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29 Aug 2013

Complications and associated bacterial co-infections among children hospitalized with seasonal or pandemic influenza, United States, 2003-2010 (J Infect Dis., abstract, edited)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

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

Fatimah S. Dawood 1, Sandra S. Chaves 1, Alejandro PĂ©rez 1, Arthur Reingold 2, James Meek 3, Monica M. Farley 4, Patricia Ryan 5, Ruth Lynfield 6, Craig Morin 6, Joan Baumbach 7, Nancy M. Bennett 8, Shelley Zansky 9, Ann Thomas 10, Mary Lou Lindegren 11, William Schaffner 11, Lyn Finelli 1, for the Emerging Infections Program Network

Author Affiliations: 1Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA 2California Emerging Infections Program, Oakland, California, USA 3Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA 4Emory University School of Medicine, the Atlanta Veterans Affairs Medical Center, and the Georgia Emerging Infections Program, Atlanta, Georgia, USA 5Maryland Department of Health and Mental Hygiene, Baltimore, MD 6Minnesota Department of Health, St. Paul, Minnesota, USA 7New Mexico Department of Health, Santa Fe, New Mexico, USA 8Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA 9Emerging Infections Program, New York State Department of Health, Albany, NY, USA 10Oregon Public Health Division, Portland, Oregon, USA 11Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee

Corresponding Author: Fatimah S. Dawood, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd MS A-32, Atlanta, GA 30333, United States; telephone: (404) 639-0431; fax (404) 639-3866; email:

Alternate Corresponding Author: Lyn Finelli, DrPH, Tel: 404.639.2554, Email:




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 (2003-2009) and influenza A(H1N1)pdm09 (2009-2010).


Population-based surveillance for laboratory-confirmed influenza hospitalizations was conducted among 5.3 million children in 10 states. Complications were identified by ICD-9 codes in medical records.


During 2003-2010, 7,293 children hospitalized with influenza were identified, of whom 6,769 (93%) had complete ICD-9 code data. Among the 6,769 children, the median length of hospitalization was 3 days (interquartile range 2-4), 975 (14%) required intensive care, 359 (5%) had respiratory failure, and 40 (1%) died. The most common complications were pneumonia (28%), asthma exacerbations (793/3616 children >2 years, 22%), and dehydration (21%). Lung abscess/empyema, tracheitis, encephalopathy, bacteremia/sepsis, acute renal failure, and myocarditis were rare (<2%) but associated with median hospitalization >6 days and 48-70% of children required intensive care. Positive bacterial cultures were identified in 2% of children (107/6769); Staphylococcus aureus and Streptococcus pneumoniae were most commonly identified.


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

Received June 26, 2013. Revision received July 26, 2013. Accepted August 1, 2013.

Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013.