Influenza B is back and more children are ending up in hospital

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Talking points

• Influenza B strain has sparked a spike in infections and rising hospitalisations among Australian children.
• In June, 200 children infected with the flu were admitted to hospital at Monash Health, eight requiring intensive care.
• Influenza strain A previously accounted for about 75 per cent of all cases in Australia, but influenza B has surged to around half of new cases.

After a four-year lull due to the pandemic, influenza B cases are spiking, causing a rise in the number of children going to hospital – some critically ill after developing rare and life-threatening complications.

Doctors warn that the flu season is yet to peak in Victoria, and with school now back after the mid-year break and flu vaccination rates lower than usual, the state’s hospitals are bracing for a surge in cases among children.

Merrin Schnabel’s sons Luke and Jack have recently recovered from influenza.Credit: Paul Jeffers

Last week, two children – a year 9 student from the NSW’s Central Coast, and an 11-year-old girl in Queensland – died after contracting influenza B, prompting health authorities to urge parents to get their children vaccinated.

Professor Kristine Macartney, director of the National Centre for Immunisation Research and Surveillance, which is tracking the flu outbreak, said there had been a jump in the number of school-aged children infected with influenza B in the past two months.

“They’re at home with terrible headaches, muscle aches and sore throats,” she said.

“But then a number of these children are then having some kind of rare complications from the virus itself, which can cause infection, inflammation of the heart muscles, very severe inflammation of other muscles, brain swelling, seizures and viral pneumonia.”

Macartney said some children were also arriving at hospitals with secondary infections including strep and pneumococcus, which can lead to rapid deterioration or severe illnesses including meningitis or sepsis.

“Really kids are set up because the flu is the first big hit and then the secondary bacterial infection is the second big hit,” she said. “That’s been landing a proportion of the children in our intensive care unit and on heart-lung machines.”

Macartney said until about two months ago, the common influenza strain A accounted for about 75 per cent of all cases in Australia, but influenza B had surged to make up some 50 per cent of total notifications.

Merrin Schnabel thought her two sons had coronavirus again when they had high temperatures, sore throats and body aches that left them bedridden – but tests revealed it was influenza B.

Professor Kristine Macartney says some children are arriving at hospitals with secondary infections after contracting influenza B.Credit: Kate Geraghty

The 42-year-old life coach and motivational speaker from Geelong said she could not recall her 13-year-old son, Jack, who was left vomiting and ashen-faced, ever being so sick.

At night, Schnabel was running between their bedrooms with cold face washers as their fevers raged.

“It was really nasty,” she said. “As a mother you are just left so worried.”

Schnabel said it took nine days for Jack and 11-year-old Luke to recover. “We were all hit pretty hard by coronavirus, but this felt even more intense,” she said.

Health authorities are urging more young people to get the flu vaccine.Credit: Paul Jeffers

Queensland health authorities this month warned the state was in uncharted territory amid an outbreak that had sparked a significant surge in the number of children hospitalised with the flu. A similar picture has also emerged in NSW, with local health authorities warning cases of influenza B remain at concerning levels.

The head of infection and immunity at Monash Children’s Hospital, Dr Jeremy Carr, said Victoria had seen cases start to kick off through June and July.

“Cases are continuing to rise in children given that schools have just gone back,” he said.

Last month, 200 children infected with the flu were admitted to hospital at Monash Health, eight requiring intensive care. That’s more than double the number of admissions in May.

“We have not seen a rapid increase in critical cases requiring intensive care,” he said. “Those really severe respiratory presentations don’t appear to be any different from previous years.”

The Royal Children’s Hospital in Melbourne has reported 425 admissions for influenza this year, including 179 for the month of June.

About 10 per cent of children who end up in hospital with the flu can have neurological problems, such as memory loss, seizures and learning and speech difficulties.

The most common reasons for children with the flu presenting to emergency departments are prolonged fevers, dehydration and difficulty breathing.

“Most children who present to primary healthcare can be managed at home with appropriate advice around hydration,” Carr said, adding that parents should trust their instincts and seek medical help if concerned.

Australia has not experienced a significant wave of influenza B since 2019, before the COVID-19 pandemic, leaving young children vulnerable.

“The thing about influenza B is it tends to affect more school-aged children,” Macartney said. “It causes slightly different types of disease including a lot of muscle inflammation.”

As of July 9, about 70 per cent of Australians admitted to hospital for influenza in 2023 were children younger than 16, according to federal government data. About 5.9 per cent were so ill they were admitted directly to intensive care.

The NSW Health respiratory surveillance report showed that during the week ending July 8, 3976 out of 7202 reported cases of all influenza strains were people aged 19 and under. Almost half of all admissions to hospitals for influenza-like illnesses in NSW were in children 16 and younger.

Carr said that while influenza was circulating at concerning levels among Victorian pre-schoolers and school-aged children, it had the potential to spill over to older Australians who are at heightened risk of severe disease.

National data shows 14.3 per cent of Australians aged 5 to 15 have been vaccinated against the flu this year, compared with almost 22 per cent last year. For children aged 6 months to five years, flu vaccination rates are hovering at 24.5 per cent compared with 28.9 per cent last year.

“The best defence against the flu every year is the influenza vaccine,” Macartney said, urging parents to keep their children home if they were unwell. Flu vaccination is free for Australian children aged under five.

There have been 25,960 cases of the flu reported in Victoria so far this year and almost 150,000 nationally. At least 134 people have died.

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