Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection.
ABSTRACT 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.
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.
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.
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.
- SourceAvailable from: Yi-Wei Tang[show abstract] [hide abstract]
ABSTRACT: Reports from various geographic regions indicate that the prevalence of community-acquired methicillin-resistant (MRSA) infection is increasing. The primary reservoir is the anterior nares; nasal carriage is a risk factor for infection in a variety of populations. Little is known about MRSA nasal carriage rates among children in Nashville, TN and the associated likelihood of community MRSA transmission. Nasal swabs were collected from 500 children at well-child visits at either a university hospital pediatric clinic or a private pediatric office. Cultures were plated onto selective staphylococcal media, with or without oxacillin. isolates were confirmed by coagulase tube testing. Antibiotic susceptibilities were determined for suspected methicillin-resistant isolates by standard broth microdilution methods (National Committee for Clinical Laboratory Standards). Pulsed field gel electrophoresis was used to evaluate epidemiologic relatedness. PCR testing was done to assess for the gene. A parent questionnaire was administered regarding MRSA risk factors. Four patients had oxacillin-resistant isolates (MIC >or= 4 microg/ml), and two had borderline resistant isolates (MICs = 1 and 2 microg/ml). One of the borderline-resistant isolates and one of the MRSA isolates had pulsed field gel electrophoresis typing results indicating close relatedness. The gene was present in all resistant isolates and one of the borderline-resistant isolates. Only having a household member employed in a hospital was associated with a greater risk of MRSA nasal carriage (odds ratio, 9.6; P= 0.008). MRSA nasal colonization is present within Nashville's healthy pediatric population. Children with household contacts employed in a hospital are significantly more likely to be colonized.The Pediatric Infectious Disease Journal 10/2002; 21(10):917-22. · 3.57 Impact Factor