Flu plus staph is killing more kids

[Shiloh]

Source: http://www.suntimes.com/news/nation/1203743,flu1005008.article

Flu plus staph is killing more kids

October 5, 2008

FROM ASSOCIATED PRESS

CHICAGO ? More children have died from flu because they also had staph infections, according to a new government report that urges parents to have their kids get the flu shot.

The number of deaths wasn?t high ? 73 during the 2006-07 flu season ? but there was more than a fivefold increase in hard-to-treat complications. And preliminary figures indicate deaths rose again during this past winter?s flu season.

Public health officials say the numbers underscore the importance of a brand new recommendation that all children, from 6 months through 18, get routine flu shots. Before this year, shots were recommended for kids under 5.

More than half the children who died were between the ages of 5 and 17 and had been healthy until they got the flu.

Parents shouldn?t panic, ??but it?s an important message to say even healthy children develop complications and die almost before anything much can be done for them,?? said Dr. Gregory Poland, a Mayo Clinic infectious disease specialist. He was not involved in the federal study, but has worked with a federal vaccine advisory committee and has consulted for vaccine makers.

Flu season is just beginning and this year?s vaccine should be widely available later this month.

While few children die from the flu virus, it puts about 20,000 U.S. kids in the hospital each year.

Only 6 percent of the children studied who died had been fully vaccinated against the flu. Two doses are recommended each flu season for children aged 6 months to 8 years who have not been vaccinated previously; for older kids, just one dose a year is needed.

The study, appearing in the October edition of Pediatrics, is based on an analysis of reported flu deaths from the 2004-05 through 2006-07 seasons. Flu deaths in children during those years totaled 47, 46 and 73, respectively.

The percentage of those who also had bacterial infections jumped from 6 percent to almost 36 percent. Most had staph infections, and 60 percent of those involved the dangerous MRSA bug that is resistant to antibiotics.

More recent data suggest flu deaths among children have continued to rise, with 86 tallied for the 2007-08 season in a preliminary report last month, said Lyn Finelli, the study?s lead author, who is a researcher for the Centers for Disease Control and Prevention.

Preliminary information also suggests there?s been no drop in fatal flu-staph cases in children and those could still be on the rise too, she said.

Staph germs commonly live in the nose or skin without causing illness; more than one-fourth of U.S. children and adults carry them.

These bugs can become deadly when they get into the bloodstream, sometimes through wounds. The flu is thought to make people more susceptible to bacterial infections like staph, Finelli said.

Details on how children in the study died were not available but some developed bacterial pneumonia, seizures and shock.

Finelli said parents should take children to the doctor when they have flu symptoms and signs of other complications. These could include extreme fatigue, no thirst, or in older children complaints about feeling very ill.

 

[Giuseppe]

Re: Flu plus staph is killing more kids

Also at FT: http://www.flutrackers.com/forum/showthread.php?t=81439

 

[Giuseppe]

Re: Flu plus staph is killing more kids

CIDRAP >> Bacterial coinfections boosting child flu deaths

Bacterial coinfections boosting child flu deaths

Maryn McKenna * Contributing Writer
Oct 7, 2008 (CIDRAP News) ?

The number of children who have died from a combination of influenza infection and bacterial pneumonia?in many cases due to the superbug methicillin-resistant Staphylococcus aureus (MRSA)?has risen sharply over the past few years, federal epidemiologists say in a new report that urges flu shots as a preventative.


Overall, the researchers say, child deaths from influenza are relatively uncommon.

There were 166 between autumn 2004 and spring 2007, according to a new national reporting system, only a few more than the 153 that occurred in the harsh 2003-04 flu season and prompted the reporting system's founding.

But child deaths from flu are rising, and serious complications from bacterial infections such as MRSA are playing a much larger role.

Staph infection is difficult to prevent:
The bacterium lives on the skin and in the nostrils and causes disease unpredictably. But "you can't have this overwhelming catastrophic complication without also having the flu, so if you can prevent the flu, you can prevent the coinfection," Lyn Finelli, DrPH, chief of influenza surveillance at the Centers for Disease Control and Prevention (CDC), said in an interview.

Finelli is lead author of the report in the October issue of Pediatrics, which is co-authored by flu and MRSA researchers from two CDC divisions.

The article analyzes reports of child deaths from flu filed by 39 states and two local health departments since the CDC made child death from flu a nationally reportable illness in 2004.

Issue emerged 4 years ago
The rate at which children die because of flu is thinly researched; it emerged as an important health issue only after the 153 deaths in the 2003-04 season were tallied. Up to that point, modeling based on flu surveillance reports and death-certificate data had estimated that 28 to 92 children younger than 5 died of flu each year in the United States.

The new surveillance system, which the authors acknowledge does not yet report all deaths, found 47 child deaths from flu in the 2004-05 season, 46 in 2005-06, and 73 in 2006-07, all relatively mild flu seasons. (Preliminary reports from 2007-08, not included in the paper, have identified 86 deaths.)

The deaths were very rapid: 45% of the children died within 72 hours of their first symptoms and 75% died within a week, while 43% died either at home or in an emergency room.

Bacterial infection superimposed on flu was not the only cause of death; children also died from seizures, encephalitis, and shock.

But it played an important role: Coinfections were involved in 6%, 15%, and 34% in the three successive seasons, a fivefold increase.

Almost all of that increase was due to S aureus: There were one staph infection in 2004-05, 3 in 2005-06, and 22 in 2006-07, and 64% of the staph infections were drug-resistant.(Oddly, very little illness was attributed to Streptococcus pneumoniae [pneumococcus] historically the No. 1 cause of pneumonia in children?a finding that may reflect the influence of new pneumococcal vaccines.)

Staph pneumonia is not a new phenomenon; from 3% to 10% of pneumonias that begin outside hospitals have been attributed to staph, but those pneumonias tend to occur in the elderly and immune-impaired. And the severity of simultaneous staph and flu infections has been documented after each influenza pandemic, in which large numbers of deaths were attributed to bacterial pneumonia.

But the staph pneumonias recorded by the new reporting system represent an apparently new development, because they occurred in previously healthy children infected with a seasonal flu virus that presumably does less damage to the lungs and immune response than a novel pandemic one. And they appear to be occurring at the same time as a rapid rise in MRSA colonization in the United States, which doubled between 2001 and 2004.

Most victims weren't vaccinated
A troubling aspect of the report is that most of the children who died had not been vaccinated against flu, which would have protected them from primary viral onslaughts such as encephalopathy, as well as from the lethal synergy of flu and bacterial infection. Ninety of the 166 had an underlying condition such as asthma or a seizure disorder, but only 18 of them had received even one of the two flu shots recommended for young children.

But, on the other hand, flu-shot recommendations for young children have changed over the past few years; 76 of the children were in age-groups not specifically recommended to receive flu shots in the years they died.

This flu season, for the first time, federal guidelines call for all children and teens up to 18 to receive flu shots. But motivating parents to get children vaccinated is proving challenging. A recent CDC report said that only about 21% of children 6 to 23 months old were fully vaccinated in the 2006-07 flu season, 2 years after guidelines recommended they be immunized, and a smaller study this year found only 16.5% of 2- to 5-year-olds were fully vaccinated.

Given low levels of vaccine protection, physicians should consider giving influenza antiviral drugs when children are hospitalized with flu, because the drugs have been shown to reduce complications, the article says. And given how rapidly the reported deaths occurred, vancomycin or another antibiotic of last resort should be considered if MRSA is suspected and until it can be ruled out by lab tests.

Finelli L, Fiore A, Dhara R, et al. Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection. Pediatrics 2008;122:805-11 [Abstract]
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<cite cite="http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct0708flumrsa.html">CIDRAP >> Bacterial coinfections boosting child flu deaths</cite>