Complications and associated bacterial coinfections among children hospitalized with seasonal or pandemic influenza, United States, 2003-2010.

Abstract

BACKGROUND:

Data on the range and severity of influenza-associated complications among children are limited. We describe the frequency and severity of complications in hospitalized children aged <18 years with seasonal influenza (during 2003-2009) and 2009 pandemic influenza A(H1N1) (during 2009-2010).

METHODS:

Population-based surveillance for laboratory-confirmed influenza hospitalizations was conducted among 5.3 million children in 10 states. Complications were identified by International Classification of Diseases, Ninth Revision (ICD-9) codes in medical records.

RESULTS:

During 2003-2010, 7293 children hospitalized with influenza were identified, of whom 6769 (93%) had complete ICD-9 code data. Among the 6769 children, the median length of hospitalization was 3 days (interquartile range, 2-4 days), 975 (14%) required intensive care, 359 (5%) had respiratory failure, and 40 (1%) died. The most common complications were pneumonia (in 28% of children), asthma exacerbations (in 22% [793/3616] aged ≥ 2 years), and dehydration (in 21%). Lung abscess/empyema, tracheitis, encephalopathy, bacteremia/sepsis, acute renal failure, and myocarditis were rare (each ≤ 2% of children) but associated with a median hospitalization duration of ≥ 6 days, and 48%-70% of children required intensive care. Bacterial cultures with positive results were identified in 2% of children (107/6769); Staphylococcus aureus and Streptococcus pneumoniae were most commonly identified.

CONCLUSIONS:

Complications contribute substantially to the disease burden among children hospitalized with influenza, through intensive care requirements and prolonged hospitalization, highlighting the importance of primary prevention with influenza vaccination.

• Authors: Fatimah S Dawood, Sandra S Chaves, Alejandro Pérez, Arthur Reingold, James Meek, Monica M Farley, Patricia Ryan, Ruth Lynfield, Craig Morin, Joan Baumbach, Nancy M Bennett, Shelley Zansky, Ann Thomas, Mary Lou Lindegren, William Schaffner, Lyn Finelli, Emerging Infections Program Network
• Journal: The Journal of infectious diseases (J Infect Dis) Vol. 209 Issue 5 Pg. 686-94 (Mar 01 2014) ISSN: 1537-6613 [Electronic] United States
• PMID: 23986545 (Publication Type: Journal Article)

Topics

• Bacterial Infections (etiology, virology)
• Child
• Child, Preschool
• Coinfection (etiology, microbiology, virology)
• Hospitalization
• Humans
• Infant
• Influenza A Virus, H1N1 Subtype
• Influenza, Human (complications, epidemiology, microbiology, virology)
• International Classification of Diseases
• Pandemics
• Population Surveillance
• Respiratory Tract Diseases (etiology, microbiology, virology)
• Seasons