By Susan Levine
Washington Post Staff Writer
Tuesday, March 7, 2006
As he waited his turn at the microphone, in an Atlanta auditorium filled with doctors and scientists, Gary Stein wondered whether what he had to say would make much difference. These were the experts, he realized, the people who spend a lifetime studying viruses and vaccines. They already knew all the facts, the statistics.
Still, they didn't know 4-year-old Jessica.
So Stein began talking, as a father who once had a little girl with hair the color and shimmer of champagne, a child who loved dress-up and Barbies and who was as healthy as they come until the day in January 2002 when she caught the flu. Less than 72 hours later, she was dead. Stein thought he could get through the main points of his remarks without stumbling. But as he stood before the federal Advisory Committee on Immunization Practices, explaining how his Falls Church family had been devastated, he choked up.
"Nothing and no one will ever fill the void left by Jessica," Stein told the gathering.
"It hit me pretty hard," he admitted later. It may have hit the experts hard, too.
The next morning, the 15-member committee voted for a surprise revision in national policy: It unanimously recommended that starting this fall, all children between 2 and 5 years old be vaccinated annually against influenza.
The previous recommendation only advised flu shots for children ages 6 months to 23 months and those 6 months and older with chronic illnesses. As long as they are generally healthy, children older than toddlers tend to just get sick from the flu. They go to doctor's offices or outpatient clinics but are seldom admitted to the hospital.
Children still suffer a "substantial" amount of influenza, however, said Raymond A. Strikas, an associate director at the National Immunization Program, which is part of the federal Centers for Disease Control and Prevention. And that was the major impetus for the committee's decision late last month. Its expanded coverage even includes parents and older siblings, because they also suffer by getting sick themselves or taking time off work to care for ailing youngsters.
All told, nearly 17 million additional people now will be urged to get protection against the flu, bringing the total to more than 120 million men, women and children across the United States.
"We're saying, 'This is the standard of care,' " Strikas said. "This is what you should be doing."
For Jessica Stein's parents, the new recommendation brings some comfort.
"If there are other kids that will get vaccinated," explained Doris Stein, the words hanging in the air without elaboration. The inference was clear: Other parents won't have to bury a child.
In this country, influenza is a serious public health problem that many health officials complain does not get the respect it deserves. It kills more than 36,000 Americans a year, of whom most are very young or very old or suffering from conditions or diseases that compromise their body's ability to fight the virus.
Children do die, however. During the 2003-04 flu season, when the new guideline was first broached, a particularly nasty strain struck earlier than usual and began killing healthy children -- more than 70 by the final count. One of its victims was 3-year-old Emily Lastinger. Her father traveled from Texas to Atlanta to address the advisory committee with Stein.
"It took great courage," said Gregory A. Poland, an internist at the Mayo Clinic who specializes in immunology and vaccine development. As a committee member, he has pushed for a recommendation to make universal coverage the national standard. Others support incremental progress, worrying that vaccine supplies could never meet demand otherwise. Any disruption to yearly production of flu vaccine would only worsen the problem, they fear.
"It's absolutely heart-wrenching to me to hear these stories and have people die of something so preventable," Poland said. "It's as if each person, each generation, each community has to learn the hard way."
This influenza season has seen few aberrations and no unusual virulence. As of mid-February, the CDC reported that just a dozen children had died. But each of those is an individual tragedy, stress the Steins, who recently began venturing into advocacy, connecting with other parents through a nonprofit organization called Families Fighting Flu. "It's very therapeutic," Doris Stein said.
Jessica is rarely out of sight in her family's home. Photos remain on the refrigerator, on a kitchen counter. On one end of the living room mantel is a picture of her, her parents and her younger brother, Eric, taken the Christmas before her death. At the mantel's other end is a more recent shot, of Doris and Gary, Eric and Johnny and Katie, the children born after Jessica died.
"It's like we have two different families," Doris said quietly as Katie, a 15-month-old burst of energy, took off across the room. Her older sister would be 8 now and in third grade, and "not a day goes by that you don't think about what she would be doing, what she would be like," Gary said.
Neither parent had any time to prepare emotionally when Jessica got sick. A virus had been going around her preschool, and both she and Eric caught it and then both got better. More than a week later, Jessica had a play date, and only after that did her mother notice that she seemed more tired than normal. By morning, all symptoms pointed to the flu, but Jessica was still eating well, her energy was no worse and she had no fever.
The third day was different. Jessica's hands were icy cold, and by evening her breathing seemed somewhat labored. Her mother called the pediatrician, who suggested they "walk -- don't run" to the hospital to check for dehydration. The next several hours replayed for a long time in her parents' minds: their daughter suddenly having trouble breathing, Doris being asked to step out of the room, Gary rushing over from home, a doctor saying Jessica had been stabilized. Five minutes later, an entire medical team emerged. The virus had fatally attacked Jessica's heart.
No one in the family had gotten a flu shot that year.
But no one in the family will ever again go without.