Flu vaccine reduces pediatric deaths

Seasonal influenza vaccination was associated with substantially lower risk of influenza-related death in children.
*Case-cohort observational study; Level 2b (OCEBM).

Citation

Leonard JS, Reinhart K, Lu P-J, et al. Influenza Vaccine Effectiveness Against Pediatric Death in the United States: 2016–2025. Pediatrics. 2026;158(2):e2026076453.

Background

Influenza can rarely cause death in children, including those without chronic illness. U.S. pediatric influenza deaths reached a reported high in the 2024–2025 season while child influenza vaccination rates declined.

Patients

U.S. children aged 6 months to 17 years with laboratory-confirmed influenza-associated death reported during 2016–2017 through 2024–2025, excluding the low-activity 2020–2021 season. Children younger than 6 months and deaths with unknown vaccination status were excluded from primary vaccine effectiveness analyses.

Intervention

Full current-season influenza vaccination at least 14 days before illness onset.

Control

No current-season influenza vaccination; partially vaccinated children were excluded from effectiveness analyses.

Outcome

Influenza vaccine effectiveness against laboratory-confirmed influenza-associated pediatric death.

Follow-up Period

Eight influenza seasons from 2016–2017 through 2024–2025.

Results

Among 1,234 reported deaths, 1,086 had usable vaccination data for effectiveness analysis. Average vaccination coverage in comparison cohorts was 49%.

Group Vaccine effectiveness against death
Overall 80% (95% CI, 75–84)
Children with underlying medical conditions 77% (95% CI, 71–82)
Children without known underlying conditions 87% (95% CI, 84–89)
Influenza A-associated death 68% (95% CI, 61–74)
Influenza B-associated death 77% (95% CI, 72–81)

CI = confidence interval.

This observational analysis was not intention-to-treat. The unvaccinated control group does not reflect recommended preventive care.

Limitations

Deaths without influenza testing were missed. Vaccination status and underlying conditions may have been misclassified. Survey-based comparison vaccination rates may overestimate true coverage, although sensitivity analyses still showed protection.

Funding

No study-specific funding disclosed; CDC-led surveillance.

Clinical Application

Strongly reinforce annual influenza vaccination for all eligible children, especially those with chronic conditions, to reduce rare but preventable deaths.