Influenza–associated Pediatric Death

Influenza–associated Pediatric Death

Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2008)

I.    IDENTIFICATION

A.    CLINICAL DESCRIPTION: An influenza-associated death is defined for surveillance purposes as a death resulting from a clinically compatible illness that was confirmed to be influenza by an appropriate laboratory or rapid diagnostic test. There should be no period of complete recovery between the illness and death. Influenza-associated deaths in all persons aged <18 years should be reported.

B.    REPORTING CRITERIA: Laboratory confirmation.

C.    LABORATORY CRITERIA FOR CONFIRMATION: Laboratory testing for influenza virus infection may be done on pre- or post-mortem clinical specimens, and include identification of influenza A or B virus infections by a positive result using at least one of the following:

Influenza virus isolation in tissue cell culture from respiratory specimens;

Reverse-transcriptase polymerase chain reaction (RT-PCR) testing of respiratory specimens;

Immunofluorescent antibody staining (direct or indirect) of respiratory specimens;

Rapid influenza diagnostic testing of respiratory specimens;

Immunohistochemical (IHC) staining for influenza viral antigens in respiratory tract tissue from autopsy specimens;

Four-fold rise in influenza hemagglutination inhibition (HI) antibody titer in paired acute and convalescent sera*.

*Serologic testing for influenza is available in a limited number of laboratories, and should only be considered as evidence of recent infection if a four-fold rise in influenza (HI) antibody titer is demonstrated in paired sera. Single serum samples are not interpretable.

D.   CASE CLASSIFICATION:
        Confirmed - A death meeting the clinical case definition that is laboratory confirmed.

II.    ACTIONS REQUIRED / PREVENTION MEASURES

A.    WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.

B.     EPIDEMIOLOGY REPORTS REQUESTED:

Acute and Communicable Diseases Case Report (DPH 4151).

Pediatric Death Data Collection Form (CDC)

C.    PUBLIC HEALTH INTERVENTIONS:

Source investigation by LHD to include history of influenza vaccination, co-infection with other viruses or bacteria

III.    CONTACTS FOR CONSULTATION

A.    DPH REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

B.    BCD / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 265-5326 or (608) 267-7422.

C.    WSLH /VIRUS ISOLATION: (608) 262-3185.

IV.    RELATED REFERENCES

1.     Heymann DL, ed. Influenza. In: Control of Communicable Diseases Manual. 18th ed. Washington, DC: American Public Health Association, 2004:281-287

2.    Pickering LK, ed. Influenza. In: Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2006:401-411.