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Cited by 312Influenza Virus Research StudiesRespiratory viral infections researchPneumonia and Respiratory Infections

Influenza-Associated Pediatric Mortality in the United States: Increase of Staphylococcus aureus Coinfection

Finelli, Lyn, Fiore, Anthony, Dhara, Rosaline, Brammer, Lynnette, Shay, David K., Kamimoto, Laurie, Fry, Alicia, Hageman, Jeffrey +3 more·2008·PEDIATRICS
DOI 10.1542/peds.2008-1336
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Abstract

OBJECTIVE: Pediatric influenza-associated death became a nationally notifiable condition in the United States during 2004. We describe influenza-associated pediatric mortality from 2004 to 2007, including an increase of Staphylococcus aureus coinfections. METHODS: Influenza-associated pediatric death is defined as a death of a child who is younger than 18 years and has laboratory-confirmed influenza. State and local health departments report to the Centers for Disease Control and Prevention demographic, clinical, and laboratory data on influenza-associated pediatric deaths. RESULTS: During the 2004-2007 influenza seasons, 166 influenza-associated pediatric deaths were reported (n = 47, 46, and 73, respectively). Median age of the children was 5 years. Children often progressed rapidly to death; 45% died within 72 hours of onset, including 43% who died at home or in an emergency department. Of 90 children who were recommended for influenza vaccination, only 5 (6%) were fully vaccinated. Reports of bacterial coinfection increased substantially from 2004-2005 to 2006-2007 (6%, 15%, and 34%, respectively). S aureus was isolated from a sterile site or endotracheal tube culture in 1 case in 2004-2005, 3 cases in 2005-2006, and 22 cases in 2006-2007; 64% were methicillin-resistant S aureus. Children with S aureus coinfection were significantly older and more likely to have pneumonia and acute respiratory distress syndrome than those who were not coinfected. CONCLUSIONS: Influenza-associated pediatric mortality is rare, but the proportion of S aureus coinfection identified increased fivefold over the past 3 seasons. Research is needed to identify risk factors for influenza coinfection with invasive bacteria and to determine the impact of influenza vaccination and antiviral agents in preventing pediatric mortality.

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  • Influenza B can also cause severe secondary bacterial infection during seasonal influenza episodes, especially within younger age groups.

    “Influenza B, although generally regarded as having less impact on morbidity and mortality in healthy persons can also cause severe secondary bacterial infection during seasonal influenza episodes, especially within younger age groups.”

    From Bacterial and viral infections associated with influenza (2013) · cites this paper as [5]

  • Deaths, especially in children, are also associated with S aureus infection, as highlighted by the recent emergence of community-acquired MRSA.

    “deaths, especially in children are also associated with S aureus infection, as highlighted by the recent emergence of community‐acquired methicillin‐resistant Staphylococcus aureus (MRSA)”

    From Bacterial and viral infections associated with influenza (2013) · cites this paper as [5]

  • Streptococcus pneumoniae is the dominant pathogen involved in the synergistic process of co/secondary bacterial infection with influenza, followed mainly by Staphylococcus aureus and Haemophilus influenzae.

    “Streptococcus pneumoniae continues to be the dominant pathogen involved in this synergistic process7 followed mainly by Staphylococcus aureus 5 and Haemophilus influenzae.12, 18”

    From Bacterial and viral infections associated with influenza (2013) · cites this paper as [5]

  • Community-acquired MRSA infections are leading to high levels of morbidity and mortality in individuals with influenza, especially children.

    “with evidence that community‐acquired MRSA infections are leading to high levels of morbidity and mortality in individuals with influenza, especially children.5”

    From Bacterial and viral infections associated with influenza (2013) · cites this paper as [5]

  • Influenza B has also been associated with severe bacterial co/secondary infection, although reported less.

    “Although reported less, influenza B has also been associated with severe bacterial co/secondary infection (Finelli et al., 2008; Aebi et al., 2010).”

    From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Finelli et al., 2008

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Authors
Finelli, L., Fiore, A., Dhara, R., Brammer, L., Shay, D. K., Kamimoto, L., Fry, A., Hageman, J., Gorwitz, R., Bresee, J., & Uyeki, T.
Affiliations
  • National Center for Immunization and Respiratory Diseases (US)
  • Centers for Disease Control and Prevention (US)
Corresponding author
Finelli, Lyn
ORCID
Venue
PEDIATRICS
Publisher
American Academy of Pediatrics (AAP)
Published
2008-10-01
Volume
122
Issue
4
Pages
805-811
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2008-1336
OpenAlex
W2032287546
Cited by
312
References
45
Citations by year
2026: 4 · 2025: 6 · 2024: 3 · 2023: 6 · 2022: 15 · 2021: 14 · 2020: 13 · 2019: 18 · 2018: 19 · 2017: 18 · 2016: 14 · 2015: 13 · 2014: 13 · 2013: 27 · 2012: 31
FWCI
23.75
Type
journal article
Language
en
Open access
closed
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
  • Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
Keywords
methicillin-resistant Staphylococcus aureus, bacterial co-infection, influenza vaccination coverage, pneumonia, acute respiratory distress syndrome, influenza surveillance
MeSH terms
Adolescent, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Influenza, Human, Influenza Vaccines, Male, Prognosis, Retrospective Studies, Risk Factors, Staphylococcal Infections, Staphylococcus aureus, United States, Superinfection, Incidence, Survival Rate, Age Distribution, Sex Distribution

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