515. Influenza-Associated Pediatric Mortality and the Application of Multiplex Testing to Detect Respiratory Virus Coinfection — Wisconsin, October 4, 2014–February 7, 2015
Session: Poster Abstract Session: Respiratory Infections: Pediatric
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • PED_influenza deaths.gif (683.9 kB)
  • Background: Laboratory-confirmed influenza-associated pediatric mortality is reportable in Wisconsin and nationally. During the 2014–15 influenza season, 6 pediatric deaths were reported among Wisconsin residents. We investigated to determine if virus coinfection was a factor among these deaths.

    Methods: We reviewed reports of influenza-associated pediatric (aged <18 years) deaths in the Wisconsin Electronic Disease Surveillance System during the 2014–15 influenza season. An influenza-associated death was defined as a death resulting from a clinically compatible illness that was confirmed to be influenza using a laboratory or rapid diagnostic test. Available nasopharyngeal or oropharyngeal autopsy specimens were tested for the presence of 16 respiratory viruses by using a multiplex respiratory virus panel (GenMark eSensor RVP). Targeted viruses included influenza A/H1, pd2009 H1, H3 and influenza B, parainfluenzavirus types 1-4, RSV A/B, adenovirus, rhinovirus/enterovirus, human metapneumovirus and four coronaviruses.

    Results: Among the 6 deceased patients, median age was 3 years (range: 6 months–12 years); 4 were male; and 1 had an underlying medical condition (chromosomal abnormality). Among the 6 patients, 4 received no influenza vaccine during the 2014–15 influenza season, 1 received only an initial dose of vaccine, and 1 received vaccine 3 days before death.  Three patients had concomitant methicillin-susceptible Staphylococcus aureus (MSSA) pneumonia with bacteremia. Autopsy specimens from 5 patients were available for multiplex testing. All 5 patients had influenza A/H3 infections; 2 patients with MSSA pneumonia had no viral coinfection. Three patients had virus coinfections: 1 with MSSA pneumonia was coinfected with RSV-A, parainfluenza-3, and adenovirus-C; 1 was coinfected with rhino/enterovirus and adenovirus-C; and 1 was coinfected with influenza B and coronavirus (OC43). 

    Conclusion: Occurrence of pediatric deaths among unvaccinated or undervaccinated children underscores the importance of routine annual influenza vaccinations recommended for all persons aged ≥6 months. Multiplex testing detected coinfection with >3 viral pathogens among 3 of the 6 deceased patients; however, the role of viral coinfection in development of clinically severe disease among patients with influenza remains unclear.

    Lina I Elbadawi, MD, MS1, Thomas Haupt, MS1, Anna Kocharian, MS1, Erik Reisdorf, MPH2, Tonya Danz, BS2 and Jeffrey P Davis, MD1, (1)Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison, WI, (2)Communicable Disease Division, Wisconsin State Laboratory of Hygiene, Madison, WI

    Disclosures:

    L. I. Elbadawi, None

    T. Haupt, None

    A. Kocharian, None

    E. Reisdorf, None

    T. Danz, None

    J. P. Davis, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.