title: Pediatric influenza-associated myositis - Nebraska, 2001-2007.
abstract: OBJECTIVE
  Influenza-associated myositis (IAM), characterized by severe lower-extremity myalgia and reluctance to walk, is a complication of influenza among children. We investigated IAM in Nebraska during six influenza seasons, 2001-2007.
  
  
  METHODS
  During 2006-2007, we requested reports of severe influenza illness among persons aged <18 years and investigated medical records to identify and confirm IAM cases defined as severe myalgia with elevated serum creatinine kinase level in a patient aged <18 years, occurring within 7 days of laboratory confirmed influenza illness onset. Statewide hospital discharge data (HDD) were reviewed to identify retrospectively confirmed IAM cases during 2006-2007 and five previous seasons, by using surveillance data to define periods of influenza activity. Statewide IAM incidence was estimated for 2001-2002 through 2006-2007.
  
  
  RESULTS
  During 2006-2007, a total of 13 IAM cases were confirmed by enhanced surveillance. Median age was 6 years (range, 4-11 years). Influenza diagnosis was established by viral isolation from six patients (one influenza A and five influenza B) and rapid diagnostic tests for seven. Twelve (92%) patients, including one who died, were hospitalized for a median of 3 days (range, 1-4 days). Review of HDD identified 12 retrospectively confirmed IAM cases during 2006-2007, including four not reported through enhanced surveillance, and only one during five previous seasons (2003-2004). The HDD-derived, retrospectively confirmed statewide IAM incidence estimates/100,000 population aged <18 years were 2.693 and 0.225 during 2006-2007 and 2003-2004, respectively.
  
  
  CONCLUSIONS
  An IAM epidemic occurred in Nebraska during the 2006-2007 influenza season.
authors.affiliation: Nebraska Department of Health and Human Services, Office of Epidemiology, Lincoln, NE 68509, USA. bryan.buss@nebraska.gov
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Buss
authors.forename: Vivek M
authors.initials: VM
authors.lastname: Shinde
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Safranek
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Uyeki
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D007251:Influenza, Human / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D009220:Myositis / Q000453:epidemiology* / Q000209:etiology*; D009329:Nebraska / Q000453:epidemiology; D010770:Phosphotransferases / Q000097:blood; D012189:Retrospective Studies
chemical_list: D010770:Phosphotransferases