Sex: U
Vaccine: FLU3
Symptoms: Death, Influenza, Influenza virus test positive
Clinical narrative: This literature report (initial receipt 19-Sep-2011) concerns 17 children. This literature report summarises 115 cases of influenza-associated pediatric mortality reported to CDC (Centre for Disease Control and Prevention) that occurred from 01-Sep-2010 to 31-Aug-2011. A case was defined as a death from a clinically compatible illness confirmed to be influenza by a diagnostic test in a resident aged < 18 years, with no period of complete recovery between illness and death. Confirmatory influenza testing methods include commercial rapid diagnostic tests, viral culture, fluorescent antibody, enzyme immunoassay, reverse transcription-polymerase chain reaction and immunohistochemistry. Information about influenza vaccination was available for 74 children aged 6 months or greater; 17 received influenza vaccine in the appropriate number of doses at least 14 days before illness onset. Of 39 vaccine-eligible children with agency-defined high-risk medical conditions who had vaccination data available, 12 had been vaccinated according to 2010 agency recommendations. Among children who dies from influenza described in the report, 23% were vaccinated. 49% of the children who died had no known agency-defined high-risk medical conditions, 57 children were reported with medical conditions recognised by agency that placed them at increased risk for influenza-related complications and the medical history of two children was unknown. Of the 57 children with at least one agency-defined high-risk condition, 31 had a neurologic disorder, 17 had pulmonary disease, 14 had a chromosomal abnormality or genetic disorder, 11 had congenital heart disease or other cardiac disease, and 11 had asthma or reactive airway disease. Obesity was reported in two of the 57 children. Other types of agency-defined high risk conditions that were reported for children who died from influenza associated illness include immunosuppressive disorder (9 children), endocrine disorder (5 children), mitochondrial disorder (3 children), renal disease (2 children) and pregnancy (1 child). Of the 115 influenza-associated pediatric deaths reported, 72 occurred in males. The median age of patients was 6 years, and 53 cases were in children aged < 5 years. 71 of these cases were associated with influenza A virus infection; 30 cases were 2009 influenza A (H1N1), 21 cases were influenza A (H3N2) and 20 cases were influenza A viruses for which the subtype was not determined. The remaining 44 cases were associated with influenza B virus infections. Of 64 children who had specimens collected for bacterial culture from normally sterile sites (including 58 blood cultures), 25 had positive cultures; staphylococcus aureus was detected in nine patients (six with methicillin-resistant S. aureus, two with methicillin-sensitive S. aureus, and one with unknown sensitivity). streptococcus pneumoniae was detected in six patients, and Group A streptococcus was detected in three. The most frequent complications reported were radiographically confirmed pneumonia (62%), shock or sepsis (40%), and acute respiratory distress syndrome (34%). Encephalopathy or encephalitis was reported in 12 children (14%). Other complications included seizures (13%), hemorrhagic pneumonia/pneumonitis (6%), croup (5%), cardiomyopathy/myocarditis (4%) and bronchiolitis (2%). Of the 47 children who received antiviral therapy, three died in the emergency department and 44 died after being admitted to the hospital. All three children who died in the emergency department received oseltamivir. Of the children who died after being admitted to the hospital, 41 received oseltamivir only, two received oseltamivir and zanamivir and one received zanamivir only.