The 2024–25 influenza season has seen an alarming spike in pediatric influenza-associated deaths across the nation, with a total of 280 fatalities reported. This marks a disturbing rate of 3.8 deaths per million children, raising serious concern among health professionals and communities alike.
The median age for these tragic deaths was 7 years, with the majority occurring in children under 9 years old, emphasizing the vulnerability of younger children during flu season.
Among the death toll, infants younger than six months had the highest mortality rate, accounting for 11.1 deaths per million. Interestingly, female children were slightly more affected, showing a death rate of 4.5 compared to 3.1 for males.
While White children accounted for the largest proportion of influenza-associated deaths at 42%, they exhibited the second lowest death rate, following Asian children. The highest mortality rate was observed in Black or African American children, who made up 23% of the deaths with a rate of 5.8 deaths per million.
The peak of influenza-associated deaths occurred during weeks six and seven of February 2025, underscoring a critical period in the season, where health interventions can be vital.
Influenza Virus Testing Results
In a major aspect of understanding these fatalities, reverse transcription–polymerase chain reaction (RT-PCR) testing was conducted on specimens from 251 of the reported decedents, amounting to 90% of the deaths.
Among those tested, influenza A viruses were implicated in 240 deaths, accounting for 86%, while influenza B viruses were responsible for 38 deaths, demonstrating a clear predominance of influenza A in this season’s fatal cases.
Of the 169 influenza A deaths with known subtypes, a significant majority—56%—were linked to A(H1N1)pdm09, while 43% were associated with A(H3N2).
Clinical Insights and Vaccination Status
A thorough examination of medical histories revealed that 56% of the pediatric decedents had at least one underlying medical condition, with neurologic disorders being the most frequently reported comorbidity.
Among the 260 children eligible for vaccination, information was available for 208, of which an alarming 89% had not been fully vaccinated against influenza during the 2024–25 season.
Interestingly, children with underlying medical conditions had a slightly lower rate of unvaccinated status—86%, compared to 95% in those without such conditions.
Clinical Course and Circumstances of Death
A review of clinical complications indicated that 88% of the children had experienced significant health issues before death, with the most common being shock or sepsis, affecting 50% of the cases, followed by pneumonia and acute respiratory distress syndrome.
The isolation of bacterial pathogens from sterile sites occurred in 41% of cases tested, indicating a concerning trend of co-infections alongside influenza.
The use of antiviral medication was reported in 40% of cases, with oseltamivir being the most commonly administered drug. However, a stark contrast in treatment efficacy emerged between different settings; only 23% of those who died outside a hospital had received antivirals, compared to 62% among hospitalized children.
A significant number of deaths occurred outside of hospital settings, with 22% taking place at home and 27% in emergency departments. This raises an important public health concern about the timely recognition and treatment of severe influenza symptoms in children.
The median time from onset of illness to death exacerbated these concerns, with children who died outside the hospital experiencing a much shorter interval than those who had been admitted.
Analysis of Seasonal Trends
The severe impact of the 2024–25 influenza season has drawn comparisons to previous years; it recorded the highest number of pediatric deaths since influenza deaths were made nationally notifiable in 2004.
The historical context underscores the significance of this season, as it surpasses even the more disastrous pandemic year of 2009, which recorded 288 pediatric deaths. With a total of 43 million flu illnesses, approximately 560,000 hospitalizations, and 38,000 deaths nationwide, the severity classification of this season has necessitated urgent public health measures.
Experts remain unsure about the specific reasons behind this increase in influenza activity; however, it is noted that the easing of COVID-19 restrictions allowed for influenza to regain prevalence after a significant decline during the pandemic year.
The co-circulation of both A(H1N1)pdm09 and A(H3N2) subtypes could have compounded the severity and spread of the virus this season.
Public Health Considerations
As pediatric deaths attributed to influenza typically mirror trends from previous seasons, the current findings reiterated the necessity for greater vaccination efforts; approximately 90% of vaccine-eligible children who died from influenza had not received the seasonal vaccine.
A considerable proportion of those who succumbed to the virus had underlying health conditions, emphasizing the need for targeted vaccination campaigns aimed particularly at vulnerable populations.
Parents and caregivers are urged to seek medical attention promptly should signs of respiratory distress in children manifest, particularly as nearly half of the pediatric deaths occurred outside hospital settings.
The distribution of influenza virus types and subtypes mirrors public health laboratory data, reinforcing the need for continued surveillance and monitoring of circulating influenza strains.
In conclusion, the findings from the 2024–25 influenza season signal a dire need for public health action to address the increase in pediatric deaths. Vaccination stands as a pivotal preventive measure.
All individuals aged six months and older, without contraindications, should receive annual influenza vaccinations to safeguard against severe illness and mortality associated with influenza.
Health authorities stress the importance of ongoing education for parents, caregivers, and healthcare providers regarding the warning signs of severe influenza in children and the necessity for immediate medical intervention.
image source from：cdc
