Neurologic Disorders Among Pediatric Deaths Associated with the 2009 Pandemic Influenza

Overview

Journal Pediatrics

Specialty Pediatrics

Date 2012 Aug 31

PMID 22931899

Citations 23

Authors

Lenee Blanton

Georgina Peacock

Chad Cox

Michael Jhung

Lyn Finelli

Cynthia Moore

Affiliations

Soon will be listed here.

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.

Citing Articles

Characteristics and outcome of influenza-associated encephalopathy/encephalitis among children in China.

Yang M, Yi L, Jia F, Zeng X, Liu Z Clinics (Sao Paulo). 2024; 79:100475.

PMID: 39096859 PMC: 11345302. DOI: 10.1016/j.clinsp.2024.100475.

Impact of COVID-19 on Utilisation of Funds by People With Disabilities: Lessons Drawn From the Australian National Disability Insurance Scheme.

Zhang Y, Chand S Int J Health Policy Manag. 2024; 12:7663.

PMID: 38618802 PMC: 10590233. DOI: 10.34172/ijhpm.2023.7663.

Use of antiviral drugs for seasonal influenza: Foundation document for practitioners-Update 2019.

Aoki F, Allen U, Mubareka S, Papenburg J, Stiver H, Evans G J Assoc Med Microbiol Infect Dis Can. 2022; 4(2):60-82.

PMID: 36337743 PMC: 9602959. DOI: 10.3138/jammi.2019.02.08.

COVID-19 and Acute Neurologic Complications in Children.

Antoon J, Hall M, Howard L, Herndon A, Freundlich K, Grijalva C Pediatrics. 2022; 150(5).

PMID: 35949041 PMC: 9633383. DOI: 10.1542/peds.2022-058167.

Guideline-Concordant Antiviral Treatment in Children at High Risk for Influenza Complications.

Antoon J, Hall M, Feinstein J, Kyler K, Shah S, Tang Girdwood S Clin Infect Dis. 2022; 76(3):e1040-e1046.

PMID: 35867691 PMC: 10169402. DOI: 10.1093/cid/ciac606.

References

Ginocchio C, Zhang F, Manji R, Arora S, Bornfreund M, Falk L . Evaluation of multiple test methods for the detection of the novel 2009 influenza A (H1N1) during the New York City outbreak. J Clin Virol. 2009; 45(3):191-5. PMC: 7172175. DOI: 10.1016/j.jcv.2009.06.005. View

Keren R, Zaoutis T, Bridges C, Herrera G, Watson B, Wheeler A . Neurological and neuromuscular disease as a risk factor for respiratory failure in children hospitalized with influenza infection. JAMA. 2005; 294(17):2188-94. DOI: 10.1001/jama.294.17.2188. View

Uyeki T, Prasad R, Vukotich C, Stebbins S, Rinaldo C, Ferng Y . Low sensitivity of rapid diagnostic test for influenza. Clin Infect Dis. 2009; 48(9):e89-92. DOI: 10.1086/597828. View

Hartshorn K, Liou L, White M, Kazhdan M, Tauber J, Tauber A . Neutrophil deactivation by influenza A virus. Role of hemagglutinin binding to specific sialic acid-bearing cellular proteins. J Immunol. 1995; 154(8):3952-60. View

Inal-Ince D, Savci S, Arikan H, Saglam M, Vardar-Yagli N, Bosnak-Guclu M . Effects of scoliosis on respiratory muscle strength in patients with neuromuscular disorders. Spine J. 2009; 9(12):981-6. DOI: 10.1016/j.spinee.2009.08.451. View

Harper S, Fukuda K, Uyeki T, Cox N, Bridges C . Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2005; 54(RR-8):1-40. View

Hancock K, Veguilla V, Lu X, Zhong W, Butler E, Sun H . Cross-reactive antibody responses to the 2009 pandemic H1N1 influenza virus. N Engl J Med. 2009; 361(20):1945-52. DOI: 10.1056/NEJMoa0906453. View

Bhat N, Wright J, Broder K, Murray E, Greenberg M, Glover M . Influenza-associated deaths among children in the United States, 2003-2004. N Engl J Med. 2005; 353(24):2559-67. DOI: 10.1056/NEJMoa051721. View

Weir K, McMahon S, Barry L, Ware R, Masters I, Chang A . Oropharyngeal aspiration and pneumonia in children. Pediatr Pulmonol. 2007; 42(11):1024-31. DOI: 10.1002/ppul.20687. View

10.

Fiore A, Uyeki T, Broder K, Finelli L, Euler G, Singleton J . Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep. 2010; 59(RR-8):1-62. View

11.

Nickerson C, Jakab G . Pulmonary antibacterial defenses during mild and severe influenza virus infection. Infect Immun. 1990; 58(9):2809-14. PMC: 313571. DOI: 10.1128/iai.58.9.2809-2814.1990. View

12.

Peltola V, McCullers J . Respiratory viruses predisposing to bacterial infections: role of neuraminidase. Pediatr Infect Dis J. 2004; 23(1 Suppl):S87-97. DOI: 10.1097/01.inf.0000108197.81270.35. View

13.

. Surveillance for pediatric deaths associated with 2009 pandemic influenza A (H1N1) virus infection - United States, April-August 2009. MMWR Morb Mortal Wkly Rep. 2009; 58(34):941-7. View

14.

Fiore A, Fry A, Shay D, Gubareva L, Bresee J, Uyeki T . Antiviral agents for the treatment and chemoprophylaxis of influenza --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011; 60(1):1-24. View

15.

HERS J, Masurel N, Mulder J . Bacteriology and histopathology of the respiratory tract and lungs in fatal Asian influenza. Lancet. 1958; 2(7057):1141-3. DOI: 10.1016/s0140-6736(58)92404-8. View

16.

Hurt A, Baas C, Deng Y, Roberts S, Kelso A, Barr I . Performance of influenza rapid point-of-care tests in the detection of swine lineage A(H1N1) influenza viruses. Influenza Other Respir Viruses. 2009; 3(4):171-6. PMC: 4634687. DOI: 10.1111/j.1750-2659.2009.00086.x. View

17.

. Update: influenza activity - United States, 2009-10 season. MMWR Morb Mortal Wkly Rep. 2010; 59(29):901-8. View

18.

Young N, McCormick A, Gilbert T, Ayling-Campos A, Burke T, Fehlings D . Reasons for hospital admissions among youth and young adults with cerebral palsy. Arch Phys Med Rehabil. 2010; 92(1):46-50. DOI: 10.1016/j.apmr.2010.10.002. View

19.

Finelli L, Fiore A, Dhara R, Brammer L, Shay D, Kamimoto L . Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection. Pediatrics. 2008; 122(4):805-11. DOI: 10.1542/peds.2008-1336. View

20.

Cox C, Blanton L, Dhara R, Brammer L, Finelli L . 2009 Pandemic influenza A (H1N1) deaths among children--United States, 2009-2010. Clin Infect Dis. 2011; 52 Suppl 1:S69-74. DOI: 10.1093/cid/ciq011. View