Methods: Deaths in children aged <18 years with laboratory-confirmed influenza virus infection were reported by state health departments to the Centers for Disease Control and Prevention using a standard case report form to collect data on demographics, underlying medical conditions, bacterial co-infections, clinical course, and laboratory results.
Results: From August 1, 2004 to May 5, 2012, 817 influenza-associated deaths in children were reported (range: 22 in 2011–2012 season to 282 in 2009–2010 season). Of 802 children with influenza type distinguished, 641 (80%) were infected with influenza A virus and 160 (20%) were infected with influenza B virus; 1 child had influenza A&B virus co-infection. Median age was 7 years (interquartile range: 2–12). Thirty-five percent of children died in the emergency department or outside the hospital. Of the 781 with a known medical history, 333 (43%) had no high-risk conditions; of children with high-risk conditions, 57% had neurologic disorders, 45% had asthma or other pulmonary disease, and 22% had genetic or chromosomal disorders. Median duration of illness from symptom onset to death was shorter among children with no underlying high-risk conditions compared with children with at least one high-risk condition (4 versus 7 days; p<0.01). Of 390 children with a specimen collected for bacterial culture from a normally sterile site, 150 (38%) had ≥1 bacterial co-infection; the most common bacterial co-infection was Staphylococcus aureus, which was identified in 76 (19%) of the children who were tested.
Conclusion: Influenza can be fatal in children with and without underlying high-risk conditions. Children with neurologic conditions and chromosomal disorders were highly represented among those who died. Influenza vaccination should be a high priority for all children, especially for those with conditions that place them at high risk for complications. Because influenza infection can progress rapidly to death, children with high-risk conditions or severe illness should receive antiviral treatment as early as possible.
K. K. Wong,
A. Fry, None
L. Brammer, None
L. Blanton, None
R. Dhara, None
L. Finelli, None