OBT Magazine

It is the season of swine flu, and what parent out there isn't scared, even as we keep telling ourselves our concerns are overblown? At least I kept telling myself my concerns were overblown, until I met a mother last week whose 24-year-old son had just spent three weeks in hospital, receiving antibiotics intravenously, because of swine flu. This was a healthy young man with no underlying risk factors. Now I'm scared.

Should I be? According to a new study in the Journal of the American Medical Association (JAMA), probably not, but it's not a bad idea to get my 11-year-old daughter vaccinated anyway. And if you do get the flu, be concerned if the symptoms seem to improve, and then worsen again--it could be a sign that the flu has set off pneumonia or another bacterial disease.

There have been almost 4,000 deaths from H1N1 (the virus that causes swine flu) nationwide since the epidemic started last April, according to federal estimates. That's nowhere close to the 36,000 people who die each year from standard issue seasonal flu, but the difference is that 90% of those flu victims are elderly. Swine flu appears to be far less deadly for the aged, possibly because a similar strain of virus was circulating when they were young and they built up immunity. That means that deaths in young people are disproportionately higher, but overall deaths are much, much lower.

To figure out just who gets sickest, researchers sponsored by the Calif. Department of Public Health studied statewide data on California residents who were hospitalized with H1N1 flu between April 23 and August 11, 2009. They found 1088 cases of hospitalization, and 11% of those died. Just like with standard flu, the most fatalities, 18%, were in persons aged 50 years or older. Eight children, 7% of the total, died.

Overall, 32% of the hospitalized were children younger than 18, with infants having the highest rate of hospitalization. The median age (midpoint) of the victims was 27 years, slightly younger than typically found during a flu epidemic. Here's a key point: two-thirds of those hospitalized had underlying medical conditions that put them at greater risk from the flu, such as asthma or cerebral palsy. If you are healthy, you have less to worry about.

But here's another key point--over half of those hospitalized were obese. The researchers warned that "obesity may be a newly identified risk factor for fatal pandemic 2009 influenza A(H1N1) infection and merits further study." Given that one-third of the population is obese, including 10% of children, that's a worry.

In another study by the Centers for Disease Control and Prevention(CDC) of 36 children who died from H1N1 from April to August, researchers found that six had no chronic health conditions. But all of the children had a bacterial infection, the most common being staphylococcus aureus, the most frequent cause of staph infections. A third of the population carries this staph bacteria, usually in their nose or on their skin. There is a particularly worrisome strain of staph called MRSA that is resistant to the most common antibiotics, and can be deadly. Because the flu causes upper respiratory damage, it can allow the staph bug to make its way into the lungs. So again, if you or your child improves, but then gets sicker, it could be a sign that a bacterial infection has taken hold and you should seek medical attention immediately.

From the latest CDC briefing, where it was announced that the virus is active throughout the nation:

We wouldn't expect this many states to have this widespread of a disease. Flu can last until May. We don't know what we will see with this virus in general. Most of the illness is in younger people. More than half the hospitalizations are in people under 25. 90% of the deaths are in people under 65. A flip-flop from what we see with seasonal flu. The pediatric deaths are high...Two-thirds of the children who died from the H1N1 virus have underlying condition that is increase their risk of this problem. The leading underlying conditions in children who have died are severe neurologic problems like cerebral palsy and muscular dystrophy and asthma in terms of contributing to the severe outcomes.

Nationwide, the CDC reports that there were almost 5,000 lab-confirmed H1N1-related hospitalizations between Aug 30 and Oct 10. Of those, 19% were children 4 and under; 25% were 5 years to 18 years; 9% were people 19 years to 24 years; 24% were 25 to 49 years; 15% were 50 to 64 years; and 7% were people 65 years and older.

There were 292 lab-confirmed H1N1 deaths reported to the CDC over the 40 day period. The breakdown: children 4 and under, 3%; 5 to 18 years, 14%; people 19 to 24 years, 7%; people 25 to 49 years, 33%; 50-64 years, 32%; and people 65 years and older, 12%. (Note: These are the cases that have been confirmed by lab tests. New estimates released by the CDC on Nov. 12, using algorithms that multiply out the lab-confirmed cases, determined that 22 million Americans have become ill with pandemic H1N1 influenza in the past six months and 3,900 have died, including 540 children).

If you want to stay on top of H1N1 developments, the CDC maintains the most comprehensive and up-to-date web site, found here.

To learn how one family dealt with swine flu, read Working Parents co-writer Anne Newman's account here. And I wrote about the safety of flu vaccines here.