Children Killed by Flu in US in 2003-2004

December 28, 2005

Over 150 children in the US died of influenza or related complications during the 2003-2004 flu season, according to Centers for Disease Control and Prevention (CDC). Almost half of these children had previously been in good health.

The findings were published in the New England Journal of Medicine (NEJM) and reported by MedPage Today on 14 December 2005.

The report highlighted the need for improved diagnosis and treatment, as well as gaps in vaccine coverage, said Timothy Uyeki, MD, of the CDC's National Center for Infectious Diseases, according to MedPage Today.

Study Rationale

This was the first study to track influenza's effects on children in the US, according to Dr Uyeki, noting that death is a rare flu-outcome among children. Pediatric flu deaths confirmed by a laboratory were made nationally reportable for the 2004-2005 flu-season.

The study reported that 153 children died of laboratory-confirmed influenza-associated causes in the period 28 September 2003 to 22 May 2004.

"We can't really say if this is high, low, or average," said Dr Uyeki, according to MedPage Today. "What we do know is that it appeared to be a severe year for children."

In fact, the researchers commented that the actual toll may have been higher. The CDC requested reports of flu-related deaths in children at flu season's peak, and children who died of respiratory illness before then may not have been tested. Additionally, the study included data from only 40 US states and territories.

Results

The study found that:

• Overall mortality was 0.21 deaths per 100,000 children In 2003-2004.
• Among children aged <6 months (the youngest group) the death-rate was 0.88 per 100,000; the rate declined with increasing age.
• Three years was the median age of children who died; 63% were aged <5 years old.
• In total, 31% of children's deaths occurred outside a hospital setting, and 29% died within three days of the illness's onset.
• In 24% of the 102 children tested, bacterial co-infections were identified.

Of the children who died, 47% had previously been healthy, a finding Dr Uyeki called "stunning."

"Those were predominantly very young children," he said. "It suggests that young children are at high risk for serious complications of influenza that can result in hospitalization and death. And it's not just chronically ill children."

Pediatric vaccination guidelines have changed since the 2003-2004 flu season: flu shots for children under age six months are now recommended, Dr Uyeki reportedly said, instead of simply encouraged when possible.

However, the authors wrote that vaccinating children under age six months is not feasible, because "influenza vaccination and antiviral agents are not approved for children in this age group."

However, it may be possible to overcome that limitation by encouraging pregnant women to have a flu shot, wrote Raphael Dolin, MD, dean for academic and clinical programs at Harvard Medical School, in an accompanying Perspective article in NEJM.

"Such immunization may also provide the additional benefit of protection to the newborn during the first six months of life," Dr Dolin wrote. He also noted that a live, attenuated flu vaccine, administered by nasal spray, may be a practical alternative for young children, although it is currently approved only for people aged 5-49 years.

A large-scale study of the vaccine in children aged 6-36 months, undertaken last year, "should provide important safety and efficacy data," Dr Dolin wrote, possibly leading to wider use.

Sources:
Flu or Complications Killed 153 Children in U.S. in 2003-2004 Season, MedPage Today, 14 December 2005.
Influenza-Associated Deaths among Children in the United States, 2003-2004. Bhat N et al, New England Journal of Medicine, volume 353, pages 2559-2567, 2005.
Influenza - Interpandemic as Well as Pandemic Disease. Raphael Dolin, New England Journal of Medicine, volume 353, pages 2535-2537, 2005.

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