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Re: Invitation for Your Participation in Enhanced Surveillance for Influenza-Associated Pediatric ICU Admissions and Pediatric Deaths: 2005-06 Season

Dear Infection Control Practitioners, Hospital Epidemiologists and Pediatric Infectious Diseases Specialists/Chiefs,

In December 2003, Contra Costa Public Health and the California Department of Health Services (CDHS) initiated surveillance for pediatric influenza requiring hospitalization in the pediatric intensive care unit (PICU) and for pediatric influenza-associated deaths. The 2003-2004 season was characterized by the emergence of a drift "Fujian" variant strain of influenza A. A total of 125 cases of severe influenza requiring hospitalization in a PICU were reported in California in the 2003-04 season. The following 2004-05 season was characterized by an increase in/predominance of influenza B virus and the emergence nationally of a new strain called A/California/07/2004-like (H3N2). Only 35 cases of severe influenza requiring hospitalization in a PICU were reported in 2004-05.

For both seasons, the mean and median age was 3.1 years and 1.5 years. The peak weeks of admissions for severe influenza coincided with peaks in other measures of influenza activity. The predominant clinical presentation was lower respiratory tract infection, with almost half requiring mechanical ventilation. Over half (56%) of patients had an underlying medical condition, including neurologic disease, genetic disorder or prematurity, that were not part of existing ACIP recommendations for influenza vaccination. These findings were consistent with national surveillance data monitoring pediatric influenza-associated deaths, and in May 2005, the ACIP added recommendations to vaccinate "(a)ny condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk of aspiration".

Enhanced surveillance for severe pediatric influenza remains important. Our ability to monitor severe pediatric influenza is due in large part to the hard work of you and your colleagues. As part of our surveillance, weekly communications summarizing overall activity as well as demographic and clinical characteristics are sent to Contra Costa Public Health, infection control practitioners and other interested stakeholders, who have expressed their satisfaction in being able to receive updates of regional and statewide activity on a regular basis.

Contra Costa Public Health and CDHS would like to request your assistance in continuing this enhanced surveillance for the 2005-2006 season. You will be asked to monitor your hospital for cases meeting the following case definition and report them to Contra Costa Public Health:

A. Pediatric Influenza Cases Hospitalized in The PICU:

• Age 0 - 17 years; AND
• A clinical syndrome consistent with influenza or its complications, including lower respiratory tract infection, acute respiratory distress syndrome, apnea, cardiopulmonary arrest, myocarditis, Reye or Reye-like Syndrome, or acute CNS syndrome (e.g.,encephalitis,seizures); AND
• Confirmation by laboratory testing for influenza; AND
• Have been hospitalized in the ICU.

B. Pediatric Influenza-Associated Deaths:

• Age 0 - 17 years; AND
• A fatal clinical syndrome consistent with influenza or its complications, including lower respiratory tract infection, acute respiratory distress syndrome, apnea, cardiopulmonary arrest, myocarditis, Reye or Reye-like Syndrome, or acute CNS syndrome (e.g.,encephalitis,seizures); AND
• Confirmation by laboratory testing for influenza; AND
• No period of complete recovery between the illness and death.
• Hospitalization or ICU care not required.

There are two associated case report forms. For any case that is hospitalized in the PICU, please complete only the

• Pediatric Severe Influenza Case History Form For any deaths, please complete both the
  1. Pediatric Severe Influenza Case History Form (118k PDF, 1p.) and
  2. Pediatric Death Supplemental Form (136k PDF, 1p.)

Please fax completed forms to Contra Costa Public Health.

Updates about severe pediatric influenza cases occurring in California will be sent electronically throughout the respiratory season. As long as you remain on our Pediatric Influenza Surveillance List you will receive these updates. If you wish to be removed from this list please notify Janice Louie at jlouie@dhs.ca.gov. Thank you in advance for your participation. We hope this information will be of shared benefit.

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