Bhat Niranjan, Wright Jennifer G, Broder Karen R, Murray Erin L, Greenberg Michael E, Glover Maleeka J, Likos Anna M, Posey Drew L, Klimov Alexander, Lindstrom Stephen E, Balish Amanda, Medina Marie-jo, Wallis Teresa R, Guarner Jeannette, Paddock Christopher D, Shieh Wun-Ju, Zaki Sherif R, Sejvar James J, Shay David K, Harper Scott A, Cox Nancy J, Fukuda Keiji, Uyeki Timothy M
Epidemic Intelligence Service, Career Development Division, Office of Workforce and Career Development National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
N Engl J Med. 2005 Dec 15;353(24):2559-67. doi: 10.1056/NEJMoa051721.
Although influenza is common among children, pediatric mortality related to laboratory-confirmed influenza has not been assessed nationally.
During the 2003-2004 influenza season, we requested that state health departments report any death associated with laboratory-confirmed influenza in a U.S. resident younger than 18 years of age. Case reports, medical records, and autopsy reports were reviewed, and available influenza-virus isolates were analyzed at the Centers for Disease Control and Prevention.
One hundred fifty-three influenza-associated deaths among children were reported by 40 state health departments. The median age of the children was three years, and 96 of them (63 percent) were younger than five years old. Forty-seven of the children (31 percent) died outside a hospital setting, and 45 (29 percent) died within three days after the onset of illness. Bacterial coinfections were identified in 24 of the 102 children tested (24 percent). Thirty-three percent of the children had an underlying condition recognized to increase the risk of influenza-related complications, and 20 percent had other chronic conditions; 47 percent had previously been healthy. Chronic neurologic or neuromuscular conditions were present in one third. The mortality rate was highest among children younger than six months of age (0.88 per 100,000 children; 95 percent confidence interval, 0.52 to 1.39 per 100,000).
A substantial number of influenza-associated deaths occurred among U.S. children during the 2003-2004 influenza season. High priority should be given to improvements in influenza-vaccine coverage and improvements in the diagnosis and treatment of influenza to reduce childhood mortality from influenza.
尽管流感在儿童中很常见，但全国范围内尚未对实验室确诊流感相关的儿科死亡率进行评估。
在2003 - 2004年流感季节，我们要求各州卫生部门报告18岁以下美国居民中与实验室确诊流感相关的任何死亡病例。对病例报告、病历和尸检报告进行了审查，并在美国疾病控制与预防中心对可用的流感病毒分离株进行了分析。
40个州卫生部门报告了153例儿童流感相关死亡病例。这些儿童的中位年龄为3岁，其中96例（63%）年龄小于5岁。47例儿童（31%）在医院外死亡，45例（29%）在发病后三天内死亡。在102例接受检测的儿童中有24例（24%）发现有细菌合并感染。33%的儿童有已知会增加流感相关并发症风险的基础疾病，20%有其他慢性疾病；47%此前身体健康。三分之一的儿童存在慢性神经或神经肌肉疾病。6个月以下儿童的死亡率最高（每10万名儿童中有0.88例；95%置信区间为每10万名儿童中有0.52至1.39例）。
在2003 - 2004年流感季节，美国儿童中发生了大量流感相关死亡病例。应高度优先提高流感疫苗接种覆盖率，并改善流感的诊断和治疗，以降低儿童流感死亡率。
