Report Finds Swine Flu Has Killed 36 Children

Federal health officials reported Thursday that at least 36 children in the United States had died of swine flu as of Aug. 8, including many who had underlying disorders of the nervous system. Some also had chronic lung disease, and one had leukemia.

But some of the children had been perfectly healthy, and died of bacterial infections with staph or strep that set in after the flu.

A report on the deaths was published online Thursday by the Centers for Disease Control and Prevention and discussed at a news conference by Dr. Thomas R. Frieden, the centers’ director.

The report said the confirmed death count among people of all ages was 477 as of Aug. 8, but it focused on the toll on children.

The 36 who died ranged in age from 2 months to 17 years, with a median age of 9 years. Nearly two-thirds had nervous system disorders like cerebral palsy, muscular dystrophy or developmental delays. Children with nerve and muscle problems may be at especially high risk for complications from the flu because they cannot cough hard enough to clear their airways.

It is too soon to tell whether the H1N1 swine flu will turn out to be more deadly in children than other types of influenza, Dr. Frieden said, adding that in most years 50 to 100 children die of seasonal flu. But so far the swine flu seems to be taking a heavier toll among chronically ill children than the seasonal flu usually does.

The deaths mean that children with neurological conditions need to be seen quickly by a doctor if they run a fever, Dr. Frieden said.

“Treatment in the first 48 hours can make a big difference in hastening your recovery,” he said.

In children without chronic health problems, it is a warning sign if they seem to recover from the flu but then relapse with a high fever, Dr. Frieden said. The relapse may be bacterial pneumonia, which must be treated with antibiotics.

Dr. Frieden urged that children be vaccinated as soon as swine flu vaccine becomes available, probably next month. Health officials have recommended that children be among those given first priority for the vaccine, because they seem more vulnerable than adults to the H1N1 virus and to complications from it.

Pregnant women will also receive top priority for the vaccine, because they have a high risk of infection and complications from the flu.

Glen Nowak, a spokesman for the disease centers, said health officials worried that pregnant women who were vaccinated and then had miscarriages would blame the vaccine. But he said there was no evidence that flu vaccine increased the risk of miscarriages, which generally occur in 15 percent of pregnancies. Even so, Dr. Frieden said the disease centers would carefully monitor miscarriage rates to determine whether the new vaccine had any such effect.

Another report issued Thursday, by the Institute of Medicine, recommended that health care workers treating people with swine flu protect themselves from infection by wearing a type of specially fitted mask called an N95 respirator, which is tighter and better able to seal out viruses than the more common types of surgical masks.

Dr. Frieden said the disease centers had not yet had time to evaluate the new report about masks. A spokesman for the centers said the nation had 79.7 million N95s in the “strategic national stockpile” controlled by the government.

To put the H1N1 flu in perspective, Dr. Frieden emphasized that so far, most stricken people had had a relatively mild illness and that the virus had not become any more virulent over time in the United States or any other country.