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. 2012 Sep;130(3):390-6.
doi: 10.1542/peds.2011-3343. Epub 2012 Aug 29.

Neurologic disorders among pediatric deaths associated with the 2009 pandemic influenza

Lenee Blanton  1 , Georgina Peacock, Chad Cox, Michael Jhung, Lyn Finelli, Cynthia Moore
Affiliations

Neurologic disorders among pediatric deaths associated with the 2009 pandemic influenza

Lenee Blanton et al. Pediatrics. 2012 Sep.

Abstract

Objective: The goal of this study was to describe reported influenza A (H1N1)pdm09 virus (pH1N1)-associated deaths in children with underlying neurologic disorders.

Methods: The study compared demographic characteristics, clinical course, and location of death of pH1N1-associated deaths among children with and without underlying neurologic disorders reported to the Centers for Disease Control and Prevention.

Results: Of 336 pH1N1-associated pediatric deaths with information on underlying conditions, 227 (68%) children had at least 1 underlying condition that conferred an increased risk of complications of influenza. Neurologic disorders were most frequently reported (146 of 227 [64%]), and, of those disorders, neurodevelopmental disorders such as cerebral palsy and intellectual disability were most common. Children with neurologic disorders were older (P = .02), had a significantly longer duration of illness from onset to death (P < .01), and were more likely to die in the hospital versus at home or in the emergency department (P < .01) compared with children without underlying medical conditions. Many children with neurologic disorders had additional risk factors for influenza-related complications, especially pulmonary disorders (48%). Children without underlying conditions were significantly more likely to have a positive result from a sterile-site bacterial culture than were those with an underlying neurologic disorder (P < .01).

Conclusions: Neurologic disorders were reported in nearly two-thirds of pH1N1-associated pediatric deaths with an underlying medical condition. Because of the potential for severe outcomes, children with underlying neurologic disorders should receive influenza vaccine and be treated early and aggressively if they develop influenza-like illness.

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Figures

FIGURE 1
FIGURE 1
Number of influenza-associated pediatric deaths reported to the CDC and percentage of children with neurologic disorders among those with underlying conditions according to influence season, United States, 2004–2010. An influenza season is typically defined as October 1 through September 30 of the following year. To clearly delineate seasonal influenza activity from the 2009 influenza A (H1N1) pandemic, the 2008–2009 season was defined as October 1, 2008, through April 14, 2009, and the 2009–2010 season as April 15, 2009, through September 30, 2010.
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