Rising Concern Over Influenza-Related Brain Damage in Children and Rising Pediatric Deaths
Nikhil Prasad Fact checked by:Thailand Medical News Team Feb 28, 2025 10 hours, 37 minutes ago
Medical News: The U.S. Centers for Disease Control and Prevention (CDC) has issued a concerning warning regarding a sharp increase in pediatric deaths associated with acute necrotizing encephalopathy (ANE), a severe neurological complication of influenza. According to the latest data from the CDC’s Influenza-Associated Pediatric Mortality Surveillance System, 13% of children who have died from seasonal flu this year had influenza-associated encephalopathy or encephalitis (IAE), with four cases specifically identified as ANE.
Rising Concern Over Influenza-Related Brain Damage in Children and Rising Pediatric Deaths
This
Medical News report highlights that ANE, the most severe form of IAE, leads to significant brain dysfunction, inflammation, and other neurological complications. The U.S. CDC, in collaboration with state health departments, has been tracking these cases closely to assess whether the rising numbers this season deviate from historical trends.
Understanding ANE and Its Impact on Pediatric Flu Deaths
The CDC began receiving reports of ANE-related pediatric flu deaths in January 2025. By February 8, 68 U.S. children had been confirmed dead from influenza-related causes, with nine of these cases involving IAE and four being fatal ANE cases. Alarmingly, all ANE victims were under the age of five and had tested positive for influenza A (H1N1). Among them, two children had received flu vaccinations, two had undergone antiviral treatment with oseltamivir (Tamiflu), and all required mechanical ventilation.
Historically, from the 2010 - 11 to the 2024 - 25 flu seasons, the U.S. CDC documented 1,840 pediatric influenza deaths, of which 166 (9%) involved IAE. The percentage of flu-related pediatric deaths involving IAE has ranged from 0% in the 2020-21 season to 14% in the 2011-12 season. These cases predominantly involved influenza A, with 40% affecting non-Hispanic white children.
Given the absence of dedicated national surveillance for IAE or ANE, it remains unclear whether this season’s numbers are an anomaly. However, the U.S. CDC emphasizes the importance of recognizing early neurological symptoms in children with febrile illnesses to ensure timely medical intervention.
How ANE Develops and Why It’s So Dangerous
ANE is a rare but life-threatening complication of viral infections, including influenza. Unlike general encephalitis, which involves direct viral invasion of the brain, ANE results from an exaggerated immune response leading to widespread brain inflammation.
Common symptoms of IAE and ANE include seizures, altered mental status, extreme lethargy, hallucinations, and personality changes lasting more than 24 hours. The key hallmark of ANE is the presence of distinctive symmetrical brain lesions, particularly in the thalamus, visible on MRI scans.
Trends and Risk Factors for Pediatric IAE and ANE
Data collected from the past 15 years indicate that pediatric IAE cases account fo
r about 9% of all flu-related child deaths. During the 2024-25 flu season alone, preliminary data suggest that 13% of all pediatric flu deaths involved IAE.
The majority of fatal cases required mechanical ventilation, with common complications including acute respiratory distress syndrome (34%), pneumonia (33%), and sepsis (28%). Interestingly, more than half (54%) of the children who died from IAE had no underlying health conditions, underscoring that even healthy children are at risk. Additionally, only 20% of these children had received a flu vaccine at least two weeks before falling ill.
What Parents and Healthcare Providers Should Know
Given the potential severity of IAE and ANE, the U.S. CDC is urging healthcare providers to consider these conditions in children presenting with flu symptoms and abnormal neurological signs. Early intervention, including flu testing, neuroimaging, and antiviral treatment, can be crucial in preventing fatal outcomes.
Children who exhibit neurological symptoms such as seizures, confusion, delirium, or extreme fatigue should receive immediate medical evaluation. The U.S. CDC also highlights the importance of early antiviral treatment, even before lab confirmation of influenza, to reduce potential complications.
Public Health Implications and Future Surveillance Needs
The growing number of influenza-related encephalopathy cases has raised concerns about the need for enhanced surveillance and public health strategies. The U.S. currently lacks a dedicated national system for tracking IAE and ANE cases, making it difficult to assess long-term trends accurately. To address this gap, the U.S. CDC has launched a national call for possible pediatric IAE cases identified during the current flu season and has urged healthcare providers to report suspected cases.
Conclusion
The alarming increase in pediatric flu deaths associated with ANE serves as a stark reminder of the dangers of influenza beyond respiratory complications. This season, 13% of flu-related child deaths involved neurological complications, with four confirmed ANE fatalities. While the exact cause of the increase remains unknown due to the lack of a national surveillance system, the U.S. CDC stresses the importance of flu vaccinations, early antiviral treatment, and heightened awareness of neurological symptoms in flu-infected children.
Given the unpredictable nature of influenza and its potential to trigger severe neurological disorders, enhanced public health measures and dedicated surveillance systems are crucial. Future studies should focus on identifying risk factors, optimizing treatment protocols, and developing strategies to prevent these devastating complications. Meanwhile, parents and healthcare providers must remain vigilant in recognizing early warning signs to ensure prompt intervention.
More details can be found in the U.S. CDC’s Morbidity and Mortality Weekly Report (MMWR).
https://www.cdc.gov/mmwr/volumes/74/wr/mm7406a3.htm
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