MR. JIM ASENDIOFrom WAMU 88.50 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your community with the world. I'm news director Jim Asendio sitting in for Kojo. Later this hour, we'll speak with prolific author Frederick Royse whose new book "A Geography of Secrets" explores the secret lives of some Washingtonians. They may be our neighbors or occupy the next office or cubicle, but do we really know them at all?

MR. JIM ASENDIOThat's coming up. But first, a year ago, many of us were very concerned about a potential pandemic. Remember H1N1? There were long lines of worried parents, pregnant women and seniors snaking around city blocks, all trying to get a swine flu shot. Schools closed when students were diagnosed with the flu and mass clinics were conducted throughout the region. Well, that flu pandemic never fully materialized, but the flu season starts again soon and health officials say now is not the time to drop your guard. This time around there's plenty of vaccine, but questions remain who should be vaccinated. Is this year's vaccine different from the one many received last season?

MR. JIM ASENDIOFor our flu debriefing, we're joined in the studio by Dr. Robert DeBiasi -- no, Roberta DeBiasi. She is definitely a female, a pediatrician and an immunologist who is on the faculty in the Department of Infectious Diseases at Children's National Medical Center. And you also are an associate professor of pediatrics at the George Washington University. You must have one incredible business card. It just keeps folding, folding out.

MR. JIM ASENDIOOn the phone, Dr. Pierre Vigilance. He's the director of the District of Columbia Department of Health. He's a public health specialist who previously served as director of Baltimore County's Health Department and as the assistant commissioner for health promotion and disease prevention in Baltimore City. You're invited to join us by calling 1-800-433-8850. You can e-mail us at kojo@wamu.org. You can get in touch through our Facebook page or you can send us a tweet to @kojoshow. Thanks for joining us, doctors.

MR. JIM ASENDIOThe World Health Organization last month declared the end of the H1N1 flu pandemic. And Dr. DeBiasi, in the end, how did the pandemic compare with those of the past? We've heard there were a lot of media stories. We had coverage here on WAMU and the television, in newspapers and magazines. There was all sorts of information out there. People were expecting the pandemic and it happened, but it sort of didn't happen.

DR. ROBERTA DEBIASIYeah, thankfully, it didn't turn out quite as terrible as 1918, which is what everyone knows about where really a large proportion of the world was infected and a lot of people died. But to say it didn't happen is actually not quite accurate. We actually did have a significant number of hospitalizations and deaths. And I think what's really interesting, and particularly as a pediatrician and as a mom, is to look at who was it that was affected by this pandemic. And it was children, is the answer.

DR. ROBERTA DEBIASISo if we look at the difference between how many people got sick, how many people were hospitalized and how many people died, overall it wasn't really much different than a seasonal influenza year. But if we look a little closer and say, well, who got sick and who got hospitalized and how many deaths were there, there really was a big difference this time. And it was really our children under 18 who made up a large amount of the people that got more chance of getting infected. So over half of the kids got infected, which is more than we see usually in a seasonal influenza year.

ASENDIOWhat did we learn from that? Were they in particular situations? Did they not get vaccinated?

DEBIASIWell, part of it is actually due to the virus itself so -- it was such a novel virus coming on the scene. And as we talked about way back in April, I guess the way viruses, new viruses come about in the case of influenza is they re-assort. So it's sort of like a lotto machine and different parts of viruses get together and make a new one. And it turns out that the one that came about, if you were older than 50, you had a little bit of previous immunity way back when to something related to this virus. Whereas if you were very young, you had zippo immunity so you were much more likely to get infected. And if you got infected, you were actually at a higher risk of getting severely sick and hospitalized.

DEBIASIAnd what that ended up being was we had four times as many pediatric deaths than we usually do in a normal seasonal influenza year. So you know, as a pediatrician, it really did make an impact. And I can tell you as working in the hospital during the peak of this, you could palpably tell this was different than a usual flu year.

ASENDIODr. Vigilance, can you tell us -- leading up to last year's flu season, as I said, there were many stories. Public health departments put out the information. Should we do anything differently this year?

DR. PIERRE VIGILANCEYes. I think this year the big changes -- and I agree 100 percent with what Dr. DeBiasi had to say about what the population difference was versus last -- versus our normal flu season. The thing that was a big difference for us was when the flu season started, it really sort of never ended. It sort of started early in April or so. We were still dealing with flu and it continued through the summer and then went into the fall, which is a little abnormal. So we've seen this bigger drop-off in flu cases in the June to September window this year than we did last year. And so there's slightly less vigilance, excuse me, around the issue right now. But I think, at the same time, there needs to be a maintained level of concern given the fact that, as Dr. DeBiasi mentioned, the children who were affected were affected a bit more significantly than would normally be the case.

DR. PIERRE VIGILANCEAnd the folks who were affected, who were adults who had upper respiratory conditions or actually chronic lung disease were also affected a bit more significantly than they would have been otherwise. And that working population was a bit more susceptible to this than would normally be the case. So I think that this year, the work needs to continue with respect to making sure that people take the preventive measures that are necessary, including getting vaccinated. But before that, even taking some more basic steps which we can talk about.

ASENDIOSo first off, we're looking at October as the start of the flu season. When does it actually start?

VIGILANCEWell, typically, it's sort of when the temperature drops such that it allows for flu droplets, if you will, to be able to be carried a bit more effectively than they are in the warm temperature of the summer. And that's when we start seeing things sort of pick up so October, November for some folks. You know, the temperature starts to drop a little bit and certainly later into November and into the fall, then into the early part of the winter is when we see a lot more sort of coming down the pipe.

VIGILANCEI think that the availability of vaccine this year is earlier than it was last year. And certainly we were scrambling with a couple of different types of vaccine last year. And with the H1N1 vaccine being a separate shot last year, that made things a little different. Certainly, and the media attention around this also affected the desire for people to actually get vaccinated or in some instances, to not get vaccinated.

ASENDIONow, as we go into this season, I've already noticed, even around the radio station and with friends and family, people coming down with flu-like symptoms. So are they sort of the early cusp of this?

DEBIASITo my knowledge, there hasn't been a significant amount of circulating influenza yet. I mean, we have had isolated cases, but we're hoping we're ahead of the curve this year. It seems that way.

ASENDIOBut before we went on the air, I mentioned to you that when I passed by a drug store, a pharmacy, I was surprised that the sign was up, get your flu shot. And I'm going, didn't we just get our shots? Are we dealing now with public perception that, oh, I got it then, but they actually needed to get it -- a shot for this season?

DEBIASIYeah, I mean, I think this is really a key point is that old is old and now we're back to a regular -- we're in the regular timing of what we'd expect for seasonal influenza. And this is the time that the vaccine gets rolled out so we're lucky we're going to expect 165 million doses this year, which should be plenty. And as of September 10th, we have almost a third of those already rolled out and that's why you're starting to see the signs up to make your appointment. And this year, it's going to be much easier to figure out what you should do. There's one shot. It's going to contain, as usual, three types of influenza virus and one of those is what used to be called novel H1N1. Now, it's just boring old 2009 H1N1. You know, this is just like we said last time. It had its 15 minutes of fame to be exciting and crazy so now that will be part of just the standard shot that you'll need.

DEBIASIAnd the advisory committee on immunization practices from the CDC this year actually made a recommendation that anyone over six months of age should get vaccinated. So you don't even have to figure out if you're in this weird category or is that or not or whatever. Basically, if you're over six months of age, you should get vaccinated.

ASENDIOHave we reached the point where people make this part of their annual checkup or their annual thought about their health? That it's not when a pandemic is threatened, but this is something that you should do every year?

DEBIASIAbsolutely. And it's really always been that way. I think it just -- when you get the media attention from a pandemic, it maybe comes to people's minds a little bit more. I would make a plug, you know, again, as a pediatrician and as a mom, even if you feel like, I know they're saying I should get it, but you know I'm not going to get it because the chances are I'll be fine, just remember that you're also protecting children. And it's really -- when we look at our kids that were hospitalized at Children's Hospital this last season, fully 25 percent of them got it from someone in their household. So, you know, this is a preventable thing you can do to protect the children or your grandchildren or any small person in your life by getting a safe vaccine.

VIGILANCECan I just throw something in there to add to this? It's unfortunately true that flu vaccine uptake is typically not that great. There are some populations that do a very good job of making sure that on an annual basis they get vaccinated, maybe because they've got a chronic lung condition and they've been told by their doctor that they really should or they may be old or a member of a slightly more seasoned population, a little older. But generally, from a public health perspective, we find that many people don't get their flu shot. And last year's situation with H1N1 and with a lot of trepidation around the vaccine, there were some populations that got their shots at very, very low rates. And so it's going to be interesting this year to see whether or not there is greater vaccine uptake, just in general, knowing that the H1N1 part of the vaccine is included in the quote/unquote "regular vaccine."

ASENDIOHave you gotten your flu shot? Are you thinking that maybe this year you'll bypass it? Join us by calling 1-800-433-8850, e-mailing us at kojo@wamu.org or getting in touch with us through our Facebook page or by sending us a tweet to @kojoshow. Now, some people may have gotten their flu shot for last season late and they say, oh, I got it, I think, maybe less than a year ago. Do I still need to go in this year, in the fall now, to get a shot?

DEBIASIYeah, great question, a common question and the answer is yes. Because this year, we -- as I said, the vaccine is going to contain not only the 2009 H1N1, but two other strains of influenza that can also make you really sick. And you would not have had those strains in the prior year's vaccination.

ASENDIONow, you spoke earlier about recommending that children as young as six months old get the shot. Is that a change from protocol? Is that something new?

DEBIASINo. The over six months is what has always been recommended. What's different is that there's no kind of window in between the 18-year-old and, you know, there used to be sort of like, oh, well, less than -- sorry, over six months up to five years. Definitely, five years to 18, yes, but, you know, maybe between 18, if you're totally healthy and 49. Maybe you don't have -- you know, it was very confusing, I think, to people. So I think what's clear, from looking at what happened last year or last season, that -- and the population that was most severely affected, it makes sense that everyone should get vaccinated.

DEBIASINot only to protect themselves, but this younger population and in particular, the babies that are less than six months old who really have no defense. They can't even get vaccinated. It's really important if you're a caretaker of them, live in the household with them, you're a nanny of them, a teacher or healthcare worker. I mean, that's the only way those kids can be protected. And that's really important to think about.

ASENDIODr. Vigilance, can you talk about the -- how they put together the vaccination for this year? Dr. DeBiasi talked about the 2009 H1N1 being in there. Is there a panel somewhere that sits down or just a general knowledge in the medical community that they choose which ones to put in the vaccine?

VIGILANCESo flu does a world tour. And as it does that tour, we're able to determine from other hemispheres exactly what strains of flu are causing illness in other parts of the word. So there's a knowledge of what it is that's going to come around to this hemisphere kind of before it gets here. And vaccine development is a function of surveillance and then appropriate growth, if you will, of the vaccine strains that are appropriate from year to year. So that's how the process goes on an annual basis.

ASENDIONow, we have a Facebook post from Gayle. She says, "I'm 62 and I will never, ever take a flu shot. Eat well, rest, exercise, wash your hands and manage symptoms as soon as you notice them. That's the best cold and flu vaccine." How do you respond to that?

DEBIASIWell, it's not going to help the baby who's under six months of age if you're near them. So that would be my first response. And, you know, if you're playing the odds for yourself and you're thinking just about your health, you're right. The odds are you're not going to get severely ill or hospitalized or die. But the problem is, we can't figure out who, of the people that otherwise live normal, are not going to get really sick and end up hospitalized and die.

DEBIASIBut she's absolutely right. If you're going to just play this straightly on the odds, you're right. Most people are not going to get hospitalized and die. But you need to think about this. I think, personally, I think, you need to think about it more as outside of you and even outside of your household about the impact on other people in the community.

ASENDIOAnd another Facebook post, this one from Robert, "Last year, I tried and tried to get both regular and H1N1 flu shots and ended up getting neither. I get one every year and have never gotten the flu. However, last year, I waited a little too long for the regular shot and they ran out. For the H1N1, we saw day-long lines of eligible groups and I was never in one of those groups. I tried and tried to get a shot and finally gave up. I wonder what my prospects will be this year?"

DEBIASIAnd I feel for this person because they did what they really were try -- you know, what you're telling them to do and they tried their hardest. And believe me, we were even frustrated, as healthcare workers, trying to get our shots. But we did the best we could. The virus didn't cooperate last year, didn't give us the six month's time we needed to get it into the vaccine. But this year, it's a totally new year. We have the vaccine ready. Everything's in there. We're already delivering doses so you should not meet the same problems you did last year. Don't give up.

ASENDIODr. Vigilance, how do you counter people who say, look, I didn't get the shot. I'll never get the shot and I don't get the flu?

VIGILANCEYou know, I agree again with Dr. DeBiasi, that it's more than just about you as an individual. It's about your family members. And some people do make an informed decision about this. I did meet a lot of patients last year who said, you know, normally I don't do this but there's a new addition to our family. I've got a new granddaughter, or whatever it is, and I want to make sure that she's protected.

VIGILANCESo if they -- first place booker is somebody who knows that they're not going to be around anybody, than, I think, that the measures that she, I think it is, was referring to are perfectly reasonable. But if she is going to be around other folks, especially folks who may be unable to be protected or maybe at risk for a severe complications of the disease, then it would make sense for them to do so. But the other thing is this that -- you know, we in the district had a very interesting experience with H1N1. There were lots of our neighbors from Maryland and Virginia who were able to walk right into a few of our clinics, especially of those -- certain parts of town, walk in, get their shots and walk right out.

VIGILANCEAnd so I think that being aware of the fact that the H1N1 offerings last year were very broad, the different jurisdictions did things slightly differently, but you were able to get access to vaccine, you know, here in the district as well as in specialty clinics in Maryland and Virginia. Means that, you know, sometimes there's some additional networking and some additional research that has to go in to actually getting your shot. But this year, it should be a different story.

ASENDIOBefore we take a break, let's go to Winchester, W. Va., to Alex. You're on the air, Alex.

ALEXHello, thank you. I am eight months pregnant right now and I was wondering when your guests would recommend that I get the flu shot. I'm assuming I wouldn't want to do it while I'm pregnant, but when should I? And then, also, are there any contraindications with breast feeding and getting the shot? And then, lastly, there's controversy about the preservative thimerosal and I had heard that the flu shot uses that so I was wondering what is the preservative in the flu shot?

DEBIASISure, these are all excellent questions. And brings up one of the highest risks groups that we noticed last year for severe and fatal disease were pregnant women. So actually, there is not only not a contraindication to getting vaccinated during pregnancy, it's actually recommended that you get vaccinated during pregnancy with the inactivated vaccine, which is the shot. You should not get the live nasal flu spray as a pregnant person. So that answers your first question. The breast feeding, there's no contraindication whatsoever to breast feeding with having had a vaccine. And lastly, the preservative I think you're referring to is thimerosal, which is a mercury containing preservative and it's used at very low levels in some of the bulk preparations of flu vaccines. But at least half of the vaccines that are going to be available this year will be thimerosal free.

DEBIASIAnd if you're concerned about that, you can ask that you not have one of the thimerosal containing vaccines. If for some reason you can only get one of the thimerosal containing vaccines, there's actually a wonderful discussion of this on the CDC website that explains that at the levels that are in the vaccine, there's no health effects. So -- but even if you don't believe that, you can get a thimerosal free vaccine.

ASENDIOWe'll continue our conversation about the upcoming flu season and what health professionals say you should do to prepare for it after this short break. You're listening to the Kojo Nnamdi show.

ASENDIOAnd welcome back. I'm news director Jim Asendio sitting in on "The Kojo Nnamdi Show" today. We're speaking with Dr. Roberta DeBiasi from the Department of Infectious Diseases at Children's National Medical Center. And on the phone, Dr. Pierre Vigilance, the director of the District of Columbia's Department of Health. Let's go to the phones right now. Arlington, Va. Gail, you're on the air.

GAYLEHi, thanks for taking my call. And that was my e-mail that you read. I wanted to say that -- or ask the question, if I am very, very healthy -- If I do all the things I mentioned in my e-mail and I don't have the flu or don't get the flu, how on earth am I going to pass it on to a baby or a vulnerable person?

DEBIASIIf you don't get the flu, you won't pass it along. That's correct.

GAYLEExactly. So I still maintain that this over-hyper -- get people to take drugs instead of getting people to take better care of themselves. When I walk into a store and see people putting their hands in food that, you know, I don't know when they washed their hands last or making unhealthy choices about their health, their diet, the rest that they get, their exercise, being overweight, these are things that set you up, if you're a normal healthy adult, for a lower resistance to being able to fight off the flu. So I don't think that I'm doing anything selfish to say that, you know, I prefer to exercise, eat well, rest. If I get a symptom of the flu, I have some various things that I do personally. One of which is stay away from anybody else. And I usually don't get it. So to just pooh-pooh the idea that you can be a healthy person without getting a flu shot, I think, it's disingenuous.

VIGILANCENo. And I don't see that that was what was happening. I think that your approach is a very good one and certainly a very healthy one. And it's certainly one that we respect in the health department, people's right to not necessarily take a flu shot. But I think that everyone is not necessarily healthy or assiduous as you are about your health and so some people may not take all the measures that you take to ensure that you are somebody who doesn't get the flu in the first place. And so that -- those are the folks who make up a far greater portion of the population that we're concerned about.

DEBIASIAnd just to add one other thing that -- we also have found last year and in general, up to a third of people can be completely A-symptomatic and still be shedding flu virus for two weeks and inadvertently infecting other people. So I do respect your opinion, but I just would, again, make the point that you don't necessarily know that you have the flu and are spreading it to other people. You could feel completely fine.

ASENDIOAs we wrap up this half hour, Dr. DeBiasi, what do people need to know?

DEBIASII think it's just important to remember that every year, flu is an important problem. We have lots of hospitalizations and deaths. We have concerns about our pediatric population. And with our normal flu strains, our older population are people that are -- have chronic illness and the vaccine is safe. It's available. It's going to be easy to understand, easy to get this year and I encourage everyone to do it.

ASENDIOAnd Dr. Vigilance?

VIGILANCEI think that the washing of hands has gotten, you know, it gets some play, but it doesn't -- it's just not actually done nearly as assiduously as it needs to be. Covering your cough and staying home if you're sick, those are the things that we were telling people to do before vaccine availability came into play. And we think that those are the cornerstones of staying flu free. But the vaccine certainly does offer protection that is significant and not to be downplayed. And so doing all of these things is an important piece of -- are all important pieces of the puzzle. So we all have some responsibility to make sure that we're keeping ourselves healthy so that we can keep our family members and our communities healthy as well.

ASENDIOThank you very much. He's Dr. Pierre Vigilance, the director of the District of Columbia's Department of Health, a public health specialist who previously served as the director of Baltimore Counties Health Department and the assistant commissioner for Health Promotion and Disease Prevention in Baltimore City. And joining me in the studio has been Dr. Roberta DeBiasi, a pediatrician and immunologist and mom who's on the faculty of the Department of Infectious Diseases at Children's National Medical Center and she's also an associate professor of pediatrics at the George Washington University. Thanks very much for the information and for joining us.

ASENDIOWhen we come back, the author, Frederick Reuss, whose new book explores the lives of some Washingtonians who may not be the people we think they are. I'm Jim Asendio and you're listening to "The Kojo Nnamdi Show."