14 year yold Texas girl dies without antiviral Tamiflu

By John Ballard

Via H5N1 blog.

FORT WORTH - Five days ago, Fort Worth eight grader Chloe Lindsey came down with a fever. She was diagnosed with the flu Friday and died Sunday. The 14 year old didn't get Tamiflu at her doctor's visit because she wasn't considered high risk.

Chloe's mother, Tammy Osborne, said it all happened so fast. She said she did everything medical professionals told her to do and can't understand how a touch of a fever turned so deadly in just a few days.

Chloe's symptoms began with a fever Wednesday. By Friday, Osborne said a visit with a Fort Worth doctor confirmed her 14-year-old daughter had the flu, possibly the swine flu.

But, Chloe went home from the doctor's visit without Tamiflu, the medication that can ease the flu's severity."They were advised by the CDC to not give Tamiflu to people that were normally healthy," Osborne said. "So, they wouldn't treat her."

When Chloe's fever got worse Friday night, Osborne called the after hours phone line at he doctor's office and was told to keep watching her.
"Saturday she felt really bad," she said. "She couldn't eat or drink or take the medicine."

It only got worse from there. "She took a deep breath, it wasn't very deep, and I could hear crackling in there," Osborne said. "I said, 'That's it; I'm going to the hospital."

By sunrise Sunday, Chloe was at the hospital.

"Everybody just looked at her and just started running around like crazy," Osborne said.

By sunset, Chloe was gone.
"I was scared for them to put her to sleep because I was afraid she would never wake up and she didn't, she didn't," Osborne said through tears.

She said she doesn't blame the doctor, but does question the guidelines that originally ruled out Tamiflu for her daughter.

Dr. Donald Murphey, the director of Pediatric Infectious Diseases at Cook Children's Medical Center, said it is an unfortunate case of short supply.
"We want to do everything we can for every single kid every day," he said. "It's very difficult when resources are stretched and we have to try to balance what's available."

Murphey confirmed guidelines encourage doctors to reserve Tamiflu for the very old, very young and people with other complicating medical problems.
However, he did say there are red flags that can warn a parent when to call their doctor immediately. High fever, difficulty breathing and not being awake, alert and active are all serious signs.

Children who have had the flu more than a couple of days should also be taken to a doctor.

"They just kept telling me it would get better, but it didn't," Osborne said in the case of her own daughter. "I wish now I might have listened to my instincts a little bit better."

Dallas County is seeing a growing number of flu cases. So far, 99 people have been hospitalized with confirmed cases of H1N1. One in four were placed in intensive care units. The number of those who have died remains at four, including two children and two adults.
Tests are being done to determine if Chloe had the swine flu at the time of her death.

I hear news reports almost daily about people who refuse flu shots and parents who refuse to have their children vaccinated. Very sad. Fear is a powerful de-motivator, especially fear of the unknown. Defeating a pandemic involves large numbers of people being pro-active and cooperative, sharing the risks of action against the risks of inaction.  And it is risks, not certainties, freezing these people into inaction.

Another question is how long after vaccination does the protection begin? Again, Kilian's blog has a link to an NIH report

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The preliminary results are based on blood samples taken eight to 10 days after the first vaccination. Immune responses were strongest among the oldest children, those 10 to 17 years old.

  In this group of 25 children, a strong immune response was seen in 76 percent who received one 15-microgram dose of vaccine. The immune responses in children nine years old and younger were not as strong. Among 25 volunteers aged 3 to 9 years old, a strong

In the youngest group, 20 children between 6 months to 35 months old, a single 15-microgram dose of vaccine produced a strong immune response in 25 percent of recipients.

The response time varies with age being the determining factor which is consistent with younger individuals being more vulnerable to the virus itself. Immune systems become stronger with age so younger children need more protection.

Officials and experts continue to push vaccinations because they understand that it is not necessary that every individual in a population be immunized to protect the whole. The more who are immunized the less likely it will be that those who are not will get the disease. Statistics derive from large numbers and although it is cold-blooded to say so, what we must do is protect the herd. At a much safer level it's very much like soldiers in uniform acting together in a combat situation.