What's the harm? Pediatric flu deaths this year twice normal and rising

Swine flu is not any nastier than the usual seasonal flu but young people are particularly susceptible to it. The mortality rate is quite low—-even at it’s worst, flu mortality rarely goes about 1-2%, as it did in the 1918 pandemic. But this flu is attacking a very large number of people; 1% of a large number is still a large number. For a low mortality rate to reflect large numbers, a disease has to hit a lot of people. If you can lower that number significantly, the mortality rate remains the same, but fewer cases will be reflected in fewer deaths. Since this flu tends to hit the young and otherwise healthy, the deaths from swine flu may disproportionately affect the young.

Currently, pediatric mortality from the flu is at twice the level usual for this time of year, and rising.

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Thankfully, we have a way to reduce the number of cases, thereby reducing the number of deaths.  Vaccination reduces deaths from the flu in two ways—by reducing the overall number of cases, and by reducing the severity of cases in people who get the disease despite being vaccinated.

You may look at the national data and think, “Well, less than 150 kids have been killed by the flu so far this year.  That doesn’t seem like anything to be alarmed about.”  As a parent, I’m alarmed.  Presumably, none of these dead children had been vaccinated—the swine flu vaccine is not yet widely available and most of these cases were swine flu.  Think of the hundreds of other deaths we can actually prevent with vaccination this year.  There are potentially hundreds of more children who will die of the flu this year, not because it is more virulent, but because it is more common.  We can reduce this number with one simple intervention.  Do it.

31 Comments

  1. I’ve been haunting Maryland’s Dept of Health website waiting to find out where I can take my kids to get them this vaccine. (My husband has diabetes, so I’m dragging him next and I figure I’ll get it then if they’re vaccinating healthy adults.)
    So far Maryland has had one clinic but I didn’t find out in time, which is why I’m now checking the site every day.
    I’ve also been talking the vaccine up at my daughter’s preschool, urging the vaccine on everyone I can get to stand still long enough. I figure that every person I can convince to get vaccinated makes my children a little bit safer.

  2. Denice Walter

     /  October 11, 2009

    Friday,CNN’s Sanjay Gupta cited 76 children’s deaths from swine flu *alone*.I didn’t notice altmed “experts” quoting your/his figures, as they keep reciting the mantra of “Flu is mild”/”Fear the squalene,etc.”.(This may be the new altmed teaching: flu is “mild”,just like “cancers spontanously regress”, and “HIV doesn’t progress”).

  3. There are three issues that seem to be very hard for the public to understand.
    1. The naivety of the population to a novel virus means we will most likely see a anomalously high year of “flu-like” infections.
    2. The 2009 H1N1 vaccine is no different in the fact that a new vaccine is produced every year by the same process. The seasonal vaccine is just as new as the 2009 H1N1 vaccine this year and has undergone the same production process.
    3. Though this virus is not any more dangerous than the seasonal virus we see a quite different population at risk
    It amazes me that these are such hard concepts for the public to understand, maybe once the flu season comes around and we have co-circulation people will see why this is an important problem to deal with. Australia seemed to learn this lesson and it looks like we’re set to do the same in US.

  4. BaldApe

     /  October 11, 2009

    Simple concepts are hard for the public to understand because of the “help” the media gives. The idea that “both sides” must be given, when one side is, well, right, and the other is asinine doesn’t help much.
    But the bigger problem is that nobody in the media has the sense of a grasshopper’s hindquarters. The simplest middle school level science is beyond their feeble grasp. Examples are legion.

  5. davidp

     /  October 11, 2009

    In Australia’s swine flu epidemic earlier this year, the death rate seemed well below 1% – perhaps because it infected so many otherwise healthy kids. Obviously the lower death rate is a very good thing, especially since it spread incredibly far and fast among kids in Northern Melbourne where I live.
    My oldest child and I are off to get vaccinated this week, having successfully taken prophylactic tamiflu when three kids in the household had swine flu.

  6. PalMD

     /  October 11, 2009

    I certainly don’t expect a death rate anywhere near 1 percent…that would be a disaster. But it has happened. Even with a low death rate, the increased number of cases will mean more deaths.

  7. Chuck

     /  October 11, 2009

    Looking at the graph in detail, it appears to me that the death rate is far more than twice as high for this point in the season. Looking at weeks 31 through 39 (roughly August and September) for the various years, it appears that:
    In August and September 2006 there were no pediatric flu deaths.
    In August and September 2007 there was 1 pediatric flu death.
    In August and September 2008 there were no pediatric flu deaths.
    In August and September 2009 there were 37 pediatric flu deaths.

  8. Mu

     /  October 12, 2009

    One question, does the immunization still make sense if you have been exposed to the virus already; both my work place and my kid’s daycare had confirmed H1N1 cases?

  9. PalMD

     /  October 12, 2009

    The graph figure for this year’s flu deaths includes seasonal flu and swine flu. We have both, although it’s switching over to mostly swine. IOW, we have a butt-ton more flu cases this year which means a lot more deaths.

  10. Calli Arcale

     /  October 12, 2009

    Mu — probably, yes, the vaccine still makes sense. Just because the flu had an opportunity to reach you doesn’t mean it did.
    That said, the H1N1 vaccine will not be available as quickly as the seasonal flu vaccine, because production started later. (And it is also impacting seasonal flu vaccine availability, since there is really only so much vaccine manufacturing capability available, and more H1N1 means less seasonal.) But the H1N1 season has clearly started, so authorities are triaging use of it. I think right now it’s still just health care workers who are getting it, so they can’t make their patients sicker, can’t bring it out of the hospital and into the general public, and can stay healthy to tend to the ill later. Next will be children with specific serious health concerns, and maybe pregnant women. It’s possible they’ll actually run out before they get to healthy adults, but keep your fingers crossed. 😉 I know they were talking about having doctors specifically call their patients in, rather than allowing people to make appointments, as this also permits triaging. They’ll call you if you fit the profile of someone who would get maximum benefit.
    I’ve been fighting a resurgence of my asthma lately, so I’m gonna get it as soon as I can. I’m getting the seasonal flu vaccine on Friday, along with the rest of my family.

  11. Dr. Feere

     /  October 12, 2009

    I just heard on the Today Show from Dr. Nancy Snyderstein that 5,000,000,000 kids will die and 1,000,000,000,000 could be permanently damaged from the flu. I suggest getting the live nasal mist vaccine twice, the seasonal flu shot 4 times and the H1N1 shot six times. Then maybe, just maybe, you might live. Please forward to the NY Times, Newsweek, Time, CNN and all the other fair, non-conflicted media outlets! Also, check out Dr. Profits wonderful article in todays NY Times!

  12. Dr. Trueth, MD

     /  October 12, 2009

    Hey Pal, is this science?
    0.5 parts per billion (ppb) mercury = Kills human neuroblastoma cells (Parran et al., Toxicol Sci 2005; 86: 132-140).
    2 ppb mercury = U.S. EPA limit for drinking water
    20 ppb mercury = Neurite membrane structure destroyed (Leong et al., Neuroreport 2001; 12: 733-37).
    200 ppb mercury = level in liquid the EPA classifies as hazardous waste based on toxicity characteristics.
    25,000 ppb mercury = Concentration of mercury in multi-dose, Hepatitis B vaccine vials, administered at birth from 1991-2001 in the U.S. and no other industrialized countries.
    50,000 ppb mercury = Concentration of mercury in multi-dose DTaP and Haemophilus B vaccine vials, administered 8 times in the 1990’s to children at 2, 4, 6, 12 and 18 months of age and currently “preservative” level mercury in multi-dose flu, H1N1, meningococcal and tetanus vaccines. This can be confirmed by simply analyzing the multi-dose vials.

  13. PalMD

     /  October 12, 2009

    Dr. Feere,
    I find it hard to believe that anyone is claiming that 5 billion children will be affected, given that there are not 5 bil. children in the world.

  14. Robert S.

     /  October 12, 2009

    Dr truther,
    No, that’s not science.

  15. Joe

     /  October 12, 2009

    Million, billion, trillion? They all mean the same now. Just ask the W.

  16. Calli Arcale

     /  October 12, 2009

    Yes, Dr Trueth, if you soak a neuron in a vial of thimerosal-preserved vaccine, it probably will not end well for the neuron.
    Fortunately, vaccines are not injected into the brain, and very few people happen to keep their cerebral neurons in their deltoids or quadriceps or subcutaneous fat. You may be different; if your brain is actually in your arm, you might want to request that a different injection site be use.

  17. JohnV

     /  October 12, 2009

    @ Calli Arcale
    I would suggest the rare gluteus maximus injection might target his neurons.
    *rimshot*
    @ Dr. Trueth
    I could have used that as an example to my students of why they must engage their brains before mindlessly repeating information they’ve read.
    Here’s a similar problem, perhaps you can point out what is missing: Car A gets 30 mpg. Car B gets 60 mpg. Which car drove further?

  18. Mu

     /  October 12, 2009

    The old concentration vs. amount gambit; it’s like the people ranting against energy saving light bulbs due to the mercury content, and not realizing that the amount of mercury in the bulb is negligible compared to the amount blown in the air by coal fired power plants (500 kg annually vs. 50 tons annually). So if we save 5 % energy, we reduce the mercury output 4 times over the amount needed for the bulbs.

  19. Kenneth

     /  October 12, 2009

    I’m wondering what the source of the graph is? I have looked around for information on the mortality rate and haven’t found this anywhere else.

  20. PalMD

     /  October 12, 2009

    sorry, thought i gave it:
    http://cdc.gov/flu/weekly/

  21. Paula

     /  October 13, 2009

    Calli writes, re vaccine first going to healthcare workers and ” Next will be children with specific serious health concerns, and maybe pregnant women. It’s possible they’ll actually run out before they get to healthy adults”–curious how we’re only now hearing these hints/admissions that maybe there won’t be vaccine for everyone, after all. In this state, prison guards and some police are among the first responders slated to get it (no prisoners, mind you); isn’t this a case of “sauve qui peut”? And consider the placing of seniors last (very possibly vaccine will run out before they, etc.), whereas the serology studies (NEJM 9/10, and others) indicate only 33 percent of older persons showing immunity. Grab grab, is it not?

  22. Mary

     /  October 13, 2009

    Calli, unfortanently the purpose of intramuscular injection of vaccines is to provide rapid access to the bloodstream which I think connects to the brain.

  23. PalMD

     /  October 13, 2009

    Only in people with the requisite organ.

  24. Kemist

     /  October 13, 2009

    Calli, unfortanently the purpose of intramuscular injection of vaccines is to provide rapid access to the bloodstream which I think connects to the brain.

    Ah, if it were that simple to get something in the brain…
    A brain cancer patient might be very happy indeed to avoid having to take chemo directly into his cerebro-spinal fluid. Would avoid quite some pain and risk of dangerous infection.
    Well, I suppose Google-U anatomy lessons don’t include anything on the hemato-encephalic barrier.

  25. novaccine4me

     /  October 13, 2009

    A friend’s son was recently in the hospital in a major metropolitan city with appendicitis, and asked the nurse how many cases of swine flu had been seen at the hospital, and was shocked to hear “none.” Over the next several days she asked the different nurses how many cases and each nurse confirmed that there had been no cases. Since all we have heard over the past few months has been that there is a raging epidemic and that it is having a more serious effect on children, she was very interested to hear there had been no hospitalizations. On her last day at the hospital, the nurse seemed in a hurry to get them out of the room, and when asked why, the nurse said there were a lot of very sick children. When asked what they were sick with, the nurse replied “asthma.”
    I recalled reading about two studies that were never written about in any major newspaper in the US, but which were very significant. One, “Childhood asthma is reduced by half when the first dose of diphtheria, pertussis, and tetanus (DPT) is delayed by more than 2 months vs given during the recommended period, according to the results of a retrospective longitudinal study reported in the March issue of the Journal of Allergy & Clinical Immunology.” This is an extremely important study in light of the chronic, life threatening and expensive nature of asthma. Second, from “ScienceDaily:
    Children Who Get Flu Vaccine Have Three Times Risk Of Hospitalization For Flu, Study Suggests.” Not only is the flu vaccine not preventing cases of flu in asthma patients, it is associated with vaccinated asthmatics being more likely to be hospitalized than asthmatics who did not receive the flu vaccine. Reporters, please let this be a call to you to end this propaganda campaign and report all the facts having to do with vaccination. These two studies paint a very clear picture about the relationship between vaccination and chronic illness, and there are many other studies, which can be easily found with a few strokes of a keyboard.
    According to the Asthma and Allergy Foundation of America:
    * Asthma accounts for one-quarter of all emergency room visits in the U.S. each year, with 2 million emergency room visits. [7] (This epidemic dwarfs the swine flu epidemic)
    * Each year, asthma accounts for more than 10 million outpatient visits and 500,000 hospitalizations. [8]
    * The average length of stay (LOS) for asthma hospitalizations is 3 days. [9]
    * Nearly half (44%) of all asthma hospitalizations are for children. [10]
    * Asthma is the third-ranking cause of hospitalization children. [11]
    * Asthma is the #1 cause of school absenteeism among children accounting for more than 14 million total missed days of school. [12]
    * African Americans are three times more likely to be hospitalized from asthma. [13]
    * Each day 11 Americans die from asthma. There are more than 4,000 deaths due to asthma each year, many of which are avoidable with proper treatment and care. In addition, asthma is indicated as “contributing factor” for nearly 7,000 other deaths each year. [14]
    * Since 1980 asthma death rates overall have increased more than 50% among all genders, age groups and ethnic groups. The death rate for children under 19 years old has increased by nearly 80% percent since 1980. [15] (22 doses of childhood vaccines recommended from birth to age 6 in 1983 – 48 doses of childhood vaccines by the age of 6 recommended in 2009 – not including swine flu vaccine)
    * More females die of asthma than males, and women account for nearly 65% of asthma deaths overall. [16]
    * African Americans are three times more likely to die from asthma. African American Women have the highest asthma mortality rate of all groups, more than 2.5 times higher than Caucasian women. [17]
    There is no action without an equal and opposite reaction. In the effort to prevent all experience with infectious disease, children are becoming immunologically and neurologically poisoned and have developed high rates of chronic illness and disability. Reporters, you owe it to this and future generations, to report the facts, not the hype.

  26. Kemist

     /  October 13, 2009

    The problem, you see, is that your anecdote is from the US, an industrialized nation where infections, thanks to vaccination and antibiotics, are not such killers of children.
    Where childhood infections and malaria are endemic, the few cases of severe asthma will almost certainly be overlooked, or in populations with no access to modern medicine, mistaken for something else.
    Another thing to mention is that the incidence of asthma is linked to obesity, because adipous tissue is, in addition to a storing place for fat, a producer of certain hormones, among which are inflammatory cytokins. Therefore, it is to be expected that in a country where obesity is on the rise (even among children, and for very unmysterious reasons), asthma, like type II diabetes (and other autoimmmune diseases as well as certain cancers), will definitely be on the rise.
    Please note that I am not saying that every person who has asthma has it because he/she is overweight, but that obesity is a known risk factor for asthma, which means that the obese will be overrepresented in the asthmatic population.
    Furthermore, asthma mortality is strongly linked to the lack of therapeutic control of the disease. As such, seeing statistics that african american women, who number among the poorest of the US, are oeverrepresented in asthma mortality rates surprises me almost as much as the fact that the sun rose today. As an asthmatic myself, I can tell you that asthma can be controlled, but depending on the severity of the disease, the correct medication to do so can be quite costly (fortunately, I happen to live in evil canuckistan, where that medicine is provided to me at reasonable cost).

  27. T.M.

     /  October 13, 2009

    Coming from a family with many asthmatics I can never understand the hype over such things as flu. My 8yo nephew cant even walk out his door without having an asthma attack. My 16 yo niece from other sister was found dead at home with the inhaler near her body. All 3 of my children 8-13yrs have asthma, and people just dont understand how hard it is on family life. Every trip, every food, every weather change comes with high risk. The numbers of children with asthma way outnumber the flu cases, but you dont hear about that every single day on the news. Every day!…I am so sick of hearing about the swine flu. My kids tried the flu vaccine 5 years ago, and all 3 ended up hospitalized with complications. Our allergist did not reco the h1n1 vaccine for them, but they all got the virus before the vaccine came out anyway. WIthin 10 hrs, all 3 had come down with a fever. Tested + for h1n1, and tamiflu was not recommended. One day of very high fever, one day mild fever, never stopped eating, and then it was over. We have been to the hospital 57 times for asthma related problems with our 3 kids, but not for the swine flu. Asthma is a much bigger problem for children all year long, and it gets no attention…
    so sick and tired

  28. Quint

     /  October 14, 2009

    Regarding the reference Kemist made about the incidence of asthma is linked to obesity. I believe you have it backwards. Obesity is more logically linked to asthma. As one who was born with it, in my my own experience, the issues with asthma prevented me from developing healthier habits early on. I’ll never be a track star. Further, growing up, I was never told I had asthma and therefore never received the controls & aid one gets nowadays.
    Regarding vaccines. I find the whole religion of flu shots baffling. It is the biggest faith-based malarkey I have ever witnessed. Scientific method is simply thrown out the window.
    Flu Bible Excerpts:
    “…the shot always works.” “…it will keep you from getting the flu…” “Oh, and if you get it, it is guaranteed to be less severe than without it.”
    I have only had one flu shot in the last 20 years. My wife and nurse mother-in-law badgered me into it. I have only ever had the flu once in 20 years….14 days after the shot. Bed ridden for a week and took 2 months to fully recover.
    You ask anyone on ‘the street’ why a flu shot isn’t good for more than one season, they know the answer, its been programmed into their brains. Yet, ask them why they should trust a shot formulated from a guess (albeit educated) 6-9 months before and you get a look of Gomer Pyle on Double Jeopardy.
    As an asthmatic, the greatest fear to my health is allergy season, not flu season.
    If people would exercise common sense in their dealings with people, the flu would not be nearly as prevalent. Wash your hands. If you are coughing/sneezing or otherwise spewing bodily fluids everywhere, stay home or wear a chemical suit.
    Knowing how fast influenza mutates, especially something of an interspecies flavor, do you really think the swine flu shot is anything more than placebo?

  29. Chris

     /  October 14, 2009

    T.M.:

    Coming from a family with many asthmatics I can never understand the hype over such things as flu.

    Though you might be interested in this Washington Post article: Asthma Most Common Condition In Hospitalized Swine Flu Patients:

    An analysis in 10 states of people hospitalized with the pandemic strain of H1N1 influenza shows that asthma is by far the most common underlying condition associated with severe cases of the disease.

  30. T.M.

     /  October 14, 2009

    Chris, You missed the point. Asthma is already prevalent. Why not the hype for asthma to begin with? It has been there causing death and complications for many many years before h1n1 came around. WHy dont I see that on the news every day!?
    Quint, dead on!

  31. JohnV

     /  October 14, 2009

    I’m sure once infectious asthma starts making the rounds, you’ll hear more about it.

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