Pediatric Influenza-Associated Encephalopathy and Acute Necrotizing Encephalopathy — United States, 2024–25 Influenza Season

In January 2025, CDC received several reports of deaths among children aged <18 years with a severe form of influenza-associated encephalopathy (IAE) termed acute necrotizing encephalopathy (ANE). Because no national surveillance for IAE currently exists, CDC requested notification of U.S. pediatric IAE cases from clinicians and health departments during the 2024-25 influenza season, a high-severity season with a record number of pediatric influenza-associated deaths. Among 192 reports of suspected IAE submitted to CDC, 109 (57%) were categorized as IAE, 37 (34%) of which were subcategorized as ANE, and 72 (66%) as other IAE; 82 reports did not meet IAE criteria and were categorized as other influenza-associated neurologic disease. The median age of children with IAE was 5 years and 55% were previously healthy, 74% were admitted to an intensive care unit, and 19% died; 41% of children with ANE died. Only 16% of children with IAE who were vaccination-eligible had received the 2024-25 influenza vaccine. Health care providers should consider IAE in children with encephalopathy or altered level of consciousness and a recent or current febrile illness when influenza viruses are circulating. Annual influenza vaccination is recommended for all children aged ≥6 months to prevent influenza and associated complications, potentially including severe neurologic disease such as IAE and ANE.

Authors

Publication Details

Journal
MMWR Morbidity and Mortality Weekly Report
Published
2025-09-25
DOI
https://doi.org/10.15585/mmwr.mm7436a1
Citations
5
Primary Topic
Infectious Encephalopathies and Encephalitis
Type
article
Field-Weighted Citation Impact
6.98

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article

Pediatric Influenza-Associated Encephalopathy and Acute Necrotizing Encephalopathy — United States, 2024–25 Influenza Season

Pam Daily Kirley, Justin Frederick, Ryan R. Hurtado, M. Cecilia Di Pentima et al.
5 citations
MMWR Morbidity and Mortality Weekly Report
Infectious Encephalopathies and Encephalitis
6.98
article

Pediatric Influenza-Associated Encephalopathy and Acute Necrotizing Encephalopathy — United States, 2024–25 Influenza Season

Pam Daily Kirley, Justin Frederick, Ryan R. Hurtado, M. Cecilia Di Pentima, Felice C. Adler‐Shohet, Erica Wilson, K Schultis, Thomas C. Westbrook, Sandra R. Arnold, Andrea C. Pardo, Andrea Scioscia, Elizabeth Doran, Curi Kim, Annabelle de St. Maurice, Jennifer Wall Forrester, Kristina Betters, D. Neal, Suchitra Rao, Sarah Winders, Khalil Harbi, Ruth Lynfield, Allison P. Williams, Shivani Patel, Anna Unutzer, Dawn Nims, Asha Mary Thomas, Jessica D. Wharton, Julie Hand, Justin Henderson, Suresh B. Boppana, Timothy D. Minniear, D. C. Grant, William Burton, Meghan Gray, Bethany Hodge, Donna L. Gowie, Charlotte V. Hobbs, Jade M. Murray, Joseph J. Goswitz, Stephen Tomek, Mallory Sinner, James H. Conway, Anna Krueger, David Williams, David A. Hunstad, Jennifer A. Shuford, Amanda Hartley, Andreas Faulstich, Mridula Gupta, Aaron M. Frutos, Varsha Neelam, Charsey Cole Porse, Ankita P. Desai, Vivien G. Dugan, Ibukunoluwa C. Kalu, Nancy Eisenberg, Andrew Elliott, William B. Stubblefield, Krista Kniss, Neel Shah, Elizabeth J. Harker, Juliana Jacoboski, Lori Handy, Cassandra C Lautredou, Justin Morris, Jevon McFadden, Mustafa Bakir, Joel Howard, Zain Alamarat, Neil Rellosa, Andrew Silverman, Peyton Thompson, Melissa A. Rolfes, Ana Del Valle Penella, Tina Bair, Kathleen Harriman, Susana Chávez‐Bueno, Deepam Thomas, Ayelet Rosenthal, Deepti Nagesh, Sascha Ellington, Carrie Reed, Amanda Feldpausch, Abby L. Berns, Shikha Garg, Theresa M. Dulski, Jaime Redkey, R. Burri, Derek Julian, Rachel Wester, Kedar Tilak, Fibi Attia, Maouly Fall, Derek P Bumgardner, Danielle Potter, BreeAnna Dell, Kate Shapiro, Amara Fazal, Rachel Park, Kevin A. Cassady, Melissa McMahon, Sameh W. Boktor, James W. Long, Patricia A. Marshall, Felicia A. Scaggs Huang, Coralee Del Valle Mojica, Molly Wilson-Murphy, Megan Langille, Kelly Howell, Haytham Safi, Keith Van Haren, Cassandra Collins, M. Lugo, Melissa S. Plantenga, Yomei Shaw, Scott Lindquist, Alejandro Tomasello, Adrienne G. Randolph, Isaac Armistead, Laurie M. Billing, Alisha Yamanaka, Susan C. Hutto, Charles T. Tuggle, Cindy Beard, Matthew Donahue, Tigran Avoundjian, John Bos, Cristina V. Torres, Bridget J. Anderson, Beth K Thielen, Pablo Pinedo, Sue J. Hong, Andy Weigel, Priya R. Edward, George Turabelidze, M. Davidson, Samantha M. Olson, Devin Raman, Layne Mounsey, Sarah M. Labuda, Alice Yeung, Richa Chaturvedi, Hannah Ball, VincentP Carroll, Kurt O. Reinhart, Melissa M. Campbell, Sharon L. McChesney, Jerome Leonard, John Dreisig, Adam Rowe, James W. Antoon, Eric Brownhill, David Zhang, Sue Kim, Lawrence S. Lee, Thomas Haupt, Ashley Johnson, Melissa Sutton, Kalyani McCullough, C. Taylor, Arilene Novak, Jeffrey Sanders, E Hans, Angela G. Fowler, Timothy M. Uyeki, Cynthia A. Mattingly, Aftab Bhatti, Varun Shetty, Joyce Cohen, A. Mooney, Max Habicht, M. Andraya Hendrick, Kurt Baum, Michael Patten, S. Giovanni, Chad Wetzel, Carol A. Kauffman, Carol Glaser, Lee G. Simmons, Nicholas Fisher, Evelyn S. Pangonis, Hannah E. Edelman, Whitney Tillman, Brittany Yarnell, Helen Giambrone, Courtney Swick, Devi Dwarabandam, Rachel I. Paneth-Pollak, Teegan Plackowski, Alison Bridendolph, Adrianna Stanley-Downs, Vivienne Heines, Yvonne Boire, Jeni Nybo, Yarlini Vipulanandan, Laura Hegarty-Moore, Daniel Droutman, Shivani Devaguptapu, Valerie Gosack, Amy Voris, Danielle DeCesaris, Justin Faybusovich, Lindsey McAda
article en
5 citations

Abstract

In January 2025, CDC received several reports of deaths among children aged <18 years with a severe form of influenza-associated encephalopathy (IAE) termed acute necrotizing encephalopathy (ANE). Because no national surveillance for IAE currently exists, CDC requested notification of U.S. pediatric IAE cases from clinicians and health departments during the 2024-25 influenza season, a high-severity season with a record number of pediatric influenza-associated deaths. Among 192 reports of suspected IAE submitted to CDC, 109 (57%) were categorized as IAE, 37 (34%) of which were subcategorized as ANE, and 72 (66%) as other IAE; 82 reports did not meet IAE criteria and were categorized as other influenza-associated neurologic disease. The median age of children with IAE was 5 years and 55% were previously healthy, 74% were admitted to an intensive care unit, and 19% died; 41% of children with ANE died. Only 16% of children with IAE who were vaccination-eligible had received the 2024-25 influenza vaccine. Health care providers should consider IAE in children with encephalopathy or altered level of consciousness and a recent or current febrile illness when influenza viruses are circulating. Annual influenza vaccination is recommended for all children aged ≥6 months to prevent influenza and associated complications, potentially including severe neurologic disease such as IAE and ANE.

MMWR Morbidity and Mortality Weekly ReportVol. 74(36)
U.S. Department of Health and Human Services, Bill and Melinda Gates Foundation, Pfizer, Virginia Department of Health, Council of State and Territorial Epidemiologists, Oklahoma State University, Colorado Department of Public Health and Environment, Michigan Department of Health and Human Services, Ionis Pharmaceuticals, Department of Health, Vermont, International Pediatric Research Foundation, National Institutes of Health, Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, National Heart, Lung, and Blood Institute, National Institute of Allergy and Infectious Diseases
Openalex Percentile: Top 3%
Infectious Encephalopathies and Encephalitis
6.98
DOIOpen Access PDFOpenAlex
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