Influenza-associated pediatric mortality in the United States:: Increase of Staphylococcus aureus coinfection
Influenza-associated pediatric mortality in the United States:: Increase of Staphylococcus aureus coinfection
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DOI：
10.1542/peds.2008-1336
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发表时间：
2008-10-01
期刊：
影响因子：
8
通讯作者：
Uyeki, Timothy
中科院分区：
文献类型：
--
作者：
Finelli, Lyn;Fiore, Anthony;Uyeki, Timothy
目标。2004年，儿童流感相关死亡在美国成为国家应通报的情况。我们描述了2004-2007年间流感相关的儿科死亡率，包括金黄色葡萄球菌混合感染的增加。方法：流感相关的儿科死亡定义为18岁以下并经实验室确认的流感儿童死亡。州和地方卫生部门向疾病控制和预防中心报告与流感相关的儿科死亡的人口统计、临床和实验室数据。结果：在2004-2007年流感季节，报告了166例与流感相关的儿科死亡(分别为47例、46例和73例)。这些儿童的中位年龄为5岁。儿童通常进展迅速至死亡；45%的儿童在发病72小时内死亡，其中43%死于家中或急诊室。在推荐接种流感疫苗的90名儿童中，只有5名(6%)完全接种了疫苗。从2004-2005年到2006-2007年，细菌合并感染的报告大幅增加(分别为6%、15%和34%)。2004年至2005年从无菌场所或气管内培养分离到S金黄色葡萄球菌1例，2005年至2006年3例，2006年至2007年22例，耐甲氧西林的S金黄色葡萄球菌占%。与未合并感染的儿童相比，合并感染S金黄色葡萄球菌的儿童年龄更大，更容易出现肺炎和急性呼吸窘迫综合征。结论：与流感相关的儿童死亡率很低，但S金黄色葡萄球菌混合感染的比例在过去3个季节增加了5倍。需要进行研究，以确定流感与侵袭性细菌混合感染的危险因素，并确定流感疫苗接种和抗病毒药物在预防儿童死亡方面的影响。
OBJECTIVE. 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.METHODS. 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.RESULTS. 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.CONCLUSIONS. 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.