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The Flu Is Hitting Children Especially Hard This Season
Coronavirus dominates attention, but the more widespread flu has already killed thousands across all ages, and is infecting kids at unusually high rates
Sumathi Reddy
Feb. 3, 2020 12:23 pm ET
The flu virus is hitting kids hard. Doctors say it’s not too late to get vaccinated.
Photo: Getty ImagesEvery day for the past few months, children have appeared in Ari Brown’s pediatric office in Austin, Texas, and tested positive for influenza.
“About 10% of the patients we’re seeing every day have the flu,” says Dr. Brown. “We’ve had five this morning.”
Public attention is fixated on the coronavirus. But the far more widespread flu virus is infecting people across the country—and hitting children particularly hard.
More than half of the positive influenza test results from public health laboratories this flu season have been in children and adults under the age of 25, according to the Centers for Disease Control and Prevention’s most recent weekly influenza report. That’s a higher portion than in the past few years, when less than half the cases were in kids and young adults.
The reason: The predominant strain circulating early this season was influenza B, which causes more significant illness in children than in adults.
“We’ve seen something this year that we haven’t seen in probably 27 years, which is a noticeable increase in the number of influenza B infections early in the season,” says Andi L. Shane, chief of pediatric infectious diseases at Emory University School of Medicine and Children’s Healthcare of Atlanta.
In recent weeks there has also been a growing number of influenza A infections caused by the H1N1 strain. (Coronavirus is an entirely different category of viruses than influenza.)
During the 2019-20 flu season, there have already been 68 reported pediatric deaths in the U.S., according to the CDC; 45 were caused by the influenza B strain. Typically the flu season peaks between December and February and can go as late as May. There were 143 reported pediatric deaths last flu season and 188 in 2017-18.
Overall, there have been at least 19 million U.S. cases of the flu this season, 180,000 hospitalizations, and 10,000 deaths, according to preliminary estimates from the CDC. There were 61,000 flu-related deaths in 2017-18 and 34,200 deaths in 2018-19. Public health experts say the levels of hospitalization are similar to recent seasons, but deaths are lower than usual and outpatient reports of influenza-like illness remain elevated.
Schools have felt the impact. Schools in states from Alabama to Tennessee to Oklahoma announced they were closing last week for several days to help prevent outbreaks of the flu after large numbers of students and staff were absent. Knox County schools in Tennessee closed all 88 of its schools for three days after more than 5,000 students out of about 60,000 were absent on Jan. 28, a spokeswoman for the district says.
There are three main types of the flu virus—A, B and C; humans are infected mainly by the A and B viruses. Generally, the A viruses are considered more serious, particularly H3N2.
But Dr. Brown, the Austin pediatrician, says that while influenza B has historically been considered a milder version of the flu, this year’s strain seems more virulent. “I think there was a concern that this was more of a novel strain that kids haven’t seen so they are getting sicker,” says Dr. Brown.
The current influenza B strain hasn’t appeared much in recent years, so children haven’t been exposed to it, says Lynnette Brammer, head of the CDC’s influenza domestic surveillance team. “The older adults have been exposed to it more, so they’ve got just more existing antibodies that will protect them,” she says.
The last influenza season where a B strain was predominant was in 1992-93, Ms. Brammer says.
This flu season, influenza B has been linked to 58% of reported flu cases in children under 4, and to 72% of cases in patients ages 5 to 24.
Meanwhile in adults 25- to 64-years-old, influenza B represents about 43% of cases so far, and only about 23% of cases in the 65 and over group.
Public health officials do have some relief that the predominant strain of the flu circulating is not the H3N2 strain, which has dominated in recent years and tends to cause the most deaths and hospitalizations, particularly in the elderly.
“Any time we can not have a H3N2 season, it’s a good thing,” says Ms. Brammer. “H3N2 tends to be very hard on the elderly—that’s who is most likely to be hospitalized and most likely to die.”
It’s unclear if this year’s flu vaccine was a good match for the Victoria B virus circulating. The CDC expects to have its vaccine effectiveness report out in late February.
Making the flu vaccine is an imprecise science that includes some guesswork. Scientists predict months ahead of time which strains will circulate the following flu season, choosing two A and two B strains to include in the virus.
The vaccine included the B Victoria but some experts speculate that it may be a different version. Ms. Brammer says though the vaccine B strain is genetically different than the one circulating, it’s 60% antigenically similar, meaning the molecular structures on the surface of the virus are similar. “The match isn’t bad,” Ms. Brammer says.
Experts say that even if the vaccine doesn’t exactly match the circulating strains, it’s still far better to get a flu shot than to skip it. The vaccine helps lessen the duration and severity of the illness for people who do get sick. And most importantly, vaccination helps prevent the spread of flu to others, including infants 6 months and under, who can’t get a flu shot.
Heather Felton, a Louisville, Ky., pediatrician, says she’s seeing three to four children a day test positive for influenza B. But if children come in and they have been symptomatic for more than 48 hours, they aren’t always tested, because it doesn’t change the way influenza is treated.
Those who have been symptomatic for under 48 hours can take an antiviral medication, which can reduce the duration of influenza by a day or two.
Dr. Brown, the Austin pediatrician, says she is starting to see more influenza A now, mostly among children who weren’t vaccinated. She says children and adults who get the flu despite getting vaccinated will often have a shorter and milder course of illness.
“Some protection is better than none, and it’s not too late to get the vaccine, because we will be in our flu season for some time,” she says.
Protecting Yourself and Your Child From the FluDoctors recommend these steps:
*Get the flu vaccine: It’s never too late.
*Stay home if you have the flu or think you have it.
*Cover your mouth when you cough or sneeze.
*Don’t return to school or work until you are fully recovered and have been fever-free for at least 24 hours.
*Don’t share food and drink.
*Wash your hands with soap and water frequently.
*Don’t touch your face. Your hands are the main carriers of germs and can introduce them into your body by rubbing your eyes, nose, and mouth.
Write to Sumathi Reddy at sumathi.reddy@wsj.com |
