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The flu-related death of a Washington County girl last week has put the spotlight on flu vaccines as this season's outbreak is peaking.

It remains unknown whether Payton Pierson, 10, of Washington received a flu shot. Her aunt, Carissa Worobec, said she was unsure whether the girl was vaccinated.

So far this season, 20 children have died due to flu nationally, according to the Centers for Disease Control and Prevention.

That number likely will climb as about 100 to 200 children under 18 years old die annually from flu complications, said Dr. John Williams, chief of pediatric infectious diseases at Children's Hospital of Pittsburgh of UPMC.

The flu kills more than 30,000 people a year on average, according to the CDC.

“A common challenge in this field is that many people think of the flu as a mild disease,” Williams said. “For many it is, but tens of thousands of people die each year of flu-related illnesses.”

Children and the elderly are particularly vulnerable.

“Almost almost all of the children who die of influenza are not vaccinated,” Williams said.

This season's vaccine, which contained components aimed at preventing illness from two A strains of the flu — H3N2 and H1N1 — and a so-called B strain appears to be effective, said Dr. Marc Itskowitz, an internal medicine physician at Allegheny General Hospital.

He said Western Pennsylvania appears to be in the midst of the outbreak's peak. Generally the vaccine is about 60 percent effective each season. Nationally, flu is widespread in 43 states, including Pennsylvania.

Even when those vaccinated contract the flu, their symptoms are usually less severe, Itskowitz said.

“You might spend two days in bed rather than five to seven days in bed,” he said. “Even if you get sick, you are likely to have a better outcome if you vaccinate.”

It takes about two weeks for the flu shot to provide full protection.

About 46 percent of Americans — 144 million people — received flu vaccines during the 2015-16 season, down by 1.5 percent from the previous season, according to the CDC.

“It's still not too late to get a flu shot,” Itskowitz said. “There's still a lot of activity out there.”

Between Oct. 1 and Feb. 4, 6,804 confirmed flu-associated hospitalizations were reported, according to CDC statistics. The highest rate of hospitalization was among adults over 65.

The Pennsylvania Department of Health has confirmed 26,675 flu cases and 38 flu-related deaths this season.

There have been 2,582 flu cases in Allegheny County, 762 in Westmoreland and 787 in Washington County. Updated statistics will be available later this week.

Payton, a third-grader at Trinity South Elementary School, died Thursday at Children's Hospital, four days after being transferred from Washington County.

Doctors at Washington Hospital diagnosed Payton with the flu through a rapid nasal test on the evening Feb. 4, and she returned home, Worobec said. She collapsed Sunday morning and was rushed back to Washington Hospital before being flown via helicopter to Children's.

She remained in a coma until Thursday, when she was removed from life support, her aunt said. Her funeral was Monday.

Before this flu season, experts wondered whether more children would avoid the vaccine because nasal sprays like FluMist are no longer available.

Many children preferred the mist to the shot, but officials have determined the spray to be ineffective.

Itskowitz said it's still too early to gauge whether the lack of nasal sprays led to a decline in pediatric vaccinations.

Oftentimes, patients experiencing intense flu symptoms contract a secondary infection, such as bacterial pneumonia, that can lead to respiratory failure, he said.

While pediatric deaths connected to the flu are rare, “it's just a tragic outcome when I child dies,” Itskowitz said.

Besides a vaccination, Williams said hand hygiene is extremely important. The flu is commonly spread from person to person via hand contact.

“When our moms told us to wash our hands when we were growing up, they were actually right,” he said.

Ben Schmitt is a Tribune-Review staff writer. Reach him at 412-320-7991 or bschmitt@tribweb.com.

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