Outbreaks at 52 camps in 20 states have been reported to the federal Centers for Disease Control and Prevention, spokesman Joe Quimby said yesterday. Because the CDC and states don't require such reporting, the true number of camp outbreaks is likely higher, Quimby said.

“When you congregate children together, you are going to see increased clusters of infections,” said Dr. Wilma Wooten, San Diego County's public health officer.

At least 27 asthmatic children who attended a pair of American Lung Association camps in Julian and Livermore in Northern California came down with the flu, the organization told parents in a recent letter.

Four campers were hospitalized. Two were treated at Rady Children's Hospital in San Diego, spokesman Carlos Delgado said.

In the past two weeks, 44 children who were taken to Rady Children's Hospital with flu symptoms tested positive for swine flu, also known as H1N1 influenza A. The tally included two patients who had attended other camps in the county.

With normal strains of seasonal flu in hibernation, nearly all influenza cases now being detected are H1N1, Quimby said.

Swine flu has been mild overall, but it continues to claim victims. Yesterday, San Diego County's health officials said the disease contributed to the death of a 50-year-old woman on June 29, six days after she was admitted to Paradise Valley Hospital in National City with severe flu symptoms.

The woman, whom the county declined to name, had underlying respiratory and immune-system problems that played a role in her death, Wooten said. She was the fourth swine flu victim in the region.

In general, people with other serious health problems have been hit harder by swine flu. Asthma, diabetes, chronic heart disease and a weakened immune system are some conditions commonly associated with swine flu hospitalizations, the CDC said.

That pattern prompted the Muscular Dystrophy Association to cancel its summer camps nationwide, including one at Camp Cuyamaca in Descanso.

Other camps have delayed opening to guard against the virus, but most have kept their normal schedules. That was the case with Camp Marston in Julian, which hosted about 180 children over six days for the asthma camp that started June 21.

Camp Marston is operated by YMCA of San Diego. For 10 weeks each summer, the site runs camps for various groups of sick youngsters.

Nyeree Bell, 9, of San Diego's Encanto neighborhood, attended the program sponsored by the American Lung Association. By the second day of camp, she felt ill and threw up twice, said her mother, Kenya Bell.

After being checked by the camp's doctor, Nyeree said, she was allowed to continue sleeping in a cabin with other girls and participate in regular camp activities. Nyeree said she asked several times to go home but wasn't permitted to call her parents.

“I didn't find out she was ill until I picked her up” on June 26, Kenya Bell said. “When I got her home, she had a temperature over 100.”

The sickness developed into bronchitis and triggered repeated asthma attacks, forcing Nyeree to take antibiotics and a steroid-based medication, Bell said.

“I thought this would be a good thing for her to experience — going away, meeting new people, having fun doing outdoor things,” Bell said. “She never wants to go to camp again.”

Darin Borgstadter, associate executive director of Camp Marston, said staff members follow CDC and county health guidelines, which include screening campers for illness when they arrive. The standards also call for segregating sick children until their parents can be notified to take them home or until they have been symptom-free for seven days.

“That's not our practice,” Borgstadter said of Kenya Bell's description of her daughter's experience. “I would be surprised if that's what happened.”

Seven children tested positive for swine flu in the first three weeks of the summer season at Camp Marston, he said.

“Just like running a school, kids get sick” at camp, Borgstadter said. “The camp is sanitized regularly. The beds are wiped down. The kids are required to wash their hands before meals.”

Parents play a critical role in preventing swine flu outbreaks from occurring at camps, Quimby of the CDC said.

“If your children have influenza, they need to stay home,” he said. “Young people are very susceptible to this new flu, and there is no vaccine.”

Union-Tribune

2:00 a.m. July 9, 2009

As more parents report that their children weren't properly treated for flu symptoms during a June camp in Julian for asthmatics, the camp's sponsors yesterday raised the tally of sickened youngsters to 89.

Nearly 200 children attended the American Lung Association gathering from June 21 to 26 at Camp Marston. One of the doctors who cared for the children defended his work but also said event officials were reluctant to cut short the camp experience for ill children by sending them home.

That dilemma mirrored the struggle waged for the past 12 weeks by public health officials worldwide, who have tried to balance concerns about swine flu with the need to avoid unnecessary panic.

As the disease, also called H1N1 influenza A, persists into summer, it has caused infections at children's camps in at least 20 states, according to the federal Centers for Disease Control and Prevention.

“It's a wonderful experience for these kids to go off to camp,” said Dr. Michael Welch, a San Diego pediatrician and allergist who oversaw the volunteer health staff during the asthma camp. “We try our darndest to meet their medical needs.”

In recent days, the American Lung Association has sent letters to parents of the campers notifying them about the flu outbreak. Four of the campers were hospitalized and have been released.

A day after Kenya Bell of San Diego's Encanto neighborhood said her daughter's flu symptoms weren't adequately addressed, two more parents raised similar complaints. They said doctors should have notified them of the problems and done a better job of isolating sick children from other campers.

Charlotte Griffin of Poway said her 9-year-old daughter, SaMya, threw up on the second day of camp and sought care at the infirmary. The girl's fever was treated with over-the-counter medication, and she was allowed to return to her cabin when her temperature returned to normal, her mother said.

Like Bell, Griffin wasn't notified about the illness. She learned that her daughter was sick when she picked up SaMya on the last day of camp.

“She had the worst cough. She had fever of 102 (degrees). She was shaking, and she had diarrhea,” said Griffin, a registered nurse who works for Kaiser Permanente.

“I was so angry,” she said. “I was just floored at how it got to the point it did.”

Rukhsana Budhwani of Mira Mesa said her 10-year-old daughter, Simran, didn't develop flu symptoms until she had left the camp for a day. She later tested positive for influenza A.

Public health officials said this week that nearly all flu cases surfacing this summer are H1N1 because seasonal varieties of influenza have all but disappeared.

While most swine flu cases have been mild, the virus has worried health officials because no one appears immune to it and there is no vaccine. Younger patients and people with underlying health issues have been affected most.

Budhwani said another girl in her daughter's cabin became sick with a cough and sore throat early on and spent much of her time in the infirmary. But the girl returned to Simran's cabin each night to sleep with the other campers.

Health guidelines from the CDC and San Diego County call for segregating campers with flu symptoms until their parents can be notified to take them home or until they have been symptom-free for seven days.

Welch said doctors didn't realize something unusual was happening until four days into the asthma camp, and by then they thought most of the symptoms didn't point to anything serious.

“It's always unfortunate when this happens,” he said. “I'm not sure we could have done things differently