Giuseppe
Emeritus
Influenza-Associated Pediatric Mortality in the United States: Increase of Staphylococcus aureus Coinfection [Pediatrics]
Influenza-Associated Pediatric Mortality in the United States: Increase of Staphylococcus aureus Coinfection
Lyn Finelli, DrPHa, Anthony Fiore, MDa, Rosaline Dhara, MPHa, Lynnette Brammer, MPHa, David K. Shay, MDa, Laurie Kamimoto, MDa, Alicia Fry, MDa, Jeffrey Hageman, MPHb, Rachel Gorwitz, MDb, Joseph Bresee, MDa and Timothy Uyeki, MDa
a Influenza Division, National Center for Immunization and Respiratory Diseases
b Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
OBJECTIVE.
Pediatric influenza-associated death became a nationally notifiable condition in the United States during 2004. We describe influenza-associated pediatric mortality from 2004 to 2007, including an increase of Staphylococcus aureus coinfections.
METHODS.
Influenza-associated pediatric death is defined as a death of a child who is younger than 18 years and has laboratory-confirmed influenza. State and local health departments report to the Centers for Disease Control and Prevention demographic, clinical, and laboratory data on influenza-associated pediatric deaths.
RESULTS.
During the 2004?2007 influenza seasons, 166 influenza-associated pediatric deaths were reported (n = 47, 46, and 73, respectively). Median age of the children was 5 years. Children often progressed rapidly to death; 45% died within 72 hours of onset, including 43% who died at home or in an emergency department. Of 90 children who were recommended for influenza vaccination, only 5 (6%) were fully vaccinated. Reports of bacterial coinfection increased substantially from 2004?2005 to 2006?2007 (6%, 15%, and 34%, respectively). S aureus was isolated from a sterile site or endotracheal tube culture in 1 case in 2004?2005, 3 cases in 2005?2006, and 22 cases in 2006?2007; 64% were methicillin-resistant S aureus. Children with S aureus coinfection were significantly older and more likely to have pneumonia and acute respiratory distress syndrome than those who were not coinfected.
CONCLUSIONS.
Influenza-associated pediatric mortality is rare, but the proportion of S aureus coinfection identified increased fivefold over the past 3 seasons. Research is needed to identify risk factors for influenza coinfection with invasive bacteria and to determine the impact of influenza vaccination and antiviral agents in preventing pediatric mortality.
Key Words: influenza ? influenza vaccine ? mortality rates ? Staphylococcus aureus
Abbreviations: CDC?Centers for Disease Control and Prevention ? ACIP?Advisory Committee on Immunization Practices ? MRSA?methicillin-resistant Staphylococcus aureus
Accepted Jul 1, 2008.
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<cite cite="http://pediatrics.aappublications.org/cgi/content/abstract/122/4/805">Influenza-Associated Pediatric Mortality in the United States: Increase of Staphylococcus aureus Coinfection -- Finelli et al. 122 (4): 805 -- Pediatrics</cite>Lyn Finelli, DrPHa, Anthony Fiore, MDa, Rosaline Dhara, MPHa, Lynnette Brammer, MPHa, David K. Shay, MDa, Laurie Kamimoto, MDa, Alicia Fry, MDa, Jeffrey Hageman, MPHb, Rachel Gorwitz, MDb, Joseph Bresee, MDa and Timothy Uyeki, MDa
a Influenza Division, National Center for Immunization and Respiratory Diseases
b Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
OBJECTIVE.
Pediatric influenza-associated death became a nationally notifiable condition in the United States during 2004. We describe influenza-associated pediatric mortality from 2004 to 2007, including an increase of Staphylococcus aureus coinfections.
METHODS.
Influenza-associated pediatric death is defined as a death of a child who is younger than 18 years and has laboratory-confirmed influenza. State and local health departments report to the Centers for Disease Control and Prevention demographic, clinical, and laboratory data on influenza-associated pediatric deaths.
RESULTS.
During the 2004?2007 influenza seasons, 166 influenza-associated pediatric deaths were reported (n = 47, 46, and 73, respectively). Median age of the children was 5 years. Children often progressed rapidly to death; 45% died within 72 hours of onset, including 43% who died at home or in an emergency department. Of 90 children who were recommended for influenza vaccination, only 5 (6%) were fully vaccinated. Reports of bacterial coinfection increased substantially from 2004?2005 to 2006?2007 (6%, 15%, and 34%, respectively). S aureus was isolated from a sterile site or endotracheal tube culture in 1 case in 2004?2005, 3 cases in 2005?2006, and 22 cases in 2006?2007; 64% were methicillin-resistant S aureus. Children with S aureus coinfection were significantly older and more likely to have pneumonia and acute respiratory distress syndrome than those who were not coinfected.
CONCLUSIONS.
Influenza-associated pediatric mortality is rare, but the proportion of S aureus coinfection identified increased fivefold over the past 3 seasons. Research is needed to identify risk factors for influenza coinfection with invasive bacteria and to determine the impact of influenza vaccination and antiviral agents in preventing pediatric mortality.
Key Words: influenza ? influenza vaccine ? mortality rates ? Staphylococcus aureus
Abbreviations: CDC?Centers for Disease Control and Prevention ? ACIP?Advisory Committee on Immunization Practices ? MRSA?methicillin-resistant Staphylococcus aureus
Accepted Jul 1, 2008.
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