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Explosion in Student
Deaths Linked to School Openings
And those with underlying health problems, such as cerebral palsy, muscular dystrophy and neurodevelopmental disorders, are at the highest risk and should be among the first to be vaccinated against the virus, according to a report in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.
The government's warning takes on added urgency as schools begin to reopen and increases in infections from the virus, commonly known as swine flu, become apparent. Swine-flu outbreaks are sporadic throughout the country, especially in the Southeast.
"The most likely explanation is that schools started earlier there," said Dr. Thomas R. Frieden, CDC director.
The above comments linked to today's MMWR are largely US cases from the spring, when the pandemic H1N1 was beginning to spread. However, the school year was ending so most of the patients had significant underlying conditions and were not in the schools which served the vast majority of students. Now that those schools are opening, the number of pediatric deaths has exploded.
The week 33 CDC report has 5 pediatric (ages 0-18 years) deaths, and media reports describe 13 more in the past two weeks. Most of these cases do not have obvious underlying health problems and most are in the south or California, where the school year started in early August. In many cases, the fatalities are in school districts where the absentee rate exceeds 10%. However, these schools are remaining open, and the fatalities are soaring. Moreover, these pediatric cases will lead to more serious adult cases in teachers and parents since school serve as an efficient transmission environment.
These clusters are also appearing further north in Tennessee (see map) or Pennsylvania (see map). In Ringgold Middle School the absentee rate in the 6th grade reached 44% and now the 7th grade is following suit with 60 students out. The number of absentees for the middle school is over 200, representing more than 25% of the school's population and media reports cite one student as more seriously ill. Other school districts have closed to break the cycle, but the number of schools with 10% or more absent is growing, so the breaking of the cycle is difficult.
Reports of 200 or more students out in local schools, including Universities, are widespread, and most of these schools have only been in session for a few weeks. It is likely that these numbers will increase dramatically as more schools open and large school gatherings, including sporting events, increase.
Although many schools are reporting the massive outbreaks, others are attributing the absenteeism to other causes. Since over 50% of H1N1 infections do not produce fever, a runny nose is considered and allergy or a cold. A cough is diagnosed as bronchitis. Gastro-intestinal problems are call the "stomach flu". A sore throat is diagnosed as strep throat. Conjunctivitis or pink eye is attributed to other infections. Influenza A positive cases are called seasonal flu or "normal flu, even though over 99% of influenza A positive cases at this time are swine flu.
Thus, the true extent of the swine flu infections are grossly underestimated, but the increase in hospitalized and fatal cases in the upcoming weeks will focus attention on the true cause of the massive outbreaks in schools.