In memory of Amanda:A Child’s Death Raises Awareness of the Risks of Flu

On the morning of March 1, 2004, Alissa and Richard Kanowitz awoke in their Upper East Side home to every parent's worst nightmare. They found their 4-year-old daughter, Amanda, lifeless in her bed after two days of what had appeared to be a moderate case of the flu.

A third of Amanda's nursery school classmates were also ill with influenza. The night before, the Kanowitzes' pediatrician had given them the standard advice to keep their child hydrated and to see that urination was normal.

Devastated, but with the support of family and friends, the Kanowitzes have since launched the Amanda Kanowitz Foundation to raise awareness of the dangers of the flu. By establishing the foundation, Alissa Kanowitz explains, "We can channel our energies into something positive, something that will save other children. We owe it to Amanda."

Richard, a lawyer, adds: "We struggle through each day without our precious Amanda. There is nothing more we can do for our daughter, but we feel it's our social responsibility to raise awareness of the risks of influenza and the importance of vaccination."

The couple also has a son, Adam, now 2.

Influenza B causes approximately 36,000 deaths per year. Last year, for the first time, the Centers for Disease Control and Prevention (CDC) tracked the number of pediatric deaths; there were 152. The median age of death was 3.1 years.

Emergency warning signs in a child with the flu are:

• high or prolonged fever • fast or troubled breathing • bluish skin color • not drinking enough fluids • changes in mental status, seizures, not waking • extreme irritability, i.e., child does not want to be held • flu-like symptoms that improve but return with fever and more dramatic cough • worsening of underlying chronic medical conditions such as diabetes and heart and lung diseases

In 2003, Dr. Tim Uyeki, a pediatrician and medical epidemiologist in the influenza branch of the CDC, along with other infectious disease experts, established the need for surveillance of pediatric influenza-associated deaths. While the flu shot cannot protect against every form of the continually evolving influenza virus, the vaccine is created every year to protect against strains predicted to be most prevalent. The CDC currently recommends annual vaccination for a number of high-risk groups, including children 6-23 months and their household caretakers.

Very little research has been done in the U.S. to understand these sudden death or 'rapid deterioration' cases.

According to the Kanowitzes, "The foundation's work will not be done until the CDC officially changes their recommendation for vaccination to cover all children — and especially kids under 5 — and until we figure out how to identify which children are high risk, and effective treatments are developed."

The week before Amanda died, she requested that her fifth birthday party be held at Victorian Gardens at Wollman Rink in Central Park, the same amusement park where she had had her fourth birthday. On September 12, the Amanda Kanowitz Foundation's First Annual Family Fun Day will be held in Amanda's wished-for spot. From 11am-3pm, the event will feature rides, games, face-painting, art projects, live entertainment, raffles and a silent auction. Tickets are $100 in advance ($120 on day of event), adults; $50 in advance ($65 on day of event), children. To purchase tickets, send check or credit card to Amanda Kanowitz Foundation, P.O. Box 8039, New York, N.Y 10150. More information on the benefit as well as on how to donate or offer sponsorships is on the foundation’s website,, which also includes valuable medical information and links. (Tickets to the September 12 event can also be purchased online).

There is a photograph on the website of Amanda running in front of a sand dune at sunset. The caption reads: "Amanda's sunset came too soon." With all the light Amanda and her family have shed on lifesaving information about influenza, sunrises also come to mind.


For more information:

—Amanda Kanowitz Foundation: —Centers for Disease Control and Prevention: —National Institute for Allergy and Infectious Diseases:


Flu shot update:

This year’s recommendations

By Mary Patricia Silver As we enter another flu season, there are many questions and concerns of parents still unanswered. What exactly are this year’s pediatric flu vaccination recommendations? When is the most effective time to receive it? Are officials predicting another vaccine shortage this season? And, of course, is the vaccine safe and effective?

The Centers for Disease Control (CDC) pediatric recommendations for this season have been slightly modified from last year’s. This update now includes all children aged 6-23 months as high risk, along with children aged 2 years or older with underlying chronic medical conditions. Close contacts (family, household members, and health care workers) of high risk children should also be vaccinated. The best time to receive the flu shot is in October because the flu season often begins as early as November. It takes two weeks to build up maximum immunity. Simply put, two weeks post flu shot, your body is best able to fend off the flu.

A new option introduced last year is the needle-free nasal vaccine. This live vaccine (LAIV) is only intended for healthy persons aged 5-49 years. As with the previously mentioned inactivated flu shot, any child who has a severe allergy to hens’ eggs or has in the past had a bad reaction to the vaccine, should refrain from receiving it.

Parents can breathe a big sigh of relief — the CDC has stated that “the Department of Health and Human Services has set aside $80 million over the next two years to build a 4 million dose stockpile intended for children.” This means that parents won’t be scrambling to find pediatric offices with readily available flu shots.

There is even more good news — flu vaccine manufacturers are heeding parents’ concern regarding the use of mercury (thimerosol) in their preparations. LAIV does not contain any mercury. And the number of single-dose syringes of inactivated vaccine (flu shot) available without mercury will more than double for this 2004-05 season. Parents interested in obtaining mercury-free flu shots need to be aware that only two manufacturers (Chiron and Aventis Pasteur) are producing them and only in the single-dose syringes. Multi-dose vials do contain mercury to prevent bacterial contamination.

Many parents mat still be pondering how effective flu vaccinations really are when last year’s news reports were all stating that the vaccine was not a good “match” with the strain causing illness. Then the CDC (post flu season) issued a statement saying that last year’s flu season was “fairly typical.” So how does one reconcile these seemingly opposing views? Dr. Joel Katz, an infectious disease consultant at Brigham and Women’s Hospital in Boston, shares his opinion on this issue: “We are never very good at predicting, and the factors remain more complex than even our best models. With that said, the flu season peaked early last year, raising the consciousness of providers, and perhaps preventing lapses in precautions that might have resulted in more undiagnosed cases and more spread.” When asked directly if he would still advise his patients to get the flu shot if the same circumstances were presented today, he responded with an emphatic “yes.”