Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection.
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.
Finelli
Lyn
L
Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. lfinelli@cdc.gov
Fiore
Anthony
A
Dhara
Rosaline
R
Brammer
Lynnette
L
Shay
David K
DK
Kamimoto
Laurie
L
Fry
Alicia
A
Hageman
Jeffrey
J
Gorwitz
Rachel
R
Bresee
Joseph
J
Uyeki
Timothy
T
D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007252:Influenza Vaccines / Q000627:therapeutic use; D007251:Influenza, Human / Q000150:complications / Q000401:mortality* / Q000517:prevention & control; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013203:Staphylococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D015163:Superinfection / Q000453:epidemiology* / Q000382:microbiology; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
D007252:Influenza Vaccines