The CDC has warned that co-infections with COVID-19 and influenza can potentially cause more serious illness in children and should be monitored.
Surveillance data from the 2021-2022 flu season found that 6% of flu-related hospitalizations and 16% of flu-related deaths involved children co-infected with COVID-19, Katherine Adams, MPH, of the CDC at Atlanta, and colleagues reported.
Of the seven co-infected children who died, none had received the flu vaccine, although six were eligible, according to the findings of the Morbidity and Mortality Weekly Report.
Co-infected children were more likely to need bi-level positive airway pressure (BiPAP) or continuous positive airway pressure (CPAP) compared to those who only had influenza (16% vs 6% , respectively, P=0.05), and they were also more likely to require invasive mechanical ventilation (13% versus 4%, P=0,03).
Influenza antivirals were underused, “particularly among people younger than 18 with influenza virus and SARS-CoV-2 co-infections who died,” the group wrote, noting that only one of the seven children who died had received flu antivirals.
The 2021-2022 influenza season has recorded 44 pediatric deaths attributed to influenza, while to date there have already been 21 pediatric influenza deaths in the current 2022-2023 season.
“These results represent a small number of influenza and SARS-CoV-2 co-infection cases, thus limiting the ability to draw definitive conclusions,” the group warned, but added that “the high degree of co -circulation of several respiratory viruses during the current season and higher than usual influenza activity at the start of the season, underscore the importance of raising awareness among parents and caregivers that co-infections with the influenza and SARS-CoV-2 occur in pediatric patients and that co-infection can potentially cause more serious illnesses.”
For pediatric patients with symptoms of acute respiratory illness with suspicion of severe illness, researchers suggest testing for influenza, SARS-CoV-2, and other respiratory viruses to identify if there is more than one infection. This is “essential to facilitate early detection of co-infections and help guide clinical treatment and management,” Adams and colleagues wrote.
The data for their report was collected from three CDC surveillance systems — including the Influenza Hospitalization Surveillance Network (FluSurv-NET) and the Pediatric Influenza-Associated Mortality Surveillance System — and identified 575 influenza-associated pediatric hospitalizations, including 32 patients who were co-infected with SARS-CoV-2.
The median age of the 32 children hospitalized with a co-infection was 3 years (IQR 1-12 years). Four were vaccinated once morest influenza and 19 were not vaccinated, while five were not eligible.
Divulgations
Adams had nothing to reveal. Co-authors reported relationships with Goldbelt Professional Services, General Dynamics Information Technology, Pfizer, Merck, PaxVax, Micron, Sanofi-Pasteur, Janssen, MedImmune, GSK, Sanofi-Pasteur, Kentucky Bioprocessing, WCG, ACI Clinical, the NIH , Michigan Department of Health and Human Services, and the Council of State and Territorial Epidemiologists.
Main source
Morbidity and Mortality Weekly Report
Source reference: Adams K, et al “Prevalence of SARS-CoV-2 and influenza co-infection and clinical features among children and adolescents aged <18 years who were hospitalized or died from influenza — United States , influenza season 2021-22" MMWR 2022; DOI: 10.15585/mmwr.mm7150a4.
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