76 Pediatric Deaths Due to H1N1- Special Precautions for Children at High Risk
THIS ARTICLE PUBLISHED TUESDAY, OCT 12, ON GOOGLE NEWS TOP STORIES OF THE DAY, USA TODAY, BASIL AND SPICE.COM, THE GEORGIA STATE DEPARTMENT DIVISION OF PUBLIC HEALTH SITE, FLORIDA TODAY, ALLTOP.COM, AND NUMEROUS OTHER ONLINE NEWS SITES.
As of last Friday, October 9, 2009, a total of 76 H1N1-associated pediatric deaths in the U.S. were confirmed by the Centers for Disease Control and Prevention (CDC). Over the last three years, deaths among children from the regular seasonal flu have ranged from 46 to 88. Given that it is yet only early October, the loss of 76 children due to the H1N1 virus raises significant concerns for their protection and safety. In this post, I address some important facts relevant to the care of children who may be at a higher than average risk for an H1N1-related complication, and also reiterate prevention guidelines that may be of benefit both to physicians and others taking care of such children.
DEFINING WHICH CHILDREN ARE AT A PARTICULARLY HIGH RISK FOR FLU-RELATED COMPLICATIONS:
1. It is well known that children younger than 5 years of age, and those who have high-risk medical conditions are at an increased risk of Influenza related complications. Children at higher risk include all children with immune supression, chronic kidney disease, diabetes, asthma, heart disease, sickle-cell disease, or other problems related to the lungs.
2. In addition to the above, children with any condition that affects respiratory function including neurological conditions such as intellectual and developmental disability, cerebral palsy, spinal cord injuries, seizure disorders, metabolic conditions or other neuromuscular disorders have higher risk.
3. Finally, children with poor nutritional and fluid intake because of prolonged vomiting and diarrhea, and children with an underlying metabolic disorder such as Medium-Chain Acyl-CoA Dehydrogenase (MCAD) Deficiency – are more susceptible to both the seasonal flu- and the H1N1 flu related complications.
It is particularly important that parents, caregivers, and physicians stay on the alert for worsening disease symptoms in ALL children, but particularly in high-risk children. In addition to the expected symptoms of H1N1 (fever, sore throat, cough, etc.), if new symptoms appear in sick children, such as apnea, dehydration, recurring infection, an altered mental state, or extreme irritability - any of these should be a signal to immediately take more aggressive steps to prevent the situation from getting worse. Children experiencing any one or more of the above mentioned conditions should be under continuous expert care.
CONCERNS ABOUT CONTRACTING PNEUMONIA
One of the main concerns that is relevant both for adults and children is the fact that oftentimes during serious flu outbreaks, bacterial pneumonia infections can also become widespread. Generally speaking, Influenza predisposes people to community-acquired bacterial pneumonia, and can often be an important related cause of illness and death. Because of this fact, CDC’s Advisory Committee on Immunization Practices recommends the following:
- A single dose of PPSV23 (pneumococcal polysaccharide vaccine) for all people 65 years and older, and for persons 2 to 64 years of age with certain high risk conditions. This is due to the fact that people in these groups are at an increased risk of pneumococcal disease as well as serious complications from influenza (both seasonal and the H1N1).
- PCV7 (pneumococcal conjugate vaccine) is recommended for children aged less than 5 years.
COMMON SENSE RULES APPLY
In nearly all cases involving efforts to prevent an H1N1 infection (whether in adults or children), common sense rules must apply – many of which have been stated in previous posts. Further, keeping well-informed with respect to the types of drugs available, as well as their side-effects is also equally important. As the H1N1 Flu is an emerging disease, it become particularly critical for us to observe its course carefully, and to stay soundly informed as well as equipped with up-to-date information. It is quite clear that children are particularly vulnerable to the H1N1 virus; For this reason, it is incumbent upon us to minimize the tragic loss of life in this population by becoming as well-informed as possible with respect to their protection. To that end, please refer to some critical precautions presented in previous posts (links above) and take advantage of the important resources provided at the end of this one.
RESOURCES:
CDC Guidelines for Prevention of Pneumococcal Disease
