Influenza and its complications killed 115 children and teens in the United States during 2010-2011, researchers from the Centers for Disease Control (CDC) reported on September 16. Many of those deaths could have been prevented if the children had been vaccinated against the flu, the CDC said in a separate press release.

Of children and teens who died, 77 percent had not received the flu vaccine. Only half of the 94 children who died in hospitals or emergency rooms had received anti-viral therapy. These findings, the researchers said, suggest that the primary and secondary tools for preventing, controlling, and mitigating the effects of influenza are being underused.

The CDC report, which appeared September 16 in the Morbidity and Mortality Weekly Report, covered September 1, 2010 to August 31, 2011.

“It′s vital that children get vaccinated,” said Dr. Lyn Finelli, chief of the CDC′s Surveillance and Outbreak Response Team, in the accompanying press release. “We know the flu vaccine isn′t 100 percent effective, especially not in children with high risk medical conditions. That′s why it′s essential that these two medical tools be fully utilized. Vaccinate first; then use influenza antiviral drugs as a second line of defense against the flu. Right now we aren′t fully using the medical tools at our disposal to prevent flu illnesses and deaths in children.”

Pediatric Influenza Deaths Rare — but Could be Rarer

Comparatively few children and teens, especially youngsters in good health, die from flu. Most people who die from flu and its complications are elderly and/or have underlying health problems such as heart disease, lung disease, or obesity. Reporting of childhood deaths from influenza became mandatory in October 2004. Since then, the annual number of pediatric flu deaths has varied widely. The fewest childhood influenza deaths – 46 – occurred in 2005-2006; the most deaths — 282 — occured during the 2009-2010 season, the year of the H1N1 (“swine flu”) pandemic.

But the CDC analysis suggests that even fewer children and teens could — and should — be dying from flu. Many deaths among healthy children and adolescents could have been prevented with vaccination and proper use of anti-viral drugs, the researchers said.

Almost half (49 percent) of children who died from flu and its complications in 2010-2011 were otherwise healthy. Among these previously healthy children, bacterial infections were most often the cause of death. Most previously healthy children died sooner after the illness began and were more likely to die at home or in an emergency room than children with underlying health problems.

The median age of the children was six years, and nearly half (46 percent) of children were less than five years. Nearly one out of three — 29 percent — were less than two years. Children less than five years old are considered “high risk” for influenza death, and children less than two years are extremely high risk. However, 20 teenagers (aged 13 to 17 years) were included the the death toll, comprising 17 percent of the total.

Only 23 percent of children and teens who died were vaccinated. The vaccination rate (31 percent) was higher among children with high-risk medical conditions, but still lower than the national rate of 49 percent. Only 12 percent of previously healthy children who died had received the vaccine. These findings emphasize the need to improve vaccination coverage among all children, especially those at increased risk for influenza-related complications, the researchers wrote.

The CDC analysis revealed another troubling trend: the underuse of anti-viral agents. Only half of the 94 children who died in a hospital or emergency room received the antiviral drugs oseltamivir (Tamiflu) or zanamivir (Relenza). Both drugs have been shown to shorten the duration of fever and illness and reduce the risk of complications from influenza, including ear infections in young children, pneumonia, respiratory failure, and death. The ACIP recommends that anti-viral drugs be given immediately to any person who is known or suspected to have influenza and who is hospitalized, has severe, complicated or progressive illness, or is at higher risk for influenza complications. Children aged less than two years are included in the high-risk group.

These results confirm what public health officials have been preaching for years: Flu is not a disease to be taken lightly. Influenza is a serious disease, even for healthy children and teens. The CDC researchers concluded that continued efforts are needed to ensure annual influenza vaccination in all persons aged six months or more. Children with high-risk medical conditions should be specially targeted for vaccination. In addition, they cautioned, health-care providers should be aware that severe complications of influenza can occur in children without high-risk medical conditions.

Which Children are Most at Risk?

Through studies of the pattern of influenza deaths (called epidemiological studies), researchers have identified several groups that are at increased risk of complications from the flu. Any child who falls in one of the following categories should be vaccinated. If signs and symptoms of flu develop, call the child’s physician promptly:

Age: Any child aged less than five years. Children less than two years old are considered extremely high risk.
Chronic disease: Any child with an underlying medical condition including chronic lung disease (including asthma); heart or blood vessel disease; kidney, liver, or blood disorders (including sickle cell anemia), metabolic disorders (including diabetes mellitus)
Neurologic and neurodevelopmental conditions: Any child with neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke,
Children with Intellectual disability (mental retardation),
Moderate to severe developmental delay,
Muscular dystrophy
Spinal cord injury
Immunosuppression, including that caused by medications or by HIV infection
Any child or teen who is receiving long-term aspirin therapy
American Indians/Alaska Natives
Children who are morbidly obese (i.e., BMI ≥40)

Why Emphasize the Flu Vaccine?

Flu viruses spread rapidly and easily. Infected people can spread the virus a full day before symptoms appear and for five to seven days after symptoms appear. Flu is thought to spread primarily through tiny, invisible droplets that form when people with flu cough, sneeze, or talk. When a nearby person breathes, he or she can inhaled these virus-containing droplets. Flu also spreads — albeit more rarely — when someone touches a surface or object that has flu virus on it and then touches their own mouth, eyes, or nose.

Good hygiene can help to slow the spread of flu. Children should be taught proper handwashing techniques and encouraged to wash hands frequently, especially before meals or after using the restroom. Children with flu should be kept at home until 24 hours after fever is gone.

However, good hygiene can only go so far. Vaccination is the primary means of preventing the flu and minimizing the risk of complications. The Advisory Committee on Immunization Practices (ACIP) recommends that everyone six months and older receives the flu vaccine each year. Children up to age five should receive the killed flu vaccine, while children, teens, and adults ages five and older can opt for the live vaccine in a nasal spray. Children who take aspirin are not candidates for the live vaccine. Because the flu virus changes rapidly, it’s necessary to get vaccinated every year. Immunity usually develops about two weeks after the vaccine is administered.

The 2011-2012 influenza vaccine protects against three influenza viruses: the 2009 influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. These are the same three flu virus strains that were circulating in 2010–2011 – just the eighth time since 1969 this phenomenon has occurred. Moreover, it is important to note that vaccine immunity wanes over time so CDC is recommending that everyone get vaccinated this season, even if they got vaccinated last season, in order to be optimally protected.

Infants younger than six months cannot receive the vaccine; however, to protect infants who are too young to be vaccinated, the ACIP recommends pregnant women, household contacts, and out-of-home caregivers get the flu vaccine.

The ACIP recommends that flu shots starting in September and through May, depending on where you live. Peak flu activity usually occurs in January or February, but cases start occurring as early as October and continue through the spring.

All children aged six months or more should be vaccinated, as should their parents, in-home and out-of-home caregivers, and others in the household. Most people need receive only one dose of flu vaccine.

Only one flu vaccine is being made this year and most people will only need to get vaccinated once. There is one exception to this: The ACIP recommends that children aged 6 months through 8 years of age who have never received a seasonal flu vaccine get two doses of vaccine spaced at least 4 weeks apart. Children who only got one dose in their first year of vaccination should get 2 doses the following year. This includes children who received one or two doses of the 2009 H1N1 flu vaccine, but who have never received a seasonal flu vaccine.

What are the Symptoms of Flu?

Symptoms of flu include:

Fever (not everyone with flu will have a fever)
Fatigue
Headache
Body aches
Sore throat
Cough
Stuffy or runny nose
Malaise (a general run-down feeling)
Diarrhea and vomiting (most commonly in children).

What to Do if You Suspect Your Child has the Flu

Most healthy young children who contract the flu will be sick — very sick — for a week or more. It may take several weeks for them to return to their usual energy levels. Supportive care is the key to recovery from the flu. Give the child ample chance to rest, drink plenty of fluids, and take the described dose of acetaminophen (Tylenol). Do not give aspirin to children younger than 18, as it may increase the risk of Reye’s syndrome, a deadly disease that is poorly understood. Nasal saline spray and steamy hot baths can help to open clogged noses and make breathing easier. Installing a humidifier in the child’s room can also be helpful. The child should be allowed to eat whatever appeals to him or her, whether or not she or he has a fever.

If the child’s condition worsens, however, or you simply don’t know what to do, consult a health professional. Children, especially very young children, who show signs and symptoms of influenza infection should be seen by a health-care provider sooner rather than later. The physician may prescribe an antiviral medication or, if she suspects a secondary bacterial infection, an antibiotic.

Call the child’s doctor if the child has:

A fever that lasts for more than three days;
Nasal discharge that becomes thick and yellow;
Nasal discharge that lasts for more than 10 days; or
Discharge coming from the eyes.

Call for emergency help (9-1-1 in many areas) or take the child to an emergency room immediately if the child:

Appears extremely sick, listless and lethargic;
Does not respond normally — for instance, crying or objecting when a stranger approaches or a favorite toy is taken away;
Has difficulty breathing or is breathing very fast even after suctioning and cleaning the nose
Has blue skin or is extremely pallor;
Appears dehydrated and is not drinking fluids well. Signs of dehydration include decreased urine output (fewer diapers in very young children);
Has a fever that does not respond to acetaminophen (Tylenol) (Be sure that you are giving the child the correct dose of acetaminophen for his or her weight);
Has a seizure;
Vomits severely or persistently.

References

Centers for Disease Control and Prevention. (2011, September 15). CDC Report Details Influenza Prevention and Treatment for Children and Teens. Press Release. Retreived from http://www.cdc.gov/media/releases/2011/p0915_flu_prevention.html?source=govdelivery

Centers for Disease Control and Prevention. (2011). 2011-2012 Influenza Antiviral Medications: Summary for Clinicians. Retrieved from http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm

Centers for Disease Control and Prevention. (2011, September 21). Key Facts About Influenza (Flu) and Flu Vaccine. Retrieved from http://www.cdc.gov/flu/keyfacts.htm