721. Clinical Respiratory Syndromes and Association with Influenza Clinical Diagnostic Testing and Antiviral Treatment among Children Hospitalized with Acute Respiratory Illness, 2015-2016
Session: Poster Abstract Session: Respiratory Infections: Viral
Thursday, October 4, 2018
Room: S Poster Hall

Background:  We investigated clinical influenza testing and treatment in children hospitalized with acute respiratory illness (ARI) who had distinct respiratory syndromes.

Methods:   Children <18 years old with ARI were enrolled at 7 hospitals in the New Vaccine Surveillance Network (NVSN) between 11/1/15–6/30/16. ICD10 admission diagnosis codes were grouped to define syndromes of bronchiolitis, asthma, pneumonia, and croup. At clinician discretion, influenza testing with a rapid influenza diagnostic test or molecular assay was performed on respiratory samples. As part of the study, each site performed influenza testing using molecular assays on mid-turbinate nasal and throat swabs from all enrolled children. Analysis was restricted to influenza season; children who received antivirals before hospitalization were excluded.

Results:   Among 2134 children with available ICD10 codes, on preliminary analysis 1119 (52%) had influenza testing ordered by a clinician: 111 (10%) were positive, and 57 (51%) of 111 received antiviral treatment. Of the 2134, 858 (40%) had 1 of the 4 mutually exclusive syndromes (Table). Hospital clinical testing per clinician discretion was influenza positive in 16 of the 858 children (percent positivity per syndrome ranged from <1% to 38%; Table). Research study testing of children not undergoing clinical influenza testing identified 11 additional positives. Antiviral treatment was highest for pneumonia patients.

Conclusion: Understanding testing and treatment practices by clinical syndrome may help to identify missed opportunities for influenza diagnosis and treatment.

Bronchiolitis

Asthma

Pneumonia

Croup

n=392

n=320

n=117

n=29

n

%

n

%

n

%

n

%

Age <5 years

391

>99%

156

49%

76

65%

23

79%

<2 days from illness onset to admission

87

22%

171

54%

28

24%

15

52%

>1 known underlying condition

84

21%

277

87%

62

53%

6

21%

Hospital clinical testing performed

209

53%

90

28%

68

58%

8

28%

      Positive influenza

1

<1%

4

4%

8

12%

3

38%

            Antiviral treatment

0

1

6

0

Research study result in children without hospital clinical testing

      Additional positive influenza

1

3

5

2

            Antiviral treatment

0

0

3

0

Angela P. Campbell, MD, MPH, FPIDS, FIDSA1, Brian Rha, MD, MSPH2, Constance Ogokeh, MPH1, Janet Englund, MD, FIDSA3, Natasha B. Halasa, MD, MPH, FPIDS4, Rangaraj Selvarangan, PhD5, Mary A. Staat, M.D., M.P.H.6, Geoffrey A. Weinberg, MD, FIDSA, FPIDS7, Parvin H. Azimi, MD8, Julie A. Boom, MD9, Monica McNeal, MS6, Leila C. Sahni, MPH9, Monica Nayakwadi Singer, MD, MPH8, Peter G. Szilagyi, MD, MPH7,10, Christopher J. Harrison, M.D., FAAP, FPIDS5, Eileen J. Klein, MD, MPH11, Joana Yu, MPH2,12, Daniella Figueroa-Downing, MPH2, Daniel C. Payne, PhD, MSPH13 and Alicia M. Fry, MD, MPH1, (1)Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, (2)Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, (3)Department of Pediatrics, University of Washington, Seattle, WA, (4)Vanderbilt University School of Medicine, Nashville, TN, (5)The Children's Mercy Hospital and Clinics, Kansas City, MO, (6)Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (7)Univ. of Rochester Sch. of Medicine and Dentistry, Rochester, NY, (8)UCSF Benioff Children's Hospital Oakland, Oakland, CA, (9)Baylor College of Medicine, Texas Children's Hospital, Houston, TX, (10)University of California at Los Angeles, Los Angeles, CA, (11)University of Washington/Seattle Children's Hospital, Seattle, WA, (12)IHRC, Atlanta, GA, (13)Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

A. P. Campbell, None

B. Rha, None

C. Ogokeh, None

J. Englund, Gilead: Consultant and Investigator , Consulting fee and Research support . Novavax: Investigator , Research support . GlaxoSmithKline: Investigator , Research support . Alios: Investigator , Research support . MedImmune: Investigator , Research support .

N. B. Halasa, Sanofi Pasteur: Investigator , Research support . GSK: Consultant , Consulting fee . Moderna: Consultant , Consulting fee .

R. Selvarangan, None

M. A. Staat, None

G. A. Weinberg, None

P. H. Azimi, None

J. A. Boom, None

M. McNeal, None

L. C. Sahni, None

M. Nayakwadi Singer, None

P. G. Szilagyi, None

C. J. Harrison, None

E. J. Klein, None

J. Yu, None

D. Figueroa-Downing, None

D. C. Payne, None

A. M. Fry, None

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