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

BACKGROUND: 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 (during 2003-2009) and 2009 pandemic influenza A(H1N1) (during 2009-2010).

METHODS: Population-based surveillance for laboratory-confirmed influenza hospitalizations was conducted among 5.3 million children in 10 states. Complications were identified by International Classification of Diseases, Ninth Revision (ICD-9) codes in medical records.

RESULTS: During 2003-2010, 7293 children hospitalized with influenza were identified, of whom 6769 (93%) had complete ICD-9 code data. Among the 6769 children, the median length of hospitalization was 3 days (interquartile range, 2-4 days), 975 (14%) required intensive care, 359 (5%) had respiratory failure, and 40 (1%) died. The most common complications were pneumonia (in 28% of children), asthma exacerbations (in 22% [793/3616] aged ≥ 2 years), and dehydration (in 21%). Lung abscess/empyema, tracheitis, encephalopathy, bacteremia/sepsis, acute renal failure, and myocarditis were rare (each ≤ 2% of children) but associated with a median hospitalization duration of ≥ 6 days, and 48%-70% of children required intensive care. Bacterial cultures with positive results were identified in 2% of children (107/6769); Staphylococcus aureus and Streptococcus pneumoniae were most commonly identified.

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