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

Background 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. Methods We performed a retrospective, descriptive study of all reported influenza-associated pediatric deaths in 2007-2008 influenza season in the United States. Results 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 center dot 05) and less likely to have a high-risk medical condition (P < 0 center dot 05) than children with cultures from the designated sites that did not grow S. aureus. Conclusions 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.