As the flu continues its achy, feverish march across the state and nation, U.S. health officials said the most common strain is one that can be particularly tough on kids. And many of Baltimore’s youth may not be protected.
The rate of vaccination of city students during school clinics has been far lower than those in other Maryland counties, with just a small fraction of schools even offering the vaccine because there were too few takers.
“I am quite concerned that the overall flu vaccination rates in Baltimore City may be lower” than in the counties, said Tiffany Tate, executive director of the Maryland Partnership for Prevention, the nonprofit that manages school clinics in Baltimore and six counties. “For some reason, the uptake has not matched the effort and what we expect and need to ensure optimal flu vaccination coverage.”
This season’s flu already appears to be taking a toll statewide. About 8% of those hospitalized with flu-related complications were aged 5 to 17, according to state health data collected through Jan. 11. That’s double the percentage this time last year.
There have been two deaths of children reported from flu complications so far in Maryland this season, according to the data. Officials do not disclose where the deaths occurred.
A total of 37,000 people of all ages had gone to an emergency room with flu-like symptoms and 23,000 had gone to a doctor’s office, according to a voluntary reporting system in the state.
“The flu got off to an earlier start this year than normal; things are in full swing now, without a doubt," said Dr. Monique Duwell, chief of the Maryland Department of Health’s Center for Infectious Disease Surveillance and Outbreak.
In the Baltimore region, the Maryland Partnership for Prevention program vaccinated 12,000 students in Howard, 5,000 in Carroll and 6,000 in Harford counties, and most schools participated. In Baltimore, it vaccinated fewer than 1,500 and only about 17% of the city’s 130 elementary and middle schools participated.
At least 25 students must sign up for a school to host an influenza clinic.
Tate notes that the group can’t say how many kids go to their doctors or elsewhere for the vaccine. The city health department continues to offer some vaccinations to children, including those who do not have a medical provider, have Medicaid or don’t have insurance that covers immunizations.
Andre Riley, a spokesman for Baltimore schools, echoed Tate, saying the school-based clinics are not the only place where kids can be vaccinated.
“If students opt not to receive shots through the partnership, they can request the vaccination through a private physician, another external program, or students do not receive flu shots at all," Riley said. "Our goal is to provide an avenue for students to receive this preventative measure to work to achieve the healthiest, safest learning environments possible.”
Duwell said health officials “are concerned about any child or adult not vaccinated that can be.”
“The challenge is in how we get messages out to people," she said. "We continue to pursue getting those messages out and getting access to flu shot to as many people as we can in Maryland.”
In Maryland, like nationally, the dominant strain is a B strain called Victoria. Normally A strains are more common this time of the season, which generally runs from fall to spring.
Duwell said both A and B strains can be deadly, particularly for high-risk groups like the very young, seniors, pregnant women and those with certain medical conditions. The U.S. Centers for Disease Control and Prevention, however, recently issued an advisory that said in past seasons the B strain has been associated with a higher proportion of pediatric deaths.
The CDC reported that there have been 39 deaths among children and 6,600 total deaths linked to flu through Jan. 11. The agency also reported there have been 13 million flu illnesses and 120,000 hospitalizations. Accurate counts can be difficult because many people don’t seek medical care or are not tested for the flu.
The flu is a nasty virus that causes fever, aches, cough, runny nose and other discomfort. For some, the illness leads to serious complications such as pneumonia.
Officials have to decide in spring which strains to include in the annual vaccine, and in some years they don’t match well. The CDC reports that this year’s vaccine is effective against B/Victoria strain about 58% of the time.
Doctors emphasize that even if the vaccine is not fully preventive, it can stave off some cases and can make others less severe.
That will help given the high level of flu out there, said Dr. Adam Spanier, a pediatrician in a doctors’ office at the University of Maryland Medical Center Midtown Campus.
One recent day, he said every slot on the office’s walk-in clinic was filled with flu cases, and he said, "It feels a lot busier than last year.” The test used by the office also shows most cases are the B strain.
Many children coming to the Baltimore practice have not been vaccinated, which Spanier said wasn’t out of the ordinary.
“I think the flu vaccine is one of the vaccines where there is the most hesitancy,” said Spanier, also an associate professor of pediatrics at the University of Maryland School of Medicine. “We offer it to everybody and encourage everybody, but we have parents of some that don’t believe in the flu shot. They haven’t gotten it and they aren’t starting now.”
Since the flu vaccine isn’t always a great match for the flu strains circulating, like this year, some people believe they shouldn’t bother getting vaccinated, he said. Others still mistakenly believe that the flu shot can give people the flu. Some people are just distrustful of vaccines, though they are considered safe.
Spanier said he wasn’t surprised some parents in the city were not signing forms to have their children vaccinated at school, despite the convenience. Many city parents can have “a lot going on in their lives,” and focusing on one more thing is hard, he said. Many of his patients miss appointments.
The vaccine, however, should be a priority. He said children who die from the flu are not vaccinated.
The CDC recommends the vaccine for anyone 6 months and older, and Spanier said it’s not too late to get a shot at school, a doctors’ office, a pharmacy or elsewhere.
Normally the vaccines are offered at no cost to those with health insurance. The children’s vaccine is the same as the adult version, but some clinicians limit who they offer the service, he said.
“I live in Howard County and when they do a school clinic and we get a note home asking if we want our children to have flu shots, we always say sure,” he said. “I, of course, get vaccinated. I try and tell my patients that I walk the walk.”
12:50 p.m. Jan. 22: This story has been updated to reflect that while the Baltimore City Health Department does not host flu vaccination clinics, it does offer the vaccine for some children.