Influenza-associated deaths among children in the United States, 2003-2004.

BACKGROUND: Although influenza is common among children, pediatric mortality related to laboratory-confirmed influenza has not been assessed nationally. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

United States Notifications of Travelers from Ebola-Affected Countries.

The International Health Regulations (IHR), an international law under the auspices of the World Health Organization (WHO), mandates that countries notify other countries of "travelers under public health observation." Between November 10, 2014, and July 12, 2015, the US Centers for Disease Control and Prevention (CDC) made 2,374 notifications to the National IHR Focal Points in 114 foreign countries of travelers who were monitored by US health departments because they had been to an Ebola-affected country in West Africa. Given that countries have preidentified focal points as points of contacts for sharing of public health information, notifications could be made by CDC to a trusted public health recipient in another country within 24 hours of receipt of the traveler's information from a US health department. The majority of US health departments used this process, offered by CDC, to notify other countries of travelers intending to leave the United States while being monitored in their jurisdiction.

Racial and ethnic disparities in hospitalizations and deaths associated with 2009 pandemic Influenza A (H1N1) virus infections in the United States.

PURPOSE: Concerns have been raised regarding possible racial-ethnic disparities in 2009 pandemic influenza A (H1N1) (pH1N1) illness severity and health consequences for U.S. minority populations. METHODS: Using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, Emerging Infections Program Influenza-Associated Hospitalization Surveillance, and Influenza-Associated Pediatric Mortality Surveillance, we calculated race-ethnicity-specific, age-adjusted rates of self-reported influenza-like illness (ILI) and pH1N1-associated hospitalizations. We used χ(2) tests to evaluate racial-ethnic disparities in ILI-associated health care-seeking behavior and pH1N1 hospitalization. To evaluate pediatric deaths, we compared racial-ethnic proportions of deaths against U.S. population distributions. RESULTS: Prevalence of self-reported ILI was lower among Hispanics (6.5%), higher among American Indians/Alaska Natives (16.2%), and similar among non-Hispanic blacks (7.7%) compared with non-Hispanic whites (8.5%). No racial-ethnic differences were identified in ILI-associated health care-seeking behavior. Age-adjusted pH1N1-associated Emerging Infections Program hospitalization rates were higher among all minority populations (range: 8.1-10.9/100,000 population) compared with non-Hispanic whites (3.0/100,000). The proportion of pH1N1-associated pediatric deaths was higher than expected among Hispanics (31%) and lower than expected among non-Hispanic whites (45%) given the proportions of the U.S. population they comprise (22% and 58%, respectively). CONCLUSIONS: Racial-ethnic disparities in pH1N1-associated hospitalizations and pediatric deaths were identified. Vaccination remains the primary intervention for preventing influenza.