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
  • 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


    L. I. Elbadawi, None

    T. Haupt, None

    A. Kocharian, None

    E. Reisdorf, None

    T. Danz, None

    J. P. Davis, None

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