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How the flu turns deadly

This flu season is fierce and has already claimed the lives of at least ...

Posted: Jan 26, 2018 5:55 PM
Updated: Jan 26, 2018 5:55 PM

This flu season is fierce and has already claimed the lives of at least 37 children in the United States, according to the Centers for Disease Control and Prevention.

There were 11,965 new laboratory-confirmed cases during that week ending January 20, bringing the season total to 86,527. The number of people infected with influenza is believed to be much higher because not everyone goes to their doctor when they are sick, nor do doctors test every patient.

Flu commonly kills the elderly by leading to pneumonia, but can prove lethal in other ways

Children, especially those under age 5, are at higher risk than healthy adults for flu-related complications

Added to those scary stats, the World Health Organization estimates that annual flu epidemics result in about 3 to 5 million cases of severe illness globally and 290,000 to 650,000 deaths.

Although the fever and aches may feel terrible, most of us don't die from the flu. So how exactly does this common illness lead to so many dying?

"Influenza and its complications disproportionately affect people who are 65 and older. They account for 80% of the deaths," said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University.

But young children and people who have an underlying illness, such as heart disease, lung disease or diabetes, are susceptible to dying from the flu as well, he said. There are three ways adults can succumb:

Pneumonia

"The usual flu death is a person who gets influenza, gets all that inflammation in their chest, and then has the complication of pneumonia," explained Schaffner, who added that this is a "long, drawn-out process."

Pneumonia is an infection that causes the small air sacs of the lungs to fill with fluid or pus. Though this is the most common route to death, flu can be fatal for more unusual reasons.

Sepsis

"Much of the systemic symptoms that any of us have with influenza -- the fever, the aches and pains, the sense of exhaustion -- all of those are part of (our body's) response to the virus," said Schaffner. The symptoms we experience are an inflammatory response to the immune system "soldiers" that our body sends to fight any pathogen, he said.

"Pushing the war analogy, we all know there is incidental damage that occurs during the course of a war," said Schaffner, and so the flu can also take a perfectly healthy person "and put them in the ER in 24 to 48 hours."

Flu stimulates an immune response in everyone's body, but for some people, this natural response can be "overwhelming," noted Schaffner. "Young robust people can have such an overwhelming response that it's called a cytokine storm." Cytokines -- proteins that are created as part of the inflammatory response -- create a "storm" in the body, explained Schaffner: "And this cytokine storm can actually lead to sepsis in the person."

Kyler Baughman, 21, is one example of that happening. He died unexpectedly in December at UPMC Presbyterian Hospital in Pittsburgh after a bout with the flu. Baughman, a college student, worked two jobs and often posted pictures of himself at the gym on social media. The cause of his death, as reported by the Allegheny County Medical Examiner, was influenza, septic shock and multiple organ failure.

Heart attack

Chances of a heart attack are increased sixfold during the first seven days after a flu infection, a new study published Wednesday in the New England Journal of Medicine found. The study looked at nearly 20,000 cases of flu in Ontario adults age 35 or older.

The risk may be higher for older adults, said Dr. Jeff Kwong, lead author of the study and a scientist at the-Institute for Clinical Evaluative Sciences and-Public Health Ontario. Heart attack occurs when blood flow to the heart is abruptly cut off; this is also called acute myocardial infarction.

Since a few days usually elapse between getting sick and getting a lab test, Kwong said "the increased risk is probably within the first 10 days or so after exposure to the virus."

The research, which identified 364 hospitalizations for acute myocardial infarction among the flu cases studied, also showed a stronger association for influenza B than influenza A. "We would have needed more cases to determine if the difference was real or just a chance finding," said Kwong.

Though the new study did not identify the reasons why flu might lead to heart attack, Kwong and his co-authors theorize that infectious illness may cause inflammation, stress and constriction of blood vessels, which increases blood pressure.

Threats to children

The overwhelming majority -- 99% -- of children under age 5 who die from flu-related illness are in developing countries.

Children in the developed world may not face such high risks, but they are still vulnerable if they develop flu. Sepsis resulting from flu can cause the death of very young children, said Dr. Flor M. Munoz, an associate professor of pediatrics and infectious diseases at Baylor College of Medicine.

"Children have different risks depending on their age," said Munoz, and the most worrisome ages are "infants in the first year of life and those under 5 years of age."

"What's different from adults is children have a lot of opportunities to not only be exposed to flu but also to spread the flu," said Munoz. In general, children are the first to get sick when flu season begins, mainly because they are in school and playing with others -- and spreading germs.

"They can be completely healthy and still have problems with the flu," said Munoz. "The flu shot doesn't offer the same protection as it does for adults."

This is due to the lack of "immunologic experience" that children have. The immune system in infants is "still developing and it has different responses, let's say, to new things," said Munoz. "Young children will not necessarily have the same response that older children, adolescents or adults have." The same is true for very old people, said Munoz: "That's just a normal way the immune system works."

However, the worry whenever a young child or infant gets flu symptoms, including fever, is that they might have a more serious infection occurring at the same time. "Young children at that age can have meningitis, pneumonia, bacterial infections, not necessarily flu-related," said Munoz. "One needs to be more cautious."

"Certainly, we do tend to see secondary infections," said Munoz. So a child will start with the flu and the irritation in their noses and throats leave them exposed to more germs and so they develop another bacterial infection --- ear infections, say, or sinusitis or pneumonia.

With the child's immune system already fighting the flu and then another bacteria on top of that, sepsis may be the result. These are the cases we hear on the news, said Munoz, "previously healthy children that don't feel well and in a day or two they die of some complication."

Another threat? Though children and adults experience the same symptoms when sick with the flu, children are more likely to get diarrhea and to vomit. This can lead to dehydration in infants and small children, Munoz said, and it can be life-threatening at such a young age.

What do parents need to know?

"Every year we're going to have the flu. Every year we have anywhere between 50 and 100 deaths of children from the flu," said Munoz, who is also a member of the Committee on Infectious Diseases for the American Academy of Pediatrics. "This is something to be taken seriously."

Parents can make sure their children are vaccinated, she said. "As a mother, if you have something at hand that can protect your child, why not?"

"It's a very safe vaccine -- it is not true that you can get the flu with the vaccine," she added.

Lynnette Brammer, head of the CDC's Domestic Flu Surveillance team, supported Munoz' view. "We want to continue to emphasize that there's still a lot of flu activity to come, people that haven't been vaccinated should still get vaccine," said Brammer. "We may be getting close to the peak of this wave, it's not unusual to have a second wave of influenza B come through."

The flu shot is admittedly imperfect, Schaffner said, but there are still benefits. "If you get the vaccine and you have a flu-like illness, it's likely the illness is less severe," he said. "Data show you're less likely to get pneumonia and less likely to die."

If a child, especially a small one, becomes sick, parents should visit a doctor or health care provider who may prescribe medication, said Munoz.

By treating illness, antiviral drugs become a second line of defense against serious consequences. While most otherwise healthy people will not need to be prescribed antiviral drugs, those who may benefit from these medications are "people who are high risk, the elderly, children under 2, pregnant women and people with chronic health problems," said Brammer.

Antiviral drugs are known to work best when started within two days of getting sick. Studies show these drugs, which rarely produce side effects, can lessen symptoms and shorten the time a person is sick by one or two days.

"It's a brisk influenza season and I think it will end up being a moderately severe one," said Schaffner. "We'll take any bit of protection and prevention we can get."

Minnesota Coronavirus Cases

Data is updated nightly.

Cases: 270157

Reported Deaths: 3297
CountyCasesDeaths
Hennepin579261084
Ramsey24528470
Anoka19211213
Dakota18738176
Washington12351104
Stearns1200389
Scott735654
St. Louis712297
Wright646135
Olmsted604730
Sherburne499538
Clay435954
Carver397312
Blue Earth367011
Rice350331
Kandiyohi337613
Crow Wing306729
Nobles293828
Chisago27778
Benton256338
Otter Tail251415
Winona240928
Mower232822
Polk222221
Douglas211929
Morrison207521
Lyon189810
McLeod18089
Beltrami177115
Goodhue173126
Becker16769
Itasca165223
Steele16396
Todd161412
Isanti159115
Carlton148310
Nicollet144523
Freeborn13625
Mille Lacs129030
Le Sueur12899
Waseca128710
Pine11625
Cass11538
Brown112610
Meeker10117
Martin97020
Roseau9443
Hubbard92822
Wabasha8961
Dodge7770
Watonwan7604
Redwood75118
Chippewa7437
Renville68818
Sibley6844
Cottonwood6800
Wadena6706
Pipestone65618
Aitkin64722
Rock6259
Houston6012
Fillmore5910
Yellow Medicine55310
Unassigned52756
Murray5173
Pennington5076
Kanabec49711
Swift4835
Faribault4650
Pope4620
Stevens4342
Clearwater4156
Marshall4047
Jackson3981
Lake3463
Koochiching3275
Wilkin3175
Lac qui Parle3123
Lincoln3081
Norman3006
Big Stone2711
Mahnomen2404
Grant2256
Red Lake1833
Kittson1786
Traverse1190
Lake of the Woods821
Cook570

Iowa Coronavirus Cases

Data is updated nightly.

Cases: 210482

Reported Deaths: 2173
CountyCasesDeaths
Polk31270322
Linn13252158
Scott1022075
Black Hawk10209126
Woodbury9870111
Johnson900835
Dubuque866490
Story637819
Dallas595555
Pottawattamie574666
Sioux349925
Webster330928
Marshall327841
Cerro Gordo323041
Clinton303637
Buena Vista290214
Muscatine266964
Des Moines266116
Plymouth257937
Warren254610
Wapello239971
Jones221112
Jasper202739
Marion191518
Carroll188220
Lee188015
Bremer176012
Henry16847
Crawford168215
Benton157414
Tama145140
Jackson13608
Delaware134721
Boone127711
Washington126513
Dickinson126210
Mahaska119027
Wright11425
Buchanan10789
Page10774
Hardin105810
Clay10434
Harrison101428
Clayton10084
Cedar98913
Hamilton9877
Mills9806
Calhoun9787
Fayette9588
Lyon9458
Floyd92614
Kossuth9214
Poweshiek91512
Butler8943
Winneshiek88910
Winnebago87423
Iowa86711
Louisa79916
Hancock7947
Chickasaw7853
Grundy77310
Sac7617
Cherokee7484
Cass73519
Appanoose7336
Shelby7184
Allamakee71111
Mitchell7074
Emmet70123
Guthrie69215
Union6866
Franklin67619
Humboldt6495
Madison6414
Jefferson6121
Palo Alto6044
Unassigned5810
Keokuk5237
Pocahontas5072
Howard4999
Osceola4941
Greene4860
Clarke4564
Ida42810
Monroe42812
Montgomery42610
Davis4225
Taylor4162
Adair4066
Monona3912
Fremont3432
Worth3330
Van Buren3294
Lucas3056
Decatur2950
Wayne2836
Audubon2811
Ringgold1832
Adams1521
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