Published online October 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. 805-811 (doi:10.1542/peds.2008-1336)

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ARTICLE

Influenza-Associated Pediatric Mortality in the United States: Increase of Staphylococcus aureus Coinfection

Lyn Finelli, DrPH^a, Anthony Fiore, MD^a, Rosaline Dhara, MPH^a, Lynnette Brammer, MPH^a, David K. Shay, MD^a, Laurie Kamimoto, MD^a, Alicia Fry, MD^a, Jeffrey Hageman, MPH^b, Rachel Gorwitz, MD^b, Joseph Bresee, MD^a and Timothy Uyeki, MD^a

^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.

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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

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Accepted Jul 1, 2008.

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