Announcer:
Presentation of "Here & Now" is made possible in part by the Animal Dental Center of Milwaukee and Oshkosh. A veterinary specialist working with pet owners and family veterinarians throughout Wisconsin, providing care for oral disease and dental problems of small companion animals. Additional support for "Here & Now" is provided by the LE Phillips Family Foundation.  

Frederica Freyberg:
I'm Frederica Freyberg. Welcome to a special edition of "Here & Now: Preparing for H1N1." 

Shawn Johnson:
I'm Shawn Johnson, Wisconsin Public Radio state capitol reporter. It's here. The H1N1 is spreading in Wisconsin.

Frederica Freyberg:
Testing is turning up higher-than-normal numbers of influenza for this time of year, with sporadic H1N1 reported statewide. Public school nurses are seeing sick children, isolating them and sending them home.

Shawn Johnson:
Universities have been dealing with the first big wave of cases. Health center staffers are helping students ride out the symptoms even as schools set up rows of beds for expected student quarantine.

Frederica Freyberg:
Tonight, two of the state's top H1N1 experts answer your phone-in questions. We'll also talk with the person who is teaching the preparedness program to public school staffs around the state.

Shawn Johnson:
And the Milwaukee health commissioner describes how his city will meet the demands of H1N1. Bevan Baker's comments will come later in the hour. We invite you to phone in your questions about H1N1 to our on-camera guests. Just call 1-800-442-4613. That's 1-800-442-4613. Or if you prefer to ask your questions off the air, dial 1-888-732-1359. We have medical professionals from Dean and UW Health standing by for your off-air questions in our next-door studio. You can send us your e-mail questions too. Our address is H1N1@wpt.org. Plus you can follow us at twitter at H1N1HEREANDNOW. We’ll be tweeting live updates about what the experts say throughout the show. We’ll get to your questions in just a moment, but first some background info. There were 6,600 confirmed and probable cases of H1N1 in Wisconsin between April and August, including eight deaths. More than 200 hospitalizations since April, six of those in September. The latest report from the state Department of Health says H1N1 cases have been confirmed statewide with a larger incidence in southern Wisconsin due to the large number of students at UW-Madison. So far none of the H1N1 cases have been resistant to antiviral treatment. Ninety-nine percent of all suspected cases that have been lab tested have been confirmed. We want to put some of that information into context. To help us with that we welcome Dr. Jeff Davis, the state epidemiologist. Dr. Davis, thanks for joining us.

Jeff Davis:
Pleasure. Thank you.

Shawn Johnson:
Give us a status report, a snapshot of where Wisconsin is right now. What's the latest that you know as of this week?

Jeff Davis:
Well, we have had influenza in each of our five public health regions. The southern region has been most heavily affected, which includes Dane County. As you mentioned, there was a lot of activity here on campus. Right now, in some areas there's some, what I would say, a little deceleration of activity. In some it's increasing. It's hard to say exactly what's going to happen over the next few weeks. There might be a little regression in the number of cases, but we certainly expect more and more cases in the weeks to come.

Shawn Johnson:
How do Wisconsin rates of H1N1 illness compare to the rates in other states?

Jeff Davis:
Right now in the Southeast there are very, very high rates. The rate of influenza illness among all outpatient visits has been very, very high. If you look at the southern half of the United States, the Southeast and the Southwest, the southern half, there's widespread influenza reported in all of those states. In the northern tier states there's less influenza. That may have something to do with when school began, particularly when universities started courses.

Shawn Johnson:
How seriously are public health officials taking H1N1, and why is that?

Jeff Davis:
Very seriously. And the reason why is there's a lot we don't know about it. We do know there's things on the horizon that are very exciting. We have a vaccine which is an excellent match to the wild virus. We know that people who are receiving the vaccine are responding very well. The likelihood that they're going to convert from having no antibody to having antibody is very high. We anticipate that will be very effective. Obviously, we're fighting the clock. It would be great to have vaccine available before all this influenza occurs. There are a lot of other things we can do to help prevent influenza in our communities and trying to take all of those plans and activities and putting them into operation to try to hold off the influenza until the vaccine is available is very important. We're taking it very seriously and trying to apply a lot of practical measures.

Shawn Johnson:
You mentioned there’s a lot we don't know, and the CDC calls this virus “very unpredictable.” With that caveat, how do you expect the H1N1 to progress in Wisconsin this season?

Jeff Davis:
It's — we're going to see a lot of it. I mean, there's just so many people that are susceptible. And it just never went away during the summer. Even though it was at low numbers. And we saw when people from different parts of the country came together in areas like at universities, a lot of influenza occurred. So we certainly expect to see a large number of cases. The main thing is, you know, managing that as best we can, trying to make sure that the people who need aggressive, immediate care get it. Having people understand that if they have mild illness, generally it could be at home. They don't have to see a physician or take an antiviral. We want to make sure the people that need certain interventions get it and the people who don't need them get the appropriate management at home. There's a lot of education. We have to continue to do that. We hope the virus doesn't mutate. We hope that it stays just the way it is so we can manage it real well.

Shawn Johnson:
We'll take some questions for Dr. Davis as well as for other medical guests in just a moment. The number to call for our on-air experts is 1-800-442-4613. If you'd rather talk with a health professional off the air, dial 1-888-732-1359. Now here's Frederica with more baseline information on the H1N1 flu.        

Frederica Freyberg:
Health department officials say there are specific symptoms to watch for as the 2009 H1N1 virus spreads this fall. Be aware of a sudden onset of illness, a fever of 100 or higher, chills, coughing, headache and/or sore throat could also be symptoms, as could a stuffy nose, muscle aches or weakness. And diarrhea or vomiting are signs you may have contracted H1N1. Medical experts are standing by to take any questions you'd like to ask off the air. The off-air number to call to talk with them is 1-888-732-1359. And sitting right in the middle of it all is our cyber producer, Andy Soth. Andy, what should people know about talking with us online?

Andy Soth:
Well, if you'd like to e-mail a question, that address is H1N1@wpt.org. You can also submit a question through our website, which is wpt.org/H1N1. But in the meantime, we’ve already been receiving some e-mail questions. Donna from Madison asked about Purell, and hand sanitizer. She wants to know if it works against viruses in addition to bacteria. Shawn, what do our physician guests say about that?

Shawn Johnson:
Dr. Jeff Davis you already met. Also joining us is Dr. Nasia Safdar, who is an infectious disease specialist with the UW School of Medicine and Public Health. Dr. Safdar, we use the term Purell. That's a name brand. This stuff has become fairly ubiquitous, this clear gel that you see everywhere. It says on the back that ethyl alcohol is the ingredient in there. How effective is this against H1N1, and what do you tell your patients?

Nasia Safdar:
It works very effectively against bacteria and viruses, and it's recommended.

Shawn Johnson:
How frequently do you use it? Seems like you see this everywhere now?

Nasia Safdar:
You can't overstate the importance of hand hygiene when it comes to preventing transmission of infectious diseases. Every time someone coughs or sneezes, they should cover it, and then they should immediately wash their hands, either soap and water or if that’s not available, then the hand gel will work just as well.

Shawn Johnson:
Dr. Davis, is this advice that you're giving to state agencies, universities, to have this stuff around?

Jeff Davis:
Absolutely. That is very important. Look to it as being your friend. It really is very, very good in helping to protect you and to protect others.

Shawn Johnson:
We've got our first caller now, Jo from Mauston. Jo, go ahead with your question.  

Jo:
I want to know if you can get this flu more than one time.  

Shawn Johnson:
Doctors, can you get this flu more than one time? If you get it once this season or if you had it earlier this year, can you come down with it again?

Jeff Davis:
If you have a very specific infection with this virus, you will have a very specific immunity and in all likelihood you will not get infected with that virus again.

Shawn Johnson:
We're going to go to another e-mail question now with Andy Soth.  

Shawn Johnson:
Sorry about that. My mistake. We're talking about how we protect against this. How long does this virus last on surfaces, so the door knobs that you go to in a public building, how long can it linger there?

Nasia Safdar:
It depends on the surface it's applied to, but generally about two to eight hours on surfaces is how long it would last.

Shawn Johnson:
And are there any precautions you can take in that instance?

Nasia Safdar:
I would say for people, especially in workplaces and schools and things like that, that frequently surfaces should be wiped down and cleaned and occasionally disinfected. That includes things like door knobs, computer tops, work stations, things like that.

Shawn Johnson:
We're going to go now to another caller, Peggy from Monona. Go ahead.

Peggy:
Yes. I wanted to know, has anybody thought about what to do about the people who are likely not to stay home? One, they can't even go to a doctor because they don't have any health insurance. And these are the — and, two, they can't afford to take time off because they don't have sick leave. And these are the people who are sacking our groceries, serving us in restaurants, taking care of kids in child care centers and in nursing homes. Last year, I was served lunch by somebody and I said, “Gee, you look like you don't feel very well.” She said, “I've been sick for three weeks. I can't afford to go to a doctor. I can't take time off from work.” This is potentially a serious hazard, particularly because people will go back to work, they won't wait that extra day if they're ill.  

Shawn Johnson:
Doctors, what about that? I mean, Peggy's describing a fairly vulnerable population of people who are in contact with — almost every day, whether bagging groceries, taking care of kids, but feel like because they don't earn enough or they don't have health insurance, they can't afford to miss work. I mean, what is the advice? What can you realistically say to these people when they come down with this?

Jeff Davis:
That's a very difficult issue. Clearly we want employers to have liberal policies, recognizing that this is an unusual time. We have a very large susceptible population because this is a new virus, even though we had a phase earlier this year. So there has to be recognition that this is going to happen to a lot of people, and a lot of people are not making a lot of money and really are motivated to be there because they're afraid of missing work. So that is -- that's where the employers have to be sensitive to those issues, have liberal policies so that people can be at home if they are ill so that they don't infect others or be at home if they have dependents at home that they have to take care of. It's a difficult social issue, but it's very, very important to stress how important it is.        

Shawn Johnson:
I just want to remind you that if you have a question for our on-air guests, the number to call is 1-800-442-4613. If you want to speak with an expert privately off-air, the number is 1-888-732-1359. We're going to go to another caller now, Phyllis from Waupaca. Go ahead with your question.

Phyllis:
Yes. I have a grandson who has autism and he had a major regression after he had a flu shot a few years ago. And my question is can you get the H1N1 flu shot without mercury in it if you pay for it?

Shawn Johnson:
A few things there. One, a concern about what this flu shot could do to people. And then also the different types of flu shots for the H1N1. Doctor, can you address that?

Nasia Safdar:
There are mercury-free vaccines that will be available for the H1N1 vaccine as well. Single-dose vials will not have mercury in them. The multi-dose will. That definitely will be available. That's the preservative that has historically been thought to be linked to autism, but several studies have conclusively shown that that's not the case.

Shawn Johnson:
And what about the concern that this vaccine or a vaccine can make you sick?  

Nasia Safdar:
Well, it doesn't cause the flu and certainly over the years there's been a debate about whether it can cause regression in children and adults who have neurological symptoms. The evidence suggests it does not and therefore it's a safe vaccine to get, and that's why we're recommending people do that.            

Shawn Johnson:
We're going to go now to Tim in Madison. Tim, go ahead and ask your question.  

Tim:
Actually, my question is kind of more of a comment.

Shawn Johnson:
Sure.

Tim:
A few days ago, my daughter was vomiting and had a high fever and the doctor diagnosed her as having the H1N1 virus. A couple days later, we took her back because as parents we just got a bad feeling about the situation. And it turns out she had pneumonia. I guess my comment is I hope physicians aren't too quick to diagnose this because, frankly, she suffered for a couple days longer than she should have when she did see a second physician, our regular pediatrician, who diagnosed the pneumonia, she was given antibiotics and cleared up fairly quickly and is doing much better. As a follow-up question, I wanted to touch again on the subject of how effective or how safe the upcoming H1N1 vaccine is going to be for my children, my 5-year-old and my 3-year-old. Thank you.

Shawn Johnson:
All right. What about the danger of misdiagnosis right now? There's a lot of focus, a lot of unanswered questions about H1N1 right now. Is there a danger that doctors are too keyed in on that and something as serious as pneumonia could slip by?  

Nasia Safdar:
I would say so, there is. The symptoms are fairly nonspecific. You have fever, a cough, a sore throat or any other number of symptoms like body aches, in some cases diarrhea and vomiting. A whole host of illnesses can cause those symptoms. It's important to consider H1N1 as a major circulating virus, but other things can cause the same type of presentation. Equally important is the fact that children especially need close follow-up. If they don't improve, they need to be taken back to the physician, not only because they could have a different illness, but because H1N1 has complications that need to be attended to as well.

Shawn Johnson:
Tim raised the question we addressed a moment ago, he's concerned about the safety of his 5-year-old in giving this vaccine.

Nasia Safdar:
As best as we can tell, the vaccine is equal in safety to the seasonal influenza vaccine that people get every year.

Jeff Davis:
The vaccine is made the same way as it has been. And so far the tests on immunogenicity have been good in adults, and there are more and more trials now.

Shawn Johnson:
Immunogenicity?

Jeff Davis:
The ability to produce antibodies that is likely to be effective. And the early safety trials were good, too. There are side effects to taking the vaccine. There's local pain and there's tenderness. That's very, very common with all influenza injections, influenza vaccines. There's some headache as well. And there may be some muscle aches as well. But all of the side effects that have been occurring have been categorized as mild or moderate. There hasn't been severe reactions. There will be more and more experience as the vaccine is used among more and more people, but so far it appears to be like other influenza vaccines that we've used in recent years.

Shawn Johnson:
All right. We're going to go to Jack in Cross Plains for our next question. Jack, go ahead.

Jack:
Yes. Hi. I'm a 64-year-old on immune-suppressing meds for rheumatoid arthritis. What advice could you give me if I contract H1N1 symptoms for self care or should I be coming in?

Shawn Johnson:
Just to rephrase, Dr. Davis couldn't hear the question. Jack is 64, and I hope he's still on the line here. He takes medications for immunosuppression. And he's worried about what — he wants to know what he should know about H1N1 and the vaccine as well. I hope I phrased that right. And he's in a special age group there, too, 64-years old is sort of a magic number as we divide up key age groups.            

Jeff Davis:
Well, given the fact that he has an underlying condition, and age alone, he has an age indication for getting vaccinated every year with seasonal influenza vaccine, and he would also have an indication for being vaccinated with the H1N1 just because he has underlying conditions. So it's very important that he be vaccinated. And it's important that he be vaccinated with both vaccines because seasonal influenza is quite serious, and it's more serious among people who are older. So it's very, very important for him to get both vaccines.

Shawn Johnson:
I just want to make sure I'm clear, because people over the age of 64 are not on the priority list for the H1N1 vaccine.        

Jeff Davis:
That is correct.

Shawn Johnson:
But they're on the high-risk list. How do those sort of juxtapose?

Jeff Davis:
If somebody has underlying illness, immune compromised or cardiac illness or pulmonary disease, you're at increased risk regardless of what kind of influenza is circulating so it’s important to be vaccinated. If you have no underlying conditions and you're older, you're not going to be in the first tier of individuals that will be receiving the H1N1 vaccine when it's first made available and there's not a lot of it. But ultimately there will be enough for everyone and it's important to be vaccinated.

Shawn Johnson:
I just want to remind everyone that the numbers if you want to call in and talk to our on-air guests are 1-800-442-4613. That's 1-800-442-4613. If you want to talk to our off-air experts, you want to speak privately, the number to call is 1-888-732-1359. That's 1-888-732-1359. We're going to go now to a caller in Madison. Chic, go ahead with your question.  

Chic:
Hi. I'm 84, and I had salmonella last winter, and I continue to have the follow-up. That used to be called Reiter’s Disease. Now it's referred to as reactive arthritis. It's an autoimmune effect, following up the end of the salmonella. And I'm wondering, while I'm still fighting this autoimmune disease, am I in danger by taking any of these vaccines, either the regular flu one or I should say the regular one or the H1N1?  

Nasia Safdar:
I would say that, no, you are in no danger of taking either of the two vaccines. The seasonal is highly recommended definitely. It's available right now. When the H1N1 arrives, you won't be in the first tier because you’re not, it appears at least, on immuno-suppressant medications, but eventually the vaccine will be available for that person to get as well.

Shawn Johnson:
We're going to go to Bonnie in Dubuque now. What's your question?

Bonnie:
Yes. I have just had breast cancer and lymph nodes taken out Dec. 10 of this past year, and I also have COPD, and I have diabetes and — let's just say this: I have a very low immune system. And two years ago I had the regular flu shot every year, and I nearly died the next morning. I couldn't breathe. And I haven't had any shots at all for two years. So I guess my concern is should I take both or one or — I'm just very confused because I still get very ill with — I'm on a hormone pill and — what's the other one, Allen? Steroid pill for the cancer. So I don't know what I'm supposed to do? Could you help me?

Shawn Johnson:
This is a similar question to our last caller.

Nasia Safdar:
You know, with extensive immuno-compromise and COPD, diabetes, history of breast cancer, it's absolutely critical to get the vaccine. I don't think we can overstate this enough. Definitely that individual would be on the priority list for both the seasonal for sure and then also H1N1. You cannot get the flu from these vaccines. Now, it is possible — there are mild symptoms that you can get, side effects, and in someone who has little reserve, they might have more severe symptoms of side effects. In general, it's very safe. It’s many times also coincidental. You are in the middle of flu season, you get the flu shot and then you happen to get the flu. Either you were exposed to someone who had it who was also waiting for their shot, or maybe you just got it from the community. People often tie the two together, but there’s no basis for it.

Shawn Johnson:
All right. We have a call now from Eve, I believe. Steve. There we go. Steve in Rome. Steve, go ahead with your question.

Steve:
Yes. I was wondering if I had a choice between the two vaccines or — which one should I opt for and if I could get both, should I get both? I'm 57 and relatively good health.

Jeff Davis:
Steve, I'd love to say that you can get the live attenuated vaccine, but you're past the age limit. Two years to 49 years is the age range for the live attenuated vaccine. And the only people that can take that besides being in that age range are healthy people. They can't have any underlying condition. So I highly recommend that you receive the inactivated vaccines, the trivalent vaccine for seasonal influenza and the monovalent for H1N1. You can receive them both at the same time if you happen to go to the clinic, and they have them both.  

Shawn Johnson:
Marcia in Chippewa Falls, go ahead and ask your question.  

Marcia:
I wondered if the experts would please speak to when people should be specifically tested for the virus and when they should just be clinically assessed given that most insurance companies are not...

Shawn Johnson:
And sounds like we lost Marcia there. But the question was when should you be tested. And she had a concern regarding insurance in that instance.  

Nasia Safdar:
Initially when this first started to come about, testing was done very frequently because we wanted to get an idea of the magnitude of the problem and to see how many people were getting affected by it. Now that it's in the community, there is — the testing requirements are somewhat more restrictive. So anybody that's hospitalized or severely ill, is pregnant, would all be people that should be tested to see whether they have H1N1 or not. If it's an influenza-like illness in an otherwise healthy individual, they don't need to be tested.

Shawn Johnson:
She wanted to know about the cost per test.

Nasia Safdar:
That depends on where the cost is being done. UW Health now offers its own in-house PCR. Before that the state lab of hygiene was doing the test. I don't know how much they charge. Do you, Jeff?

Jeff Davis:
A lot of the testing was done, you know, with re-agents from the CDC pretty early on and then the fee situation came in later. I can't say exactly how much, but it's expensive. It's certainly well over $100.        

Shawn Johnson:
We'll be back with more of your questions for Dr. Davis and Dr. Safdar in a few minutes. You can call 1-800-442-4613 to talk to our on-air guests. You can talk to off-air experts by calling 1-888-732-1359. Now here's Fred with info about how local schools are getting ready for H1N1.

Frederica Freyberg:
School districts around Wisconsin are following an H1N1 preparedness plan designed by our next guest. Sue Todey is in charge of helping schools plan for what may come with H1N1. As of last week, she's run preparedness workshops in all regions of Wisconsin, and she joins us now from Green Bay. Thanks very much for doing so.

Sue Todey:
Yes. You bet, Frederica.

Frederica Freyberg:
What is your surveillance showing about rates of H1N1 in school districts across the state?  

Sue Todey:
Well, we know that the school-age population is one of those populations that is impacted by H1N1, and we are making every effort to help our schools prepare to deal with those situations.

Frederica Freyberg:
When will schools close? 

Sue Todey:
There are new guidelines now put out by the Centers for Disease Control which really emphasize keeping healthy kids and healthy staff in our schools and keeping sick children and sick staff at home. This is different than what we saw last spring. Now, this is the procedure if we see H1N1 to be about the same severity that we saw in the spring. Having said that, if we see an increase in severity of the H1N1, then we would look at the possibility of closing schools, particularly if we have large numbers of students who are out and large numbers of staff, because we cannot operate our schools in an environment that is not conducive to learning and safe for everyone involved.

Frederica Freyberg:
But you've got a plan for whatever happens.  

Sue Todey:
We are working with school districts to help them address all of the components that they need for a plan that will be thorough, easy to understand, one that they can communicate to all the community stakeholders, one that is flexible, because we know that change, change and more change is really the name of the game when it comes to H1N1.

Frederica Freyberg:
Who should not go to school?  

Sue Todey:
Well, we have set through the CDC certain guidelines for children who are ill, those who are running a fever, who are showing the symptoms as you described earlier, the runny nose, the coughing, et cetera. And the same with staff. We don't want staff at school if they are ill. They need to be home taking care of themselves. And then generally returning 24 hours after there is no fever that's being reduced through medications.

Frederica Freyberg:
I guess I probably don't have to tell you that school hallways are full of people with stuffy noses and sore throats and potentially fevers. Could you end up keeping a lot of students and staff home that actually don't have H1N1, but they've got the common cold?  

Sue Todey:
Well, that certainly could be the possibility. I think one of the physicians referred earlier to the fact that some of these symptoms are characteristic of other types of illness such as the common cold. Sometimes it's hard to distinguish which this is. But I think even things like the common cold we would like students to be at home and getting well before they come to school and spread those diseases to other people.

Frederica Freyberg:
Now, you tell us that critical elements of a pandemic plan for schools includes the nutritional needs of children. How so?  

Sue Todey:
Yes. Many of our schools provide children with breakfast and lunch, and some of our families depend very much upon our schools for good nutrition for their children. What we are suggesting to schools is that they work with community partners such as food pantries or other types of agencies that might provide meals or food supplies for families. We know that it's very important for children to have the proper nutrition if they are going to stay healthy or if they are going to recover from an illness. And if schools are closed for a prolonged period of time, the nutritional needs of children could be compromised.

Frederica Freyberg:
Are schools expected to be vaccination sites when that vaccine becomes available?

Sue Todey:
There are some schools that are working with their local health departments and those schools are looking at the possibility of providing on-site vaccinations. I think that is a decision that will be made at the local level by the schools and the local health departments as to what is the best plan for that particular community.

Frederica Freyberg:
Now, what kind of problems might you expect or might districts have with parents who simply cannot come and pick up their children should they come down with a high fever and other symptoms of H1N1 or they can't stay home with them? This is kind of like one of the callers had a question about this. What kinds of provisions are there for that?  

Sue Todey:
That definitely is very challenging, Frederica. We saw that in the spring. When schools were closed, it was very difficult for parents who had to go to work and were unable to stay home with their children. What many schools are doing is getting letters out to parents now or they have done it earlier in the school year even to help parents develop alternative plans. For instance, if schools are closed, what might be a backup for child care in your particular family? Or if you can't come to work to pick up a sick child, is there someone else who can, a neighbor, a friend, another relative who could come in and pick up the child and take him or her home and provide some care. I think the knowledge ahead of time that these kinds of things can occur can be helpful to families in their planning with this. Certainly these are very difficult issues, but some forethought could make them more manageable.

Frederica Freyberg:
All right. Sue Todey out of Green Bay, thanks very much for joining us.

Sue Todey:
Thank you.

Frederica Freyberg:
If you need more information about how schools are preparing for H1N1, visit our website at wpt.org/H1N1. We'll be taking more of your questions in just a moment. Call us with your on-air questions at 1-800-442-4613. We also have medical professionals from Dean and UW Health answering your questions off the air at this number, 1-888-732-1359. Here's Shawn with some specific information about who falls into the high-risk category for contracting H1N1.

Shawn Johnson:
Certain medical conditions place people into the high-risk category. Those include pregnancy, diabetes, heart problems, kidney diseases and diseases that suppress the immune system. Others are chronic lung disease like asthma and emphysema, cystic fibrosis, chronic bronchitis and tuberculosis. Anyone over 65 is considered high-risk. A lot of people with those risks live in Milwaukee. That city led the nation in confirmed H1N1 outbreaks last spring. Milwaukee Health Commissioner Bevan Baker says his department is closely watching those high-risk categories.

Bevan Baker:
We are concerned about asthma as one of the complications that influenza really can impact in individuals with chronic conditions. We know that nearly 30,000 people within Milwaukee County suffer from asthma and most of them are children. So we have to be concerned about that. I think the best case scenario is that we have a vaccine on the ground that we can get in the arms of those who are at high risk. But as the waves come, we hope that the public understands that while this disease was mild in the spring and throughout the summer, that that could change and that they will take advantage of the best prevention method that we have against any influenza, which is a vaccine. Hopefully health care workers and those at risk will take this vaccine. We have to work really hard to overcome some of the social stigma and the fear that individuals have with vaccines. In some communities they question safety. They question — and whether or not they trust the government that these vaccines actually work. And that is our hard job here in public health. We struggle with that every year. If it's a mild year, then less people take it. If there are high rates of death, then there would be greater demand than there is vaccines and we'll run into trouble there too. The worst-case scenario is we have shortages of the vaccine or there's a shift in the makeup of this virus that's circulating and that it becomes much more severe instead of mild. If that should happen, we'll have to use all the tools in our toolbox to fan back this strain because we are in the midst of a global pandemic. Right now it's mild. But if it moves to a severe case, there could be many, many hospitalizations that could overpower our hospital and health care system and unfortunately many deaths to many vulnerable populations.

Shawn Johnson:
Bevan Baker. You can see and listen to Wisconsin Public Broadcasting's coverage by visiting our website. Here's Wisconsin Public Television web producer Andy Soth to tell you about that.

Andy Soth:
Thanks, Shawn. As we learned tonight, there's a lot to keep track of and a lot to be learned by going to our web page, wpt.org/H1N1. Start by typing wpt.org/H1N1 into your browser, where you’ll be able to watch all of “Here and Now’s” pandemic discussions. You can also listen to Wisconsin Public Radio coverage and link to state resources This features the latest on the federal government site, flu.gov, and even includes Dr. Clark’s H1N1 rap. If your tastes run more toward the academic, the site also offers lectures on the science of influenza, from University Place, a service of Wisconsin Public Television's Wisconsin Channel. For all this and more the place to start is wpt.org/H1N1.  

Andy Soth:
That's a look at what we have available for you on the web. And our operators have been answering a lot of phone calls here and we've been getting a lot of web questions, including this one, a question for Dr. Davis and Dr. Safdar. Donna of Madison wants to know if her husband has the H1N1, does she need to worry even if she doesn't develop it, does she need to worry about being a carrier at her workplace?  

Nasia Safdar:
If a family member is sick and the other individual is well, they can still go to work and they don't have to worry about being a carrier of H1N1. I think that common sense practices should apply when taking care of a sick family member. You want to maintain your distance from them to the extent that it's possible. If there's a separate room in the house that can be designated for them, they should stay there until they're well. You shouldn't eat with the same utensils, although there doesn’t need to be any special processing with those. In general, you want the liberal use of hand hygiene, Kleenex you dispose of when the sick individual uses it and things of that nature. Individuals that are exposed don't necessarily have to stay at home. They just need to be vigilant that if they should happen to get sick, they need to immediately go home.

Frederica Freyberg:
I read also there should be — if someone is sick and they're in your family or your classroom or your work hallway, six feet away? Is that the guidance?

Nasia Safdar:
Because influenza is transmitted by large droplet, six feet I would say is a reasonable distance, a minimum of three, preferably six. Would you agree?

Jeff Davis:
Yeah. If we get to a situation where this pandemic is more severe and we have to get into more aggressive social distancing, then more adherence to that six-foot recommendation will occur.

Frederica Freyberg:   
We also have another e-mail question that came in ahead of this program. It was a viewer from New Glarus. What are the health signals that make a case of flu an emergency?  

Jeff Davis:
Well, I think some of the real important things have to do with much more labored breathing, the problems with color, feeling blue — I mean being blue, just changes in color, feeling pressure in the chest, being dehydrated, being inconsolable, having a difficult time keeping food down, much more systemic illness. Those are all important signals that that individual should seek immediate care.

Frederica Freyberg:
In fact, we have a graphic to kind of reiterate some of these complications of H1N1. Health officials ask us to watch out for these things. They say to seek help if you're having difficulty breathing, if you're coughing up blood, feeling dehydrated, unable to communicate, also seeking help if there is pain or pressure in the chest and they also talked about experiencing seizures. Another sign of complications due to flu is feeling better and then feeling worse. And then it says finally with infants younger than two months look for fever, poor feeding or infrequent urination. I have a question about that feeling better and feeling worse. What does that mean?

Nasia Safdar:
Well, it suggests that you're getting a complication from influenza. The biggest thing people have to worry about is pneumonia in that case. It alters your respiratory to the extent that you become susceptible to secondary infection, which generally is bacterial pneumonia.

Frederica Freyberg:
We have a caller on the line, Debra from Manitowoc. Go ahead.

Debra:
Hi. I'm just wondering if someone has received Tamiflu prophylactically, how long do they have to wait before actually getting the vaccine?  

Jeff Davis:
If they've received Tamiflu prophylactically, they can take the inactivated vaccine right away. There is — the antivirals will not interfere with the immune response to the killed vaccine. If a person has Tamiflu on board, you would need to wait before you were to take live attenuated vaccine because some of the — even if you have a little bit of Tamiflu onboard, that can impair the immune response, so you'd have to wait a couple of weeks.

Frederica Freyberg:
I have a question. You're using these terms and I just want to make sure I understand. The live vaccine is the spray?

Jeff Davis:
The nasal spray is a live vaccine. It's the flu mist. The injection is killed.

Frederica Freyberg:
Who can have the spray? For a lot of children, that sounds a lot better than a shot.

Jeff Davis:
People who are between two and 49-years old who have no underlying conditions can receive flu mist.

Frederica Freyberg:
Are there as many doses as there are with a shot?

Jeff Davis:
About a fifth to a fourth of the doses that will be available this year will be flu mist will be the nasal spray. However, in the very early phase of vaccination there will be a lot of flu mist available because their ability to produce vaccine virus was very efficient so they were able to produce a larger supply earlier. So a lot of the early vaccine available will be flu mist.

Frederica Freyberg:
Get it early. We have Kathy on the line from Minocqua.

Kathy:
Thanks to everyone for this opportunity. I have two questions. First of all, in the beginning of the flu news, we heard if you had the Asian flu in 1957, that you might be immune to this one. I haven't heard anything since. Our whole family had it in a camper on the shores of Lake Michigan, and we were deathly sick. And then I have another comment. I caught something in the 1980s. I live in northern Wisconsin and we have an influx of people from Madison, Milwaukee, Chicago, everywhere up here. I caught some kind of deathly virus that lasted a month. I ended up in the hospital. Only three people in our area caught it. I was the only local person that caught it. The other two were from Illinois. I was the first one that caught it. I believe I caught it in the emergency room at our local hospital the previous week when I had a broken bone. And I had this flu for about three weeks and then the first evening that I was home alone, I started to get sick again. I had felt better. I started to shake. And I was shaking uncontrollably. I could hardly dial the phone to call the emergency room. And they said that the virus was pepping up again and that I was getting sick again. And I did. I got the whole thing over again. So that might be helpful to someone else that gets the virus. Thank you so much.  

Frederica Freyberg:
I was wondering if Kathy's question was that because she felt that she and her family in this camper in was it 1957 were somehow exposed to this other virus that there would be some kind of immunity?

Nasia Safdar:
I think you can't rely on that. In general, for H1N1 the population is considered naive to this, so there's no preexisting immunity. This strain has not been seen before in the population.

Frederica Freyberg:
Nancy from North Freedom is on the line. Go ahead. Okay. Nancy from North Freedom is not there. Perhaps she got her question answered. We were talking a little bit about the complications of H1N1 and then some callers called in talking about the Tamiflu or the antivirals. Who can get an antiviral or who should be given that?  

Nasia Safdar:
Sure. So the vast majority of people, if they're otherwise healthy, they're young, they don't have any preexisting, complicating conditions will not require an antiviral to feel better. They'll feel sick or three or four days and recover without any complications. There are people, the very young, over the age of 65 or those that have any underlying medical conditions that predispose them to complications should get early antiviral treatment. You shouldn't wait for the results of the tests to come back before you prescribe it. Or you treat them without tests if you're convinced that it's H1N1.        

Frederica Freyberg:
There's some discussion now of resistance to some of these antivirals, but I understand that's not happened in Wisconsin?

Jeff Davis:
Right. There have been reports of influenza H1N1 that have been resistant to Tamiflu. It's a very, very small number. The total number globally is 28 events. A couple events this summer occurred while people were taking prophylactics and acquired an infection. These are rare events. We have had no such events in Wisconsin. The other antiviral that's available that's very effective is called Zanamivir or Relenza, and it’s important to recognize that that is effective, as well.

Frederica Freyberg:
Apparently we have Nancy back on the line from North Freedom. Go ahead.  

Nancy:
That's okay. You answered my question.

Frederica Freyberg:
Oh. Well, great. Nancy's back off the line.

Jeff Davis:
Terrific.

Frederica Freyberg:
I wanted to get to some of the questions about pregnant women, because of course this is a population that is at risk and would be very concerned. And we had an e-mail question from previously who asked what about the vaccine for pregnant women and how might it affect the fetus?          

Jeff Davis:
The vaccine is very important for pregnant women to receive. The vaccine that a pregnant woman is recommended to receive will be the inactivated vaccine, not the live vaccine, but the inactivated vaccine. The severe morbidity risk to a pregnant woman compared to other women who are not pregnant is six-fold higher, very significant risk of severe morbidity. And the mortality, if you look at the mortality associated with H1N1, the proportion of the deaths that occurred in pregnant women is greater than the proportion of pregnant women in the country. So there is definitely the increased risk of increased severity of illness and the increased risk of dying. It's very, very important to have that protection. The vaccine is safe and effective. To our knowledge, it does not have any adverse effects on the fetus. 

Frederica Freyberg:
And should a woman who — a pregnant woman then who really needs to get the vaccine have the one that is mercury-free?

Nasia Safdar:
If they wish to, yes. They will be available and they can get it, definitely.  

Frederica Freyberg:
I've just been told that a Twitter question has come in, and they're asking whether you can get it simply by shaking somebody's hand.  

Nasia Safdar:
You can. The major route of transmission is droplet, but contact, direct and indirect, is also thought to be a route. If someone sneezed, you shake that person's hand and touch your nose or mouth, it's easy to get influenza that way.

Jeff Davis:
It is recommended to wash your hands or use an alcohol gel after you shake hands.  

Frederica Freyberg:
Jeff is on the line from La Crosse.  

Jeff:
Yes. Hi. I'm an infectious disease physician in La Crosse, and I get information from Minnesota and Wisconsin's public health departments about issues related to H1N1, and there seems to be a difference in the infection control approach, health care workers and (inaudible). Minnesota has adopted a less stringent approach that is afforded by IDSA and some of the infectious disease and control organizations, whereas Wisconsin has a more strict approach, utilizing the N95 mask, and I was wondering since we are going into the flu season, where we'll have —

Producer (accidental interruption):
Linda in Montello –

Jeff:
We'll have a mixture of viruses.

Producer:
Can you guys talk about a priority list for the infections?

Jeff Davis:
There are two voices on.

Frederica Freyberg:
Right.

Jeff Davis:
But I think I understand what Jeff is asking. There are differences between Wisconsin and Minnesota. Our occupational safety and health regulations are different because we are a federal OSHA state. In other words, we are regulated by federal OSHA, whereas Minnesota has a state OSHA, so they have — as long as they have regulations that in general are as stringent as the federal guidelines for different occupational safety and health issues, then they are allowed to have their own state OSHA. The federal government allows that. We are a state — a federal OSHA state, so we follow federal regulations. And that's why there are differences. One of the things that is going to happen is there will be new guidance on infection control forthcoming. I don't know exactly when it will come out, but we hope it will be soon. And certainly there will be some fine-tuning of the recommendations. But we certainly have to wait for those updated guidance statements to come out.

Frederica Freyberg:
Speaking of updated guidance statements, I think there was some updated guidance on who should get the vaccine. Can one of you run through that for us and tell us who is on that priority list?  

Nasia Safdar:   
So the population that needs to get the vaccine are people that — anybody that's looking after children who are less than six months of age because they can't get the vaccine and then children and young adults from six months all the way up to 24 years of age and then 25 to 64 if they have complicating medical conditions. So this is assuming that we have enough vaccine for these groups. If we don't have enough vaccines for these groups, within these, also health care workers are on the priority list as well and emergency services personnel. If we don't have enough, within these groups they have designated higher priority areas. Health care workers that come directly in contact with patients would be the group there. For children, it would be up to the age of four and then five to 18 with complicating conditions.

Frederica Freyberg:
What do we know about whether we do have enough vaccine to cover the people that will need it?

Jeff Davis:
Initially vaccine will be released, we'll probably have the initial distribution of vaccine in the first week of October, and that will focus on the high-priority list that Nasia just mentioned. As more vaccine is released — and this will be a gradual thing with a lot of releases — it will be expanded to that full first phase of vaccination and then to the next phase where we're expanding age groups and ultimately to anyone who wants to receive the vaccines. Initially I had heard there were estimates of 159 million doses. But it really involved — that's how many people could be vaccinated. Well, now that the recommendation for most people is just needing one dose of vaccine, many more people will be able to be vaccinated. There are estimates that perhaps even 300 million people could be vaccinated.

Frederica Freyberg:
And it's just children under 10 that need the two doses?

Jeff Davis:
That's correct. Children under 10.  

Frederica Freyberg:
All right. Elizabeth is on the line from Fish Creek. Go ahead.

Elizabeth:
Hello. I have two questions. I'm trying to wrap my brain around exactly what the strategies are for dealing with this should it morph into a more deadly strain. I know that during the 1918 epidemic there were three strains, and I know that they hit some army encampments, for example, multiple times. So it looks like protection wasn't offered by having already been exposed to one. So my question is, it seems like the strain that exists right now is not particularly dastardly. So is the push for immunization to reduce the number of human incubators and thus reduce the likelihood that the virus will have the opportunity to become worse? And if it does, do we believe that the vaccine would offer protection against a new strain or an adaptation, a changed, more dastardly virus?

Frederica Freyberg:
Elizabeth, that is a really interesting and good question. We don't have very much time left, so I want to give either one of you a shot at that. But we have less than one minute.  

Jeff Davis:
Okay. 

Nasia Safdar:
All I want to say is I think that the vaccine currently protects against the strain that's present. It depends on how it changes. If it changes to the point where it no longer — the vaccine is no longer immunogenic, it will no longer be effective.
   
Jeff Davis:
It's important to prevent as many cases as we can and do what we can to reduce the severity of illness and to make sure the mortality is very, very low. Even if we're past the peak, as long as there's transmission, there's benefit from being vaccinated if you're not already vaccinated. So we're going to encourage that.

Frederica Freyberg:
We so appreciate both of you being here and I know our viewers and listeners did too. That is all the time we do have for tonight's broadcast. But if you are waiting for an off-the-air expert to answer your question, don't hang up. Our volunteers from Dean and UW Health will be here for another half hour taking questions.

Shawn Johnson:
Don't forget there's a wealth of information on our web page. That address is wpt.org/H1N1. I'm Shawn Johnson. Stay tuned to Wisconsin Public Radio for all the latest.

Frederica Freyberg:
Also to Wisconsin Public Television. I'm Frederica Freyberg. Thanks for watching.