How To Prevent The Flu, Measles and Whooping Cough

Maureen Cavanaugh: Our top story on Midday Edition, San Diego County has recorded the first two flu deaths this season, and the number of confirmed flu cases in San Diego has risen from 213 last week to 302 this week. These numbers have prompted the county to remind us that January and February are the months when the flu virus really becomes active in San Diego. And speaking of infectious disease, the county is also warning of a potential exposure to measles at a mall in El Cajon. Joining me to talk about how to avoid catching nasty and dangerous contagious diseases this winter is my guest Dr. Ellen Rodarte with Sharp Rees-Stealy Medical Center. Dr. Rodarte, welcome to the program. Dr. Ellen Rodarte: Thank you, Maureen. Maureen Cavanaugh: I’m going to ask you to start by explaining how influenza is different from the common cold and potentially more dangerous? Dr. Ellen Rodarte: Well, that’s a good question. So, influenza is more deadly than the common cold. So we all hate the common cold, and the common cold is a group of viruses, but they don’t tend to be life threatening. It’s the influenza that has a potential to kill people every year. Maureen Cavanaugh: And are there specific symptoms that tell you, you have the flu instead of a cold? Dr. Ellen Rodarte: They overlap, which makes it difficult for folks to figure out what’s going on, it even makes it difficult for us, but in general, it’s a high fever and body aches… Maureen Cavanaugh: With the flu? Dr. Ellen Rodarte: With the flu in those first two or three days that makes a difference. Maureen Cavanaugh: Who is at greatest risk to catch the flu? Dr. Ellen Rodarte: Well, there are certain folks that are – so everyone is at risk to catch the flu, but there are certain folks that are at risk to have bad outcomes from the flu. So, the very young, less than two, folks over age 65, and then anyone with chronic illness, so diabetes or lung disease, and then also uniquely native Americans are more at risk for getting bad complications from the flu. Maureen Cavanaugh: And is that because the people, the demographics that you just mentioned, the very young, the very old et cetera, their bodies have more difficulty fighting off the virus? Dr. Ellen Rodarte: Exactly, yeah, they – there is different – sometimes it’s because your immune system isn’t as good fighting it off or sometimes it’s just they have underlying disease, which makes them more at risk. Maureen Cavanaugh: The women who were the first flu deaths in the county this year were both in their 80s and in nursing homes. Are elderly patients in nursing homes usually vaccinated? Dr. Ellen Rodarte: We try to get them all vaccinated. That is definitely – any time there is a group of folks together, they’re at higher risk for any infectious disease, so we encourage all nursing homes to vaccinate not only all of them, folks living at the nursing home, but everyone that works there as well. Maureen Cavanaugh: How effective is the flu vaccine? Dr. Ellen Rodarte: Well, you know, every year, the CDC gets together, makes a best guess about which flu strains are going to be coming to the United States, and then they put together a vaccine, and we don’t know how effective it is until the flu season hits. Now, this year the flu vaccine covers four strains, so it’s very effective for three of the strains, one strain has gotten away from us a little bit and mutated the H3N2, has drifted, that’s what we say, and so it has been less effective against that strain, but for the other three strains, it’s very effective this year we think. Maureen Cavanaugh: And in a way, we, here in Southern California, have a little bit of an advantage, because we can actually see how flu is tracking across the country, the season starts earlier on the East Coast than it does here, doesn’t it? Dr. Ellen Rodarte: Well, yeah, and you also see – you can see right now if you look at the CDC map, so the rest of the country and the East Coast is having a much harder time and… Maureen Cavanaugh: Our season peaks like in February, March, something like that? Dr. Ellen Rodarte: Usually February. So folks are saying, oh, the flu has already hit, I didn’t get the flu shot, I shouldn’t get it this year, but that’s not true. Remember there’s multiple strains, so right now we’re fighting mostly the A strain, but the B strain could come in later on. So I tell folks, if you haven’t gotten the flu shot, and you think you got the flu, it’s still worth it to get it, so you don’t get the next one. Maureen Cavanaugh: I’m speaking with Dr. Ellen Rodarte, and we’re talking about preventable diseases, and just a few more questions about the flu if I may because if you do get the flu, and you haven’t had a vaccine, let’s say, and you do get the flu, is there any way to may be prevent the complications to treat it correctly so that you won’t get seriously ill? Dr. Ellen Rodarte: Yeah, there is two things to focus on. First, if you are one of those folks that we mentioned that’s high risk for getting very sick from the flu, contact your doctor within 48 hours of getting that fever, to see if you’re someone that should be on an antiviral medicine like Tamiflu. So, we do have an antiviral medicine that works to help prevent hospitalization and death from the flu, but you got to get it within the first two to three days. The other thing is if you’re sick, rest, stay home, drink tea, don’t push yourself because some even low-risk patients if they don’t rest, they can get a secondary pneumonia from the flu and get real sick. Maureen Cavanaugh: Do you find that people are reluctant to get the flu vaccine? Dr. Ellen Rodarte: You know, every year, I beg my patients to get the flu vaccine. But I think people are tired of hearing about the flu, it’s annoying. Every year you have to get another vaccine, you know. Maureen Cavanaugh: Right, because the flu changes. Dr. Ellen Rodarte: The flu changes and the vaccine protects you for six months, so I think people get a little flu vaccine fatigue until of course they come into my clinic with the flu. And then I say, “Did you get the vaccine?” They say, “Oh, no doctor, but I swear next year I will.” So it’s usually hindsight. Maureen Cavanaugh: Right. I’m shedding a little sort of harsh reality on that. You know, the last season the flu claimed 70 people here in San Diego. That was the highest total since the county health department began tracking the disease. In looking at where we are now and looking how the rest of the country has been dealing with this particular flu season, any predictions on how this season might shape up for us? Dr. Ellen Rodarte: Well, we have to see. The main circulating one right now is H3N2, and in the past years when H3N2 when that strains went circulating, we have had worse years, but we never know. So we’ll just have to cross our fingers on hope. Other things that people can do is wash their hands, use hand sanitizers, stay away from folks who are sick. Maureen Cavanaugh: Now, San Diego County has released a warning about a potential public exposure to the measles virus, and this all stems from an incident last month up in Disneyland, can you tell us about that? Dr. Ellen Rodarte: Well, yeah, it seems that someone at Disneyland exposed a large group of people to measles, and measles – you know, in 2010, we declared that measles was gone from the United States, but since then, we’ve had a resurgence, and we’re not – it’s a combination of international travel, because measles continues to be rampant causing severe disease and killing folks in other countries around the world where they’re not immunized, but we also worry that there is decreased immunizations here in the United States. That people aren’t immunizing their children as much as they used to. So we do get these outbreaks of measles. Maureen Cavanaugh: Now, seven of the people exposed and diagnosed with measles were from California, two apparently either are from Sand Diego or spent some time here because that county health warning is about two Sand Diego siblings who went to Parkway Plaza in late December, they were I guess subsequently diagnosed as having measles, how contagious is measles? Dr. Ellen Rodarte: Measles is very contagious. So, if you have 10 people in a room, and one of them has measles and is coughing, about nine of them will get sick. So it’s very contagious. Maureen Cavanaugh: How long is the incubation period, because we’re talking about these two siblings were walking around Parkway Plaza at the end of December. Is that possibility of contagion over by now? Dr. Ellen Rodarte: So the contagion – contagious period is about 14-17 days, so it does last a while, and the CDC and the health department are excellent. When they find out about these cases, they get on these patients and they find out who they had contact with and where, so they can track them down. Maureen Cavanaugh: So if you were – the location is not contagious, but the people are contagious, so if you brushed up perhaps against these two somewhere in the mall, just did at the end of the year, it’s possible that you haven’t seen any symptoms yet. Dr. Ellen Rodarte: It is possible. But the thing to remember is that if you have measles, you’ll know you get a high fever and a bad rash, so you get pretty sick and be – if you’ve been immunized, which most people have been immunized for measles, if you gotten the two immunizations MMR, you’re protected. It’s a wonderful immunization. It protects 97% of people. So, if your mom did not refuse immunizations when you were younger, you probably have the measles protection. Maureen Cavanaugh: How dangerous is the measles virus? Dr. Ellen Rodarte: So most people get – have a bad illness for two to three weeks, and then recover. So it’s inconvenient and uncomfortable. But about 1 in 300 children who get it will have a bad outcome. Maureen Cavanaugh: I’m speaking with Dr. Ellen Rodarte of Sharp Rees-Stealy Medical Center, and we are talking about infectious diseases, and I want to go back to a point that you were making earlier, Dr. Rodarte, about why we’re hearing about measles again? Why this disease isn’t under control? Is this really – does this really stem from the fact that a lot of people seem to be resisting getting their kids immunized? Dr. Ellen Rodarte: Well, we’re not 100% sure. Again, measles is out in other countries, so international travels are major cause for bringing the measles back into the United States. But what we do now is when we look at – so what we’ll do parents refusing immunizations for their children have on these outbreaks. What we do now is when we look at schools when 5% or more of the families refuse immunizations, there’s more outbreaks of pertussis and these kind of diseases in them. When 1% of the families refuse immunization, we don’t have that. So you don’t need that many people to refuse immunization to make these outbreaks come back. Maureen Cavanaugh: And because measles is so contagious, you need a very high level of the population immunized before you get that immunity, right? Dr. Ellen Rodarte: Yes. Yeah, the herd immunity is important in measles. It’s also important because the herd immunity protects our children under age one. So we don’t immunize children for measles till they’re one, and so between birth and the first birthday, it’s that herd immunity that protects our children. Maureen Cavanaugh: Right. Let me move on to whooping cough. That’s another disease that should be in the past, but last year, California had the same rate of infection of whooping cough as in 1958. How dangerous is whooping cough? Dr. Ellen Rodarte: It depends. If you are a newborn baby, it is very dangerous. So, whooping cough is what we call the 100-day cough. It causes a terrible cough and the funny thing – not the funny thing, the difficult thing about whooping cough is none of the medicines we have treat the cough once you have it. So when my patients – and I’ve seen many patients with whooping cough, when they come to see me, there’s nothing I can give them to treat their cough. They just have to suffer through it. So, most adults just have this terrible cough for a while. Now… Maureen Cavanaugh: Months? Dr. Ellen Rodarte: If you’re unimmunized, the cough will last on average two months. If you’re immunized and you get the whooping cough, which you still can with the immunization, you don’t get it as bad, so it might just be a couple of weeks. Maureen Cavanaugh: So you can get a whooping cough with – after being immunized. Dr. Ellen Rodarte: Well, the immunization is very good, but it’s not a 100%. So we used to use an immunization for whooping cough that was stronger and worked better, but it did cause more side effects. So we introduced a safer, acellular pertussis vaccine that causes less side effects, but also is not as strong. Maureen Cavanaugh: Is there any way to tell whether or not you’ve still got immunity from whooping cough or really any of these diseases where you get immunized? Is there something your doctor can do, may be see if that vaccination is still in your blood in some way? Dr. Ellen Rodarte: Yeah, we do titers. So anyone, say, who works in the healthcare industry, has to have titers to show that they’re still immune and that is something that can be done. Maureen Cavanaugh: I don’t want to leave whooping cough before I do talk about the effect on babies and infants who are too young to be immunized. That is just a really horrible and sad thing when a baby contracts whooping cough. Dr. Ellen Rodarte: It’s awful, Maureen, and this is – we’ve had infant deaths in California with the last whooping cough outbreaks, and they’ve been heartbreaking. One exciting thing that has been happening is that we’ve found that if we immunize pregnant women in their third trimester, they pass the antibodies for whooping cough onto their babies and protect them for that first two months. So babies when they’re born, they get their first whooping cough shot at two months. Unless their mother gets this immunization, they’re not protected, and that’s when we see infant death, that’s when we see children die from whooping cough. So, very exciting that we can get third-trimester pregnant women immunized to protect their baby, so... Maureen Cavanaugh: Any other virus immunizations that third-trimester pregnant women can take that might help their very young children have some immunity from measles or any of those diseases? Dr. Ellen Rodarte: So we also recommend that pregnant women get immunized for influenza while they’re pregnant. We don’t recommend MMR during pregnancy, because it’s a live virus, but we hope that folks before they get pregnant have had their regular immunizations. Maureen Cavanaugh: Now, physicians – if someone thinks that they might be coming down with one of the diseases that we’ve been talking about, how should they seek medical help? Should – because going to an emergency room might expose an awful lot of people, if you are actually sick with one of these communicable diseases, right? Dr. Ellen Rodarte: Yes. And besides who like to wait in the emergency room… Maureen Cavanaugh: [laughter] Right. Dr. Ellen Rodarte: So contact your doctor. At Sharp Rees-Stealy, patients have contact – can contact us and we get them in and get them taken care of. Maureen Cavanaugh: Okay, and see as few people as possible before you know for sure, right? Dr. Ellen Rodarte: [laughter] Yes. And use hand sanitizer. Maureen Cavanaugh: Wash your hands. I’ve been speaking with Dr. Ellen Rodarte with Sharp Rees-Stealy Medical Center. Thank you so much. I appreciate it. Dr. Ellen Rodarte: Thank you, Maureen. [Music…] Presenter: Coming Up: A play about Radical Politics in the Afterlife. We’ll hear how Abbie Hoffman can steal heaven. It’s 12:20, and you’re listening to KPBS Midday Edition. [Music…]