CDC Reports On Pediatric Swine Flu Deaths

Sept. 4, 2009 — -- Juggling three sick children at once can be a handful, but Kristin Davis, 43, handled three children sick with swine flu cases while battling the same virus herself.

Davis, from Phoenix, Ariz., and her family came down with the infection in April, just as public awareness about the disease began to grow.

"My oldest daughter brought it home from her junior high school," Davis said. "It gradually spread through the family... It was scary because this was when we first got news about [swine flu]."

Despite her initial fears about swine flu -- seeing her youngest daughter's school close because of an outbreak of the virus, not knowing very much about the disease -- Davis said the virus only moderately affected her and her children.

"We had all the standard symptoms -- headache, fever, chills," Davis said. "But I've had flus in past winters where I was much sicker... This time, it was just about trying to keep the kids and myself comfortable."

Davis and her family fully recovered from their bout with swine flu, but others have not been so lucky.

A report released Thursday from the Centers for Disease Control and Prevention showed children, especially those with chronic medical conditions, can have a severe illness or even die from swine flu.

CDC Report Highlights Children With Chronic Conditions

As of August 8, 36 children under age 18 have died from the H1N1 swine flu virus of 477 total deaths, according to the CDC report. Children younger than 5 years or those with chronic or neurological conditions, including asthma, cardiac problems and cerebral palsy were more likely to be severely affected or die from the infection. Of those children who died, 67 percent did have at least one such condition.

"Most of the children who had fatal H1N1 this past spring had an underlying condition," said Dr. Thomas Frieden, director of the CDC, in a press conference yesterday. "There were some children who didn't have an underlying condition and became ill, generally infected also by bacteria."

Frieden added that the data emphasized that certain groups of people, for example, children with special needs or conditions, should be "promptly treated if they develop fever in flu season and are at the front of the line for flu vaccination when it becomes available."

Masks and One-Dose Vaccines Part of New Swine Flu Developments

With increased national attention on the H1N1 virus, the Institute of Medicine released recommendations Thursday that all health care workers wear N95 respirators, which are more protective than standard paper masks, to help prevent contracting swine flu.

"The N95 mask screens out small particles," said Dr. John Bartlett, chief of the Division of Infectious Diseases at the Johns Hopkins Medical Institution. "These are better protection than the familiar surgical mask and are advocated for health care workers for two reasons: [Workers] are expected to have risk exposure and they can't get sick because that risks influenza in the patients."

But some question the viability of these masks.

"They are uncomfortable over prolonged use and should only be worn one at a time," said Laurie Garrett, senior fellow for Global Health at the Council on Foreign Relations. "Numerous studies indicate the efficacy of the masks decreases with frequent reuse, and they become smelly and intolerable to the user."

In addition, Garrett pointed out that N95 respirators are no longer manufactured in the U.S. and that importing them from China, India and other Asian countries could prove challenging if those countries feel the masks are essential to their own populations.

One-Dose Vaccine Could Improve Compliance

Meanwhile, a one-dose H1N1 vaccine has emerged from Swiss drug manufacturer Novartis and a domestic variety from China has been publicized as well.

Although the potential efficacy and side effects of these vaccines remains to be determined, experts say the advantages of a one-dose vaccine would be the ability to vaccinate twice the number of people and decrease the time it takes until a patient develops immunity.

"Compliance is a critical factor in vaccine success rates," said Dr. Harley Rotbart, professor of Pediatric Infectious Diseases at the University of Colorado Health Sciences Center at Denver. "If we need a single dose for seasonal flu and two doses for H1N1, all within a few weeks of each other, poor compliance is a risk. Hence, a single dose H1N1 vaccine would be a major advantage."

CDC Attempts to Balance Swine Flu Severity

Despite experiencing swine flu first hand, Davis said she does not plan to vaccinate her children or get vaccinated herself against seasonal influenza or the H1N1 virus.

"To me that just seems a little extreme. I worry about side effects from the vaccine," Davis said. "My kids are just perfectly healthy. I'm going to handle [their illnesses] as I would any other flu."

Since Davis's children have no underlying chronic medical conditions, they are at a significantly lower risk for developing complications from swine flu even if the do become infected a second time.

Although the CDC recommends that all those who are eligible receive the seasonal and H1N1 vaccines, Frieden said that most people who get swine flu will not need treatment.

Too Early to Predict Flu Patterns for Fall and Winter

Although the number of deaths due to swine flu has climbed into the hundreds, it is well within the range of the average number of annual influenza-related deaths, which the CDC estimates is about 36,000.

But Frieden said it was unusual for flu cases and deaths to carry over into the summer months the way it has this year. And while the typical population for which influenza is fatal is very old or very young, H1N1 fatalities seem to be occurring across age groups. And they are still unsure as to the relative severity of the H1N1 virus compared to the seasonal influenza virus.

"It is clear that H1N1, at this time, is far less lethal, although quite contagious," said Dr. Len Horovitz, a pulmonary specialist at the Lenox Hill Hospital in New York.

The CDC has not made predictions about what the impact of the H1N1 virus will be into the fall and winter but they continue to recommend vaccination, hand washing, proper cough and sneeze etiquette, and staying home to recover from illness to prevent infections.

"On the one hand, the majority of people are going to do fine, they don't need testing, don't need treatment," Frieden said about those who do not have underlying conditions that might complicate an H1N1 infection. "That's a complicated message but getting it right is important for helping people stay healthy and for hospitals and ERs to be available to the community and to the people who need the treatment."