First Pediatric Flu Death of 2019-20 Season Reported in California

The first pediatric influenza-associated death of the 2019-20 flu season has been reported in California. According to a statement issued by Riverside University Health System a 4-year-old child who tested positive for the flu and had underlying health issues passed away from his illness.

According to the US Centers for Disease Control and Prevention (CDC) a total of 130 influenza-associated pediatric deaths were reported during the 2018-19 flu season. This number was a decrease from the 187 pediatric deaths reported during the 2017-18 season.

CDC investigators hypothesize that the real-world impact of the flu is being underreported. “Using mathematical modeling to account for under-detection, CDC estimates that the actual number of flu-related deaths in children during [the 2017-18] season was closer to 600—nearly 3 times what was reported through existing mechanisms,” the authors of a recent report wrote in a flu spotlight.

Cameron Kaiser, MD, public health officer of Riverside County, says that this early season death could be predictive of a severe flu season.

“We should never forget that the flu still kills,” Kaiser said in the statement. “I always recommend people get their flu shots every year, but a death so early in the flu season suggests this year may be worse than usual.”

In the August 23^rd Morbidity and Mortality Weekly Report, the CDC’s Advisory Committee on Immunization Practices (ACIP) issued updated recommendations on the 2019-20 seasonal vaccine.

2019—20 US trivalent influenza vaccines will contain hemagglutinin (HA) derived from an A/Brisbane/02/2018 (H1N1)pdm09–like virus, an A/Kansas/14/2017 (H3N2)–like virus, and a B/Colorado/06/2017–like virus (Victoria lineage),” the committee wrote in the report.

“Quadrivalent influenza vaccines will contain HA derived from these 3 viruses and from an additional influenza B vaccine virus, a B/Phuket/3073/2013—like virus (Yamagata lineage). This composition includes updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine.”

Since the 2018-19 ACIP Influenza Vaccine Statement was issued, the US Food and Drug Administration (FDA) has issued 2 regulatory actions, including an expanded age indication and a change in dose volume.

In October 2018, the agency approved an expanded age indication for Afluria Quadrivalent, which was previously licensed for persons aged <5 years, and is now licensed for persons aged >6 months. “The dose volume is 0.25 mL per dose (containing 7.5 µg of HA per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years),” the committee noted.

In January 2019, the FDA approved a change in dose volume for Fluzone Quadrivalent for children aged 6 through 35 months. Previously, this group received 0.25 mL (containing 7.5 µg of HA per vaccine virus). Now, children aged 6 through 35 months may receive either 0.25 mL (containing 7.5 µg of HA per vaccine virus) or 0.5 mL (containing 15 µg of HA per vaccine virus) per dose. Children aged ≥36 months (≥3 years) and adults should receive 0.5 mL per dose.

"Offering pediatricians the convenience of the same 0.5 mL dose option for children, may help streamline immunization efforts," David P. Greenberg, MD, regional medical head North America for Sanofi Pasteur, said in a statement at the time. "The potentially life-threatening effects of influenza in children reported during the 2017-18 season, especially among those who were not vaccinated, is sobering. We commit ourselves every day to bring solutions to help meet ongoing public health needs related to influenza, especially among vulnerable groups such as young children."

ACIP urges individuals to get vaccinated by the end of October, but notes that vaccination in December or later may still be beneficial during a majority of influenza seasons.