Life-Threatening Complications of Influenza vs Coronavirus Disease 2019 (COVID-19) in US Children

Author:

Halasa Natasha B1,Spieker Andrew J2,Young Cameron C3ORCID,Olson Samantha M4,Newhams Margaret M3,Amarin Justin Z1,Moffitt Kristin L56,Nakamura Mari M567,Levy Emily R8,Soma Vijaya L9,Talj Rana1,Weiss Scott L10,Fitzgerald Julie C10,Mack Elizabeth H11,Maddux Aline B12,Schuster Jennifer E13,Coates Bria M14,Hall Mark W15,Schwartz Stephanie P16,Schwarz Adam J17,Kong Michele18,Spinella Philip C19,Loftis Laura L20,McLaughlin Gwenn E21,Hobbs Charlotte V22,Rowan Courtney M23,Bembea Melania M24,Nofziger Ryan A25,Babbitt Christopher J26,Bowens Cindy27,Flori Heidi R28,Gertz Shira J29,Zinter Matt S30,Giuliano John S31,Hume Janet R32,Cvijanovich Natalie Z33,Singh Aalok R34,Crandall Hillary A35,Thomas Neal J36,Cullimore Melissa L37,Patel Manish M4,Randolph Adrienne G3638ORCID,Kong Michele,Gaspers Mary Glas,Typpo Katri V,Sanders Ronald C,Katherine Irby,Peter Mourani,Schwarz Adam J,Babbitt Christopher J,Helen Harvey,Cvijanovich Natalie Z,Zinter Matt S,Maddux Aline B,Osborne Christina M,Sara Shankman,Mourani Peter M,Emily Port,Van Kevin A,Carroll Christopher L,Giuliano John S,McLaughlin Gwenn E,Tarquinio Keiko M,Michelson Kelly N,Coates Bria M,Rowan Courtney M,Wellnitz Kari,Bhoojhawon Guru,Sullivan Janice E,Montgomery Vicki L,Havlin Kevin M,Bradford Tamara T,Riggs Becky J,Bembea Melania M,Randolph Adrienne G,Newhams Margaret M,Chen Sabrina R,Young Cameron C,Moffitt Kristin L,Nakamura Mari M,Carroll Ryan W,Yager Phoebe H,Fernandes Neil D,Flori Heidi R,Heidemann Sabrina M,Hume Janet R,Levy Emily R,Hobbs Charlotte V,Martin Lora,Malloch Lacy,Inagaki Kengo,Dhanrajani Anita,Schuster Jennifer E,Kietzman Abigail,Hill Shannon,Spinella Philip C,Cullimore Melissa L,McCulloh Russell J,Clouser Katharine N,Gertz Shira J,Kleinman Lawrence C,Li Simon,Horwitz Steven M,Ratner Adam J,Dapul Heda,Soma Vijaya L,Keenaghan Michael A,Singh Aalok R,Harwayne-Gidansky Ilana,Hymes Saul R,Doymaz Sule,Schwartz Stephanie P,Walker Tracie C,Hall Mark W,Shein Steven L,Lansell Amanda N,Nofziger Ryan A,Staat Mary A,Fitzgerald Julie C,Weiss Scott,Thomas Neal J,Fink Ericka L,Carcillo Joseph A,Mack Elizabeth H,Smallcomb Laura S,Halasa Natasha B,Stewart Laura,Romero Yesenia,Hayek Haya,Loftis Laura L,Munoz Alvaro Coronado,Bowens Cindy,Maamari Mia,Crandall Hillary,Smith Lincoln S,McGuire John K, ,

Affiliation:

1. Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center , Nashville, Tennessee , USA

2. Department of Biostatistics, Vanderbilt University Medical Center , Nashville, Tennessee , USA

3. Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital , Boston, Massachusetts , USA

4. COVID-19 Response, Centers for Disease Control and Prevention , Atlanta, Georgia , USA

5. Division of Infectious Diseases, Boston Children’s Hospital , Boston, Massachusetts , USA

6. Department of Pediatrics, Harvard Medical School , Boston, Massachusetts , USA

7. Antimicrobial Stewardship Program, Boston Children’s Hospital , Boston, Massachusetts , USA

8. Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic , Rochester, Minnesota , USA

9. Department of Pediatrics, Division of Infectious Diseases, New York University Grossman School of Medicine and Hassenfeld Children’s Hospital , New York, New York , USA

10. Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania , USA

11. Division of Pediatric Critical Care Medicine, Medical University of South Carolina , Charleston, South Carolina , USA

12. Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado , Aurora, Colorado , USA

13. Division of Pediatric Infectious Disease, Department of Pediatrics, Children’s Mercy Kansas City , Kansas City, Missouri , USA

14. Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine , Chicago, Illinois , USA

15. Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital , Columbus, Ohio , USA

16. Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina , USA

17. Division of Critical Care Medicine, Children's Hospital Orange County (CHOC) , Orange, California , USA

18. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham , Birmingham, Alabama , USA

19. Division of Critical Care, Department of Pediatrics, Washington University School of Medicine in St Louis , St. Louis, Missouri , USA

20. Section of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital , Houston, Texas , USA

21. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Miami Miller School of Medicine , Miami, Florida , USA

22. Department of Pediatrics, Department of Microbiology, Division of Infectious Diseases, University of Mississippi Medical Center , Jackson, Mississippi , USA

23. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children , Indianapolis, Indiana , USA

24. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA

25. Division of Critical Care Medicine, Akron Children’s Hospital , Akron, Ohio , USA

26. Miller Children’s and Women’s Hospital of Long Beach , Long Beach, California , USA

27. Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children’s Medical Center, Dallas , Texas , USA

28. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children’s Hospital and University of Michigan , Ann Arbor, Michigan , USA

29. Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center , Livingston, New Jersey , USA

30. Department of Pediatrics, Division of Critical Care, University of California–San Francisco , San Francisco, California , USA

31. Department of Pediatrics, Division of Critical Care, Yale University School of Medicine , New Haven, Connecticut , USA

32. Division of Pediatric Critical Care, University of Minnesota Masonic Children’s Hospital , Minneapolis, Minnesota , USA

33. Division of Critical Care Medicine, University of California–San Francisco Benioff Children’s Hospital Oakland , Oakland, California , USA

34. Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College , Valhalla, New York , USA

35. Division of Pediatric Critical Care, Department of Pediatrics, University of Utah , Salt Lake City, Utah , USA

36. Department of Pediatrics, Penn State Hershey Children’s Hospital, Pennsylvania State University College of Medicine , Hershey, Pennsylvania , USA

37. Division of Pediatric Critical Care, Department of Pediatrics, Children’s Hospital and Medical Center , Omaha, Nebraska , USA

38. Department of Anaesthesia, Harvard Medical School , Boston, Massachusetts , USA

Abstract

Abstract Background Clinical differences between critical illness from influenza infection vs coronavirus disease 2019 (COVID-19) have not been well characterized in pediatric patients. Methods We compared demographics, clinical characteristics, and outcomes of US children (aged 8 months to 17 years) admitted to the intensive care or high-acuity unit with influenza or COVID-19. Using mixed-effects models, we assessed the odds of death or requiring life support for influenza vs COVID-19 after adjustment for age, sex, race and Hispanic origin, and underlying conditions including obesity. Results Children with influenza (n = 179) were younger than those with COVID-19 (n = 381; median, 5.2 years vs 13.8 years), less likely to be non-Hispanic Black (14.5% vs 27.6%) or Hispanic (24.0% vs 36.2%), and less likely to have ≥1 underlying condition (66.4% vs 78.5%) or be obese (21.4% vs 42.2%), and a shorter hospital stay (median, 5 days vs 7 days). They were similarly likely to require invasive mechanical ventilation (both 30.2%), vasopressor support (19.6% and 19.9%), or extracorporeal membrane oxygenation (2.2% and 2.9%). Four children with influenza (2.2%) and 11 children with COVID-19 (2.9%) died. The odds of death or requiring life support in children with influenza vs COVID-19 were similar (adjusted odds ratio, 1.30; 95% confidence interval, .78–2.15; P = .32). Conclusions Despite differences in demographics and clinical characteristics of children with influenza or COVID-19, the frequency of life-threatening complications was similar. Our findings highlight the importance of implementing prevention measures to reduce transmission and disease severity of influenza and COVID-19.

Funder

CDC

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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