A 7-year-old boy was released from a New Orleans hospital Sunday after a 480-day battle with H1N1 influenza; the once pandemic virus remembered not so fondly as swine flu.
Robert "Boo" Maddox V was admitted to New Orleans Children's Hospital in critical condition Nov. 19, 2009, five months after the World Health Organization (WHO) declared the H1N1 outbreak a global pandemic.
Boo's epic hospital stay, which spanned two birthdays and included 10 surgeries, was a shock therapy of sorts for a family once unfamiliar with the agony of having a sick child.
"I've got five kids, the oldest being 20, the youngest 3, we never had a sickness," Boo's dad, Robert Maddox IV, told ABC News affiliate WGNO. "So we didn't really realize what went on [in] these places, but God has ... [given] us a valuable lesson that will stick with us the rest of our lives."
H1N1 wreaked havoc on Boo's body, leaving him open to one complication after another.
"There were times when it seemed like he was getting better, and then he'd have a setback," Children's Hospital communications manager Chris Price said.
Machines took over for Boo's heart and lungs while he fought off near-fatal infections, he said. But even with organs failing, the lively "jokester" never lost hope, or his sense of humor, Price added.
"He loved to pull pranks," he said. "He would put little rubber roaches in the bed with him for when the nurses would come.
"That's one of the most amazing things: to spend 480 days stuck in a bed in one room and to still have a sense of humor."
Although no age group was safe from the never-before seen flu strain, children were particularly vulnerable.
"What we had was this avalanche of illness in children that flooded our emergency rooms at children's hospitals," said Dr. William Schaffner, chair of preventive medicine at the Vanderbilt University Medical Center in Nashville.
"Most of them got better. But there are those among them that had to be held in emergency room for 24 hours. Some had to be admitted, and some needed intensive care."
The first American H1N1 case, reported April 15 2009, involved a 10-year-old from California. Two days later and 130 miles away, an 8-year-old became the second of what would be 41,821 cases, 2,117 of them fatal.
Once the subject of daunting headlines, H1N1 dropped off the media radar when the WHO declared the pandemic officially over in August 2010 despite 237 cases and 77 related deaths reported by the Centers for Disease Control and Prevention for the 2010-2011 flu season so far.
"The numbers haven't been such that they haven't caught the attention of the media because the season was not a pandemic, and there have been a few other things that caught our attention," Schaffner said, alluding to the unrest in the Middle East and the crisis in Japan.
The proportion of H1N1 cases dropped off slowly but steadily, Schaffner said, now representing an estimated 28.4 percent of all reported flu cases. But the possibility of a comeback or the emergence of a new strain is very real, he added.
"When it comes to influenza, the only constant is change," he said. "That's why we have to create a new vaccine each year."
This fall, the flu shot will be the same as last year's and cover H1N1 as well as H3N2 -- the most common strain right now -- and influenza B.
"Experts looked at the behavior of the various viruses and made their best judgment that the same strains are going to be out there next year," Schaffner said. "But that doesn't mean influenza can't surprise us."
Schaffner said Boo's 480-day flu battle is rare for a child.
"The situation usually gets resolved much, much earlier, either for the better or, unfortunately, the illness becomes grave in the root sense of that word and the patient dies," he said
Only a few other children were admitted to the New Orleans Children's Hospital for H1N1, Price said. Most were given Tamiflu -- a drug that can prevent the virus from spreading throughout the body -- and sent home.
"We're thrilled that Boo is going home after almost 500 days," Price said. "He's missed out on a lot of the activities that a 5, 6, 7-year-old kid does. The idea that he can go home and be a normal kid again is great."
But Boo will still needs to come in for dialysis three times a week because of kidney damage. And if his kidneys don't recover, he'll be on dialysis for life without a transplant.
"He's not completely out of the woods yet," Price said. "The doctors are monitoring him closely."