Fwd: Feds Request Reports of Children's Flu Deaths - guess why?

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http://www.signonsandiego.com/news/metro/20031231-9999_6m31flu.html

Federal officials want better tracking of virus

By Hasemyer

UNION-TRIBUNE STAFF WRITER

December 31, 2003

When children started dying and worried parents started asking how

bad the flu season is this year, federal health officials decided it

was time to keep better track of the virus that has sickened much of

the nation.

Until last Friday, states were under no obligation to report flu

deaths among children or people of any other age.

Although there still is no requirement that flu deaths among adults

and nonfatal cases of flu be reported, deaths of children under 18

are now supposed to be reported to the Centers for Disease Control

and Prevention.

National health officials made the request to doctors and hospitals

to determine whether a pattern of flu and flu-related illnesses is

emerging in children. However, figuring the number of overall flu

cases remains an imprecise science.

In San Diego County, at least nine people of all ages have died of

flu-related illness, this flu season, and the best indicator of the

severity of the illness in the county is that hospital emergency

rooms report 28 percent of the people seeking treatment come in for

the flu.

When alarm started to spread over the deaths of youngsters, " it

became apparent that it was time to start building a better

understanding of pediatric deaths attributed to influenza, " said Dr.

Tim Uyeki, a medical epidemiologist in the influenza branch of CDC.

" By asking for reports of deaths of children, I think we are hoping

to better understand the impact of influenza this year and in the

future, " he said.

That understanding may lead to better prevention to protect children

from the illness, he said.

Health officials say at least 42 children nationwide have died this

season, about half of the number of children health officials

estimate die annually of the flu.

But that estimate is so variable it could be way off in any year.

Consequently, it cannot be trusted as an accurate measure of whether

the death count this early in the flu season is extraordinary, Uyeki

and other health officials say.

Because the infectious bug has sickened so many more people early in

the season, which generally runs from November through March, health

officials want to go beyond the usual ballpark estimates that are

based on computer models and a sampling of confirmed cases.

" We'd like to be a little more precise, especially when it concerns

children, " Uyeki said.

The flu, a seasonal virus that attacks the respiratory system and

leaves people with high fever, cough, congestion and body aches, has

never been a reportable illness.

This year, the flu has hit 46 states, prompting CDC to say it is

nearing epidemic levels.

The CDC and a large majority of states do not track flu cases because

it's difficult to tell the flu from other common winter viruses, and

because testing is often unreliable.

That, coupled with the large numbers of cases – an estimated 20

percent of the population gets sick with the flu every year – make

reporting fickle and not enlightening, health officials say.

Complicating the issue is that by the time people seek medical

treatment they often are suffering from aftereffects of the flu, such

as bronchial infections.

From San Diego County across the state and nation, the best health

officials can do is estimate the number of people getting sick with

the flu and dying because of it. For adults, mostly people over 65,

there are an estimated 36,000 deaths associated with the flu

nationwide in any given year.

Yet Uyeki agrees with other heath officials who say they do not think

people face any greater risk because of the lack of definitive flu

reporting.

Simply put, doctors know the flu will strike every year. So unlike

reportable diseases such as hepatitis A or meningitis, the flu does

not come as a surprise, said Dr. Gonzalo Ballon-Landa, the chairman

of the San Diego County Medical Society's Group to Eradicate

Resistant Microorganisms.

" If there is an outbreak of hepatitis A, for example, you want to

know quickly so you can isolate the source and make precautions

against any further spread, " Ballon-Landa said. " With the flu we

cannot get a great deal of control over it like other reportable

diseases. "

An informal network of doctors, nurses, hospitals and clinics serves

as a reliable grapevine that keeps health officials in touch with the

spread of flu, health officials say.

If there is a surge in flu cases at one hospital, doctors there alert

other facilities, said Dr. Jim Knight, president of the county

medical society.

" You get an idea of what's going on day to day because of the chatter

going back and forth, " Knight said. " If there is a spike or some

matter of concern to one doctor or hospital the word will get out –

big time. "

When emergency rooms start to fill up and more people are admitted to

hospitals with flu and flu-related illnesses, that's a good gauge,

health officials say.

Besides informal communications, CDC has established sentinel

hospitals throughout the country that report flu cases. Ten of San

Diego County's 26 hospitals have been designated as sentinel

facilities.

Such hospitals report flu cases, and from that information the CDC

makes estimates.

" It gives a pretty accurate picture of something that can be

difficult to gauge, " said Dr. Wilma Wooten, deputy health officer for

the county's Health and Human Services Agency.

Over the last decade, the system has proven to be a reliable

predictor of flu, she said.

Exact numbers really aren't important, Wooten said. What is important

is recognizing the onset of the flu season and trying to get the word

out to people to take precautions to avoid getting sick.

" What we see in the trends serves us just as well as knowing precise

numbers, " she said.

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Hasemyer: (619) 542-4583; david.hasemyer@u...

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