Influenza-Associated Deaths among Children in the United States, 2003-2004

doi:10.1056/NEJMoa051721

Volume 353:2559-2567		December 15, 2005		Number 24

Influenza-Associated Deaths among Children in the United States, 2003–2004

Niranjan Bhat, M.D., Jennifer G. Wright, D.V.M., M.P.H., Karen R. Broder, M.D., Erin L. Murray, M.S.P.H., Michael E. Greenberg, M.D., M.P.H., Maleeka J. Glover, Sc.D., Anna M. Likos, M.D., M.P.H., Drew L. Posey, M.D., M.P.H., Alexander Klimov, Ph.D., Stephen E. Lindstrom, Ph.D., Amanda Balish, B.S., Marie-jo Medina, M.S., Teresa R. Wallis, M.S., Jeannette Guarner, M.D., Christopher D. Paddock, M.D., M.P.H.T.M., Wun-Ju Shieh, M.D., M.P.H., Ph.D., Sherif R. Zaki, M.D., Ph.D., James J. Sejvar, M.D., David K. Shay, M.D., M.P.H., Scott A. Harper, M.D., M.P.H., Nancy J. Cox, Ph.D., Keiji Fukuda, M.D., M.P.H., Timothy M. Uyeki, M.D., M.P.H., M.P.P., for the Influenza Special Investigations Team

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ABSTRACT

Background Although influenza is common among children, pediatricmortality related to laboratory-confirmed influenza has notbeen assessed nationally.

Methods During the 2003–2004 influenza season, we requestedthat state health departments report any death associated withlaboratory-confirmed influenza in a U.S. resident younger than18 years of age. Case reports, medical records, and autopsyreports were reviewed, and available influenza-virus isolateswere analyzed at the Centers for Disease Control and Prevention.

Results One hundred fifty-three influenza-associated deathsamong 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 ofthe children (31 percent) died outside a hospital setting, and45 (29 percent) died within three days after the onset of illness.Bacterial coinfections were identified in 24 of the 102 childrentested (24 percent). Thirty-three percent of the children hadan underlying condition recognized to increase the risk of influenza-relatedcomplications, and 20 percent had other chronic conditions;47 percent had previously been healthy. Chronic neurologic orneuromuscular conditions were present in one third. The mortalityrate 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 deathsoccurred among U.S. children during the 2003–2004 influenzaseason. High priority should be given to improvements in influenza-vaccinecoverage and improvements in the diagnosis and treatment ofinfluenza to reduce childhood mortality from influenza.

Source Information

From the Epidemic Intelligence Service, Career Development Division, Office of Workforce and Career Development (N.B., J.G.W., K.R.B., M.E.G., M.J.G., A.M.L., D.L.P.); and the Influenza Branch (E.L.M., A.K., S.E.L., A.B., M.M., T.R.W., D.K.S., S.A.H., N.J.C., K.F., T.M.U.), Infectious Disease Pathology Activity (J.G., C.D.P., W.-J.S., S.R.Z.), and Office of the Director (J.J.S.), Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta.

Drs. Bhat and Wright contributed equally to the article.

Address reprint requests to Dr. Bhat at the Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC, Mailstop A-32, 1600 Clifton Rd. NE, Atlanta, GA 30333, or at nbhat{at}cdc.gov.

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