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Surveillance for Influenza-Related Deaths of Children

CDC surveillance shows 153 influenza-associated deaths in U.S. children during the 2003–2004 flu season.

Assessment of influenza-related deaths in U.S. children has been hampered by lack of laboratory confirmation. In December 2003, the CDC requested that health departments nationwide report deaths associated with laboratory-confirmed influenza among children <18 years old. CDC investigators recently detailed such mortality for the 2003–2004 influenza season.

One hundred fifty-three influenza-related deaths were reported from 40 health departments. These deaths began to peak in late November, which is unusually early. Boys accounted for 50%; median age was 3 years. The mortality rate — 0.21 deaths per 100,000 overall — was inversely related to age, ranging from 0.88 per 100,000 in infants <6 months old to 0.11 per 100,000 in 5- to 17-year-olds. For the 149 children whose health-status information was available, 49% had CDC-defined high-risk medical conditions. Vaccination status was known for 111 of the 135 children 6 months old: Only 16% overall (26% of those with defined high-risk conditions; 19% of those aged 6–23 months without such conditions) had received 1 dose of influenza vaccine during the season. Some cases of influenza in vaccinees who later died were probably due to a mismatch between influenza antigens in the vaccine and those circulating in 2003–2004. Bacterial coinfections occurred in 24%.

Comment: Since the 2003–2004 season, the CDC has gone from encouraging to recommending influenza vaccination for children 6–23 months old. Two doses are needed the first year of vaccination for those aged 6 months to 8 years. Unfortunately, many of these children missed opportunities for protection. Death rates may have been underestimated due to missed or unreported cases, a lack of testing in some cases, and the insensitivity of rapid diagnostic tests.

— Robert S. Baltimore, MD

Published in Journal Watch Infectious Diseases January 13, 2006

Citation(s):

Bhat N et al. Influenza-associated deaths among children in the United States, 2003–2004. N Engl J Med 2005 Dec 15; 353:2559-67.

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