A perfect winter storm developing?

A few news stories hit my inbox all at once yesterday--and the combination of them doesn't bode well for childrens' health; more after the jump.

First, despite several years now of banging the drum for having kids vaccinated against influenza, they're still being overlooked when it comes to pandemic planning:

Children would likely be both prime spreaders and targets of a flu pandemic, but they're being overlooked in the nation's preparations for the next super-flu, pediatricians and public health advocates reported Wednesday.

The report urges the government to improve planned child protections, including how to care for youngsters if a pandemic closes schools.

"Right now, we are behind the curve in finding ways to limit the spread of a pandemic in children even though they are among the most at risk," said Dr. John Bradley of the American Academy of Pediatrics, which co-authored the report with the Trust for America's Health.

The story brings up 3 issues that haven't been addressed: no masks available in childrens' sizes (and even if they were, would kids leave them on? Certainly it's tough enough to get even adults to use them effectively). What about vaccine doses for--and efficacy in--children? There has been some investigation already into H5N1 vaccine for adults (with not-so-great results thus far), but to my knowledge, nothing has been done yet in kids. (And of course, that's assuming H5N1 would be the pandemic strain, which is far from certain). Also, they mention something I'd not even considered regarding potential school closings: what happens to kids who rely on the school lunch program, if the schools are shut down in the event of a pandemic?

In a second story which comes as little surprise, parents are increasingly lying about their religious beliefs to avoid vaccinating their kids, due to autism fears:

Sabrina Rahim doesn't practice any particular faith, but she had no problem signing a letter declaring that because of her deeply held religious beliefs, her 4-year-old son should be exempt from the vaccinations required to enter preschool.

She is among a small but growing number of parents around the country who are claiming religious exemptions to avoid vaccinating their children when the real reason may be skepticism of the shots or concern they can cause other illnesses. Some of these parents say they are being forced to lie because of the way the vaccination laws are written in their states.

"Forced to lie." Right. Meanwhile, because she's worried about discredited research suggesting a link between vaccines and autism, she's putting everyone's kids at risk:

"When you choose not to get a vaccine, you're not just making a choice for yourself, you're making a choice for the person sitting next to you," said Dr. Lance Rodewald, director of the CDC's Immunization Services Division.

(Orac also offers his take on this topic).

These two stories also feed back into what I wrote on Monday about regarding methicillin-resistant Staphylococcus aureus (MRSA) increasing in the community, and specifically, recent outbreaks in schools. Following reports of a recent MRSA outbreak in a Virginia school comes news of another one in Texas.

So, more explicitly, how do all these stories tie into each other?

You may remember a few years back that there were reports of a spike in influenza deaths in children in the U.S.. These weren't due to influenza alone, but like many influenza fatalities, were caused by influenza complicated by secondary bacterial infections, including MRSA--which proved to be a highly fatal combination. Last year's flu season wasn't too bad, but still the combination of influenza and MRSA proved to be deadly for a number of children.

Kids still aren't getting influenza shots at the rate recommended, despite being in a high-risk group for influenza deaths (and being efficient little spreaders of the virus). Add in the resistance to vaccination that many parents are expressing (including to voluntary shots such as influenza), and the winter cold-and-flu season has the potential to be even worse than usual for kids in the coming years. Many schools are already increasing awareness regarding Staph infections, but as the article notes, they're incredibly difficult to control:

Rappahannock Superintendent Bob Chappell said school employees also followed a local hospital's advice to mop hallways and classrooms with a bleach solution. The cost of the cleanup: more than $10,000.


"What's clear to us is that this bacteria is coming into our schools from the community because the cases are so widespread, and there appears to be no pattern," said Montgomery schools spokesman Brian Edwards.

As always, washing hands and doing everything possible to keep one's germs to oneself are critical, but even our best efforts can be unsuccessful (as I can currently attest, suffering from a bad cold that unfortunately my son also caught). Once mainly a hospital pathogen, MRSA has become far more common in the community: as they note, it's widespread, and the isolates they've examined so far don't appear to be from a common source (which would likely be easier to get rid of). And of course, missed vaccinations don't only put children at a risk of serious complications from influenza, but a host of other diseases as well. I hope we don't need this kind of resurgence to make people remember how serious these diseases can be.

Image from http://www.cookiemag.com/images/brain/2006/09/br01_colds.jpg

More like this

This was first posted at Science-Based Medicine on Monday, but I can't seem to keep myself from cross-posting. --PalMD I've been thinking about an interesting organism lately, an organism that illustrates some basic principles in science-based medicine. The organism is called Haemophilus…
In William Osler's day (turn of the 20th century), pneumonia was called "the old man's friend," because it took the elderly away quietly and with relatively little fuss. It was most often caused by the pneumococcal organism, now called Streptococcus pneumoniae. When penicillin came on the scene in…
Flu shots are rolling out, and there should be no shortage this year. A few new articles remind the public of the importance of these vaccinations, especially in high-risk groups (something that I touched on here regarding data showing that vaccination during pregnancy can help protect the newborn…
Every parent's or grandparent's nightmare is to have their darling little one suddenly carried off by illness. Flu isn't on the radar screen of most parents but in recent years the public health community is taking notice. The first alarm occurred in the bad flu season of 2003 - 2004 when a…

I would love for schools to release the rate at which students are vaccinated. Perhaps that would make some parents feel bad about skipping them.

Not only do I agree that we need to worry about MSRA, but we also have other infectious diseases that are getting stronger. According to proMed-mail, a couple people died from acute gastroenteritis last season. That's a first. And as I can attest, AGE with the norovirus outbreak from last year was unbearable. I actually ended up in the ER because I was in too much pain in the bad parts of the abdomen. And already this season my children and I have shared a moderate to high fever that was likely a viral meningitis. Perhaps its having two young kids that makes me more aware of infectious outbreaks, but it seems like there have more lately of more dangerous strains.

No masks in kids sizes?

I could well be wrong but I think I've seen pictures from either urban China or Japan with kids wearing masks like their elders do when they have a sniffle. Maybe they are home modified or only available in certain markets?

In the AAP report, what they note is that "there are no FDA-cleared or NIOSH-approved respirators for children," but there are smaller ones that can fit older kids.

So the mask link I supplied that describes itself as the Bird Flu 20 or somesuch is in fact stretching the truth?

Good to know.

Lance Rodewald is THE MAN! The bit about making a choice for the person next to you...that is what needs to be hammered.

Never mind Pandemic Planning - why did 68 children die last year from a preventable disease - seasonal influenza?

After watching one of my health system's infection control specialists pound the table 'We must save the babies!', I collected every bit of vax data that I could find for her (well, find through Google, anyway). I think the most moving argument was made at American Lung Association's 'Faces of Influenza' site. Tons of downloads, but be sure you have Kleenex in the house before you go to the detail page for immunizing children.

I saw on the front page of a news paper today that supposedly MRSA is to blame for the death of a 12 year old Brooklyn boy. I do not know the details but it is the first front-page MRSA-related death I have seen so far around here.