by FERN SHEN
After a Baltimore girl’s H1N1 death, area parents are rattled, pediatricians are working overtime, some hospitals are making H1N1 inoculation mandatory and city schools are sending home anyone with “flu-like illness.”
The day Rebecca Smith heard that a local child with no other medical problems had died from swine flu, the Upper Fells Point mother thought back to earlier that morning when she’d been home with her own feverish child. After her daughter had slept for more than 17 hours straight, Smith — who considers herself “the antithesis of overreactive when it comes to her children’s health” — became concerned enough to wake the child up.
“Fortunately she woke up happy and without a fever,” Smith said. “After hearing the tragic news about the death of the young Baltimore girl, I was very grateful that I didn’t have to worry about my own child’s health, at least not this week.”

This unusually fraught flu season is changing behavior, even among laid-back parents.
Smith describes herself as “one of those let-them-get-germs parents who believes this is better for children’s immune systems long-term,” but she said she plans “to be more focused on efforts to shield them from germs this season — lots of handwashing, etc.– because the stakes are so high.”
And though Smith and her kids don’t usually get flu shots, she said, “we all will this season.”
Health officials in Maryland and Baltimore wish more parents were like Smith. A recent Associated Press poll found that more than a third of parents don’t want their kids vaccinated against swine flu.

Area principals, health officials and hospital administrators, as well as many parents, are all on alert these days following the death Tuesday night of Montebello Elementary-Middle School student Destinee Parker. Adding to the concern is the fact that while swine flu is now widespread in Maryland and across the country,the initial supplies of the H1N1 vaccine coming to Maryland are limited and just a fraction of what is needed.

When to send an ill child home from school
Anyone hoping to find out how many Baltimore City Public School students have been diagnosed with H1N1 will be disappointed. Principals are calling parents to come get students not because they have flu but because they have “ILI” (influenza-like illness). It’s up to parents to get their children treated and schools do not routinely find out who gets diagnosed, said schools spokeswoman Edie House-Foster.

So what exactly constitutes ILI in Baltimore schools? That’s actually a bit fuzzy.

“It’s a 102 or higher fever and other less-objective criteria,” said Matthew Hornbeck, principal of Hampstead Hill Academy.

“It’s 100 (F) or higher and a cough and/or a sore throat,” said Edie House-Foster, director of public information for Baltimore City Public School.

In her robo-call to parents Friday, Roland Park Elementary Middle School principal Carolyn Cole kept it a little more general.

“At Roland Park, several members of our school community have reported flu-like symptoms this week,” Cole said in the recorded message. “They have a fever and a cough or a sore throat. These individuals have been sent home and will at remain home until they are healthy and fever -free for 24 hours.”

(Click here to hear the message: Message from the Principal of Roland Park Elementary School on H1N1 )

In any event, principals said they were trying to be rigorous last week about encouraging parents to get their children seasonal flu vaccination, segregating sick kids as much as possible and wiping down the waiting area after they go home. So far, Hornbeck said, his East Baltimore school has had great attendance, record-breaking in fact. But he predicted that the err-on-the-side-of caution policy could mean a lot of empty desks in schools in the coming weeks.

“I suspect there will be pockets of low attendance at some schools. Homework and classwork will be affected,” he said. “There will be 20 to 70 percent out on some days this year.”

No word yet on exactly how the H1N1 vaccine will be made available to students. “We will have clinics set up in the schools,” said Brian Schleter, a spokesman for the Baltimore City Department of Health.

Even with the precautions, parents worry about their kids’ exposure to the flu at school.

A friend of Smith whose two-year-old came down with what might have been H1N1 was taken aback at the reaction, she said. “She goes to a pretty popular pre-school and a lot of people there were really, really freaked out,” she said.

Some pediatricians running out of seasonal flu vaccine

A more immediate concern some parents report is that pediatricians’ offices are running out of seasonal flu vaccine. The Maryland Pediatric Group, in Lutherville, has cancelled flu clinics “due to a shortage of the influenza vaccine,” according to the notice placed prominently on their website. A staffer who answered the phone there said people have been getting their seasonal flu shots much earlier than normal this year and “our flu clinics have been slammed.” She added “it’s not that we didn’t order enough (vaccine), it’s more of a demand issue.”

State officials say the local vaccine shortages are just temporary but they are part of a larger problem. There is a national delay in getting seasonal flu vaccine orders shipped because suppliers are responding first to pressures to ship H1N1 vaccine.

In Harford County, the drive-through seasonal flu clinic planned at Ripken Stadium last week was canceled due to the vaccine shortage.

Baltimore pediatrician Steven Caplan still had seasonal flu vaccine on hand late last week. But  after a packed week of seeing patients with flu-like symptoms, vaccinating lots of kids against seasonal flu and diagnosing and treating several for H1N1, Caplan said, “I’m definitely going to take inventory.”

“I’m busier than I normally would be,” he said. “A lot of people are scared.” Caplan said much of his extra patientload came from people getting their seasonal flu shot earlier than normal this year.

Asking – or telling – health care workers to get vaccinated

Area hospitals face a special challenge when it comes to preventing the spread of influenza among patients and staff. Their approaches vary.

Seasonal flu vaccine is required at Franklin Square Hospital Center in Baltimore and several suburban hospitals (Baltimore Washington Medical Center in Glen Burnie, Upper Chesapeake Medical Center in Bel Air and Harford Memorial Hospital in Havre de Grace).

Elsewhere, hospital administrators are strongly encouraging staff to get inoculated against seasonal flu. At Johns Hopkins Medicine, vaccination isn’t mandatory, but those who decline to get seasonal flu shots are required to sign a “declination form” and must wear masks around patients. “Employees who decline the seasonal flu vaccination will not be able to get the H1N1 vaccine,” according to an Oct. 1 memo to staff.

No word yet on how this is going over locally. But some health care workers in New York howled this summer when the state health commissioner ordered everyone, from hospital janitors to neurosurgeons, to get seasonal and swine flu vaccination.