Flu as child killer

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 retrospective tally showed over 150 pediatric deaths associated with flu. That was more than half again as much as we thought were occurring, although data was not very good. So a new pediatric surveillance system was put in place. One of the things it is showing is that methicillin resistant Staphylococcus aureaus (MRSA) is a surprisingly common accomplice in pediatric flu deaths. An excellent summary by Maryn McKenna at CIDRAP News gives some of the details. McKenna is an authority on MRSA and knows a lot about flu, so her piece is well worth reading, as is her blog, Superbug, which focuses on MRSA. This is from her CIDRAP piece:

The number of children who have died from a combination of influenza infection and bacterial pneumonia--in many cases due to the superbug methicillin-resistant Staphylococcus aureus (MRSA)--has risen sharply over the past few years, federal epidemiologists say in a new report that urges flu shots as a preventative.


Staph pneumonia is not a new phenomenon; from 3% to 10% of pneumonias that begin outside hospitals have been attributed to staph, but those pneumonias tend to occur in the elderly and immune-impaired. And the severity of simultaneous staph and flu infections has been documented after each influenza pandemic, in which large numbers of deaths were attributed to bacterial pneumonia.

But the staph pneumonias recorded by the new reporting system represent an apparently new development, because they occurred in previously healthy children infected with a seasonal flu virus that presumably does less damage to the lungs and immune response than a novel pandemic one. And they appear to be occurring at the same time as a rapid rise in MRSA colonization in the United States, which doubled between 2001 and 2004. (Maryn McKenna, CIDRAP News)

In the past secondary bacterial infections in flu were thought to be mainly Streptococcus pneumoniae ("Diploccus" or pneumococcus) or Haemophilus influenzae. As McKenna notes, Staph pneumonia was for the old, the immunocompromised and the chronically ill. But infection with influenza virus seems to have special abilities. A recent paper in Nature Medicine (Sun K, Metzger DW. Inhibition of pulmonary antibacterial defense by interferon during recovery from influenza infection. Nat Med 2008;14:558-64) suggests that the ability to clear bacterial invaders is inhibited early on during infection with influenza virus. The flu virus may be turning healthy children into immunocompromised children (at least locally in the lung), accounting for the increasing MRSA superinfections, whose rate has been increasing year on year:

Bacterial infection superimposed on flu was not the only cause of death; children also died from seizures, encephalitis, and shock. But it played an important role: Coinfections were involved in 6%, 15%, and 34% in the three successive seasons, a fivefold increase. Almost all of that increase was due to S aureus: There were one staph infection in 2004-05, 3 in 2005-06, and 22 in 2006-07, and 64% of the staph infections were drug-resistant.

The relative absence of pneumococcal pneumonia may be related to availability of a vaccine against this bacterial agent. There is no vaccine for MRSA. But there is an influenza vaccine, and children 6 months and older have been added to the list of those for whom flu vaccination is recommended. At my recommendation my daughter had our grandchild vaccinated. I think it's a good idea, maybe even a life saving one. The newest grandchild is too young to be vaccinated for this flu season. So I'll have to use my usual coping mechanism for a grandpa's chronic anxiety: worry.

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We talk and we plan and we have government entities which have virtual and real game days of a pandemic start up. We spend tens of millions of dollars for health, fire, police, homeland security and all the gang to get together to practice what they will need to do in a pandemic. Yet---at the schools of America which we congregate our most precious love, our children, the very educated system is going to be the source of that Pandemic.

As a common operating practice across the nation, principals order the custodial help to either remove all supplies from the bathrooms or to put a "limited amount" in. My childs school has 1000 students. How far do you think one roll of TP and 50 hand towels will go? The reason for this unthinkable act? A very small percentage of students vandalize the bathroom by stuffing sinks, urinals, and toilets with the paper items. Smear the soap on handles and seats and the floor. And being educated adults they are stymied as to how to fix the problem other than just remove the offending material. Who cares about wiping when you have a bowel movement? Women should be able to shake just like a man. When confronted, the administration says they still have water and they can wipe their hands on the front of their shirt. Have we been teaching them to cough and sneeze into their clothing? Yeah I want them wiping their hands on their clothes. Yes I contacted the school district, prinicpal authority. Not going to discuss. Yes I contacted the health department. Yes they found no supplies in the bathroom. Can they do anything? No. Department of Education law states that the primary goal of education is to "provide a safe schooling community". I guess bad bacteria and virus are safe. The state Education system and the Federal Education system say it should not happen, it is abhorent but that due to the system there is nothing they can do to see that it does not happen.

An even more ironic twist is that the Health Department sends certified nurses out to the schools to teach the kids to properly wash their hands. LOL!!!!! And when the children move to middle and high schools, they don't have the tools to do it. Also they give the students the barest of time to get to each class and penalize severly students who are not seated in the class when the bell rings. Are the teachers happy when the student says he/she needs to go the bathroom? NO, they accuse the student of just wanting out of the classroom. Yet if nature makes a call upon the teacher, they go without being chastized for natural body functions.

I have to tell you that the parents at my school say they don't want to get involved? That it is an administrative issue? This is an issue for all America. To me it is obvious how MRSA has been able to run the school highway. The gym equipment is never cleaned. I hung out for almost a month after intra-murals and watched while the kids put up the sports equipment and everybody left. Maybe they have magic and the equipment was cleaning itself? Our schools are the super highway for all disease. My school district actually had 9 students and staff contract Hepatatis A from a pre-k student who was not potty trained. The staff then spread it thru the school with improper sanitation (lack of cleaning their hands!). Even that did not give them a heads up. Are the keyboards ever cleaned? I asked the custodian, we don't. I asked the media specialist, I don't. I asked the kids, we don't. As you might have guessed I am extremely upset and I am even more upset that no official or parent seems to be concerned about the situation. I am disallusioned with myself that I still have found no door to walk thru to make this right.

I stumbled onto your blog and see how hard headed I am? I thought one more try - CAN ANYBODY HELP?!!!