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Mass. officials issue warning about pediatric flu complications

Previous studies have suggested that children with pre-existing neurological disorders or those who are unvaccinated against the flu may be at higher risk for neurological complications from influenza, according to the advisory.

Mary Conlon / AP, file

February 24, 2025

2 minutes to read

Massachusetts public health officials issued an advisory to health care providers, cautioning that the state is seeing a “possible increase” in the number of children experiencing neurological complications associated with the flu.

In a clinical advisory dated Feb. 14, the Department of Public Health said it is investigating reports of children experiencing neurological complications alongside the flu, noting that similar increases are being seen elsewhere across the country. The most common flu-related neurological complication is seizure, followed by encephalopathy or encephalitis.

“At this time, it is not clear why increased cases of neurological complications associated with influenza are being observed this season,” officials wrote to providers. “One possible explanation is that we are experiencing a relatively high rate of influenza, yielding higher than typical number of cases with complications.”

Another possibility is that flu strain circulating this year offers a higher risk or that the affected population has a higher risk for the complications than before.

Previous studies have suggested that children with pre-existing neurological disorders or those who are unvaccinated against the flu may be at higher risk for neurological complications from influenza, according to the advisory.

“Although children with chronic neurological conditions are particularly vulnerable to influenza complicated by neurologic symptoms, most children with neurologic complications of influenza do not have chronic conditions,” officials said in the advisory. “Hospital length of stay, rate of ICU admission and death are greater in children with neurologic complications of influenza compared with those without these complications.”

Those that survive the severest neurological complications are “likely to have substantial persistent health impacts,” according to the advisory.

Given the apparent increase of the complications, the department is recommending clinicians consider “urgent” neurology and infectious disease consultation for pediatric patients showing new neurological symptoms with a recent flu infection or flu-like illness.

“Symptoms can include new onset seizures, mental status changes, new onset ataxia, catatonia, mutism and severe lethargy,” the state said. “Include testing for influenza in the medical evaluation of these patients.”

Health care providers are being urged to ensure pediatric patients are vaccinated against the flu. They are also being asked to report to the state if any patients under the age of 21 have new onset neurological symptoms and a positive flu test.

The severity of the flu in Massachusetts is currently “very high,” according to DPH. The state has been seeing a level of flu infections that hasn’t been seen since before COVID-19 pandemic for the 2024-2025 flu season. While infections for last week were down slightly from the spike at the beginning of February, infection levels and hospitalizations for the illness remain elevated. So far this season, 191 people have died from the flu in Massachusetts, including six children, according to the state.