Influenza-associated mortality among children - United States: 2007-2008

Abstract

Since October 2004, pediatric influenza-associated deaths have been a nationally notifiable condition. To further investigate the bacterial organisms that may have contributed to death, we systematically collected information about bacterial cultures collected at non-sterile sites and about the timing of Staphylococcus aureus specimen collection relative to hospital admission. We performed a retrospective, descriptive study of all reported influenza-associated pediatric deaths in 2007-2008 influenza season in the United States. During the 2007-2008 influenza season, 88 influenza-associated pediatric deaths were reported. The median age was 5 (range 29 days - 17 years); 48% were <5 years of age. The median time from symptom onset to death was 4 days (range 0-64 days). S. aureus was identified at a sterile site or at a non-sterile site in 20 (35%) of the 57 children with specimens collected from these sites; in 17 (85%) of these children, specimens yielding S. aureus were obtained within three days of inpatient admission. These 17 children were older (10 versus 4 years, median; P < 0·05) and less likely to have a high-risk medical condition (P < 0·05) than children with cultures from the designated sites that did not grow S. aureus. S. aureus continues to be the most common bacteria isolated from children with influenza-associated mortality. S. aureus isolates were associated with older age and lack of high-risk medical conditions. Healthcare providers should consider influenza co-infections with S. aureus when empirically treating children with influenza and severe respiratory illness.