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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).

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.

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.