Tuesday, November 24, 2009
An update on Swine Flu in San Diego County. County of San Diego Public Health Officer, Dr. Wilma Wooten, joins us in studio to talk about the availability of the vaccine, what you can do to prevent infection and what people should do if they suspect they have the flu.
SAN DIEGO DOUG MYRLAND (Host): Good morning. I’m Doug Myrland, sitting in for Maureen Cavanaugh, and you’re listening to These Days on KPBS. In this first segment, County of San Diego Public Health Officer, Dr. Wilma Wooten is joining us in the studio to talk about the availability of the swine flu vaccine, what you can do to prevent infection and what people should do if they suspect they have the flu. So, Dr. Wooten, welcome back to KPBS.
DR. WILMA WOOTEN (Public Health Department, County of San Diego): Thank you, and good morning.
MYRLAND: So the overall sort of broad question is how serious is this threat of swine flu to average people in San Diego County?
DR. WOOTEN: Well, swine flu – the swine flu new influenza is serious in that it is causing hospitalizations and it’s causing deaths, a larger number of deaths than we’ve seen with our most severe flu season in the past – regular seasonal flu season in the past 10 years.
MYRLAND: 659 is the figure you gave me for hospitalizations.
DR. WOOTEN: As of today, yes. We have had 659 hospitalizations reported to our public health department and we anticipate that that number will continue to increase.
MYRLAND: Is that a lot? Is that a number that surprises you?
DR. WOOTEN: I can’t say it’s a number that surprises me because this virus is a new strain of influenza virus that has never been detected in the human population before so many people, particularly those that are young, between five and 44 years of age have never been exposed to this virus before so they are more susceptible. So those individuals and even older individuals, we anticipate that we will see them in the hospital and, unfortunately, we anticipate—and have seen to date—numerous deaths associated with this new influenza.
MYRLAND: Now if you would, tell us a little bit about the vaccine situation. How many doses of the swine flu vaccine do you have and how many are out there, and is it available?
DR. WOOTEN: Well, so far approximately 440,000 doses have come into the San Diego County – part of that has been through our Public Health Department. Local providers have gotten supplies directly from the distributor. That was phase 1 of the vaccine distribution process. Now we are moving into phase 2 and we are – have gotten guidance from the state about the ordering process and we should be doing that after the – over the next several week – Over the next week or so, we should be disseminating information out to our providers to let them know the process based on the guidance from the state. So we anticipate between now and the end of the year, we should start to see more vaccines come into the San Diego County.
MYRLAND: Is it going to be the case that anybody who wants to be vaccinated will have a way to do that? Or is there a strict procedure about who can get it and who doesn’t?
DR. WOOTEN: Early on when the federal government was informing the community about vaccines, that was the message that the Health & Human Services was giving. But over time, the estimated amount that manufacturers stated that could be produced have decreased because the virus itself is slow growing so the quantity of the vaccine being produced is less than was originally expected. So right now, because of the limited amounts of vaccine, we are focusing on that priority, that first tier priority group, and trying to get those individuals vaccinated first.
MYRLAND: And then what is that first tier priority?
DR. WOOTEN: That first tier priority group in – Those five groups include pregnant women, healthcare providers and emergency medical services personnel, household contacts of children less than six months of age, so anyone who takes care of a child or lives in the household of a child less than six months of age because that child cannot get the vaccine, then all individuals between six months of age and 24 years of age, whether they have health problems or not, and then adults 25 years to 64 years of age that have underlying medical problems. Those are the priority groups that we’re focusing on with our limited supply of vaccines.
MYRLAND: So you’ve had 440,000 doses. How does that spread across the – Does that pretty much take care of those five priority groups, at least in numerical terms, or are we still way short?
DR. WOOTEN: We are – That does not take care of the priority groups. We’ve estimated that in San Diego, there are 1.7 million individuals that comprise these five priority groups and getting them vaccinated will be a joint effort not only by the County but by the providers, hospitals, community clinics, an entire shared responsibility.
MYRLAND: Okay, we have – I want to ask you a couple of questions, just sort of a personal basis as a – just as an individual what we can do but we do have an interesting call, an interesting comment from a caller, Tim in San Diego. So, Tim, please join in for the conversation for a second here.
TIM (Caller, San Diego): Yeah, I heard – or, read a report from the CDC and read on several boards of virology that there have been a recent polymorphism or mutation of D225G that they had suspected in this virus, and they believe the same expression was shown between 1918 and 1919 when the flu became more virulent, and I have seen, also…
MYRLAND: So, Tim, let me just…
TIM: …another polymorphism…
MYRLAND: Tim, I…
TIM: …that they are reporting on that they…
MYRLAND: Tim. Tim, I want to ask you a question, Tim. What are you – what that number you gave out – what do you mean the expression of that? What – Can you put that in lay terms for us?
TIM: Well, I’m a layman so I can only give you lay terms, but there is the virus still has certain receptors that are in flux. It is not completely settled down yet. One of the sites on the A-protein sequence the 225 or 225.
TIM: The expression of this changing with the gene makes it so that it is embedding in the lungs much deeper and in embedding in the lungs deeper, it is making the nasal swab and the epithelial swabs come up negative for swine flu because it’s actually building populations deeper in the lungs.
MYRLAND: Okay. Let’s let Dr. Wooten respond to that. Is this virus really mutating in these ways?
DR. WOOTEN: Well, what the CDC is telling us, at least to date based on information that we have, the vaccine is well suited to the virus that is currently circulating. Now CDC is monitoring the viral strain to look at any mutation and there may be some – there can be. Influenza viruses do mutate. They have that clever characteristic. They can even mutate slightly or – which is called a drift, or significantly, which is called a shift. But at – currently, we do know that the virus that is circulating is very well matched to the vaccine that is based on the previous circulating virus.
MYRLAND: Okay, so if I am worried about contracting swine flu, I want to protect myself and I can’t get in on the priority list for the vaccine right away…
DR. WOOTEN: Umm-hmm.
MYRLAND: …what are the steps I’m supposed to be taking?
DR. WOOTEN: Preventive measures. And those preventive measures, while they sound very simplistic, work, not only for influenza but just for preventing the spread of germs in general. The first is stay away from people that are sick. The second is wash your hands and the third is not to touch your eyes, nose or mouth because when you’re touching environmental objects, that’s where germs are because of people coughing, touching those items, the germs can be left behind. Then you touch them then touch your eyes, nose or mouth and become infected. And we are encouraging people in workplaces to keep their workspace cleaned properly. That also helps to decrease the spread. That – Those measures are to be used if you cannot get the vaccine.
MYRLAND: Now just regular disinfectants are a good idea then?
DR. WOOTEN: Just your usual run of the mill disinfectants that are approved by the EPA.
MYRLAND: I went to the grocery store last night and used the little wipe that they give you…
DR. WOOTEN: Umm-hmm.
MYRLAND: …is that really a good idea?
DR. WOOTEN: That’s…
MYRLAND: Does that really make a difference?
DR. WOOTEN: That’s an excellent idea. Absolutely.
MYRLAND: And you say wash your hands often. What’s – it sounds like a silly question but…
DR. WOOTEN: Yes.
MYRLAND: …really, what’s often? You’re at work, how many times are you supposed to get up from your desk and go wash your hands?
DR. WOOTEN: Washing your hands based on your environmental exposure, whether you’ve been touching doorknobs or elevator buttons or ATM keypads or just environmental objects or after shaking hands with people, washing your hands thoroughly, which means 20 seconds between the fingers, under the fingernails, on both sides of the hands and around the wrists. And that should be done for about 20 seconds or is equivalent to singing “Happy Birthday” twice.
MYRLAND: Okay, so take your time, wash your hands…
DR. WOOTEN: Umm-hmm.
MYRLAND: …be aware, and then if you begin to feel ill, what are the symptoms that you should really – that should really cause you to seek some medical assistance?
DR. WOOTEN: Well, that’s probably a three-part question. So if you’re ill, we don’t want people who are ill to be at work. So they should go home, make sure that they work that out with their supervisors. The symptoms of influenza start out with a sore throat, scratchy throat, you might feel tired or fatigued, you could get fever, cough. But in terms of what we define as the influenza-like illness, is a fever of 100 degrees or higher, new onset cough and/or sore throat. Other symptoms can be associated with that, as I’ve already mentioned. And with this particular strain of influenza or virus, people are also developing nausea, vomiting and diarrhea.
MYRLAND: And is there a point in this development of this illness when people are more contagious or are they continuously contagious or…?
DR. WOOTEN: People can be contagious for up to 24 hours before they develop a fever and once they have a fever that is when they are also contagious. Now CDC recently, in the past several months, has issued guidance about when should a person return to work and after the fever has been gone for 24 hours without the use of fever-lowering medication, an individual can go back to work…
DR. WOOTEN: …or to school.
MYRLAND: …now some of the symptoms you describe can be caused by a lot of different things.
DR. WOOTEN: Absolutely.
MYRLAND: So how are individuals kind of sorting out whether what they’ve got is just sort of a normal kind of a malady, if you will, versus the signs of this more serious virus?
DR. WOOTEN: Well, first of all, you’re absolutely right, influenza-like illness can be caused by other types of viruses besides this H1N1 influenza. But the important thing here is if a person does have these symptoms, regardless of if it’s something else, they should remove themselves from their school or workplace and go home to recuperate. 40% of the specimens that we’re receiving in our public health laboratory are influenza A, and all of those influenza As, almost all of them have been H1N1. That means that there are 60% other type of the viruses that are causing influenza-like illnesses and those could include adenovirus, RSV or parainfluenza. They all cause influenza-like illness. But specifically with H1N1, for young children who get influenza-like illness, zero to five years of age, they should see their doctors and if they have – they should – if they have the influenza-like illness, they should be treated as if they have it until proven otherwise. And also people that are hospitalized should be treated. People that have underlying medical problems should also be treated. They don’t necessarily need to be tested. But anyone, whether they have – are healthy, they have underlying medical problems, they’re young or old, if they develop severe symptoms, difficulty breathing, chest pain, discoloration, and just feeling very severe high temperatures, they should be seen in the emergency department. And if they are admitted, they would have to be treated with Tamiflu or an anti-viral medication and tested for H1N1.
MYRLAND: Okay, well, Dr. Wooten, let’s hope that those vaccine shipments increase and that your job turns to distribution rather than prevention here over the next few months.
DR. WOOTEN: Thank you so very much.
MYRLAND: We really appreciate you coming by and giving us this update and I hope this is helpful for all of us, as individuals, to take those simple but effective actions. Dr. Wilma Wooten from – the County Health Officer from San Diego County has been our guest. For These Days in San Diego, I’m Doug Myrland.