Most H1N1 flu deaths in kids tied to high-risk conditions

David Gulliver - posted 8:30 am Friday, Sept. 4; added additional comments 11:30 pm Sept. 4.

Two out of three children whose deaths stemmed from novel H1N1 virus, or swine flu, had pre-existing, high-risk medical conditions, according to a federal study released Thursday.

The Centers for Disease Control and Prevention examined the nation's 36 pediatric deaths linked to the new virus. Of them, 24 patients had significant medical problems that past studies have linked to a greater risk of dying from the flu. Almost all of them -- 22 of the 24 -- are conditions such as cerebral palsy, seizure disorder, autism, Down syndrome, hydrocephalus or developmental delay.

While the study also found that children older than age 5 made up a greater share of the deaths than in past flu seasons, the agency also strongly cautioned that it was difficult to compare this small, minutely studied group in this study with the broad, less well-defined groups from past years. In a press briefing, CDC officials suggested the age difference may simply be because more H1N1 cases appear to have spread in schools, where children are older.

Dr. Shirley Jankelevich, the pediatric infectious disease specialist at All Children's Hospital in St. Petersburg and at Sarasota Memorial Hospital, pointed to two key messages from the study: Most H1N1 flu deaths appear to be linked to other complications, and H1N1 flu is no more dangerous than seasonal flu.

"The virus is not any more virulent than what we see in seasonal flu. It has actually caused fewer deaths in children than the seasonal flu," Jankelevich said.

(For the Sarasota Health News primer on H1N1 swine flu, click here.)

Another main finding, she said, is that in nearly half the cases with complete lab results, the child also had a bacterial coinfection, such as strep pneumonia, staph aureus and its problematic MRSA strain.

Flu not only stresses the immune system, she said, but also hinders many of the body's defense mechanisms that normally keep the bacteria -- often already present -- at bay. The normal mechanisms the body uses to clear bacteria from the lungs are compromised, allowing bacteria to invade more readily.

The best defenses for now are just what your mother tells you, Jankelevich said:" Wash your hands, wash your hands, wash your hands. Cough into your elbow." The flu spreads when particles are dispersed at close range, she said.

The study also noted that of the 36 children who died, only four received anti-viral treatment in the first two days of symptoms. Jankelevich said the flu can be difficult to recognize in children, who can present it in many different ways. It also doesn't always present with the typical symptoms adults have -- she has seen seizures, respiratory distress and fever.

But if a child has a high-risk or chronic condition, or is 5 or younger, and exhibits respiratory problems, contact a doctor, she said.