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Swine flu claims the life of a child

14-year-old, state's first young casualty with no underlying problems, dies a week before vaccine program is set to start

By Meredith Cohn and Liz Bowie

Baltimore Sun reporters

October 1, 2009

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Destinee Alicia Parker was an aspiring artist who loved animals, Lil Wayne and scary movies. She and her two sisters were known as the "Parker Posse" at Montebello Elementary/Middle School. And although she was healthy, she died of swine flu Tuesday night.

She became the state's first youth with no apparent underlying medical condition to succumb to the virus. The death comes a week before the state expects to begin vaccinating students and other people at high risk of contracting the H1N1 virus.

"She was a wonderful child, always smiling, always cracking jokes," said her stepmother, Deirdre Parker, who spoke yesterday as her husband, James Parker, sat next to her, hiding his tears behind sunglasses and at times holding his wife's hand for support.

Destinee, she said, was part of a big, close-knit family, the sixth in a family of eight girls who range in age from 7 years old to 29.

As she began eighth grade this fall, Destinee was beginning to think about what direction her life would take. She had always loved animals, so her father arranged for her to visit a veterinary clinic. But she loved art, too, and had long been happy drawing pictures, particularly black-and-white pencil drawings of cartoons. Finally, this fall she settled on the idea of trying to get into the Baltimore School for the Arts for high school, the Parkers said. Destinee had already started producing the drawings she needed for a portfolio she would submit next year in hopes of gaining admission.

In elementary school, Destinee had been a different child, though -- shy, timid and uncertain, both Montebello's principal and her stepmother said. But when circumstances in her life changed, she began sixth grade at Montebello, where her younger half sisters were already enrolled. She became close to several teachers and began to thrive. It was then, her stepmother said, that she went on "finding her voice, finding her place, finding her footing. She just blossomed."

Her death is the ninth in the state this year from swine flu. One other was a child, a Baltimore-area youth who had another medical condition. Nearly 200 people have been hospitalized in Maryland. Across the country, about 1,000 have died and more than 10,000 have been hospitalized. The majority of them had underlying health problems, according to the federal Centers for Disease Control and Prevention.

Camille Bell, the Montebello principal, had a big cardboard poster in her office Wednesday, with farewell letters to Destinee attached. She said the Parkers were model parents who showed up at every parent-teacher conference and every school event. The sisters were very close and loving, she said.

The Parkers said that Destinee had spent the weekend before she became ill with her mother and that on Monday, Sept. 21, she was a little more lethargic than normal, but she did not appear to be sick.

After Destinee climbed up two long flights of steps into Montebello that morning, the principal heard her wheezing and immediately called her father who had dropped her off at school. Bell said she called the nurse and they decided to call an ambulance because the girl's breathing wasn't getting better. Her father arrived at the same time as the ambulance and said he would drive Destinee to Mercy Medical Center, where their doctor had agreed to meet them.

When they arrived, her doctor was surprised, James Parker said, to find that Destinee was having trouble breathing because she didn't have asthma. Doctors then determined that she had pneumonia and decided to transfer her to the intensive care unit of the University of Maryland Medical Center.

In the meantime, James Parker said, he left the hospital and raced to pick up Destinee's mother so that she could join Deirdre Parker and him at the hospital. Before the 14-year-old girl was transferred to University, he said, she was getting worse.

The girl continued to deteriorate, the Parkers said, but it was not clear what the underlying cause of her illness was until the night of Sept. 23, when doctors told them she had a confirmed case of H1N1. Bell received confirmation of the diagnosis and released a statement to parents the next afternoon.

The school was thoroughly cleaned the night of Sept. 24 and the morning of Sept. 25, when by coincidence, the school was closed for a faculty meeting.

Bell fielded calls Friday from parents and had a parent meeting Monday morning as well as a Tuesday meeting that included health officials. School attendance has been down this week, she said, and she expects that to continue for the remainder of the week because parents are nervous. She said there has not been an outbreak of the flu at the school to her knowledge, although one parent called to say his child was sick with a fever. The child has since recovered.

Bell has talked to individual classes and groups of students to explain to them what has happened to Destinee. Social workers came to the school Wednesday morning to counsel children who were upset.

State officials continue to investigate, though they have officially attributed the death to swine flu, said Frances Phillips, the state's deputy secretary for public health services. She couldn't speak directly about Destinee for privacy reasons but said the virus normally is not fatal in healthy people.

No one has died of seasonal flu so far this year, although it caused three deaths among youths and about 1,000 among adults in the state last year. It normally kills about 100 children nationally.

"This is tragic and really hits home when it's your school and your community," Phillips said. "But it doesn't mean the virus is any more virulent there than anywhere else. The message is that flu is not to be taken lightly. It will infect more children than the regular flu, and ultimately some children will die."

The state will distribute vaccines to county and city health departments beginning Monday, and schoolchildren will be among the first to get them. Vaccination will be voluntary, though officials are anticipating high demand. Not everyone will be able to get a shot or nasal spray next week, but there should be supplies available over the next couple of weeks. In general, first in line in the state will be students up to 24 years old, health care workers, pregnant women, those caring for an infant and those older than 24 with medical conditions such as asthma, diabetes or heart disease. The general population is advised to get vaccinated in later rounds through their doctors or local health clinics. There is no cost for the vaccine, though doctors are likely to charge a fee.

Everyone is also advised to get a seasonal flu vaccine, which is available now.

Health officials and doctors do not know why some children contract harsher cases of the flu and why it kills some of those who are healthy. Most cases of H1N1 and seasonal flu can be treated at home, said Dr. James King, a professor of pediatrics at the University of Maryland School of Medicine.

Symptoms include fever, sore throat and aches. He recommends fluids and over-the-counter fever medicine such as Tylenol. He said those who are sick need seek medical attention only if they have another medical condition or if their symptoms worsen to include trouble breathing, lack of responsiveness or discoloration of the skin.

King and Phillips said parents of children who have underlying medical conditions could call their pediatricians now for guidance on what to do in the event of illness.

"I know there is a lot of worry and fear of swine flu because it's different," King said. "It's important to remember a small percentage end up with a more severe case. Most can be treated at home. We can't predict who will get a bad case, and that's why the recommendation is to get a shot for every child."

•Schools, hospitals and doctors' offices will be providing swine flu vaccines as early as next week.

•Supplies will come over the next few weeks for youths 6 to 24, health care workers, pregnant women, caretakers of infants and those older than 24 with underlying medical conditions.

•The general population will be able to get the vaccine after these groups through their private doctors and health clinics.

To avoid the flu: Wash your hands often, cover your mouth when you cough or sneeze with a tissue or your sleeve. Wipe common areas such as door handles, phones and keyboards frequently.

If you have the flu: Expect fever, cough, sore throat, chills, headache, fatigue, vomiting, diarrhea or shortness of breath.

Stay home and do not return to school or work until you have been fever-free for 24 hours without medication.

Seek medical help if: children have serious underlying health conditions and have flu symptoms; have bluish skin color for fair tones and grayish skin color for darker tones; aren't drinking enough fluids; are so irritable that they don't want to be held; have a fever with a rash; or have symptoms that improve but then return with fever and worse cough. Adults should see a doctor if they have difficulty breathing or pain in the chest or abdomen; sudden dizziness or confusion; or severe or persistent vomiting.