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Utah children at higher risk when H1N1 swine flu strikes

Published October 14, 2009 8:46 am

Health care » The state's unusual pneumococcal bacteria strains can pose hazard with flu.
This is an archived article that was published on sltrib.com in 2009, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Utah children who are at high risk for developing complications from the flu may be worse off than children in other states.

That's because certain serotypes -- or strains -- of pneumococcal bacteria unique to the state aren't targeted by Prevnar, a routine, recommended vaccine given to children born after 2000, said Carrie Byington, a University of Utah professor of pediatrics and infectious diseases.

And research by the Centers for Disease Control and Prevention shows such infections, when combined with the H1N1 flu, can cause severe illness.

The number of Utahns who fall ill from pneumococcal bacteria strains not covered by the shot have risen rapidly, said Byington, who is also a member of the American Academy of Pediatrics' 12-person infectious diseases committee. Those strains likely account for Utah's uncommonly high numbers of complicated bacterial pneumonia -- an area of intense research at the U., she added.

While most children's hospitals around the country see five or fewer cases in a year, she said, Utah's Primary Children's Medical Center sees about 100.

"It makes us very concerned because we know pneumonia increases during influenza season," she said. "So we have real concern for kids in Utah getting through this season."

The CDC recently reported another 19 children have died from the flu -- 16 were confirmed as H1N1 and three were unspecified influenza A, but likely to be H1N1. That brings the total number of laboratory-confirmed H1N1 pediatric deaths in the U.S. since April to 76.

The federal agency has analyzed the 36 pediatric deaths that occurred between April and early August. Among the 23 children whose laboratory results were reported, bacterial infections were confirmed in 10 of them -- or 43 percent.

Those children included all six youths who were older than age 5 years and had no underlying health conditions. That indicates a bacterial infection, in combination with H1N1, can result in severe illness in children who might be otherwise healthy, the CDC noted.

During the first wave of the H1N1 outbreak last spring, an unusually high number of Utah children -- 21 -- were hospitalized with complicated bacterial pneumonia, Byington said. That number is expected to be even higher this fall, when both the H1N1 and seasonal flu strains are circulating at full winter strength.

A new vaccine -- Prevnar 13 -- is being developed by Wyeth and will cover the 13 most prevalent types of pneumococcal bacteria. But it likely won't be released until the end of this year, Byington said.

In the meantime, there are steps parents can take to protect high-risk children from bacterial infections related to the flu, said Andrew Pavia, chief of the U.'s Division of Pediatric Infectious Diseases and a professor of pediatrics.

Pavia urges parents to be aware of whether their child is at increased risk for complications and death. Children under 5 are more likely to have problems, according to the CDC. The younger they are, the higher the risk, Pavia said.

An underlying medical condition -- heart disease, asthma, diabetes or a severe developmental delay, for example -- should also be a red flag.

One step to protect them: Seek out a protective vaccine called Pneumovax 23, for children 2 and older. The vaccine covers the 23 most prevalent types of pneumococcal bacteria, including the six that most frequently cause invasisve drug-resistant pneumococcal infections.

The doctors stress, however, that the supply of Pneumovax is limited and in most cases, pediatricians will reserve it for children with underlying health conditions.

Also, when such children fall ill, parents should promptly speak with their doctor. "For some kids at the highest risk, we want to start treating them right away," Pavia said.

In most of the pediatric deaths examined by the CDC, treatment with antiviral medication wasn't started until after two days, Byington said. That means it's critical to get a high-risk child, or any child showing symptoms of serious complications, to a doctor within the first 48 hours.

Still, when to seek treatment isn't straightforward. About 70 percent of the children who died from H1N1 had an underlying medical condition, which means 30 percent didn't, CDC data shows.

Parents looking for warning signs of serious complications should be alert to signs that a child is dehydrated or having difficulty breathing, Byington said. If a child's color changes or he or she has seizures, urgent care is needed.

For children with less serious symptoms, however, care at home may be enough. That includes offering acetaminophen, such as Tylenol, to reduce fever, plenty of fluids and rest, and keeping an ill child out of school or day care.

Byington noted parents should steer clear of aspirin and products that contain it, including Pepto-Bismol, which can cause liver problems.

And prevention is key. Pavia urges parents to get their children the H1N1 vaccine, which he said was more thoroughly tested than the average seasonal flu shot. Parents should be concerned, but level-headed, he said. "There seem to be two responses: We either panic or we blow it off, and the right response is somewhere in between," he said. "People should be concerned: take precautions, get vaccinated, practice good hygiene to protect themselves. But on the other hand, we don't want to spread panic, because it doesn't warrant panic."

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Pediatric H1N1 deaths

Between April and August 8, the Centers for Disease Control and Prevention had received reports of 477 deaths associated with H1N1 flu in the U.S. -- including 36 deaths among children under age 18. It analyzed the children's cases, which were from 15 states.

Of the 36 children who died:

19 percent were under 5 years old.

67 percent had one or more of the high-risk medical conditions.

Of the children with high-risk medical conditions

92 percent had neurodevelopmental conditions.

Of the 23 children who had laboratory tests examined by the CDC:

Bacterial co-infections were identified in 43 percent -- including all six of the children who were age 5 and older and had no recognized high-risk condition. That indicates a bacterial infection, in combination with H1N1, can result in severe illness in children who might be otherwise healthy.

Q and A

With Andrew Pavia, chief of the U.'s Division of Pediatric Infectious Diseases and a professor of pediatrics.

Should I wait to get my children vaccinated for seasonal flu until closer to the peak of flu season?

"The immunity from a regular flu shot lasts well through an entire flu season," Pavia said. "If you get vaccinated in August or September, you'll be protected long after the peak of the influenza season is gone."

What if my children -- or someone they were exposed to -- had flu-like symptoms last spring?

Unless children got sick themselves -- and tested positive for the H1N1 strain -- parents shouldn't make the mistake of thinking their children have immunity and skip the vaccine, Pavia said. Even if they got the flu, it won't harm them to get the vaccine.

Finding H1N1 vaccine

Some local Utah health departments -- including Salt Lake Valley and Davis County -- received injectable doses of the H1N1 flu vaccine on Tuesday. To learn more about vaccine availability, visit http://www.sltrib.com/fluinfo" Target="_BLANK">http://www.sltrib.com/fluinfo.