Jonathan Miller, MD, on how pediatric influenza deaths highlight importance of vaccination, early recognition

The 2024–2025 influenza season recorded 280 pediatric influenza-associated deaths, the second-highest number since national reporting began in 2004, according to the Centers for Disease Control and Prevention (CDC). The highest number was reported during the 2009–2010 influenza A(H1N1)pdm09 pandemic.¹

More than half of children who died during the past season had an underlying medical condition, but 44% were previously healthy. Influenza A viruses accounted for 86% of deaths, with influenza B viruses representing 14%. The mortality rate was highest among infants younger than 6 months.¹

Jonathan Miller, MD, a general pediatrician at Nemours Children’s Health and president of the Delaware Chapter of the American Academy of Pediatrics, emphasized that these findings reinforce the message that all children are at risk for serious influenza complications. “Kids with high risk can have problems with influenza, but kids who are otherwise healthy can also have problems with influenza,” he said.

Vaccine coverage remains low among affected children

Among the 208 vaccine-eligible children with influenza-associated deaths or encephalopathy, 89% had not been fully vaccinated. This continues a pattern seen in past influenza seasons.

“The influenza vaccine is very safe, and it's pretty effective at preventing the severe manifestations of flu,” said Miller. “So the things like pneumonia, hospitalization, needing to be in the intensive care unit, this encephalopathy that we're talking about, these are all things that are prevented by the flu vaccine.”

CDC data also show that complications before death frequently included shock or sepsis (50%), pneumonia (38%), and acute respiratory distress syndrome (28%). Bacterial co-infections were documented in 41% of tested children.¹

Recognition and referral for influenza-associated encephalopathy

Influenza-associated encephalopathy (IAE) was reported in 109 children during the 2024–2025 season, with acute necrotizing encephalopathy accounting for one-third of those cases. Seventy-four percent of patients required intensive care unit admission, and overall mortality was 19%.¹

Miller explained that while IAE is rare, it can progress rapidly and requires urgent evaluation. “Encephalopathy can make kids not act like themselves, become lethargic, very sleepy, sometimes be in a coma, or even have seizures,” he said. “If someone has those types of symptoms, regardless of whether they have the flu, those should bring them to medical attention and probably get them to an emergency room."

Practical steps to improve vaccine uptake

To increase influenza vaccination rates, pediatricians can implement strategies both within the clinic and through community partnerships. “It really is important for pediatricians to pull out all the tricks in their bag of tricks in order to get people vaccinated,” said Miller. He recommended approaches such as vaccinating at every possible visit, hosting flu vaccine clinics outside regular office hours, offering the nasal spray vaccine for children who are hesitant about injections, and continuing promotion throughout the flu season

The CDC and the American Academy of Pediatrics recommend annual influenza vaccination for all children aged 6 months and older without contraindications. For pediatricians, these findings highlight the continued burden of influenza and the need for prevention and early recognition strategies during each flu season.

Disclosure:

Miller reports no relevant disclosures.

Reference:

1. Influenza-associated pediatric deaths — United States, 2024-2025 influenza season. MMWR. September 25, 2025. Accessed September 30, 2025. https://www.cdc.gov/mmwr/volumes/74/wr/mm7436a2.htm?s_cid=OS_mm7436a2_e&ACSTrackingID=USCDC_921-DM150591&ACSTrackingLabel=Week%20in%20MMWR%3A%20Vol.%2074%2C%20September%2025%2C%202025&deliveryName=USCDC_921-DM150591