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Seattle & King County
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Seattle, WA 98104
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Health Care Providers
Communicable Diseases, Epidemiology and Immunization
January 31, 2008
Health Advisory: Influenza-Associated Pediatric Mortality and Staphylococcus aureus co-infection
Action requested:
- Health care providers should test persons hospitalized with respiratory illness for influenza, including those with suspected community-acquired pneumonia.
- Health care providers should be alerted to the possibility of bacterial co-infection among children with influenza, and request bacterial cultures if children are severely ill or when community-acquired pneumonia is suspected.
- Health care providers should consider methicillin-resistant S. aureus when choosing empiric therapy for patients with suspected influenza-related pneumonia.
- Report deaths among children associated with laboratory-confirmed influenza to Public Health at 206-296-4774.
- In cases of influenza deaths complicated by S. aureus infection, please ask the clinical laboratory to hold the S. aureus isolate for testing at CDC after consultation with Public Health, in order to better characterize S. aureus isolates from children who have died from influenza.
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Background:
From October 1, 2006 through September 30, 2007, 73 deaths from influenza in children were reported to CDC from 39 state health departments and two city health departments. Data on the presence (or absence) of bacterial co-infections were recorded for 69 of these cases; 30 (44%) had a bacterial co-infection, and 22 (73%) of these 30 were infected with Staphylococcus aureus. The number of these deaths in which pneumonia or bacteremia due to S. aureus was noted represents a five-fold increase over the 2 previous influenza seasons. No pediatric influenza deaths have been reported to-date this season locally.
The median age of children with S. aureus co-infection was older than children without S. aureus co-infection (10 years versus 5 years, p<.01) and children with co-infection were more likely to have pneumonia and Acute Respiratory Distress Syndrome (ARDS). Influenza strains isolated from these children were not different from common strains circulating in the community, and the MRSA strains have been similar to those associated with MRSA skin infection outbreaks in the United States.
References
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