2446. Clinical features and outcomes of immunocompromised adults hospitalized with laboratory-confirmed influenza in the United States, 2011–2015
Session: Poster Abstract Session: Viral Infections in Transplantation
Saturday, October 7, 2017
Room: Poster Hall CD
  • IDWeek Poster FluSurv-NET Immunocompromised final.pdf (608.2 kB)
  • Background: Data on immunocompromised (IC) adults with influenza are limited but suggest they may present differently and have worse outcomes than non-IC adults. Using a national surveillance system, we describe the epidemiology of IC adults hospitalized with influenza.

    Methods: We analyzed data on adults (aged ≥18 years) hospitalized with laboratory-confirmed influenza during the 2011-12 through 2014-15 seasons and reported to CDC’s Influenza Hospitalization Surveillance Network (FluSurv-NET). We defined IC patients as having ≥1 of the following: HIV, AIDS, cancer, stem cell or organ transplantation, non-steroid immunosuppressive therapy, immunoglobulin deficiency, asplenia, and other rare conditions. We compared IC and non-IC patients using χ2 or Fisher’s exact tests and t-tests or Mann-Whitney U tests.

    Results: Among 35,348 adults hospitalized over 4 seasons, 3633 (10%) were IC. The most common IC conditions were cancer (44%), non-steroid immunosuppressive therapy (44%), and HIV (17%). IC patients were younger than non-IC patients (mean 61±17 vs. 67±20 years; p<0.01). IC patients were more likely to have underlying renal disease (27% vs. 18%) and liver disease (7% vs. 3%) and less likely to have most other chronic underlying conditions including obesity (18% vs. 23%), cardiovascular disease (40% vs. 47%), and chronic lung disease (35% vs. 41%; p<0.01 for all). IC patients were more likely to have received influenza vaccination (53% vs. 46%; p<0.01). Among cases with symptom data (2014-15), IC patients were more likely to present with fever (68% vs. 61%; p<0.01) but respiratory distress was similar (53% vs. 54%; p=0.3). Overall, the majority of IC and non-IC patients received antivirals (87% vs. 85%; p<0.01). IC patients had a longer duration of hospitalization (median (IQR) 4 (2-6) vs. 3 (2-6) days; p<0.01) and were more likely to be diagnosed with pneumonia (34 vs. 31%; p<0.01) and to require intensive care (18% vs. 16%; p=0.01). Death during hospitalization occurred in 135 (3.7%) IC and 945 (3.0%) non-IC patients (p=0.01).

    Conclusion: Among adults hospitalized with influenza, IC patients had worse outcomes including a longer duration of hospitalization and higher probability of pneumonia and intensive care unit admission, and increased all-cause mortality, although these results are not adjusted for potential confounders.

    Jennifer Collins, MD1, Kyle Openo, MPH2, Monica Farley, MD, FIDSA3, Charisse Nitura Cummings, MPH4, Patricia Ryan, MS5, Kimberly Yousey-Hines, MPH, CPH6, Elizabeth Dufort, MD7, Ruth Lynfield, MD, FIDSA8, Krista Lung, MPH9, Ann Thomas, MD, MPH10, Nisha Alden, MPH11, Pam D. Kirley, MPH12, Seth Eckel, MPH13, Nancy M. Bennett, MD14, William Schaffner, MD, FIDSA, FSHEA15, Mary Louise Lindegren, MD, MPH15, Mary Hill, MPH16, Joan Baumbach, MD, MPH, MS17, Angela P. Campbell, MD, MPH, FPIDS, FIDSA4, Shikha Garg, MD, MPH4 and Evan J. Anderson, MD18, (1)Pediatric Infectious Diseases, Emory University, Decatur, GA, (2)Georgia Emerging Infections Program, Atlanta, GA, (3)Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, GA, (4)Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, (5)Maryland Department of Health and Mental Hygiene, Baltimore, MD, (6)Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, (7)New York State Department of Health, Albany, NY, (8)State Epidemiologist and Medical Director for Infectious Diseases, Epidemiology & Community Health, Minnesota Department of Health, St. Paul, MN, (9)Bureau of Infectious Diseases, Ohio Department of Health, Columbus, OH, (10)Oregon Public Health Division, Portland, OR, (11)Colorado Department of Public Health and Environment, Denver, CO, (12)California Emerging Infections Program, Oakland, CA, (13)Communicable Disease Division, Michigan Department of Health and Human Services, Lansing, MI, (14)University of Rochester Medical Center, Rochester, NY, (15)Vanderbilt University School of Medicine, Nashville, TN, (16)Salt Lake Valley Health Dept., Salt Lake City, UT, (17)New Mexico Department of Health, Santa Fe, NM, (18)Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA


    J. Collins, None

    K. Openo, None

    M. Farley, None

    C. Nitura Cummings, None

    P. Ryan, None

    K. Yousey-Hines, None

    E. Dufort, None

    R. Lynfield, None

    K. Lung, None

    A. Thomas, None

    N. Alden, None

    P. D. Kirley, None

    S. Eckel, None

    N. M. Bennett, None

    W. Schaffner, Pfizer: Scientific Advisor , Consulting fee
    Merck: Scientific Advisor , Consulting fee
    Novavax: Consultant , Consulting fee
    Dynavax: Consultant , Consulting fee
    Sanofi-pasteur: Consultant , Consulting fee
    GSK: Consultant , Consulting fee
    Seqirus: Consultant , Consulting fee

    M. L. Lindegren, None

    M. Hill, None

    J. Baumbach, None

    A. P. Campbell, None

    S. Garg, None

    E. J. Anderson, AbbVie: Consultant , Consulting fee
    NovaVax: Research Contractor , Research support
    Regeneron: Research Contractor , Research grant
    MedImmune: Research Contractor , Research grant and Research support

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