Medical examiner: 12-year-old died from flu strain vexing UK

7:07 p.m Friday, Feb. 2, 2018 Local
Dylan Winnick, 12, was found dead Tuesday, Jan. 23, 2018, at a home in suburban West Palm Beach. His family said he died of the flu. Winnick was a seventh grader at Okeeheelee Middle School. (Photo provided by Mike Medwin)

“He’s not coming back,” were the words on the 911 call released Thursday detailing the futile efforts to revive 12-year-old flu victim Dylan Winnik at his West Palm Beach home.

Going into the U.S. flu season, disease experts were mostly concerned with a strain of influenza A in what the world now calls the “Aussie flu,” a virus that caused the highest number of infections and deaths in Australia since the swine flu pandemic in 2009.

But it’s influenza B — one known as the Yamagata flu — that took Dylan’s life on Jan. 23 within 48 hours of him coming down with symptoms. The strain is killing dozens in Hong Kong, including young children, and wreaking havoc in Ireland.

The good news, if there is any, is that the virus is included in the U.S. quadrivalent vaccine.

Nicholas Wu, a flu researcher with the Scripps Research Institute, said researchers like himself are often focused on influenza A, which is dominant and causes more illness and deaths for decades. “So virus B is usually ignored or underestimated,” Wu said. “I think in the future we might want to start studying strain B after what we learned this season.”

The Yamagata flu strain is contracted and spread particularly in children. Experts say young children are “super shedders” of influenza B because young immune systems can’t distinguish between what makes them ill and what will kill them. So they secrete more virus. They are also not the best at washing their hands.

In general, the Yamagata – or Japanese – flu is usually thought to be less severe but more contagious than the influenza A that is still dominating the season in the U.S. A few years ago, the Centers for Disease Control and Prevention, though, said that the strain is no longer taking a backseat when it comes to fatalities.

“This contradicts a common misconception that flu B viruses are associated with milder disease than flu A viruses,” said the CDC in a 2014 report.

Dr. Reinhard Motte, an associate Palm Beach County medical examiner, said he may have contracted the flu himself right after conducting the autopsy on the boy, but because he had been vaccinated his recovery was fairly swift. “I picked it up somewhere. I could have gotten it from him,” he said.

911 call

Dylan, a seventh-grader at Okeeheelee Middle School, did not get the flu vaccine. He came down with symptoms on Jan. 22 in what his family believed was a routine cold.

He died at home the following day when his father was away for one hour becoming a U.S. citizen at a naturalization ceremony at the South Florida Fairgrounds. A neighbor, checking on Dylan when his father couldn’t get him on the phone, found the boy collapsed in the bathroom.

The 911 tape released Thursday captures the chaos of trying to revive the boy. The woman making the 911 call was actually in Wellington and talking to someone with Dylan. Complicating matters, a Spanish translator was required.

Most of the 11-minute-long call sounds like a game of telephone — first, a Fire Rescue dispatcher instructs someone to perform CPR. The message had to be translated, then passed from the 911 caller to the person on the phone in Wellington who then relayed instructions to the individual with the boy at the Sunset Lane home.

“He’s not coming back. He’s not resuscitating,” the translator states.

“I need her to do the compressions. We’re going to try to bring him back, OK?” the paramedic responded.

The caller communicated that the boy’s nose was bleeding. He wasn’t breathing. At 12:31 p.m. rescue crews confirmed what the caller feared. The boy was dead.

The influenza B proved surprisingly quick and fatal, invading Dylan’s lungs, Motte said

‘Ton of bricks’

What is so scary about this is it hits you like a ton of bricks,” Motte said. “We moved faster on this because it’s a public health issue. Why it killed him and not other people, I don’t know the answer. You never do.”

The state Health Department says usually influenza B starts appearing later in the flu season.

Ian Branam, a spokesman for the CDC, added: “We are hearing reports of influenza B outbreaks in nursing homes, which is less common for this time of year.”

In places like Ireland, there are reports that the flu vaccine doesn’t include the strain B Yamagata, but that is not true in the United States.

The United States vaccine includes four strains in the yearly virus – often an educated guess to what the upcoming flu season will bring. This year’s vaccine does indeed include protection against the Yamagata virus. However, the flu shot is usually only 40 percent to 60 percent effective in the population.

In the United Kingdom, health officials are getting the word out that the flu going around may not be the dreaded Aussie variety as first thought. The Irish Mirror reported that the Yamagata strain in the predominant flu virus in Ireland this season.

“It was not expected it to be so dominant in Ireland this year and has already overtaken the deadly Aussie flu H3N2,” the newspaper reported.

Aussie flu concerns

Still, the major concern this flu season remains influenza A, H3N2, the so-called Aussie flu. It’s especially dangerous to people older than 65 years of age and young children.

“H3N2 definitely is one that has intrinsic features about the virus that does make it more likely to cause severe disease,” said the CDC’s Dr. Dan Jernigan. “Exactly what the genetic and antigenic features are that make that happen is actually still being investigated now.”

The H3N2 influenza A virus emerged about 50 years ago and has continued to mutate, he said.

Jernigan said it might be that the Aussie flu is having a field day because of the way that vaccines are manufactured.

“We are trying to understand if in fact having to grow it in eggs is leading to some of the lower vaccine effectiveness,” he said. “Most of the vaccine that people get each year is from egg-based manufacturing.”

Wu and his fellow researchers at Scripps, which has a campus in Jupiter, have been looking to manufacture the vaccines in other ways besides using chicken eggs to cut down on virus mutations.

Run on vaccine

The flu has taken an early toll this season. Statewide, more than 3,000 people have died either from pneumonia or influenza. Across the country, more than 30 children have died from the flu.

The result has been a late run on the flu vaccine and the medicine Tamiflu. Some outlets have reported they are out of the vaccine.

And besides the flu, adenoviruses are having a field day and cause cold-like symptoms, including sore throats, bronchitis, pneumonia, pink eye, vomiting and even diarrhea, said Peter Lamelas, the chief of staff for MD Now, which has 33 urgent care centers in the tri-county area.

The MD Now Urgent Care has gone through a half of year’s supply of flu tests already and have about 200 quadrivalent vaccinations, Lamelas said.