Influenza-Associated Pediatric Mortality

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Influenza-associated Pediatric Death Definition

An influenza-associated pediatric death is a death in a child under 18 years of age resulting from a clinically compatible illness that was confirmed to be influenza by an appropriate laboratory or rapid diagnostic test.

Organism, Causative Agent, or Etiologic Agent

Influenza (“the flu”) is a respiratory illness caused by an influenza virus.


Influenza viruses are spread from person to person by respiratory droplets generated when an infected person coughs, sneezes, or talks in close proximity to an uninfected person. Sometimes, influenza viruses are spread when a person touches a surface with influenza viruses on it (e.g., a doorknob), and then touches his or her own nose or mouth. A person can spread influenza one day before they feel sick and up to seven days or longer after they feel sick.


Influenza usually comes on suddenly, one to four days after the virus enters the body, and may include these symptoms:

  • Fever or feeling feverish/chills
  • Cough
  • Runny or stuffy nose
  • Sore throat
  • Headache
  • Tiredness (can be extreme)
  • Muscle or body aches

Among children, otitis media, nausea, vomiting, and diarrhea are common. Some infected persons are asymptomatic.

Severity of Illness

Most people generally recover from illness in a few days to less than two weeks, but some people develop complications (such as pneumonia) and may die from influenza. The highest rates of influenza infection occur among children; however, the risks for serious health problems, hospitalizations, and deaths from influenza are typically greatest  among people 65 years of age or older, children aged <5 years  especially those aged <2 years, and people of any age who have medical conditions that place them at increased risk for complications from influenza.

In people with chronic medical conditions such as heart or lung disease, influenza can lead to pneumonia and other life-threatening illnesses. Persons 65 years of age and older account for approximately 90% of deaths attributed to pneumonia and influenza. Young children with influenza can develop high fevers, and a small percentage of children hospitalized with influenza can have febrile seizures. Deaths from influenza are uncommon among children, but do occur. Influenza has also been associated with neurological problems, Reye’s syndrome, muscle inflammation, and heart inflammation.

Treatment & Prevention

Most people who develop influenza illness will recover on their own by getting rest and will not need medication. Antiviral medications can shorten the duration and severity of illness if given within the first 48 hours of the illness. These medications are usually prescribed to persons who have a severe illness or to those who are at higher risk for developing serious illness or complications due to influenza.

The best way to prevent influenza is to get an influenza vaccine each year as soon as the vaccine is available to the public. Vaccination is associated with reductions in influenza-related respiratory illness and physician visits among all age groups, hospitalizations, and deaths among persons at high risk, otitis media among children, and work absenteeism among adults.

Other forms of prevention include:

  • Hand washing and using alcohol-based hand sanitizers,
  • Covering your coughs and sneezes with a disposable tissue or your arm or sleeve,
  • Avoiding touching your eyes, nose, or mouth,
  • Avoiding close contact with persons who are ill,
  • Staying home when you are ill, and
  • Taking antiviral medications if prescribed by your doctor.   
    • In certain situations (e.g., influenza outbreaks in settings like nursing homes), antiviral medications may be prescribed to high-risk individuals to prevent them from developing influenza illness after exposure to infected individuals.

School Exclusion Policy

Children with a fever should be kept out of school or childcare until they are fever free for 24 hours without the use of fever suppressing medications. Rules for exclusion of sick children from school and childcare are outlined in the Texas Administrative Code, specifically Rule 97.7 for schools and Rule 746.3603 for childcare.


 Texas Flag Image Logo Recent Texas Trends

The official influenza reporting season for the United States begins in October and continues through May; in Texas, influenza surveillance continues year-round.  Influenza activity usually peaks in January or February in Texas, although the peak of influenza has occurred as early as October.  For the 2014-2015 influenza season, influenza activity peaked in December.  Except for influenza-associated pediatric deaths and novel influenza cases, individual cases of influenza are not reportable by law in Texas.

Reporting of influenza-associated pediatric deaths began in Texas in 2007. From 2007-2014 with the exclusion of 2009, the reported number of cases of influenza-associated pediatric mortality ranged from 7 to 23. During the 2009 pandemic year, 54 cases of influenza-associated pediatric mortality were reported. In 2007, the highest influenza-associated pediatric mortality rate in Texas occurred in children ages 15-17 years, followed closely by infants under 1 year of age. From 2008-2011, the highest influenza-associated pediatric mortality rate occurred in infants under 1 year of age. In 2012, the highest influenza-associated pediatric mortality rate occurred in children ages 10-14 years. In 2013 and 2014, the highest influenza-associated pediatric mortality rate occurred in infants under 1 year of age.