Epidemiology and Infection

Original Papers

Respiratory infections

Estimated paediatric mortality associated with influenza virus infections, United States, 2003–2010

K. K. WONGa1 c1, P. CHENGa2, I. FOPPAa2, S. JAINa2, A. M. FRYa2 and L. FINELLIa2

a1 Epidemic Intelligence Service assigned to Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA

a2 Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA


Death certificate reports and laboratory-confirmed influenza deaths probably underestimate paediatric deaths attributable to influenza. Using US mortality data for persons aged <18 years who died during 28 September 2003 to 2 October 2010, we estimated influenza-attributable deaths using a generalized linear regression model based on seasonal covariates, influenza-certified deaths (deaths for which influenza was a reported cause of death), and occurrence during the 2009 pandemic period. Of 32 783 paediatric deaths in the death categories examined, 853 (3%) were influenza-certified. The estimated number of influenza-attributable deaths over the study period was 1·8 [95% confidence interval (CI) 1·3–2·8] times higher than the number of influenza-certified deaths. Influenza-attributable deaths were 2·1 (95% CI 1·5–3·4) times higher than influenza-certified deaths during the non-pandemic period and 1·1 (95% CI 1·0–1·8) times higher during the pandemic. Overall, US paediatric deaths attributable to influenza were almost twice the number reported by death certificate codes in the seasons prior to the 2009 pandemic.

(Received December 18 2013)

(Revised March 06 2014)

(Accepted April 23 2014)

(Online publication May 15 2014)

Key words

  • Influenza;
  • paediatrics;
  • pandemic


c1 Author for correspondence: Dr K. K. Wong, 1600 Clifton Rd NE, MS E-03, Atlanta GA 30329, USA. (Email: vij4@cdc.gov)