Epidemiology, Clinical Characteristics, and Outcomes of Influenza-Associated Hospitalizations in US Children Over 9 Seasons Following the 2009 H1N1 Pandemic

Author:

Kamidani Satoshi12ORCID,Garg Shikha3,Rolfes Melissa A3,Campbell Angela P3,Cummings Charisse N34,Haston Julia C5,Openo Kyle P67,Fawcett Emily67,Chai Shua J89,Herlihy Rachel10,Yousey-Hindes Kimberly11,Monroe Maya L12,Kim Sue13,Lynfield Ruth14,Smelser Chad15,Muse Alison16,Felsen Christina B17,Billing Laurie18,Thomas Ann19,Talbot H Keipp20,Schaffner William20,Risk Ilene21,Anderson Evan J126722

Affiliation:

1. Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia , USA

2. Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta and Emory University , Atlanta, Georgia , USA

3. Influenza Division, Centers for Disease Control and Prevention , Atlanta, Georgia , USA

4. Abt Associates , Rockville, Maryland , USA

5. Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta, Georgia , USA

6. Georgia Emerging Infections Program, Georgia Department of Public Health , Atlanta, Georgia , USA

7. Veterans Affairs Medical Center , Decatur, Georgia , USA

8. California Emerging Infections Program , Oakland, California , USA

9. Field Services Branch, Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention , Atlanta, Georgia , USA

10. Colorado Department of Public Health and Environment , Denver, Colorado , USA

11. Connecticut Emerging Infections Program, Yale School of Public Health , New Haven, Connecticut , USA

12. Maryland Department of Health , Baltimore, Maryland , USA

13. Michigan Department of Health and Human Services , Lansing, Michigan , USA

14. Minnesota Department of Health , St Paul, Minnesota , USA

15. New Mexico Department of Health , Santa Fe, New Mexico , USA

16. New York State Department of Health , Albany, New York , USA

17. New York State Emerging Infections Program, Center for Community Health and Prevention, University of Rochester School of Medicine and Dentistry , Rochester, New York , USA

18. Ohio Department of Health , Columbus, Ohio , USA

19. Oregon Health Authority , Portland, Oregon , USA

20. Vanderbilt University School of Medicine , Nashville, Tennessee , USA

21. Salt Lake County Health Department , Salt Lake City, Utah , USA

22. Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA

Abstract

Abstract Background Recent population-based data are limited regarding influenza-associated hospitalizations in US children. Methods We identified children <18 years hospitalized with laboratory-confirmed influenza during 2010–2019 seasons, through the Centers for Disease Control and Prevention’s Influenza Hospitalization Surveillance Network. Adjusted hospitalization and in-hospital mortality rates were calculated, and multivariable logistic regression was conducted to evaluate risk factors for pneumonia, intensive care unit (ICU) admission, mechanical ventilation, and death. Results Over 9 seasons, adjusted influenza-associated hospitalization incidence rates ranged from 10 to 375 per 100 000 persons each season and were highest among infants <6 months old. Rates decreased with increasing age. The highest in-hospital mortality rates were observed in children <6 months old (0.73 per 100 000 persons). Over time, antiviral treatment significantly increased, from 56% to 85% (P < .001), and influenza vaccination rates increased from 33% to 44% (P = .003). Among the 13 235 hospitalized children, 2676 (20%) were admitted to the ICU, 2262 (17%) had pneumonia, 690 (5%) required mechanical ventilation, and 72 (0.5%) died during hospitalization. Compared with those <6 months of age, hospitalized children ≥13 years old had higher odds of pneumonia (adjusted odds ratio, 2.7 [95% confidence interval, 2.1–3.4], ICU admission (1.6 [1.3–1.9]), mechanical ventilation (1.6 [1.1–2.2]), and death (3.3 [1.2–9.3]). Conclusions Hospitalization and death rates were greatest in younger children at the population level. Among hospitalized children, however, older children had a higher risk of severe outcomes. Continued efforts to prevent and attenuate influenza in children are needed.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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