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Reporting Delays In US Pediatric Flu Deaths
Recombinomics Commentary 15:00
January 26, 2013

Week 3 Pediatric Deaths

Eight influenza-associated pediatric deaths were reported to CDC during week 3. Two were associated with influenza A viruses for which the subtype was not determined and occurred during week 1 (week ending January 5, 2013), and six were associated with influenza B viruses and occurred during weeks 43, 46, 50, 52, and 3 (weeks ending October 27, November 17, December 15 and 29, 2012 and January 19, 2013).

A total of 37 influenza-associated pediatric deaths have been reported during the 2012-2013 season from New York City [1] and 18 states (Arkansas [1], Colorado [4], Florida [4], Indiana [1], Kansas [1], Maine [1], Massachusetts [1], Michigan [4], Minnesota [1], Nebraska [1], New Jersey [2], New York [3], Ohio [1], South Carolina [1], Tennessee [1], Texas [7], Washington [1], and Wisconsin [1]).

The above graph and descriptions are from the week 3 CDC FluView which cited 8 additional cases to raise the 2012-03 season total to 37 (and the total of 34 reported for the entire 2011-12 season.  However, as noted most of the 8 cases were from 2012 and 6 of the 8 were associated with influenza B, indicated that the wave of pediatric deaths linked the appearance of influenza A (largely H3N2) has not been reflected in the week 3 totals.  Four of the eight added in the current report had been reported in Colorado weekly reports in week 50 and week 2.  The delay in reporting the state results in the national tally increases the delays in the state lab reports.

As seen in the list below the number of probable or confirmed cases reported in the media or state lab reports is large.  Two of those listed below are cited in obituaries and may not be tested or reported even though pediatric deaths are reportable.  In addition to flu cases not tested, others are missed because of false negatives, frequently associated with the rapid test, which has a sensitivity of 30-40%.  Pennsylvania has reported the largest number of lab confirmed deaths (75, which was also reported by Minnesota), but no pediatric deaths are listed in the national tally.  One case in Lehigh Valley was cited by hospital officials, but subsequently denied due to a negative flu test.  The cause of death was not stated and reports did not describe the lab test, which may have generated a false negative.  Similarly, a fatal case in NJ (15M) is under investigation.  One media report cited a negative flu test, but that source also noted that only one third of local cases tested at emergency centers were positive, strongly suggesting that these cases are being tested with a rapid test, and two thirds or those infected register as negative.  This abysmal record for rapid tests is well known, but the tests are inexpensive and give a result within minutes, so they are widely used by emergency and urgent care sites.

In the list below, most of the listed cases are lab confirmed.  These cases highlight the lag in reporting these cases by state labs as well as the CDC.  These delays may produce a dramatic spike in reported adolescent deaths in the upcoming weeks.  The P&I Death Rate, which is independent of lab test, shows a dramatic spike in week 3, which raised the rate from 8.3% to 9.8%, which follows the spike in week 2, which raised the rate from 7.3% to 8.3%.  This dramatic increase in deaths was widespread with 36 cities reporting at least 10 deaths and a rate above 10% for week 3.

FluView pediatric cases (37)
Wk   #    Location
03    8    NYC FL(2) TX CO(4)
02    9    MA NY(2) OH MN NE TX(2) MI
01    2    KS TX
52    2    MI NY
51    8    AR FL ME MI(2) TX WA WI
50    2    NJ
49    1    TX
48    3    IN FL SC
46    1    TX
41    1    TN

Pediatric deaths not in FluView (17)
03    9    PA#  MI+ CO HI* AZ* NJ*  NJ+ TX* CA*
02    6    OH+ DE* MD* CA* NJ* IL+
52    1    IN
49    1    OH#

*  = Lab confirmed but not in state updates
+ = Under investigation
# = Obituary report

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