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Children bear the burden of this season on influenza, officials say



Many Canadian children miss the holidays that fight the flu and other respiratory illnesses – and the start of the influenza season can be partially blamed, say pediatricians and public health officials.

"We see a huge viral disease [in children]"says Dr. Catherine Farrell, a specialist in child-intensive care at CHU Sainte-Justine, a childcare and maternity hospital in Montreal.

"Our hospitals are firing at the seams. Our emergency rooms are really overloaded. Our hospital units are full and we have a very high occupation rate with respiratory diseases in the intensive care unit … and it's the same with other intensive care units here in Quebec, "said Farrell.

There are several different types of respiratory viruses that circulate, she said, including influenza A – which can lead to serious secondary infections, such as pneumonia, which put children in a hospital.

More than three times more children are hospitalized with flu across the country compared to this period last year, according to a report from the Canada Public Health Agency from the latest report by FluWatch.

Start the flu season early

Since December 15 (the latest available data), 8,245 influenza cases have been confirmed in adults and children, according to FluWatch. Approximately 10 per cent of those cases – 864 – hospitalization is required. More than 280 of these hospitalizations were children aged 16 or under.

Most of the 47 cases that were so serious that they sought admission to intensive care homes were children under the age of 10, the report said.

At this time last year in Canada there were 2,400 less confirmed cases of influenza – and only 26 children were hospitalized.

Respiratory diseases, including the flu, have hospitals such as CHU Sainte-Justine in Montreal, which shoot at the edges, "says Child Care Intensive Care Specialist, Dr. Catherine Farrell. (Radio Canada)

There are several possible reasons for the increased number of hospitalization in children this year, said Anne Madison, a spokeswoman for the Canada Public Health Agency, in an e-mail to CBC News.

"The current flu season started two weeks earlier compared to last year," she said. It started in mid-October, not at the beginning of November.

This means that it is possible that by the end of the influenza season, the total number of children hospitalized may be the same as last year, but it simply happened earlier.

Different types of influenza

The dominant flu virus circulating this year – influenza A H1N1 – is also associated with "a greater burden on the disease … among children than in adults," Madison said.

Last year, the dominant species was influenza A H3N2 – a particularly virulent type, due to which people of all ages were very ill, but sent more adults aged 65 and over to hospital than children and younger adults.

Although the flu is a "rather severe infection" compared to cold, the majority of people – both children and adults – can recover at home without having to go to hospital, says Dr. Isak Bogoch, a specialist in infectious diseases in the Toronto General Hospital.

Many young children, elderly people and people with underlying medical conditions, such as the heart or lungs, are most at risk of becoming so ill to seek hospitalization, he said.

One reason for hospitalization could be pneumonia, which is a "very well-known complication of the flu," said Bogach.

Pneumonia behaves

And CHU Sainte-Justine in Montreal and SickKids in Toronto say they have seen many children with pneumonia lately, although it is unclear whether those cases are related to the flu.

"We usually see many children presenting with pneumonia at this time of the year. Anecdotally, we've seen large amounts of children presenting with pneumonia over the past few weeks," said Jessimein Lak, a spokeswoman for Sikkids.

"Pneumonia may be associated with influenza, but it can also be caused by other viral and bacterial diseases in children."

But, unlike most other diseases, there is a flu vaccine, said Farrell, who is also president of the Canadian Children's Association.

It's not too late for parents to take their children to the flu, she said.

Public health officials acknowledged that last year the influenza vaccine was disappointing, with a low rate of effectiveness. While it is too early to measure the effectiveness of this year's version, some early indicators promise, according to the Canadian Public Health Agency.

The flu vaccine can be given to children with a needle or spray for the nose. (Dave Gilson / PS)

Based on laboratory comparisons between the form of the H1N1 virus implanted in the vaccine and the form of the virus that actually appears as the dominant virus, "the vaccine component this season seems to be a good match against the H1N1 viruses that are mostly circulating in Canada," Madison said.

In addition, Australian preliminary data, which already had the influenza season, showed that people who were vaccinated this year were 68 percent less likely to see the doctor or the nurse on the flu compared to unvaccinated people, she said.

The choice to get the flu – for yourself and your children – is "a little disappointing," said Bogach.

"[It’s] is likely to be much, much better than last year, "he said.

But even if this was not the case, such a flu is more likely to prevent the virus, he said, noting that data show that the vaccine can also help reduce the severity of the infection – which in turn can prevent hospitalization.

When to seek medical help for your child

As the number of children affected by flu and other respiratory diseases this time of the year increased, CBC News asked Dr. Jonathan Gubbay, a doctor of infectious disease and a healthcare microbiologist in Ontario for his advice to parents.

From the point of view of prevention, the best things parents can do is to vaccinate their children against the flu, to make sure they wash their hands and keep them home from school if they are ill, so as not to spread the virus to others, he said.

When their children are ill, parents should see signs of "acute" respiratory infection, including pneumonia. These signs include:

  • Fever that did not improve within a few days.
  • Lack of breath.
  • Quick breathing.

If children show any of these symptoms, parents should take them to see the doctor or nurse, or hospital, said Gubbay.


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