Serese Marotta would like to have a little talk with whoever coined the term “colds and flu.” “You hear it all the time in the media and in casual conversation,” she said.
The phrase has given the public an unfortunate and inaccurate impression of influenza. Many parents don’t realize that the flu is a potentially serious disease that has killed more than 100 children annually in the United States during the past few years. In part because of the “colds and flu” wording that they commonly hear, “maybe they don’t understand that the flu isn’t just a bad cold,” Marotta said.
She has experienced the saddest possible outcome of just how serious the flu can be, losing her 5-year-old son Joseph. That led to her active involvement as an advocate for flu awareness and prevention. And she came across the strange attitude, even from her son’s doctor, that flu wasn’t something to worry about, even though Joseph was in the hospital at the time.
“He was in the hospital for 10 days, initially diagnosed with pneumonia, not the flu,” Marotta said. “It wasn’t until his culture was growing influenza that they found out. At that point the doctor came in -- and this was the chief of infectious diseases -- and he said to me, ‘Don’t worry, it’s just the flu.’ The public has picked up on this ‘just the flu’ thing and there are a lot of people perpetuating it.”
Joseph had received his flu vaccination, but this was 2009, the year of the H1N1 “swine flu” pandemic, with a novel version of the virus that had not been included in that year’s vaccine. Two weeks after his death, an additional vaccine became available against that version, and Marotta made sure that Joseph’s older sister was among the first to get it; she and her husband followed suit as it became more widely available.
When Joseph died, Marotta learned that his was the 85th mortality from flu that season. In total, 282 American children died during the swine flu pandemic.
“Before that, I had never heard of a child passing away from flu,” she said. “I had never heard of a healthy adult passing away from flu. And then I found out this was happening every year, all the time. I’m a pretty aware person, so if I didn’t know all of this was going on, probably the majority of the people don’t know about this.”
Many parents might have turned against the idea of vaccination after it didn’t help their children, but Marotta understood the obstacles to developing flu vaccines that address the strains that will dominate during the next flu season. Because it takes months to incubate the vaccine in eggs, immunization experts must try to determine long before flu season which strains will cause the most problems. And during years when they get it right, some versions of the virus, such as the H3N2 that is causing so much misery right now, can mutate even while they’re being incubated. Even then, the U.S. Centers for Disease Control and Prevention said that this year’s vaccine was 59 percent effective against H3N2 in children, and vaccination remains both the best way of preventing flu and a significant help in provoking enough immune response so that vaccinated people experience a milder case.
“I know that they’re doing the best that they can,” Marotta said. “I think that’s why people are so hard on the flu vaccine. They don’t know the complexity of the virus. They’re monitoring those things year-round. Flu is a shape-shifter. It’s very difficult to keep up with all these strains.”
Parents must accept that no vaccine will be 100 percent effective, she said. “There’s a lot of risk in life, and I think as human beings we may not think about that risk every day, but we still get into our cars every day and go places. We still take airplanes.”
Joseph’s death made Marotta determined to keep as many families as possible from experiencing anything similar, and she knew that broader vaccine coverage was the best way to accomplish that. She became active in the group Families Fighting Flu and is now the organization’s chief operating officer.
Its original goal was to persuade the CDC to issue a universal recommendation for the annual vaccine. That happened in 2010 when the CDC said that almost everyone ages 6 months and older should be immunized yearly.
The group now is focused on awareness and higher vaccination rates.
One of its current projects is “Keep Flu Out of School,” a five-year cooperative agreement with the CDC as well as other nonprofit health organizations. The aim is to increase vaccination rates in elementary school by working with teachers, school nurses and other staff, providing resources so that they can teach children about preventive health measures, as well as materials meant to be distributed to parents and caregivers.
“What Families Fighting Flu brings to that partnership are the family stories,” Marotta said. “That resonates with people.”
Another education campaign is called “Stay in the Game,” which provides busy doctors and other health care professionals with a toolkit on vaccination to help them explain the importance of flu shots to families in the limited amount of time they have for many medical visits. It includes a cover letter from a pediatric nurse practitioner about her experiences working to stop the flu, and a FAQ section so that parents can easily get answers to their most common questions.
After years of focusing mainly on children, Marotta’s organization is taking more of a multigenerational approach now.
“Parents often get the kids vaccinated, but not themselves,” she said. “We’ve expanded our scope because we need everyone to be vaccinated to create community immunity around the flu. Less than 50 percent of Americans get vaccinated, though the numbers are higher for children.”
Families Fighting Flu is now bringing grandparents within its area of concern as well.
“Grandparents play an important role in family life, and because they are older, they are immunocompromised to a certain degree,” Marotta said. “Vaccinating the family also means protecting grandparents from the flu.”
Marotta remembers how her advocacy for others began with a meeting with Joseph’s doctor after his death.
“I knew that I had to make something good come out of my tragedy,” she said. “I did the best I could for Joseph. I was a very active parent but there was nothing more I could do for him at that point. What I asked the doctor was, ‘What can we all learn from this experience so that it doesn’t happen again?’ ”
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