Influenza-Associated Pediatric Deaths— United States, 2004–2012

Background: Influenza-associated pediatric deaths are rare.  We describe the epidemiology of influenza-associated pediatric deaths across the 2004–2005 to 2011–2012 influenza seasons. 

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.