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. 2014 Mar 1;209(5):686-94.
doi: 10.1093/infdis/jit473. Epub 2013 Aug 28.

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

Fatimah S Dawood  1 , 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
Affiliations

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

Fatimah S Dawood et al. J Infect Dis. .

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.

Keywords: bacterial infection; children; children, hospitalized; complications; influenza.

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