Influenza-associated deaths among children in the United States, 2003-2004.
BACKGROUND
Although influenza is common among children, pediatric mortality related to laboratory-confirmed influenza has not been assessed nationally.


METHODS
During the 2003-2004 influenza season, we requested that state health departments report any death associated with laboratory-confirmed influenza in a U.S. resident younger than 18 years of age. Case reports, medical records, and autopsy reports were reviewed, and available influenza-virus isolates were analyzed at the Centers for Disease Control and Prevention.


RESULTS
One hundred fifty-three influenza-associated deaths among children were reported by 40 state health departments. The median age of the children was three years, and 96 of them (63 percent) were younger than five years old. Forty-seven of the children (31 percent) died outside a hospital setting, and 45 (29 percent) died within three days after the onset of illness. Bacterial coinfections were identified in 24 of the 102 children tested (24 percent). Thirty-three percent of the children had an underlying condition recognized to increase the risk of influenza-related complications, and 20 percent had other chronic conditions; 47 percent had previously been healthy. Chronic neurologic or neuromuscular conditions were present in one third. The mortality rate was highest among children younger than six months of age (0.88 per 100,000 children; 95 percent confidence interval, 0.52 to 1.39 per 100,000).


CONCLUSIONS
A substantial number of influenza-associated deaths occurred among U.S. children during the 2003-2004 influenza season. High priority should be given to improvements in influenza-vaccine coverage and improvements in the diagnosis and treatment of influenza to reduce childhood mortality from influenza.
Bhat
Niranjan
N
Epidemic Intelligence Service, Career Development Division, Office of Workforce and Career Development National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. nbhat@cdc.gov
Wright
Jennifer G
JG
Broder
Karen R
KR
Murray
Erin L
EL
Greenberg
Michael E
ME
Glover
Maleeka J
MJ
Likos
Anna M
AM
Posey
Drew L
DL
Klimov
Alexander
A
Lindstrom
Stephen E
SE
Balish
Amanda
A
Medina
Marie-jo
MJ
Wallis
Teresa R
TR
Guarner
Jeannette
J
Paddock
Christopher D
CD
Shieh
Wun-Ju
WJ
Zaki
Sherif R
SR
Sejvar
James J
JJ
Shay
David K
DK
Harper
Scott A
SA
Cox
Nancy J
NJ
Fukuda
Keiji
K
Uyeki
Timothy M
TM
D000293:Adolescent; D000367:Age Factors; D001424:Bacterial Infections / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053122:Influenza A Virus, H3N2 Subtype / Q000302:isolation & purification; D009981:Influenza B virus / Q000302:isolation & purification; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000150:complications / Q000401:mortality* / Q000821:virology; D008297:Male; D012307:Risk Factors; D012621:Seasons; D014481:United States / Q000453:epidemiology
D007252:Influenza Vaccines