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Influenza-related Deaths in Young Children: Observations From a German Case Series

Julian A F Klein1,2, Marianne Wedde3, Ralf Dürrwald3

  • 1From the Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany.

The Pediatric Infectious Disease Journal
|June 5, 2026
PubMed

Insights

Four previously healthy children died from influenza A (H1N1)pdm09 and influenza B infections. This case series highlights the severe risks of seasonal influenza in children and suggests re-evaluating vaccination recommendations.

Area of Science:

  • Pediatric Infectious Diseases
  • Virology
  • Public Health

Background:

  • Seasonal influenza poses a significant global health challenge.
  • Severe influenza cases in children have been increasingly reported.
  • Influenza virus infections can lead to severe outcomes, even in healthy children.

Purpose of the Study:

  • To report fatal influenza cases in young children.
  • To investigate the causative influenza strains and potential virulence factors.
  • To emphasize the risk of severe influenza outcomes in pediatric populations.

Main Methods:

  • Case series of 4 fatal influenza cases in children aged 2-6 years.
  • Forensic autopsies were performed to determine the cause of death.
  • Real-time polymerase chain reaction (RT-PCR) and whole-genome sequencing were used to identify respiratory viruses in postmortem samples.

Main Results:

  • Influenza B virus was detected in one child.
  • Influenza A (H1N1)pdm09 infection was confirmed in three children.
  • Influenza A (H1N1)pdm09 was isolated from brain tissue in one case; no high-virulence mutations were identified.

Conclusions:

  • Fatal influenza outcomes are a potential risk in previously healthy children.
  • The findings support the consideration of revised influenza vaccination strategies for children.
  • Increased awareness of severe influenza risks in pediatric populations is warranted.
Abstract

Keywords:
influenza-associated encephalitismyocarditisneurologic complicationsvaccination status

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