On October 9, 2009, 5-year-old Joseph Marotta developed a sniffle and a cough. Later that day, Joseph became very lethargic and his breathing became labored. His parents called their pediatrician who suggested they take Joseph to the local urgent care. Once they arrived, the doctors and nurses decided Joseph needed to be immediately transported to the local children’s hospital. But, before they left a rapid test for H1N1 influenza was performed on Joseph, which came back negative.
At the hospital, Joseph was sent to the ICU where the doctors treated him for breathing difficulties. They determined that evening that Joseph had pneumonia. The doctors also did a PCR test for H1N1 influenza, which came back negative.
The next day, the doctors downgraded Joseph from the ICU to the regular pediatric floor because he showed improvement with his breathing. However, three days later, on October 13, the doctors stated that his cultures were growing influenza despite the PCR test being negative. At this time, Joseph was prescribed Tamiflu even though additional testing would need to be conducted to conclusively reach a diagnosis of H1N1. Two days later (and seven days into his hospital stay), Joseph finally had a positive diagnosis of H1N1 influenza.
Throughout Joseph’s hospital stay, his condition was up and down, but it never got to the point of being critical. He had a constant fever, which was treated with ibuprofen. The doctors were treating the pneumonia with two types of antibiotics as well as other medications like Xantac and Prevacid to counteract any gastrointestinal effects of the medications. Joseph also developed stomach pain, which the doctors attributed to H1N1 influenza and pneumonia, but diagnostic tests (e.g., x-rays) were conducted to rule out gastritis and pancreatitis. Joseph vomited intermittently throughout that week. He had no appetite and was on IV fluids.
However, later that week his low sodium levels became concerning to the doctors. His blood pressure dropped and his breathing became labored. The doctors sent him back to the ICU. In the ICU, doctors performed a multitude of tests. At that time, the doctors thought he had developed an autoimmune response. Over the course of seven hours, Joseph’s condition deteriorated rapidly; however, his lab work and other tests kept coming back normal. The doctor suggested Joseph be put on a ventilator to help his body take a rest (his low blood pressure was causing his respiration and heart rates to go really high). While the doctor was prepping things, his mother talked to Joseph (he had been coherent and talking the whole time). Then, all of a sudden, Joseph’s heart monitor went off indicating V-tach. He became unconscious. The doctors and nurses worked on Joseph for 35 minutes and for nine of those minutes they were able to briefly stabilize his heart rate, but ultimately after life-saving efforts, they were unable to revive Joseph.
On October 18, 2009, Joseph suffered a catastrophic intestinal rupture of approximately ¼ inch that caused him to go into shock and bleed out. It was determined during his autopsy that Joseph had developed a duodenal ulceration as a result of H1N1 influenza that slowly eroded his intestinal tract until it ruptured.
Joseph had not been vaccinated against H1N1 influenza because at the time the vaccine was not available in his community. However, Joseph’s parents are strong advocates for influenza vaccine and every year they get themselves and their daughter vaccinated against the flu.
- Joe and Serese Marotta
(father and mother)
Place of Residence:
- Springboro, OH
Date of Child's Death:
- October 18, 2009