Don't let your kids die from preventable diseases
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| Courtesy Jessica Richman |
When Cayden Smith, age 3, developed a low-grade fever and congestion one Thursday evening in December 2014, her family first thought it was a cold. The following day, they visited an urgent-care center.
“We did let them know that she had been scheduled to get a
flu shot a couple weeks before, but she had an ear infection,” Jessica Richman,
Cayden’s mom, 41, from Newport News, Virginia, told CIDRAP News. “She had a
little fever at the time, so they said we needed to reschedule the flu
shot.”
Urgent care staff didn’t test Cayden for influenza; instead,
they treated her cold symptoms and advised the family to return if the toddler
didn’t improve. “We actually took her back three different times, because she
was getting very progressively worse,” Richman recalled.
From lack of concern to a 911 call
Cayden was Richman’s first child, born May 18, 2011. The
outgoing, bubbly girl, who never met a person who would remain a stranger,
loved the color pink and her 130-pound Bernese Mountain dog. “It was cute to
see this tiny, small girl and this big, huge dog,” Richman said. “She had a
great personality.”
While Cayden had always received her vaccines, she missed
her flu vaccine in 2014 because of that ear infection. At the time, Richman
didn’t know how serious flu could be. “I didn’t realize it was super dangerous,
so I didn’t urgently reschedule her flu shot,” she said.
Each time the family took Cayden back to urgent care that
December, they mentioned she had not received her flu shot. Still, staff never
tested her for flu. “They just didn’t seem that concerned that that’s what it
was,” Richman said. “I’m not sure why.”
By Friday evening, Cayden’s breathing had become labored.
She’d take deep breaths in but still didn’t seem to get much air. Unlike other
times when she was sick, Cayden wasn’t playing with her toys and behaved
lethargically. Finally, her dad called 911.
“She was not moving, wasn’t asking for anything. She didn’t
want to eat or drink,” Richman said. “We had first responders show up to the
house. Unfortunately, she had passed at the house.”
The family felt stunned. They had no idea how their previously healthy daughter could simply not be there anymore. While the autopsy provided answers as to how Cayden died, the family struggled to understand.
“When I did get the information that it was influenza A that
caused pneumonia, I was like, ‘What?’” Richman said. “At the time, I felt like
flu was similar to a cold. In no way did I believe that it would take someone’s
life, not a small, healthy child. My child had no immune issues. She didn’t
have any medical issues.”
As Richman grappled with the loss of her daughter, she
connected with the nonprofit Families Fighting Flu.
Being connected to other families whose loved ones grappled with severe flu
complications and flu deaths helped her navigate her grief and made her feel
less alone.
“It was shocking and eye-opening,” she said. “From my
experience with other families who had a similar situation, [death has] been
fairly quick, which is surprising. You would think that it wouldn’t be, but
they get sick so quickly, and small children, their lungs are just smaller and
they can’t fight it off.”
Preventing life-threatening complications
Flu is a seasonal respiratory illness that causes symptoms
such as chills, muscle aches, nasal congestion, cough, vomiting, nausea, and
diarrhea.
“We describe it as a more severe virus,” Jennifer Duchon, MD, MPH, associate professor in the Division of Newborn Medicine in the Jack and Lucy Department of Pediatrics at the Icahn School of Medicine at Mount Sinai, told CIDRAP News. “It’s not necessarily like a cold, which you can generally feel creeping on. When you get the flu, it almost always happens suddenly.”
The flu causes people to feel “absolutely miserable,” Duchon
said. “You have a high fever. You cough for a long time. You get shaking
chills. You get terrible bone pain. People feel just awful.”
Complications cause most flu-related deaths. Flu can lead to
sinus and ear infections, lung damage and inflammation, or pneumonia caused by Staphylococcus
aureus or difficult-to-treat methicillin-resistant Staphylococcus aureus
(MRSA) pneumonia. Life-threatening encephalitis and brain inflammation can also
result.
Some people think of the virus as “just
the flu” and use that as justification to skip getting the vaccine. But
“that is greatly minimizing what the flu really is,” Duchon said. “Before
vaccines … the flu was a huge cause of mortality,” especially in the young and
the old.
Getting an annual flu vaccine helps avert these severe
outcomes. “We all know that people still get the flu even though they’ve been
vaccinated,” Duchon said. “It’s still highly recommended and one of the best
tools that we have to prevent people from dying or going to the
hospital.”
Early flu season
This year’s flu season started early, with cases first
reported in the western United States and now increasing throughout the
country. By October 30, more than 6,100 people had been hospitalized, and one
child had died, according to the US Centers for Disease
Control and Prevention.
“In New York, we’re about five to six weeks early in terms
of where we were last year,” Duchon said. “Last year at this time, we had in
New York state about 1,700 confirmed cases and 100 hospitalizations. And this
year … we have about 6,500 confirmed cases and about 400
hospitalizations.”
It’s unclear why the flu season started so early this year,
but increased travel between the Southern and Northern hemispheres could have
been a factor. “It may be that due to the changing epidemiology of borders that
flu strains are introduced to us a bit early,” she said.
This year, the predominant influenza strain is an H1N1
subvariant called G155E, which the current vaccine doesn’t match very well. But
people still benefit from receiving the flu vaccine. “Year after year, we’ve
seen that it does provide enough coverage to be able to really mitigate the
most severe consequences of the flu, death, hospitalization, secondary
infections,” Duchon explained.
People who haven’t yet received their flu vaccine should
still do so. “It is never too late to get your flu shot, and even if you’ve had
the flu, we all recommend that you get a vaccine anyway,” she said. “There are
multiple strains of the flu, and you can certainly get reinfected with a
different strain during the season.”
Honoring Cayden’s memory
Since Cayden’s death, Richman has had two other children,
Parker and Layla. Four years ago, Layla, then 3, spiked a high fever with an
elevated heart rate and was so weak she couldn’t walk. Immediately, Richman
worried Layla had the flu, even though the toddler had received her vaccine
that year.
“I explained that she had had a flu shot but I wanted her tested for the flu. I’ve had a child that passed away from flu. It’s very important to me that we do the test,” she said. “I pushed it as a parent to say we are going to do it. And she did test positive for the flu.”
Doctors gave Layla the antiviral drug oseltamivir (Tamiflu)
and monitored her vital signs for a few hours at the clinic. When she returned
home, her parents continued giving her the medication as she rested. This time,
Richman’s experience with the virus was wildly different.
“By the next morning, she was almost back to completely
normal. All of her symptoms had gone away,” Richman said. “She was up playing
and wanting to eat and being her normal self, and it was kind of crazy the
difference. And I do attribute that to the fact that she was vaccinated so it
lessened her symptoms, made her symptoms less dangerous, and we made sure was
tested and treated properly.”
Since Cayden’s passing, Layla’s bout with flu was the only
time anyone in the family has been sickened by the virus, Richman said. To
honor Cayden, every year the family wears pink when they receive their flu
vaccine.
“It’s important that I remember Cayden and use her memory in order to try to help others to make sure that people get correct information [about the flu],” Richman said. “A big deal to me is to know that I’m spreading her story, and it’s helping other people become informed and get their family the flu shot—so that hopefully there’s no more of these stories.”
