Mortality and Staphylococcus aureus co-infection
CDC is requesting that states report all cases
of influenza-related pediatric mortality during the 2007-2008 influenza season.
This health advisory contains updated information about influenza and bacterial
co-infections in children and provides interim testing and treatment
Since 2004, the Influenza-Associated Pediatric
Mortality Surveillance System, part of the Nationally Notifiable Disease
Surveillance System, has collected information on deaths among children due to
laboratory-confirmed influenza, including the presence of other medical conditions
and bacterial infections at the time of death. From October 1, 2006 through
September 30, 2007, 73 deaths from influenza in children were reported to CDC
from 39 state health departments and two city health departments. Data on the
presence (or absence) of bacterial co-infections were recorded for 69 of these
cases; 30 (44%) had a bacterial co-infection, and 22 (73%) of these 30 were
infected with Staphylococcus aureus.
The number of pediatric influenza-associated
deaths reported during 2006-07 was moderately higher than the number reported
during the two previous surveillance years; the number of these deaths in which
pneumonia or bacteremia due to S. aureus was noted represents a
five-fold increase. Only one S. aureus co-infection among 47influenza
deaths was identified in 2004-2005, and 3 co-infections among 46 deaths were
identified in 2005-2006. Of the 22 influenza deaths reported with S. aureus
in 2006-2007, 15 children had infections with methicillin-resistant S.
The median age of children with S. aureus
co-infection was older than children without S. aureus co-infection (10
years versus 5 years, p<.01) and children with co-infection were more likely
to have pneumonia and Acute Respiratory Distress Syndrome (ARDS). Influenza
strains isolated from these children were not different from common strains
circulating in the community, and the MRSA strains have been similar to those
associated with MRSA skin infection outbreaks in the United States.
Health care providers should test persons
hospitalized with respiratory illness for influenza, including those with
suspected community-acquired pneumonia. Health care providers should be alerted
to the possibility of bacterial co-infection among children with influenza, and
request bacterial cultures if children are severely ill or when
community-acquired pneumonia is suspected. Health care providers should be
aware of the prevalence of methicillin-resistant S. aureas strains in
their communities when choosing empiric therapy for patients with suspected
influenza-related pneumonia. Clinicians, health care providers, and medical
examiners are asked to contact their local or state health department as soon
as possible when deaths among children associated with laboratory-confirmed
influenza are identified.
CDC requests that state health departments
report all cases of pediatric influenza-associated deaths to CDC through http://sdn.cdc.gov and that information about bacterial pathogens isolated
from sterile sites and/or from sputum or endotracheal aspirates be completed on
the Influenza-Associated Pediatric Mortality Surveillance System case report
form. If the influenza death was complicated by S. aureus infection,
state health departments are asked to please contact the clinical agency that
reported the case to determine if the S. aureus isolate is available.
CDC will receive S. aureus isolates in order to better characterize
those S. aureus isolates from children who have died from influenza.
If you have any questions about this Health
Advisory, please call the Influenza Division, Epidemiology and Prevention
Branch at 404-639-3747.