- The Washington Times - Thursday, December 4, 2003

Health officials in the United States and abroad said yesterday that very young children might be at increased risk from this year’s flu virus — the Fujian H3N2 strain — which has hit earlier and harder than any flu strain in 30 years.

“It does seem to be affecting children more than old people,” said Lynnette Brammer, an epidemiologist with the influenza branch of the Centers for Disease Control and Prevention (CDC) in Atlanta, yesterday.

She said it was not clear whether the flu strain soon would begin attacking older people, the most common flu victims in normal years.

“Everyone has the sense that this is different. We are working to get the answers. We are concerned, and we are trying to get a handle on what is going on. But we don’t know,” she said.

Millions of cases of influenza, or flu, have been reported in Europe and across the United States, already killing at least seven children in Britain and five in Colorado.

Doctors in Maryland and Virginia say they have seen a few cases of flu, but the Mid-Atlantic region has not been hit as hard as other areas.

“I’ve given a lot of shots. I have not seen any cases yet, but I will,” said Dr. Villamore Reyes of Cheverly.

Because of mild winters in the past few years, young children have been less exposed to an influenza virus, according to Dr. Klaus Stor, head of the World Health Organization’s (WHO) influenza program. “They are immunologically naive, unprotected,” he said yesterday in Geneva.

He said flu epidemics usually begin with children and then advance to the adult population two to three weeks after schools begin reporting absences. Historically, 95 percent of the 36,000 Americans who die from the flu each year are 65 and older.

Dr. Stor said it is too early to tell how dangerous Fujian will be for small children, but there is reason for concern.

“It is a very early start of the season, and many children are affected,” he said.

U.S. public-health officials agreed.

“There will be more cases this year, and it will be more severe. All those who get it are likely to be sicker,” said Dr. Diane Griffin, department head of Molecular Microbiology and Immunology at Johns Hopkins Bloomberg School of Public Health.

The WHO said yesterday this year’s flu season could be a killer for young and old.

“It’s obviously going to be a much tougher flu season than in the last few years,” said Dick Thompson, spokesman for the WHO’s immunological division. “All indications are that it will be worse than the last couple of years. Worldwide, it’s going to be very hard. … Most of the damage is caused by this strain.”

France, Norway, Spain, Portugal and Britain have been hit especially hard, with millions of cases and a number of deaths reported in the past few weeks. France is reporting 2 million cases of flu, many of the afflicted being children.

At least seven children have died in Britain.

As the flu sweeps across the western United States, Colorado is reporting more than 6,300 cases so far — more than were reported in the past two years combined. At least five, and possibly six, children in Colorado have died from flu so far this year. There also have been flu-related child deaths in Texas, Wyoming and New Mexico.

The CDC says the flu has been reported in 43 states, with 10 states amid “widespread” outbreaks, the CDC’s highest level of disease activity. Officials in Texas are calling the epidemic “unprecedented.” Maryland and Virginia are reporting “local” flu activity, in the middle of the scale.

“Parts of Virginia are badly affected. It won’t take long for it to get to Maryland or D.C.,” said Dr. Vinod Mody, professor of medicine in the Division of Infectious Disease at Howard University.

In 1918, a flu pandemic swept across the world, killing at least 650,000 Americans and between 20 million and 40 million people worldwide.

Dr. Griffin said a version of this year’s Fujian strain has been around since it emerged in the 1968 Hong Kong flu pandemic, which killed between 1 million and 4 million worldwide. No one believes this year will be a classified as a pandemic, but several experts said this flu season could mask a return of the SARS virus.

Each year about one in five people get the flu. On average, almost everyone in the world gets the flu — and gains some degree of immunization — every five years.

This year’s flu vaccine is not an exact match for the Fujian strain, but it does confer some protection beginning 10 days after a shot is administered.

Those who get the vaccine will not be immune but should suffer milder symptoms than those not vaccinated.

The WHO’s Dr. Stor said that in a normal year from 250,000 to 500,000 people can be expected to die from flu worldwide. This year he expects the number to be “at the upper level.”

And young children, who have never had the flu, are unprotected and vulnerable.

Dr. Jeffrey Brosco, a pediatrician at the University of Miami, said there is evidence to suggest that children from 6 to 24 months are most vulnerable to the flu in any year.

“Clearly, this season is going to be worse than the last few years. Kids younger than 2 years old should be vaccinated,” he said.


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