How the flu turns deadly

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

Posted: Jan 26, 2018 6:55 PM
Updated: Jan 26, 2018 6:55 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."

Terre Haute
Clear
30° wxIcon
Hi: 40° Lo: 24°
Feels Like: 30°
Robinson
Partly Cloudy
31° wxIcon
Hi: 40° Lo: 26°
Feels Like: 31°
Indianapolis/Eagle Creek
Clear
27° wxIcon
Hi: 34° Lo: 21°
Feels Like: 27°
Paris
Clear
28° wxIcon
Hi: 38° Lo: 22°
Feels Like: 22°
Mattoon/Charleston
Clear
29° wxIcon
Hi: 39° Lo: 24°
Feels Like: 23°
Terre Haute
Clear
30° wxIcon
Hi: 39° Lo: 23°
Feels Like: 30°
Terre Haute
Clear
30° wxIcon
Hi: 39° Lo: 22°
Feels Like: 30°
Clearer Sky
WTHI Planner
WTHI Temps
WTHI Radar

Latest Video

Image

All You Need to Know for Tuesday

Image

Tuesday: Clouds move out, cold. High: 36

Image

Tyreke Key moves into Top 10

Image

IHSAA Moves Boys State

Image

GBB North Central Orleans

Image

Tracking light snow - how long will it stick around?

Image

How you can avoid carbon monoxide poisoning

Image

NAACP installs new committee members during Monday meeting

Image

West Terre Haute armed robbery under investigation

Image

Marshall, Illinois town meeting

WTHI Events

 

Illinois Coronavirus Cases

(Widget updates once daily at 7 p.m. CT)

Cases: 1072214

Reported Deaths: 20118
CountyCasesDeaths
Cook4343419046
DuPage689701151
Will58209870
Lake53227886
Kane45873676
Winnebago26265407
Madison24262463
St. Clair22191426
McHenry21591248
Champaign1539099
Peoria14966239
Sangamon14477234
McLean13170159
Tazewell11885245
Rock Island11860302
Kankakee11465179
Kendall966678
LaSalle9427247
Macon8794179
Vermilion7470112
DeKalb743792
Adams7337117
Williamson6166116
Boone553277
Whiteside5250173
Clinton500685
Coles469880
Ogle458971
Knox4579141
Grundy435954
Effingham430668
Jackson416867
Henry400776
Marion3970111
Franklin382969
Macoupin382694
Randolph371468
Livingston363566
Monroe356170
Stephenson352474
Jefferson3421104
Morgan325289
Woodford318766
Logan308356
Montgomery303841
Lee303172
Bureau299784
Christian297973
Fayette290653
Perry266560
Iroquois258756
Fulton255349
Jersey220656
Lawrence217230
McDonough214451
Saline202153
Douglas198733
Union197332
Shelby196435
Crawford175534
Cass174831
Bond173524
Warren158244
Pike154246
Richland153544
Wayne151143
Jo Daviess148224
Hancock147634
Clark147430
Washington144625
Edgar143253
Carroll142633
Ford138049
Moultrie137028
White133130
Clay130939
Greene125442
Johnson121015
Wabash117214
Mercer117029
Piatt116816
Mason116340
De Witt113927
Cumberland107927
Jasper103815
Massac101831
Menard87110
Hamilton71617
Marshall66413
Schuyler61916
Pulaski6103
Brown60811
Stark49320
Edwards4609
Henderson45216
Calhoun4384
Alexander3897
Gallatin3864
Scott3751
Putnam3462
Hardin3028
Pope2462
Unassigned990
Out of IL370

Indiana Coronavirus Cases

(Widget updates once daily at 8 p.m. ET)

Cases: 592709

Reported Deaths: 9340
CountyCasesDeaths
Marion818931301
Lake44495668
Allen32035543
Hamilton28533305
St. Joseph26847372
Elkhart24132341
Vanderburgh18759213
Tippecanoe17482122
Johnson14583285
Porter14464160
Hendricks13931242
Madison10600213
Vigo10513174
Clark10300132
Monroe9109108
Delaware8861133
LaPorte8825155
Howard7916138
Kosciusko788877
Warrick648290
Hancock642597
Bartholomew629294
Floyd6184105
Wayne5956157
Grant5848110
Dubois546172
Boone536367
Morgan519491
Henry496164
Marshall494984
Cass473160
Noble462157
Dearborn461344
Jackson416145
Shelby404279
Lawrence382075
Clinton366340
Gibson357856
DeKalb338563
Montgomery336651
Harrison332642
Knox328239
Miami311243
Steuben308742
Adams296535
Whitley295525
Wabash293945
Ripley293745
Putnam286847
Huntington285058
Jasper284434
White268438
Daviess262172
Jefferson253138
Decatur242882
Fayette242448
Greene235660
Posey232826
Wells230147
LaGrange224761
Clay218732
Scott217337
Randolph209041
Jennings193235
Sullivan189331
Spencer182717
Fountain180425
Washington178218
Starke172041
Jay163122
Fulton160230
Owen160137
Carroll153015
Orange152133
Rush150818
Perry148727
Vermillion145533
Franklin143833
Parke12908
Tipton128432
Pike114125
Blackford108022
Pulaski95137
Newton89721
Brown85730
Benton84510
Crawford7669
Martin70413
Warren6607
Switzerland6235
Union6145
Ohio4707
Unassigned0374