Latest strain threatening more of the young

By Daniel Q. Haney
The Associated Press

	MARK HUMPHREY / AP Crystal Schamel feeds a frozen snack to her son, Israel, 22 months, at Vanderbilt Children's Hospital Pediatric Emergency Room in Nashville, Tenn.
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The current flu outbreak may be the worst for young U.S. children in several years, some experts say, comparing it in Western states to the Hong Kong flu of 1968-69.

A government epidemiologist and other disease doctors predict flu deaths among babies and toddlers will exceed the estimated 92 who die in an average flu year.

"The question is how high," said Dr. William Thompson of the Centers for Disease Control and Prevention (CDC). "We can't estimate that from our data."

Even so, flu deaths among children are still rare. An average of 8,400 normally healthy children between 6 months and 24 months are hospitalized with the flu each year. The virus and its complications are the sixth-leading killer of children age 4 and under.

With the flu widespread across half of the country, large hospitals have already admitted hundreds of young patients, including a few critically ill in intensive care. Nearly all eventually get better, but the deaths have been particularly worrisome.

However, CDC officials cautioned they will not know for sure until the season is over whether it caused more illness or death than usual in children.

Dr. Keiji Fukuda, the CDC's head of flu epidemiology, said the flu can switch to a less virulent strain in mid-season. "We are concerned this could be a severe year, particularly for children, but right now we don't know that and won't know it for a while," he said.

So far, the CDC has learned of about three dozen deaths in children and teenagers. It is unclear how that figure compares to previous years because the agency doesn't keep track of flu cases.

For the first season in four winters, the dominant flu strain is a so-called H3N2 virus, the most dangerous of the three main varieties of the bug.

For that reason alone, experts say, the number of pediatric deaths will be higher than average.

The CDC estimates that in an average year, about 36,000 people — including 92 children under age 4 — die of the flu. However, the totals vary from year to year, depending on the strain that is circulating. Through the 1990s, the annual tally has ranged from 17,000 to 65,000. In a year when the more benign B-strain of flu dominates, just 24 deaths under age 4 are expected.

Flu can be a serious disease for the young because they have not built up much natural defense against the virus. Most older children and adults can fight off severe illness, even if they get sick, because previous infections have strengthened their immune systems.

This year may be especially bad because many young children have never encountered an H3N2 virus. Making matters worse, this season's virus is genetically different from the one in the late 1990s, so older children who had the flu then may not have very strong immunity.

Flu is most dangerous for youngsters who already have heart and lung problems, such as asthma, cardiac birth defects and lung damage resulting from prematurity.

However, doctors said they are especially concerned by reports of flu deaths among children who are otherwise healthy. In Colorado, where the first child flu deaths appeared, state officials said at least four of the 11 young flu fatalities had no underlying diseases.

"The fact there are deaths among children without serious underlying health problems is very unusual," said Dr. Robert Belshe of St. Louis University.

At the University of Texas Southwestern Medical Center at Dallas, Dr. Jane Siegel said an otherwise healthy teenager was among three young flu deaths there this season.

After getting the flu, he developed a severe bacterial infection, which is typically how the flu leads to death.

The hospital has treated 618 children with flu over the past two months, compared with 95 for the entire last season. Of these, more than a third were admitted to the hospital, and 5 percent were in intensive care.

In just one 12-hour period this week at Le Bonheur Children's Medical Center in Memphis, Tenn., 350 children with flu symptoms walked into the emergency department, while 50 more came by ambulance and seven arrived in helicopters.

Dr. Andrew Pavia, chief of infectious diseases at Primary Children's Medical Center in Salt Lake City, said doctors there believe this is the biggest flu outbreak among children since 1968.

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