538. Effectiveness of Antiviral Treatment among Children Hospitalized with Laboratory-Confirmed Influenza
Session: Poster Abstract Session: Respiratory Viruses
Thursday, October 8, 2015
Room: Poster Hall

Background: Early antiviral treatment can shorten influenza illness duration and may reduce the risk of complications, but limited data are available for hospitalized children. We evaluated the effect of influenza antiviral treatment on hospital length of stay (LOS) among children with laboratory-confirmed community-acquired influenza and underlying medical conditions or with severe illness requiring intensive care unit (ICU) admission.

Methods: A retrospective observational cohort was identified from the Influenza Hospitalization Surveillance Network (FluSurv-NET), and clinical information was collected by medical record review. Data for children with underlying co-morbidities (excluding asthma alone) were collected for season 2012-2013, and for children with ICU admission for seasons 2010-2013. A multivariable log-normal model was used to compare LOS between treated and untreated patients, and between patients treated early (≤2 days) versus later (3-5 and ≥6 days) after symptom onset.

Results: Of 649 children with underlying co-morbidities, 483 (74%) received antiviral treatment. Adjusted analysis showed no significant difference in LOS between treated and untreated patients (geometric mean [GM] 4.01 vs 3.82 days, respectively; p=0.41). Among treated children, LOS lengthened as days from illness onset to treatment increased (Figure). Patients with underlying co-morbidities treated ≤2 days from onset had shorter LOS compared with patients treated at 3-5 and ≥6 days (3.7 vs 4.4 GM days, p=0.02; and 3.7 vs 5.0 GM days, p=0.005; respectively). In ICU patients, 328 (74%) of 441 patients received treatment, with no difference in hospital LOS from untreated patients (GM 4.08 vs 3.51 days; p=0.12). LOS was shorter, but not significantly, for ICU patients treated ≤2 days from onset compared with later (Figure).

 

                                                                                                       

Conclusion: Early timing of antiviral treatment relative to symptom onset was related to shorter hospital LOS; however, children treated later likely differed clinically from those treated early. We did not detect a significant difference in length of hospitalization between treated and untreated children. Further study to understand treatment decisions for hospitalized children with influenza is warranted.

Angela P. Campbell, MD, MPH, FPIDS1, Sandra S. Chaves, MD, MSc1, Sue B. Reynolds, PhD1, Pam Daily Kirley, MPH2, Lisa Miller, MD, MSPH3, Kimberly Yousey-Hines, MPH, CPH4, Evan J. Anderson, MD5,6, Oluwakemi Oni, MPH7, Maya Monroe, MPH8, Seth Eckel, MPH9, Ruth Lynfield, MD, FIDSA10, Marisa Bargsten, MPH11, Shelley M. Zansky, PhD12, Christina Felsen, MPH13, Krista Lung, BS14, Ann Thomas, MD, MPH15, Elizabeth Mermel, MS, FIDSA16, Mary Lou Lindegren, MD, MPH17, Diana Thurston, APRN, PhD18 and Alicia M. Fry, MD, MPH1, (1)Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, (2)California Emerging Infections Program, Oakland, CA, (3)Colorado Department of Public Health and Environment, Denver, CO, (4)Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, (5)Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, (6)Atlanta Veterans Affairs Medical Center, Atlanta, GA, (7)Iowa Department of Public Health, Des Moines, IA, (8)Maryland Department of Health and Mental Hygiene, Baltimore, MD, (9)Communicable Disease Division, Michigan Department of Health and Human Services, Lansing, MI, (10)Minnesota Department of Health, St. Paul, MN, (11)New Mexico Department of Health, Santa Fe, NM, (12)New York State Department of Health, Albany, NY, (13)Center for Community Health, University of Rochester Medical Center, Rochester, NY, (14)Bureau of Infectious Diseases, Ohio Department of Health, Columbus, OH, (15)Oregon Public Health Division, Portland, OR, (16)Rhode Island Department of Health, Providence, RI, (17)Vanderbilt University School of Medicine, Nashville, TN, (18)Salt Lake County Health Department, Salt Lake City, UT

Disclosures:

A. P. Campbell, None

S. S. Chaves, None

S. B. Reynolds, None

P. Daily Kirley, None

L. Miller, None

K. Yousey-Hines, None

E. J. Anderson, Abbvie: Consultant , Consulting fee
MedImmune: Investigator , Research grant
Roche: Editorial assistance in writing a manuscript , Editorial assistance in writing a manuscript

O. Oni, None

M. Monroe, None

S. Eckel, None

R. Lynfield, None

M. Bargsten, None

S. M. Zansky, None

C. Felsen, None

K. Lung, None

A. Thomas, None

E. Mermel, None

M. L. Lindegren, None

D. Thurston, None

A. M. Fry, None

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