2334. Neurological Manifestations of Hospitalized Children with Influenza During the 2016-2017 Season
Session: Poster Abstract Session: Pediatric Virology
Saturday, October 7, 2017
Room: Poster Hall CD
Background: Influenza A H1N1 and B are associated with neurological complications including seizures, encephalopathy and encephalitis. However, this season, when H3N2 was the predominant strain, many patients were admitted with neurological manifestations of influenza (NMI). The study objectives were to: 1) identify clinical characteristics of children with NMI and 2) compare demographics and clinical characteristics with influenza-positive controls.

Methods: We conducted a retrospective cohort/case control study of children with NMI at Children’s Hospital Colorado from Dec 2016-Apr 2017. We reviewed the medical records to identify children with NMI, and assessed clinical characteristics and outcomes. We conducted unadjusted conditional logistic regression using influenza-positive sex, race and time-matched controls to identify risk factors associated with NMI.

Results: Of 126 inpatients with influenza, 20 (16%) had NMI; 11 (55%) had encephalopathy, meningitis or encephalitis, 13 (65%) had a seizure presentation, 4 children had both presentations (Table). Nineteen (95%) had infection with influenza H3N2. Of those with known vaccination status, 13/19 (68%) were unvaccinated against influenza. Compared with matched controls, children with NMI were more likely to have a neurological comorbidity, (40% vs 11%, OR 4.1, 95% CI 1.5-11.3) and a secondary bacterial infection (35% vs 13%, OR 4.2, 95% CI 1.2-15).

Conclusion: NMI was associated with H3N2 strains, and most cases were brief, reversible, yet required intensive care. Our findings suggest consideration of influenza testing among febrile children with altered mental status/seizures, and the importance of influenza vaccination among children with underlying neurological disorders.

Characteristics of children with NMI

Variable

Seizure

N (%)a

Encephalitis
/Encephalopathy
/Meningitis

N (%)a

Prior Neurological Condition (n=8)

n = 7

n = 2

 Age yrsb

4 (2-10)

12 (10-13)

Male

3 (43)

1 (50)

ICUc

3 (43)

1 (50)

CSF WCCbd, n = 3

2 (2-2)

3 (2-3)

Abnormal brain imaging n = 4

1 (50)

1 (50)

No Prior Neurological Condition (n=12)

n = 6

n = 9

Age, yearsb

4 (1-11)

11 (2-12)

Male

3 (50)

6 (67)

ICUc

4 (67)

7 (78)

CSF WCCbd n = 9

29 (3-545)

9 (1-29)

Abnormal brain imaging n = 10

3 (60)

4 (67)

 aUnless otherwise specified b Median (IQR) cIntensive Care Unit dCerebrospinal fluid white cell count

Suchitra Rao, MBBS1, Kevin Messacar, MD2, Jan Martin, MD3, M. Alex Ahern, MD4, Christina Osborne, MD5, Michelle Torok, PhD6, Amanda Dempsey, MD, PhD, MPH7,8, Teri Schreiner, MD3 and Samuel Dominguez, MD, PhD9, (1)Pediatric Infectious Diseases, Hospital Medicine and Epidemiology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (2)Pediatric Infectious Diseases and Hospital Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (3)Neurology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (4)Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (5)Pediatric Infectious Diseases, Children's Hospital Colorado, Aurora, CO, (6)Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, CO, (7)University of Colorado School of Medicine, Children's Hospital Colorado and Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, CO, (8)Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, (9)Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO

Disclosures:

S. Rao, GSK: Investigator , Research support

K. Messacar, None

J. Martin, None

M. A. Ahern, None

C. Osborne, None

M. Torok, None

A. Dempsey, Merck, Pfizer, Sanofi Pasteur: Consultant , no research funding

T. Schreiner, None

S. Dominguez, None

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