrin and their Tylenol to keep the fever down. I think they may have taken care of themselves a little bit better in general this year. And it's anecdotal. That's my experience. There's no data behind it. But...

CONAN: But taking care of themselves after they got it.

KIRK: Oh, yeah. Right. But, you know, people would see the things on the news and then they would say, oh, I need to keep (unintelligible) and the...

CONAN: Uh-huh.

KIRK: Yeah. We did a very good job at telling people what they had to do ahead of times.

SILBERNER: Well, there was a real concern that the emergency rooms would be absolutely flooded and the National Academy of Sciences back in October held a meeting. You know, how are we going to keep the emergency rooms from being flooded? So there were all sorts of things put out on the Internet and other places where you could say - you can answer questions about your own health. You know, this is what my fever is, this is what my symptoms are. And you would - and this is what my background health is. And it would prompt you with questions. You know, do you have lung disease, do you have this - are you pregnant? And depending on how you answered, the computer programs would come back at you and say: stay home. You know, keep your fever down. Try to stay comfortable or get to a hospital. So your emergency room was not crowded?

KIRK: Oh, it was definitely crowded. But I think it could have been a lot worse. And the people who were there were a step or two ahead. You know, they had already taken, you know, I've got this much fluid and I've already taken my Motrin and Tylenol doses and how much and when.

CONAN: Mm-hmm.

KIRK: And that's an educational (unintelligible) that I hadn't seen in past years.

CONAN: Kirk, one...

SILBERNER: That's good news.

CONAN: That's good news. One question. Always had priority for the vaccine. People who should go get it: healthcare workers. Did you and your fellow workers there at the emergency room all get the vaccine?

KIRK: Oh, of course. I consider it actually a danger to some of my more vulnerable patients if I don't get it.

CONAN: All right. Kirk, thanks very much. And continued good luck.

KIRK: Thank you very much.

CONAN: Bye-bye. Let's go next to Norma(ph). Norma with us from Riverville(ph), California.

NORMA (Caller): I've been listening to the news because I'm not feeling well right now. But I think what happened also is people became a little bit more careful. They wash their hands more. They kept them away from their face. You didn't run up and hug somebody like you might have in the past. You didn't go on planes or got in close situations with people if you weren't sure they were feeling well. And you were careful. We didn't - and we took of our selves.

CONAN: Mm-hmm.

NORMA: And I think that you - avoidance, protecting yourself so you don't get it in the first place, is a very, very important event.

CONAN: Well, very anecdotally, Joanne, the soap pumps at the sinks here in the men's room at NPR always empty.

(Soundbite of laughter)

NORMA: Exactly.

SILBERNER: Well, they should be. Sales went up. Sales of the hand soaps definitely went up. And one thing that the secretary of Health and Human Services, Kathleen Sebelius, said, I think back in January, she said, well, at least we're learning how to cough.

CONAN: And a lot of places seem to put the, you know, the antibacterial fluid, the Purell dispensers all over the place.

SILBERNER: Yeah, which is a good idea, and it's going to help with other conditions as well. You know, there are...

NORMA: Exactly.

SILBERNER: ...other more serious conditions out there that can be stopped the same way.

CONAN: Norma, thanks very much. I hope you feel better.

NORMA: You're welcome. I'm fine. Bye.

CONAN: We're talking about the pandemic and what this flu season has been like. You're listening to TALK OF THE NATION from NPR News.

And, Joanne, one of the things we're learning is how the virus, or I guess, those of us who are laypeople (unintelligible) is how this virus comes in waves and, as you're suggesting, this pandemic is acting - well, I guess more like pandemics and not like regular flu, but it's just odd to us that these flu viruses are in competition with each other.

SILBERNER: Well though, you know, if you talk to any flu expert or virus expert and you ask them to make a prediction, they will - whatever you're asking them to predict, at the end, they'll say: But the one thing I can - I can't tell you for certain, but the one thing I can tell you for certain is that flu viruses are unpredictable.

You know, I think we have this expectation of, you know, these are scientists, they've been studying it for years, this is a pretty well-funded effort by the U.S. government, you know, they should know everything. You know, there's only - as tiny as viruses are, there's only so much you can know about them. And they tend to do unpredictable things.

CONAN: And they are organisms, but should we see the - how do the strains compete with one another? Or is it simply that one strain arrives and we develop immunities to it, either because we had it or we get the shots and they can't find any hosts anymore and it goes away and makes room for the next one?

SILBERNER: You know, it's not really clear. But every year, there's only two or three strains in the vaccine. You know, they put whatever the current virus strains are into the vaccine every year. So it'll be two or three depending on how many are going around.

And when you think of the thousands that there are and then some of them kind of get extinguished when enough people have been infected, it's really not clear. You could imagine that maybe the immune system gets revved up enough. You know, these are all similar enough to be in the same family, so there's a chance that there's something universal about the immune system's reaction, which you don't get every year.

The reason you need a new flu vaccine every year is because the strains changed or your immunity wears off. But maybe there's something in this virus that created a universal enough reaction. I think we'll know that. I think that's something that researchers are working on, and that we'll know fairly soon. And it'll be great to know, because if there is something universal, you know, maybe we could just have one flu vaccine and...

CONAN: Mm-hmm.

SILBERNER:'ll be done with it.

CONAN: Well, for the rest of your life. Anyway...


CONAN: ...Christine(ph) is on the line. Christine calling from Portland.

CHRISTINE (Caller): Hi. I am a pediatric nurse in a clinic. And I - we've seen a much lower incidence of flu this year, you know, a much calmer season than usual. But we vaccinated way more kids than we ever have in the past, both with H1N1 when it was available, but when it wasn't available, we were still vaccinating the seasonal flu. And so I think that the vaccination rates have just skyrocketed this year because people were still panicked about the H1N1.

CONAN: Mm-hmm. And...

CHRISTINE: And I think that that's helped contribute to a milder flu season.

CONAN: I wonder, Joanne, given the fact that there was so much flu vaccine unused, obviously, that didn't to go across all age groups or all locations.

SILBERNER: No, but they did pretty well with kids. And one of the reasons why is that they moved to a new - the government moved to a new strategy this year, the local governments, because the vaccine was distributed by the states. And a lot of states focused on school-based clinics, where it's really easy to get fuller coverage.

But you know, there's a tremendous vaccine resistance in this country. There's a resistance, there's the concern, there's this false association between vaccines and autisms that just persists and persists. So this, you know, may have jumped the hurdle a little bit and pushed things along because they really did not find any serious safety problems with this vaccine.

CONAN: Okay.

SILBERNER: And believe me they were watching because they were worried about it.

CONAN: And was that your experience, Christine?

CHRISTINE: Yeah, absolutely. In fact, we saw a lot of parents who are - Oregon is a state that has a very high rate of unvaccinated children.

CONAN: Mm-hmm.

CHRISTINE: And we saw a lot of parents who are reticent to give vaccine to their kids, getting the H1N1 and seasonal flu for them.

CONAN: So this one, they were accepting of it. But anyway...

CHRISTINE: Yes. It was a very interesting paradigm, you know, between what we typically see and what we saw this year.

CONAN: Christine, thanks very much for the call. We hope those kids we heard in the background are doing well, too.

CHRISTINE: Yes, thank you.

CONAN: Bye-bye. And finally, Joanne, I guess the one thing that could change is if the virus change, if it mutates.

SILBERNER: Right. And they're watching for that. There's - you know, they regularly take samples of viruses from people who - and when I say they I mean both academic researchers and government scientists are taking these viruses. And they're actually looking at every single part of the virus, the composition of it. They're looking for change. They haven't seen any, but they fully expect - this is a virus that mutates all the time. And they're fully expecting that they will see it. At some point, the question is, will it be a mutation into something that's no more lethal than this one is, which is occasionally, but thankfully not too often, or will it be - you know, will it go to a more serious kind? In which case, we know we've got the vaccine capacity and they can gear up to that one quickly.

CONAN: Joanne, thanks very much.

SILBERNER: Thank you.

CONAN: NPR's Joanne Silberner, one of our health policy correspondents, with us today from the studios of Georgia Public Broadcasting in Atlanta.

Tomorrow, what teachers have to say about fixing America's school. Join us for that conversation. This is TALK OF THE NATION from NPR News. I'm Neal Conan in Washington. Transcript provided by NPR, Copyright NPR.