Flu is at best miserable and at worst can have serious complications. Children are as vulnerable to the infection as adults and in certain circumstances vaccination is recommended. Attack rates of the virus are highest in preschool and school age children. Symptoms in children are the same as in adults but may also be accompanied by nausea, vomiting and diarrhoea. Children are at higher risk of complications, especially otitis media. In England and Wales in 2003, 11 children aged between one and four died from flu.