Teens' Flu Deaths Show Illness's Unpredictable Nature

By Jennifer Huget
Special to The Washington Post
Sunday, March 1, 2009

The recent influenza-related deaths of two Maryland teens calls attention to the flu's unpredictable nature. It's not clear whether the boys, 13-year-old Ian Willis of Urbana and 15-year-old Zachary Weiland of Woodbine, had received flu vaccinations, but it appears that both were healthy teens -- not the compromised or frail people typically thought of as being susceptible.

The deaths aren't entirely anomalies. Every year, 36,000 U.S. deaths are attributed to influenza, according to the Centers for Disease Control and Prevention. Last flu season, 83 flu deaths struck people under 18; this time, with the flu season just underway, 17 children have died, not counting Ian and Zachary. (CDC flu reports are usually about a week behind.)

Influenza is a viral infection of the respiratory tract. It is characterized by rapid-onset high fever, headache, sore throat, dry cough, runny or stuffy nose and sore muscles. People with influenza typically remain quite sick for three to five days but usually recover on their own, although the cough can persist for weeks. Antiviral drugs can lessen the flu's severity if administered soon after symptoms begin, but officials have recently become alarmed because one of the two most commonly used antivirals, known by the trade name Tamiflu, has shown little efficacy against this year's prevailing flu strains.

In an apparently increasing number of cases, though, influenza is accompanied by bacterial infections; officials noted a marked increase in such secondary infections during the 2006-07 flu season and have watched numbers rise since. Bacterial infections, if caught in time and properly diagnosed, can often be treated with antibiotics. But symptoms of bacterial infection are hard for the layperson to distinguish from those of the flu, and by the time they are recognized, it's often too late for antibiotics. Moreover, many such infections are caused by bacteria such as MRSA (methicillin-resistant Staphylococcus aureus) that have become resistant to most frontline antibiotics.

Of the 17 pediatric flu deaths this season, 10 have involved Staphylococcus aureus infection, with four of those 10 involving MRSA.

The flu shot is the recommended protection, but it is no guarantee, especially because this year's formulation appears much less effective against some of the circulating strains than against this season's predominant one, against which it appears to confer strong protection. Even among healthy people it might only confer 90 percent protection; among those with chronic conditions, the elderly and the very young, protection can dip far lower.

Of the 63 pediatric deaths last year in which vaccination status was known, 58 of the victims, 92 percent, were not vaccinated.

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