SpongeBob and red Gatorade were the last things little Joseph Marotta and his mom Serese ever talked about.
Joseph died in 2009, a victim of the H1N1 swine flu pandemic. Now his parents Joe and Serese are advocates for flu vaccine. It’s a full-time job for Serese.
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On Thursday Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, got his annual flu shot for the television cameras.
“We recommend that everyone over the age of 6 months get a flu shot this year and every year,” Frieden told NBC News.
The Marotta’s ordeal is a reminder of why. It’s not a typical cautionary tale about people who don’t vaccinate their kids, but an illustration of just how dangerous and unpredictable flu can be.
“He was your typical healthy five-year-old boy. He was in kindergarten in the fall of 2009 — loved Legos and Spiderman, Transformers, loved doing puzzles,” Serese remembers.
The family always valued flu vaccines and both Joe and his big sister Emma were up to date on their immunizations.
So Serese wasn’t too worried when Joseph caught a bug in October.
“You know, with the second child, when the school calls and tells you they throw up, it's not a big deal,” she said.
“You bring them home, check them out. Well, he continued to throw up throughout the day.”
'No big deal. It's just the flu.'
Joseph’s dad Joe Serese called the pediatrician, who sent them to a local urgent care clinic. Because Joseph had a low blood oxygen level, they took him to the emergency room.
Joseph had pneumonia but his flu tests came back negative. In 2009, H1N1 was a brand-new virus and the tests didn’t always detect it. More important, the flu vaccine Joseph got earlier that year did not protect against H1N1.
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But no one suspected flu. Joseph ended up spending nine days in the hospital taking antibiotics.
It wasn’t until a few days into his stay that Joseph’s doctor found he also had influenza, and they started Joseph in Tamiflu, an antiviral drug that can help reduce serious symptoms.
"And he said, ‘No big deal. It's just the flu. We'll start him on antivirals. We'll send his sample out to the CDC for testing. But if it's H1N1, don't worry. It's just like any other flu’,” Serese said. “You know, everything'll be fine."
But it wasn’t.
“The ninth day of his hospital stay is when things all of a sudden started kind of going off the rails,” Serese said.
“We were treating the pneumonia. We were treating the flu,” she added. She tried to stay calm.
“I still felt like he's in the right place. He's in the ICU. He's in the hospital. We're doing what we need to do."
Serese stayed up late with Joseph while Joe took their daughter Emma home
“He kept asking me for red Gatorade and I kept saying, ‘Well, you can't have it. The doctor says you can't have it’,” she recalled.
“And he's like, ‘Oh, Mom.’ So I was trying to distract him with SpongeBob cartoons.”
Suddenly, Joseph’s blood pressure plunged, and doctors struggled to figure out why. It wasn’t until later —too late — that they discovered Joseph had sepsis, a rare complication of influenza, and it had damaged his intestines. There was a rupture and Joseph was bleeding to death.
All Serese knew was that one minute she was chatting with Joseph about Halloween costumes, and the next, his eyes had rolled back in his head.
He died just hours later, one of 282 U.S. children who died of H1N1 that flu season.
“We could be you. We could be anyone. Our son, you could look at his picture and that could be your child,” Serese said.
'Flu shots work'
CDC says H1N1 infected 61 million Americans during the pandemic and killed around 12,000. H1N1 is now part of the annual seasonal flu mix, and it’s one of the strains included in this year’s vaccine.
Frieden says it’s too soon to say how well this year’s vaccine will protect against flu.
“This year’s flu vaccine matches what is predicted to occur this year but whether that happens or not, only time will tell,” he said.
“What we do know is that flu shots work. When the match is reasonable, they prevent at least half of the flu cases, hospitalizations, and deaths. It's the single most effective way to protect yourself against the flu.”
Serese is now chief operating officer for Familes Fighting Flu, a vaccination advocacy group.
“You know, we've even had family members who have been reluctant to get the flu vaccine,” she said.
“And that seems a little ironic, given Joseph's situation. But again, I think it's just — sharing our story, reiterating again and again how important it is. It's the best preventative measure we can take.”
One big disappointment for many parents this year is the absence of FluMist, the popular nasal spray vaccine that saves kids the pain of a needle.
CDC is still investigating, but FluMist appears to have lost its previous strong efficacy, so it’s off the U.S. market this year.
“But there are still lots of different ways to get vaccinated, lots of different vaccines out there, no excuse not to get vaccinated," Frieden said.