Flu May Be Worst in Decades for U.S. Kids

THE ASSOCIATED PRESS ^ | 12/17/03 | Daniel Q. Haney

[leu25iso]

Flu May Be Worst in Decades for U.S. Kids By THE ASSOCIATED PRESS

Published: December 17, 2003

Filed at 9:52 p.m. ET

The current flu outbreak may be the worst for young U.S. children in several years, some experts say, comparing it in Western states to the Hong Kong flu of 1968-69.

A government epidemiologist and other disease doctors predict flu deaths among babies and toddlers will exceed the estimated 92 who die in an average flu year.

``We would expect that number would be higher in a season like this. It would be more than 92,'' said Dr. William Thompson of the Centers for Disease Control and Prevention. ``The question is how high. We can't estimate that from our data.''

Even so, flu deaths among children are still rare. An average of 8,400 normally healthy children between 6 months and 24 months are hospitalized with the flu each year. The virus and its complications are the sixth-leading killer of children age 4 and under.

With the flu now widespread across half the country, large hospitals have already admitted hundreds of young patients, including a few critically ill in intensive care. Nearly all eventually get better, but the deaths have been particularly worrisome.

``What I am hearing anecdotally is this is a very, very bad season for children,'' said Dr. Walt Orenstein, director of the National Immunization Program at the CDC.

However, CDC officials cautioned they will not know for sure until the season is over whether it caused more illness or death than usual in children.

Dr. Keiji Fukuda, the CDC's head of flu epidemiology, said the flu can switch to a less virulent strain in mid-season. ``We are concerned this could be a severe year, particularly for children, but right now we don't know that and won't know it for a while,'' he said.

So far, the CDC has learned of about three dozen deaths in children and teenagers. It is unclear how that figure compares to previous years because the agency doesn't keep track of flu cases.

For the first season in four winters, the dominant flu strain is a so-called H3N2 virus, which is the most dangerous of the three main varieties of the bug. For that reason alone, experts say, the number of pediatric deaths will be higher than average.

The CDC estimates that in an average year, about 36,000 people -- including 92 children under age 4 -- die of the flu. However, the totals vary from year to year, depending on the strain that is circulating. Through the 1990s, the annual tally has ranged from 17,000 to 65,000. In a year when the more benign B-strain of flu dominates, just 24 deaths under age 4 are expected.

Flu can be a serious disease for the young because they have not built up much natural defense against the virus. Most older children and adults can fight off severe illness, even if they get sick, because previous infections have strengthened their immune systems.

This year may be especially bad because many young children have never encountered an H3N2 virus. Making matters worse, this season's virus is genetically different from the one that circulated in the late 1990s, so older children who had the flu then may not have very strong immunity.

Flu is most dangerous for youngsters who already have heart and lung problems, such as asthma, cardiac birth defects and lung damage resulting from prematurity.

However, doctors said they are especially concerned by reports of flu deaths among children who are otherwise healthy. In Colorado, where the first child flu deaths appeared, state officials said that at least four of the 11 young flu fatalities had no underlying diseases.

[leu25iso]

Notice that several of the children who died had no underlying condition.

[leu25iso]

However, CDC officials cautioned they will not know for sure until the season is over whether it caused more illness or death than usual in children.

If 93 are confirmed dead and the season is not over, everyone should know for sure about the more than usual deaths question.

[Born Conservative]

Back in October, our large Pediatric clinic was giving out very few flu vaccines. Those that we were giving were mainly to children with asthma and other chronic conditions. Now, we exhausted our supply last week, and people are calling up in a panic, looking for their children to get the vaccine. My stock reply is that we have flu season every year; this year it is earlier and may be more widespread, but if your child is otherwise healthy and DOES get the flu, odds are that he/she will recover completely.

People don't die directly from the flu. Rather, they usually die from a superinfection, that is, a bacterial infection that sets in along with the influenza (which is a virus). The bacterial infection is usually a pneumonia, and this may spread to the blood, causing overwhelming sepsis and then death (unless treated promptly and appropriately).

[leu25iso]

I expect the season to get considerably worse for several reasons. There hasn't been much H3N2 around, but the situation is compound by the emergence of Fujian, which is quite different from Panama.

The US and the rest of the world has been using Panama since 2000, so even those who have been getting annual shots are not building up much immunity by getting the same immunization year after year. The virus does change, but unfortunately, the vaccine has not.

This is compounded by the genetic makeup of the virus. Some of the mutations are just seen in animals, while others haven't been around since 1968.

Thus many of the mutations have never been seen by children and even teenagers (or anyone born after 1968). Thus one situation compounds the next. Younger patients don't have immunity and older patients have has any immunization against Fujian. Moreover, the virus keeps mutating creating more novel mutations.

Fujian could have been included in this year's vaccine. There were some problems growing the virus in eggs, but one passage through MDCK (dog kidney) cells adapted the virus for grow in eggs. The FDA said MDCK cells were not certified (although some companies are using MDCK cells for viral growth for other vaccines in clinical trials), and industry liked doing what it has been doing since 2000 - grow Panama and remind those at risk to get yet another shot containing the same virus that has been in the vaccine since 2000.

[TheDon]

The current flu outbreak may be the worst for young U.S. children in several years, some experts say, comparing it in Western states to the Hong Kong flu of 1968-69.

Then again, some experts say, it may not.

[leu25iso]

Then again, some experts say, it may not.

The severity of the outbreak is a pretty easy call by looking at the sequence of the Fujian virus or the frequency of infections and deaths in children.

Some experts are wishful thinkers or don't want to admit that they blew it badly in February when they approved using Panama once again (for the 4th year in a row)to price an identical vaccine that the administered to 83 million and discarded another 12 million doses.

The epidemic is VERY easy to predict by anyone paying attention.

[riri]

odds are that he/she will recover completely

When you have children hearing "odds are" just isn't all that comforting.

[riri]

People don't die directly from the flu

Thank you for saying this. In ALL the news reports I have listened to or read NOT ONE has said this very basic statement. Very basic, yet I would bet 7 out of ten people don't really know this.

So as a doctor I ask you, what signs do I look for in a child that is ill?

My son (2.5) had what a presume to be a nasty bout with a flu about a month ago. This was before all the media hype about the pediatric deaths but because I had read of children dying in England and my newfound paranoia re: pnuemonia (thanks to SARS) I had to bring him into the md's office twice. Second time, it was a bacterial infection, ear infection, and, luckily, amoxicillin seemed to do the job.

So, I understand why people are flooding the doctor's offices after stories of children on the mend one day and dead the next, some with no other medical problems.

[Born Conservative]

First, I'm not a doctor, I'm an RN (don't want to mislead you). As for what to look for: if the fever lasts longer than 3-4 days, goes above 104, signs of dehydration (no urine x8 hours or more, dry mouth, pale skin, sunken eyes, listless/lethargic) or if your child has breathing difficulty (nasal flaring, breathing rapidly, the stomach or space between the ribs sucking in when breathing, grunting when breathing), then it's time to call the doctor.

[TheDon]

...easy to predict...

So we were told by Jeane Dixon.

[leu25iso]

So we were told by Jeane Dixon.

Science is much more reliable (and alive). The sequences of the viruses have been published, and the predictions are very easy calls.

[TheDon]

Jeane felt her talents were superior to the ability of science to predict the future.