“Doctor, do you recommend the flu vaccine?”
Let me tell you a true story from January 2024.
I was on duty in one of the Pediatric Emergency Rooms where I rarely worked, cold and far from home.
I had started my shift at 5:00 PM and was seeing patients in the ER office located inside the pediatric ward, as is customary in peripheral hospitals.
Around 7:00 PM, a father called me: his 18-month-old son had had a high fever since the previous evening, had been seen by his pediatrician late that morning, who had suspected influenza.
The father called me because the child, after taking ibuprofen, had vomited it up along with his entire dinner.
I therefore advised giving it again, remaining available.
I continued with my visits in the ER office where, in over 90% of cases, they were white codes that could be deferred to the next day. Typical.
Flu vaccine: why get it?
Around 9:00 PM, they called me from the central ER: a 2-year-old child with dyspnea, code red!
I thought of the usual acute bronchospasm.
I thought of the usual improperly assigned code red, but I was aware of being in a peripheral hospital and the inevitable effect that a child with breathing difficulties has on the triage nurse.
I thought that I could probably take him to the ward and manage him better there, perhaps after a good nebulizer treatment.
While having these thoughts, I was running down the stairs. The central ER was 2 floors and a long basement corridor away from me.
When I arrived in the Shock Room, the situation initially appeared calm: the child was indeed dyspneic, but the oxygen saturation wasn’t terrible and he was responding well to the administration of a little oxygen and the bronchodilator already started in the nebulizer, his color was pink, his eyes were open.
What can happen without flu vaccine?
His eyes were open, but he was barely responding to stimuli. Blood glucose was good, we hypothesized he might be having a non-convulsive epileptic seizure and decided to administer the appropriate treatment, without benefit.
To support circulation, we were infusing fluids.
Suspecting meningoencephalitis, we administered antibiotics and antivirals.
The brain CT scan came back negative (normal).
Blood tests, however, indicated a severe infection (he had 74,000 WBC/mm3!).
It probably wasn’t “just” a complex febrile seizure.
Everything seemed to allow us to wait “calmly” for transport, which was arriving.
Until he rapidly deteriorated from a respiratory standpoint and the anesthesiologists proceeded with intubation, without difficulty.
The airways were stabilized. Good, in view of transport.
This is why we vaccinate our children.
After about fifteen minutes, like a bolt from the blue, asystole: cardiac arrest.
We started advanced resuscitation without losing an instant. We were in the right place at the right time. Cardiac massage, ventilation, drugs. Nothing could go wrong.
But it did.
After 45 minutes of high-quality resuscitation, no sign of recovery. No response from that little heart to the maneuvers and drugs. Not even transiently. Not even once.
We couldn’t fathom that it could have happened. What went wrong?
Yet all the checks done and redone during resuscitation had not revealed any good reason why that little heart shouldn’t restart.
Diagnosis? Fulminant encephalitis from Influenza A + adenovirus.
A combination that, in the scarce literature available, I’ve seen to be particularly aggressive.
An 18-month-old child, basically healthy, died before my eyes within a couple of hours due to an infection for which vaccination would have almost certainly saved him.
So do I recommend the flu vaccine?
ABSOLUTELY YES!
The vaccine is RECOMMENDED for all children in the 6 months-6 years age range (and for the fragile beyond that age, as well as for those over 60).
Recommended means that we pediatricians should recommend it, not suggest it timidly.
Two types of vaccine will be available:
- nasal spray, live attenuated: for children at least 2 years old;
- intramuscular: from 6 months.
The first time, 2 doses are required about 1 month apart, only one dose from the following winter onwards.
While fulminant encephalitis is a rare event (several are described in the literature, but not the one I told you about, which unfortunately remained a draft and not by my choice), influenza often causes high fever for several days (even 8-10) and can be complicated by interstitial pneumonia requiring oxygen.
Which for me would already be enough.
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SOURCES
Steininger C, Popow-Kraupp T, Laferl H, Seiser A, Gödl I, Djamshidian S, Puchhammer-Stöckl E. Acute encephalopathy associated with influenza A virus infection. Clin Infect Dis. 2003 Mar 1;36(5):567-74. doi: 10.1086/367623. Epub 2003 Feb 14. PMID: 12594636; PMCID: PMC7199495.