Category: Virology: Studies of the Epidemiology of Viral Infections

Poster Session: Virology: Studies of the Epidemiology of Viral Infections

1712 - Epidemiology, Clinical Characteristics, and Outcomes of Influenza-Associated Hospitalizations in Children in the post-2009 Pandemic Era

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Presenting Author(s)

Satoshi Kamidani

Assistant Professor of Pediatrics in Infectious Diseases
Emory University School of Medicine and Children's Healthcare of Atlanta
Suwanee, GA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Shikha Garg

Medical Officer
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Angela P. Campbell

Medical Officer
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CC

Charisse N. Cummings

Epidemiologist
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KO

Kyle P. Openo

Viral Respiratory Surveillance Coordinator
Georgia Emerging Infections Program and Atlanta VA Medical Center
Decatur, GA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CM

Chelsea L. McMullen

Respiratory Disease Surveillance Coordinator
New Mexico Department of Health
Santa Fe, New Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SC

Shua Chai

Medical Epidemiologist
California Department of Public Health
Oakland, CA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RH

Rachel Herlihy

State Epidemiologist
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KY

Kimberly Yousey-Hindes

Epidemiologist 3
Yale School of Public Health
New Haven, Connecticut
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MM

Maya Monroe

Epidemiologist-Respiratory Program Administrator
Maryland Department of Health
Baltimore, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SK

Sue Kim

Epidemiologist
Michigan Department of Health and Human Services
Lansing, Michigan
Disclosure: Council of State and Territorial Epidemiologists (CSTE) (Grant/Research Support)
Ruth Lynfield

State Epidemiologist and Medical Director
Minnesota Department of Health
St. Paul, MN
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
ED

Elizabeth Dufort

Medical Director, Division of Epidemiology
NYSDOH
Albany, NY
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LB

Laurie M. Billing

Epidemiologist
Ohio Department of Health
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MS

Melissa Sutton

Medical Director Respiratory Viral Pathogens
Oregon Health Authority
Portland, Oregon
Disclosure: CDC funding (Emerging Infections Program) (Grant/Research Support)
HT

Helen Talbot

Associate Professor
Vanderbuilt University
Nashville, Tennessee
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KM

Keegan McCaffrey

Epidemiologist
Utah Department of Health
Salt Lake City, UT
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Evan J. Anderson

Professor
Emory University School of Medicine
Atlanta, Georgia
Disclosure: Sanofi Pasteur (Scientific Research Study Investigator)

Background: Significant changes in influenza vaccination coverage and antiviral treatment guidance occurred following the 2009 influenza pandemic in children. However, data are limited describing recent epidemiology, clinical characteristics, antiviral use, vaccine coverage, and outcomes of influenza-related hospitalizations in children.

Methods: Children < 18 years hospitalized with influenza during seasons 2010–2011 through 2018–2019 were included through the US Influenza Hospitalization Surveillance Network (FluSurv-NET). Age-stratified hospitalization rates were calculated using the number of catchment-area residents with laboratory-confirmed influenza within 14 days prior to or ≤3 days after hospital admission during October 1-April 30 of each influenza season. Data on underlying medical history, influenza vaccination, antiviral use, and outcomes were abstracted from medical records using standard case report forms by trained surveillance officers.

Results: Over 9 seasons, 13,235 children were identified. Stepwise decreases in unadjusted hospitalization rates with age occurred, with the highest rates in infants < 6 months (ranging 56–184 per 100,000 persons) (Fig.1). Among these children, 56% were male, 34% were non-Hispanic White, 55% had a preexisting medical condition, and 8% were immunocompromised (Table 1). Use of antiviral treatment substantially increased from 56% to 85%, and influenza vaccination rates among hospitalized children increased from 34% to 43% over time. Regarding severe outcomes, 2,676 (20%) were admitted to ICU, 2,262 (17%) had pneumonia, 690 (5%) required mechanical ventilation, and 72 (0.5%) died. In univariable analysis, compared to hospitalized infants < 6 months, children >13 years had higher odds of ICU admission (odds ratio (OR), 2.0; 95% CI, 1.7–2.4), mechanical ventilation (OR, 1.7; 95% CI, 1.2–2.3), and pneumonia (OR, 2.6; 95% CI, 2.1–3.3) (Table 2).Figure 1

Table 1

Table 2

Conclusion: Although influenza-related hospitalization rates decreased with increasing age, severe outcomes were more common among hospitalized older children. Room for improvement exists in influenza vaccination coverage and antiviral use. While 20% of children were admitted to ICU, death was uncommon.