Adolescents are at higher risk of dying of swine flu than younger children, a situation that is the opposite of that encountered with seasonal flu, health authorities said Thursday.
And those with underlying health problems, such as cerebral palsy, muscular dystrophy and neurodevelopmental disorders, are at the highest risk and should be among the first to be vaccinated against the new virus, according to the Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention.
Four of the otherwise healthy kids who died of swine flu were aged 2 years or younger. Kids under 5, and especially those under age 2, are at particularly high risk of serious disease when they get H1N1 swine flu.
But eight of the previously healthy kids were over age 5. Of the six tested, all died with staph or strep bacterial infections — a warning to parents and doctors to take it seriously when kids who seem to be getting better take a turn for the worse.
The government’s warning takes on added urgency as schools reopen and as increases in infections from the pandemic H1N1 influenza virus, commonly known as swine flu, become apparent. Swine flu outbreaks are already sporadic throughout the country, and they are highest in the Southeast.
“The most likely explanation is that schools started earlier there,” said Thomas Frieden, director of the CDC.
In a separate report, the American College Health Association said there were 1,640 swine flu cases during the week of Aug. 22-28 at the 165 universities reporting to it. There was only one hospitalization, however, and no deaths.
From the time of the outbreak of the swine flu pandemic in April until Aug. 8, 36 U.S. children and adolescents died with laboratory-confirmed swine flu infections out of a total of 477 deaths in the nation linked to the virus. Seven deaths were of children younger than 5.
In a normal flu season, at least half the deaths in children occur in those younger than 5. With swine flu, more than 80 percent of the child fatalities occurred in children ages 5 to 18. In a typical seasonal flu season, 50 to 100 children die of it. The swine flu deaths occurred after the normal seasonal flu outbreak was over.
Of the 36 children who died, 24 had high-risk medical conditions, such as cerebral palsy, or longstanding respiratory or cardiac conditions. Many of those who did not have such a medical condition had a bacterial infection, such as bacterial pneumonia, according to the report.
“When you get the flu, your immune system can become weakened, and you are more susceptible to other infections,” Frieden said.
The findings emphasize the need for high-risk groups to be immunized against bacterial pneumonia, which can prevent some of the complications of flu, he said.
Swine flu is responsible for almost all the flu cases in the United States. It has caused more than 1 million illnesses so far, though most were mild and not reported, the CDC estimates. About 8,800 hospitalizations for swine flu have been reported.
Those statistics don’t mean the new flu is worse than seasonal flu, which is particularly lethal to the elderly and plays a role in an estimated 36,000 deaths each year, the CDC says.
But swine flu is causing more suffering in children and young adults than is customary, and a lot of parents are worried. Some emergency room doctors say they are seeing a lot of mildly ill children brought in by parents fearful that it is a swine flu case that will turn worse.
However, there are no signs that the virus is mutating to become more deadly, as some scientists feared, Frieden said.
The CDC is urging the majority of people with flu symptoms to avoid going to doctors or hospital emergency rooms to prevent the facilities from being swamped.
“The overwhelming majority of people (with H1N1 flu) are going to do fine,” Frieden said. “They don’t need testing. They don’t need treatment.”
But children and adults with underlying medical conditions, and pregnant women, should seek treatment when a fever from the flu develops. And early treatment is best, because antiviral drugs such as Tamiflu are most effective when given in the early stages of the infection.
Among the first 36 swine flu deaths in children and teens:
- Ages ranged from 2 months to 17 years; the median age was 9 years.
- Half the children were male and half were female.
- Two of the eight healthy children over age 5 were obese.
- Duration of illness ranged from one day to 28 days; the median illness lasted six days.
- Only four of the children received antiviral treatment within the recommended 48 hours of illness onset.
- Three of the 23 children tested had MRSA (multi-drug-resistant staph) infections.
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