WASHINGTON — This year's harsh flu season — — has federal health officials trying to understand if it sparked an increase in a rare but life-threatening brain complication in children.
The Centers for Disease Control and Prevention estimates 19,000 people died from the flu so far this winter, including 86 children. Thursday, the CDC reported at least nine of those children experienced brain complications, and it asked state health departments to help investigate if there are more such cases.
There is some good news: The CDC also reported that do a pretty good job preventing hospitalization from the flu — among the 45% of Americans who got vaccinated.
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That announcement came a day after the Trump administration added to the uncertainty roiling government health agencies by canceling a meeting of experts who are supposed to help choose the recipe for next winter's flu vaccine.

A sign for flu vaccination is displayed Feb. 13, 2024, on a screen at a pharmacy store in Buffalo Grove, Ill.
Still, it's not too late to get vaccinated this year: "If you haven't gotten your flu shot yet, get it because we're still seeing high flu circulation in most of the country," said Dr. Sean O'Leary of the American Academy of Pediatrics.
Flu shot effectiveness varies from year to year. While not great at blocking infections, the vaccine's main role "is to keep you out of the hospital and to keep you alive," Vanderbilt University vaccine expert Dr. William Schaffner said.
Preliminary CDC data released Thursday found children who got this year's vaccine were between 64% and 78% less likely to be hospitalized than their unvaccinated counterparts, and adults were 41% to 55% less likely to be hospitalized.
What about those brain complications? Earlier this month, state health departments and hospitals warned doctors to watch for child flu patients with seizures, hallucinations or other signs of "influenza-associated encephalopathy or encephalitis" — and a more severe subtype called "acute necrotizing encephalopathy." Encephalitis is brain inflammation.
Health leaders have warned of a “potential second norovirus wave†– with people catching the vomiting bug more than once.
The CDC released an analysis Thursday of 1,840 child flu deaths since 2010, finding 166 with those neurologic complications. Most were unvaccinated. The agency concluded it's unclear if this year's nine deaths with those complications — four of whom had the worse subtype — mark an uptick.
There's no regular tracking of those neurologic complications, making it hard to find the answers.
In California, Dr. Keith Van Haren of Stanford Medicine Children's Health said earlier in February he'd learned of about 15 flu-related cases of that severe subtype from doctors around the country and "we are aware of more cases that may also meet the criteria." He did not say how many died.
O'Leary, with the pediatricians' academy, said parents should remember this complication is rare — the advice remains to seek medical advice anytime a child with flu has unusual or concerning symptoms, such as labored breathing.
Doctors see more neurologic complications during severe flu seasons — they may be linked to particular influenza strains — and survivors can have ongoing seizures or other lingering problems, he said.
Meanwhile, vaccine makers already are gearing up for the monthslong process of brewing next winter's flu shots.
The FDA unexpectedly canceled a meeting for advisers to discuss the composition of next flu season's vaccine.
A Food and Drug Administration advisory committee was supposed to meet on March 13 to help choose which flu strains to include but, with that meeting's cancellation, it's unclear if the government will decide on its own.
"We have historically worked really hard to get transparency around all of these vaccine discussions," said O'Leary, who said it's important for the public to understand what goes into making decisions about the flu vaccine composition and other vaccine recommendations.
"The FDA will make public its recommendations to manufacturers in time for updated vaccines to be available for the 2025-2026 influenza season," Andrew Nixon, communications director for the Department of Health and Human Services, said in an email.
How the 1918 Spanish flu pandemic hit states across America
California

- Flu mortality as percent of all deaths, 1918: 17.1% (9,675 deaths)
--- 40.4 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 8.5% (3,938 deaths)
--- 16.4 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 4.6% (2,185 deaths)
--- 9.1 times the 1910-1917 average
Colorado

- Flu mortality as percent of all deaths, 1918: 23.5% (4,126 deaths)
--- 45.0 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 10.0% (1,205 deaths)
--- 13.1 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 7.6% (1,049 deaths)
--- 11.4 times the 1910-1917 average
Connecticut

- Flu mortality as percent of all deaths, 1918: 20.6% (5,604 deaths)
--- 21.6 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 6.8% (1,234 deaths)
--- 4.8 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 4.9% (918 deaths)
--- 3.5 times the 1910-1917 average
Illinois

- Flu mortality as percent of all deaths, 1918: 15.1% (15,169 deaths)
--- Mortality data before 1918 not available
- Flu mortality as percent of all deaths, 1919: 6.7% (5,195 deaths)
--- Mortality data before 1918 not available
- Flu mortality as percent of all deaths, 1920: 6.3% (5,192 deaths)
--- Mortality data before 1918 not available
Indiana

- Flu mortality as percent of all deaths, 1918: 12.1% (5,553 deaths)
--- 10.7 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 8.2% (3,025 deaths)
--- 5.8 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 5.8% (2,295 deaths)
--- 4.4 times the 1910-1917 average
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Kansas

- Flu mortality as percent of all deaths, 1918: 16.3% (4,073 deaths)
--- 8.6 times the 1914-1917 average
- Flu mortality as percent of all deaths, 1919: 9.3% (1,784 deaths)
--- 3.8 times the 1914-1917 average
- Flu mortality as percent of all deaths, 1920: 7.3% (1,473 deaths)
--- 3.1 times the 1914-1917 average
Kentucky

- Flu mortality as percent of all deaths, 1918: 18.1% (7,149 deaths)
--- 14.0 times the 1911-1917 average
- Flu mortality as percent of all deaths, 1919: 12.6% (3,862 deaths)
--- 7.6 times the 1911-1917 average
- Flu mortality as percent of all deaths, 1920: 6.4% (1,838 deaths)
--- 3.6 times the 1911-1917 average
Louisiana

- Flu mortality as percent of all deaths, 1918: 16.5% (5,312 deaths)
--- Mortality data before 1918 not available
- Flu mortality as percent of all deaths, 1919: 9.3% (2,141 deaths)
--- Mortality data before 1918 not available
- Flu mortality as percent of all deaths, 1920: 4.2% (916 deaths)
--- Mortality data before 1918 not available
Maine

- Flu mortality as percent of all deaths, 1918: 17.3% (2,513 deaths)
--- 13.7 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 7.2% (807 deaths)
--- 4.4 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 5.0% (591 deaths)
--- 3.2 times the 1910-1917 average
Maryland

- Flu mortality as percent of all deaths, 1918: 13.8% (4,437 deaths)
--- 20.7 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 5.6% (1,232 deaths)
--- 5.8 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 3.2% (691 deaths)
--- 3.2 times the 1910-1917 average
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Massachusetts

- Flu mortality as percent of all deaths, 1918: 16.2% (12,494 deaths)
--- 32.9 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 5.4% (2,830 deaths)
--- 7.5 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 3.0% (1,584 deaths)
--- 4.2 times the 1910-1917 average
Michigan

- Flu mortality as percent of all deaths, 1918: 12.0% (6,382 deaths)
--- 13.1 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 6.6% (3,024 deaths)
--- 6.2 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 5.9% (3,018 deaths)
--- 6.2 times the 1910-1917 average
Minnesota

- Flu mortality as percent of all deaths, 1918: 18.4% (5,720 deaths)
--- 30.2 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 8.5% (2,106 deaths)
--- 11.1 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 6.5% (1,677 deaths)
--- 8.9 times the 1910-1917 average
Missouri

- Flu mortality as percent of all deaths, 1918: 13.2% (7,025 deaths)
--- 9.8 times the 1911-1917 average
- Flu mortality as percent of all deaths, 1919: 6.6% (2,633 deaths)
--- 3.7 times the 1911-1917 average
- Flu mortality as percent of all deaths, 1920: 7.8% (3,310 deaths)
--- 4.6 times the 1911-1917 average
Montana

- Flu mortality as percent of all deaths, 1918: 29.5% (2,654 deaths)
--- 84.9 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 11.9% (687 deaths)
--- 22.0 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 5.7% (304 deaths)
--- 9.7 times the 1910-1917 average
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New Hampshire

- Flu mortality as percent of all deaths, 1918: 20.9% (1,999 deaths)
--- 19.0 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 7.6% (493 deaths)
--- 4.7 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 4.5% (303 deaths)
--- 2.9 times the 1910-1917 average
New Jersey

- Flu mortality as percent of all deaths, 1918: 13.7% (8,377 deaths)
--- 25.1 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 5.2% (2,117 deaths)
--- 6.3 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 2.9% (1,202 deaths)
--- 3.6 times the 1910-1917 average
New York

- Flu mortality as percent of all deaths, 1918: 11.5% (21,903 deaths)
--- 17.6 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 4.9% (6,944 deaths)
--- 5.6 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 3.3% (4,719 deaths)
--- 3.8 times the 1910-1917 average
North Carolina

- Flu mortality as percent of all deaths, 1918: 18.8% (7,948 deaths)
--- 40.7 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 12.3% (3,802 deaths)
--- 19.4 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 9.2% (2,995 deaths)
--- 15.3 times the 1910-1917 average
Ohio

- Flu mortality as percent of all deaths, 1918: 14.7% (13,542 deaths)
--- 14.8 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 7.8% (5,668 deaths)
--- 6.2 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 5.1% (3,808 deaths)
--- 4.2 times the 1910-1917 average
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Oregon

- Flu mortality as percent of all deaths, 1918: 16.2% (1,564 deaths)
--- Mortality data before 1918 not available
- Flu mortality as percent of all deaths, 1919: 9.5% (849 deaths)
--- Mortality data before 1918 not available
- Flu mortality as percent of all deaths, 1920: 5.2% (481 deaths)
--- Mortality data before 1918 not available
Pennsylvania

- Flu mortality as percent of all deaths, 1918: 20.9% (39,301 deaths)
--- 30.1 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 5.9% (6,878 deaths)
--- 5.3 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 5.1% (6,114 deaths)
--- 4.7 times the 1910-1917 average
Rhode Island

- Flu mortality as percent of all deaths, 1918: 17.7% (2,190 deaths)
--- 25.6 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1919: 6.7% (568 deaths)
--- 6.6 times the 1910-1917 average
- Flu mortality as percent of all deaths, 1920: 4.2% (364 deaths)
--- 4.3 times the 1910-1917 average
South Carolina

- Flu mortality as percent of all deaths, 1918: 19.4% (5,964 deaths)
--- 16.2 times the 1916-1917 average
- Flu mortality as percent of all deaths, 1919: 13.8% (3,171 deaths)
--- 8.6 times the 1916-1917 average
- Flu mortality as percent of all deaths, 1920: 9.8% (2,322 deaths)
--- 6.3 times the 1916-1917 average
Tennessee

- Flu mortality as percent of all deaths, 1918: 16.9% (6,281 deaths)
--- 11.1 times 1917 mortality
- Flu mortality as percent of all deaths, 1919: 10.8% (3,093 deaths)
--- 5.5 times 1917 mortality
- Flu mortality as percent of all deaths, 1920: 8.5% (2,412 deaths)
--- 4.3 times 1917 mortality
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Utah

- Flu mortality as percent of all deaths, 1918: 22.7% (1,402 deaths)
--- 35.1 times the 1910-1915 average
- Flu mortality as percent of all deaths, 1919: 16.4% (803 deaths)
--- 20.1 times the 1910-1915 average
- Flu mortality as percent of all deaths, 1920: 11.0% (573 deaths)
--- 14.3 times the 1910-1915 average
Vermont

- Flu mortality as percent of all deaths, 1918: 19.9% (1,352 deaths)
--- 9.5 times the 1910-1913 average
- Flu mortality as percent of all deaths, 1919: 7.2% (366 deaths)
--- 2.6 times the 1910-1913 average
- Flu mortality as percent of all deaths, 1920: 5.4% (297 deaths)
--- 2.1 times the 1910-1913 average
Virginia

- Flu mortality as percent of all deaths, 1918: 19.0% (7,839 deaths)
--- 18.2 times 1917 flu mortality
- Flu mortality as percent of all deaths, 1919: 12.3% (3,858 deaths)
--- 9.0 times 1917 flu mortality
- Flu mortality as percent of all deaths, 1920: 7.6% (2,311 deaths)
--- 5.4 times 1917 flu mortality
Washington

- Flu mortality as percent of all deaths, 1918: 17.4% (2,926 deaths)
--- 27.6 times the 1910 and 1917 average
- Flu mortality as percent of all deaths, 1919: 9.5% (1,365 deaths)
--- 12.9 times the 1910 and 1917 average
- Flu mortality as percent of all deaths, 1920: 7.4% (1,121 deaths)
--- 10.6 times the 1910 and 1917 average
Wisconsin

- Flu mortality as percent of all deaths, 1918: 17.9% (6,250 deaths)
--- 18.3 times the 1910 and 1917 average
- Flu mortality as percent of all deaths, 1919: 7.9% (2,206 deaths)
--- 6.5 times the 1910 and 1917 average
- Flu mortality as percent of all deaths, 1920: 5.8% (1,726 deaths)
--- 5.1 times the 1910 and 1917 average
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