Parents warned as flu hits early, hard

By Warren King
Seattle Times medical reporter

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Health officials and pediatricians are urging parents to have young children immunized against influenza as the disease continues its early spread across the state.

Children's Hospital & Regional Medical Center physicians said yesterday they're seeing many more children than usual with serious cases of the flu.

More than 70 children with confirmed cases of the disease have been hospitalized or treated in the emergency room over the past two months, including 12 who were in intensive care. By comparison, 60 confirmed cases were treated at the hospital during the entire flu season last year.

Hundreds of other cases — about 40 a day — have involved treatment for flulike symptoms, said Dr. Danielle Zerr, chair of infection control at the Seattle hospital.

"It's not too late to get an influenza shot," said Dr. Ed Marcuse, associate medical director of Children's. "We don't know how long this is going to stay, but it typically lasts until March or April."

Flu vaccinations Health authorities recommend influenza vaccinations for: • people aged 50 and older • residents of long-term-care facilities • women who will be more than three months pregnant during the flu season • adults and children age 6 months and older with chronic lung, heart or kidney conditions, diabetes or impaired immune systems • children to age 18 who are receiving long-term aspirin therapy • health-care workers • people who will be in close contact with those at high risk for flu complications • healthy children ages 6 months to 2 years, their household contacts and out-of-home caretakers A new vaccine FluMist, is given in a nasal spray, but is not recommended for certain groups because it contains a weakened live virus. Those groups include people younger than age 5 or older than 50; those with immune deficiency, asthma, chronic diseases of the heart or lung and other disorders; and pregnant women. Consult your physician about whether you can receive the vaccine. More information is available at the company's Web site: www.flumist.com Where to get vaccinated Flu shots are available through private physicians and clinics, and through the clinics of Public Health-Seattle & King County and the Snohomish Health District. On the Web • Public Health-Seattle & King County: 206-296-4949 or www.metrokc.gov/health/sts_svs/immuniz.htm • Snohomish Health District: 425-339-5224 or www.snohd.org

Young children, through preschool, are especially vulnerable to life-threatening complications such as pneumonia because their immune systems aren't fully developed. Complications and hospitalizations are as common among infants and small children as among high-risk adults, such as the elderly, Marcuse said.

Flu shots are recommended for all children ages 6 months to 2 years and their household contacts and caretakers. Children younger than 6 months can't receive the vaccine because their immune systems aren't developed enough, so vaccination is recommended for their contacts and caretakers.

Others needing the vaccine are people 6 months and older with chronic diseases of the heart, lungs (including asthma) or kidneys; diabetes, or immune suppression, including HIV. It is also recommended for children on long-term aspirin therapy and children who are household contacts of high-risk children and adults.

Health officials have not heard of any flu-linked deaths among children in Washington state this year. But Marcuse said the disease may contribute to some children's deaths every year at the hospital. Five children in Colorado have died of the disease already this season, health officials said.

During an average flu season, about 114,000 people nationwide are hospitalized and about 36,000 die from complications, according to the U.S. Centers for Disease Control and Prevention. No figures are available for Washington state.

CDC officials have said the disease already is widespread in the country — one of the earliest flu seasons in years.

Three deaths among nursing-home residents in Yakima County last month may be linked to the flu, health authorities said. All three had other medical problems that could have been aggravated by the flu, and all three had new, "quick" tests for the flu that were positive. The tests can be a good sign of flu in patients who have flulike symptoms at a time when the flu is widespread. More-extensive, confirmatory lab tests were not done on the residents.

A 29-year-old Snohomish County man who died Tuesday also had a positive quick test. Randy Charles Rae was apparently dead on arrival at Stevens Hospital in Edmonds, according to Beth Engel, a hospital representative. Resuscitation attempts failed.

A confirmatory lab test for influenza had not been performed on Rae. The Snohomish County Medical Examiner's Office, which identified Rae as the patient, is investigating the case.

It is very rare for influenza to cause fatal complications in a young person who has no other medical problems. Most deaths are in elderly people and young children.

Many flu-linked deaths occur from pneumonia, which inflames the lungs and causes them to fill with fluid. The blood is not oxygenated adequately and vital organs cannot survive.

The influenza virus also can inflame the heart muscle, impairing its ability to pump blood. Or it can cause the brain to swell and shut down respiration and heart activity.

In adults, life-threatening symptoms include trouble breathing and fevers of 103 to 105 degrees, according to Dr. Jo Hofmann, state epidemiologist for communicable disease.

In children, Zerr said, parents should be especially watchful for lethargy, confusion, dehydration and problems with breathing.

Physicians emphasized the need to be very protective of infants up to age 6 months, who cannot be vaccinated. All contacts — family members, caretakers and others — should be vaccinated, they said.

"Influenza can be extremely severe in young infants," said Dr. Jeff Duchin, director of communicable-disease control for Public Health-Seattle & King County.

Vaccine supplies are plentiful, Duchin said.

Seattle Times staff reporter Christopher Schwarzen contributed to this report. Warren King: 206-464-2247 or wking@seattletimes.com

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