This is an official CDC HEALTH ADVISORY
Distributed via Health Alert Network
Wednesday, May 09, 2007, 11:15 EDT (11:15 AM EDT)
CDCHAN-00259-2007-05-09-ADV-N
Influenza-Associated Pediatric Mortality and the Increase of
Staphylococcus aureus co-infection
CDC is requesting that states report all cases of
influenza-related pediatric mortality from the 2006-2007 influenza season.
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 May 7, 2007, 55 deaths from influenza in children have been reported to
CDC from 23 state health departments and two city health departments.
Data on bacterial co-infections were reported for 51 cases; 20 (39%) had a
bacterial co-infection, and 16/20 were infected with Staphylococcus aureus.
While the number of pediatric influenza associated deaths is similar to that
reported during the two previous years, there has been an increase in
the number of deaths in which both influenza and pneumonia or
bacteremia due to S. aureus were identified. Only one influenza
and S. aureus co-infection was identified in 2004-2005, and 3 were
identified in 2005-2006. Of the 16 children reported with S. aureus
so far in 2006-2007, 11children had methicillin-resistant
(MRSA) isolated from a sterile site (9) or sputum (2), and 5 had
methicillin-susceptible S.aureus isolated from a sterile site (3)
or sputum (2). The median age of children with S. aureus co-infection was
older than children without S.aureus co-infection (11 years
versus 4 years, p<.01) Children with influenza and S. aureus
co-infections were reported to be in good health before illness
onset but progressed rapidly to severe illness. Influenza
strains isolated from these children have not been different from common
strains circulating in the community and the MRSA strains have been typical of
those associated with MRSA skin infection outbreaks in the United
States.
Healthcare providers should be alerted to the
possibility of bacterial co-infection among children with influenza, and
request bacterial cultures when bacterial co-infection is suspected.
Clinicians, clinical agencies and medical examiners are asked to contact their
local or state health department as soon as possible when deaths among children
due to laboratory-confirmed influenza are identified. CDC requests
that all cases of pediatric influenza-associated deaths be reported promptly by
state health departments 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, please contact the clinical agency to determine if the S.
aureus isolate is available. CDC is interested in receiving S.
aureus isolates to better characterize those from fatal cases of influenza
in children.
If you have any questions about this Health
Advisory, please call the Influenza Division, Epidemiology and Prevention
Branch at 404-639-3727.
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