890. Impact of Antivirals in the Prevention of Serious Outcomes Associated with Influenza in Hospitalized Canadian Adults: A Pooled Analysis from the Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN)
Session: Oral Abstract Session: Respiratory Infection Diagnosis
Thursday, October 5, 2017: 3:15 PM
Room: 01AB
Background: Antiviral treatment of influenza in outpatient settings is associated with modest improvement in outcomes but benefit in inpatient settings remains unclear. We assessed the impact of antiviral treatment on the severe outcomes death and intensive care unit (ICU) admission and/or need for mechanical ventilation (MV) in hospitalized influenza patients.

Methods: Patients admitted to hospitals of the CIRN SOS Network with an acute respiratory illness from 2011/12-2013/14 who tested Polymerase Chain Reaction (PCR) positive for influenza were included. Demographic and medical information was obtained from patient interview or the medical chart. Main outcomes of interest were ICU admission and/or need for MV, and death. Logistic regression with backwards stepwise selection was used to estimate odds ratios (ORs) and 95% confidence limits (CIs) for the association between antiviral use and severe outcomes overall, and stratified by time from symptom onset to antiviral start (<48hr, 48hr-<5 days, 5 days-21 days).

Results: Over 3 influenza seasons, 4,679 patients were enrolled; 59% were aged ≥65 years, 52% were female, and 89% had a comorbidity. Influenza vaccination status was available for 4019 (86%) patients, of whom 1796 (45%) had received current season vaccine. Of 4,679 patients, 16% of patients were admitted to ICU and/or required MV and 9% died. Overall, 54% of hospitalized influenza patients received an antiviral; mean time from onset of symptoms to antiviral start was 4.28 days (range: 0-21 days). Treatment with antivirals was associated with a significant reduction in admission to ICU and/or need for MV (OR= 0.10; 95% CI: 0.08-0.13; p<0.001), but was not significantly associated with a reduction in death (p=0.454) irrespective of time between symptom onset and start of antivirals.

Conclusion: In this study, treatment with antivirals in hospitalized patients with influenza was associated with a significant reduction in ICU admission and MV, even when initiated a mean of 4.28d from symptom onset. Reduction in death was not demonstrated. These findings support current recommendations for antiviral use in hospitalized adults and suggest increased compliance with these guidelines may reduce morbidity and cost.

Zach Shaffelburg, BSc1, Michaela Nichols, MSc1, Lingyun Ye, MSc1, Melissa K Andrew, MD, PhD1, Ardith Ambrose, RN1, Guy Boivin, MD, MSc2, William R. Bowie, MD, FRCPC, FIDSA3, Ayman Chit, MBiotech, PhD4,5, Gael Dos Santos, PhD6, May Elsherif, MD1, Karen Green, MSc, RN7, Francois Haguinet, PhD8, Scott A. Halperin, MD1, Todd Hatchette, MD FRCPC9, Barbara Ibarguchi, MSc10, Jennie Johnstone, MD11, Kevin Katz, MD, CM, MSc, FRCPC12, Joanne M. Langley, MD, FRCPC, FSHEA1, Jason Leblanc, PhD1, Philippe Lagace-Wiens, MD13, Mark Loeb, MD, MSc11, Donna Mackinnon-Cameron, MMath1, Anne Mccarthy, MD, MSc14, Janet Mcelhaney, MD, FRCPC, FACP15, Allison Mcgeer, MD, MSc7, Jeff Powis, MD, MSc, FRCPC16, David Richardson, MD17, Makeda Semret, MD18, Vivek Shinde, MD, MPH19, Stephanie Smith, MD20, Daniel Smyth, MD, FRCPC21, Geoffrey Taylor, MD, FSHEA22, Sylvie Trottier, MD, PhD2, Louis Valiquette, MD, MSc, FRCPC23, Duncan Webster, MD24 and Shelly McNeil, MD, FRCPC, FIDSA1, (1)Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada, (2)Centre Hospitalier Universitaire de Quebec, Quebec City, QC, Canada, (3)Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada, (4)Leslie Dan School of Pharmacy, University of Toronto, Toronto, ON, Canada, (5)Sanofi Pasteur, Toronto, ON, Canada, (6)Business & Decision Life Sciences (on behalf of GSK), Wavre, Belgium, (7)Mount Sinai Hospital, Toronto, ON, Canada, (8)GSK, Wavre, Belgium, (9)Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada, (10)GSK Vaccines (Current affiliation Bayer Inc.), Mississauga, ON, Canada, (11)McMaster University, Hamilton, ON, Canada, (12)Department of Infection Control, North York General Hospital, Toronto, ON, Canada, (13)Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada, (14)The Ottawa Hospital, Ottawa, ON, Canada, (15)Health Sciences North Research Institute, Sudbury, ON, Canada, (16)Michael Garron Hospital, Toronto, ON, Canada, (17)William Osler Health System, Brampton, ON, Canada, (18)McGill University, Montreal, QC, Canada, (19)Novavax Vaccines, Gaithersburg, MD, (20)Division of Infectious Diseases, Department of Medicine, University of Alberta Hospital, Edmonton, AB, Canada, (21)The Moncton Hospital, Moncton, NB, Canada, (22)Division of Infectious Diseases, University of Alberta Hospital, Edmonton, AB, Canada, (23)Microbiology and Infectious Disease, Université de Sherbrooke, Sherbrooke, QC, Canada, (24)Saint John Regional Hospital, Dalhousie University, Saint John, NB, Canada

Disclosures:

Z. Shaffelburg, None

M. Nichols, None

L. Ye, None

M. K. Andrew, GSK: Grant Investigator , Research grant
Pfizer: Grant Investigator , Research grant
Sanofi-Pasteur: Grant Investigator , Research grant

A. Ambrose, None

G. Boivin, None

W. R. Bowie, None

A. Chit, Sanofi Pasteur: Employee , Salary

G. Dos Santos, GSK: Employee , Salary
Business and Decision Life Sciences (Contractor for GSK Vaccines): Independent Contractor , Salary

M. Elsherif, Canadian Institutes of Health Research: Investigator , Research grant
Public Health Agency of Canada: Investigator , Research grant
GSK: Investigator , Research grant

K. Green, None

F. Haguinet, GSK: Employee , Salary

S. A. Halperin, GSK: Scientific Advisor , Consulting fee
GSK: Grant Investigator , Research grant

T. Hatchette, GSK: Grant Investigator , Grant recipient
Pfizer: Grant Investigator , Grant recipient
Abbvie: Speaker for a talk on biologics and risk of TB reactivation , Speaker honorarium

B. Ibarguchi, GSK: Employee , Salary

J. Johnstone, None

K. Katz, None

J. M. Langley, GSK: Investigator , Research grant
Canadian Institutes of Health Research: Investigator , Research grant

J. Leblanc, None

P. Lagace-Wiens, None

M. Loeb, None

D. Mackinnon-Cameron, None

A. Mccarthy, None

J. Mcelhaney, GSK: Scientific Advisor , Honorarium to institution
Sanofi Pasteur: Scientific Advisor , Honorarium to institution

A. Mcgeer, Hoffman La Roche: Investigator , Research grant
GSK: Investigator , Research grant
Sanofi Pasteur: Investigator , Research grant

J. Powis, Merck: Grant Investigator , Research grant
GSK: Grant Investigator , Research grant
Roche: Grant Investigator , Research grant
Synthetic Biologicals: Investigator , Research grant

D. Richardson, None

M. Semret, GSK: Investigator , Research grant
Pfizer: Investigator , Research grant

V. Shinde, Novavax: Employee , Salary
GSK: Shareholder , Stocks
GSK: Employee , Salary

S. Smith, None

D. Smyth, None

G. Taylor, None

S. Trottier, Canadian Institutes of Health Research: Investigator , Research grant

L. Valiquette, GSK: Investigator , Research grant

D. Webster, None

S. McNeil, GSK: Contract Clinical Trials and Grant Investigator , Research grant
Merck: Contract Clinical Trials and Speaker's Bureau , Speaker honorarium
Novartis: Contract Clinical Trials , No personal renumeration
Sanofi Pasteur: Contract Clinical Trials , No personal renumeration

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