We’re not through with the flu

The flu season has been mild so far in California, but it’s not over yet. There’s still time to get a flu shot and be protected for the rest of the season, which ends in late April.

Some Californians may have a false sense that the threat has passed because the state sailed through December and January without its emergency rooms overflowing with flu and other respiratory infections. But overall flu activity typically peaks nationally in February. Last year, California cases peaked in February and March.

Flu exacts a particularly high toll on the very old and the very young: About 150 to 200 of every 100,000 children between the ages of 1 and 2 are hospitalized because of flu complications; that compares with 125 to 225 of every 100,000 people older than 65, according to figures published in the December issue of the journal Pediatrics.

Last week, doctors at Miller Children’s Hospital in Long Beach were treating a 21-month-old who got the flu and then became critically ill with pneumonia caused by staphylococcus.

The child, who had been otherwise healthy, wasn’t vaccinated against the flu, said Dr. Jay M. Lieberman, a pediatric infectious disease specialist. “We’ve had two children die as a result of complications of influenza in the past two weeks at Miller,” he said. One was a child with cystic fibrosis, the other a 3-month-old who had been born prematurely .

Lieberman’s take-home message: Get your flu shot.

“We still have plenty of vaccine,” said Dr. David Dassey, deputy chief of acute communicable disease control for the Los Angeles County Department of Health Services. The vaccine produced for the 2002-03 season will protect against the strains that have been seen across the country this year.

Dr. Loring Dales, a medical epidemiologist with the state health department, said he hasn’t heard of flu outbreaks in California hospitals, nursing homes or jails. In the last few weeks, scattered cases have been reported statewide. L.A. County health officials investigated an outbreak in a day-care center and reported flu-like illnesses in schools. Fortunately, the rate of serious complications from flu is low among healthy school-age children.

“For most of the country, things have started picking up in the last week or two,” said Dr. Carolyn Bridges, a medical epidemiologist with the national Centers for Disease Control and Prevention’s in Atlanta. A strain of type-B flu from Southeast Asia has ripped through schools in the South and Midwest, where it hadn’t been seen before. In general, type-B strains tend to spread more easily among children, but the illness usually is milder and they recover faster.

However, the type-B strain now devastating other parts of the country hit California last March, causing some serious complications, Lieberman said. “The B-strain now hitting the Southern U.S. so hard could make its way over here, and we could have a late season outbreak of influenza B just as we did last year.”

It’s tough convincing people to get vaccinated. The CDC has long advised that senior citizens and those with chronic illnesses be vaccinated. Although it has recommended flu vaccines for chronically ill children with asthma, heart and lung disorders, diabetes, sickle cell disease or any kind of immune suppression, the vaccination rates among this group are only 10% to 20%, surveys have shown.

For the second winter in a row, the CDC’s Advisory Committee on Immunization Practices has recommended that healthy children between the ages of 6 and 23 months be vaccinated “when feasible.” In stopping short of recommending immunizations for every child, the CDC committee and the American Academy of Pediatrics have acknowledged several hurdles to overcome, including a lack of education about the consequences of flu and problems with insurance coverage. (The federal vaccine program that supplies free vaccines to doctors for low-income children will begin providing flu vaccines in March, Bridges said.) Some pediatricians said the groups also have been holding out for Food and Drug Administration approval of a flu vaccine given as a nasal spray, rather than by injection.

Without a stronger recommendation, however, many doctors didn’t provide flu shots this year for kids in this age group, and most of their parents didn’t know to ask.

One reason to vaccinate children is that they spread flu to friends and classmates, bring it home and spread it into the community. Japanese studies have shown that routine vaccination of school-age children dramatically reduced death rates from flu and pneumonia, Lieberman said. “By vaccinating the school children, they were disrupting the spread of influenza, not only preventing children from getting sick but protecting the parents and grandparents.”