2494. Influenza B Hospitalizations are Associated with Mortality in Children, FluSurv-NET, 2011-2017
Session: Poster Abstract Session: Virology Potpourri
Saturday, October 6, 2018
Room: S Poster Hall
  • B Virus_ID Week Poster.pdf (323.5 kB)
  • Background: Influenza B viruses (B) co-circulate with influenza A viruses (A) and contribute to influenza-associated hospitalizations each season. We used data from the Influenza Hospitalization Surveillance Network (FluSurv-NET) to determine the association between B virus hospitalizations and mortality among children.

    Methods: We included data from children aged 0-17 years, residing in a FluSurv-NET catchment area, and hospitalized with laboratory-confirmed influenza during 2011-12 through 2016-17. We abstracted data on underlying conditions, clinical course and outcomes from medical charts. After excluding cases with unknown influenza type or with A/B coinfection, we compared characteristics of children hospitalized with A vs B using univariate analyses and multivariable logistic regression, to determine the independent association between virus type and in-hospital mortality.

    Results: Among 7671 children hospitalized with influenza, 5607 (73%) had A and 2064 (27%) had B. The proportion of B hospitalizations varied by season from 11% during 2013-14 to 42% during 2012-13. Among children with B, median age was 4 years (interquartile range 1-8 years), 58% were male and 36% were non-Hispanic white. In univariate analysis, children with B were more likely to be older, have cardiovascular and neurologic disease, to be vaccinated (38 vs 32%), and to be hospitalized ≥2 days after illness onset, and were less likely to have asthma and receive antivirals (71 vs 79%) compared to those with A (p <0.05). There were no differences in the proportion with ≥1 underlying condition (59% both groups). Patients with B vs A were no more likely to require intensive care (19 vs 20%; p 0.34) or receive mechanical ventilation (6 vs 5%; p 0.13); however, patients with B were more likely to die in-hospital (1 vs 0.4%; p<0.01). The unadjusted odds of in-hospital mortality for children with B vs A was 2.3 (95% confidence interval (CI) 1.3-4.1), which remained elevated at 2.0 (95% CI 1.1-3.7) after adjusting for age, season and underlying conditions.

    Conclusion: Influenza B virus infections were associated with severe outcomes among hospitalized children. Although death was uncommon, children with B had twice the odds of dying in-hospital compared to those with A virus infection.

    Shikha Garg, MD, MPH1, Alissa O'Halloran, MSPH1, Charisse Nitura Cummings, MPH1, Shua J. Chai, MD, MPH2, Nisha Alden, MPH3, Kimberly Yousey-Hindes, MPH, CPH4, Evan J. Anderson, MD5, Patricia Ryan, MS6, James Collins, MPH, RS7, Chad Smelser, MD8, Debra Blog, MD, MPH9, Christina B. Felsen, MPH10, Laurie Billing, MPH11, Ann Thomas, MD, MPH12, H. Keipp Talbot, MD, MPH13, Melanie Spencer, MPH14, Ruth Lynfield, MD, FIDSA15 and Carrie Reed, DSc, MPH1, (1)Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, (2)Assigned to the California Department of Public Health, US Centers for Disease Control (CDC), Richmond, 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)Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Atlanta, GA, (6)MD Dept Health Mental Hygiene, Baltimore, MD, (7)Michigan Department of Health and Human Services, Lansing, MI, (8)New Mexico Emerging Infections Program, Santa Fe, NM, (9)Bureau of Immunization, NEW YORK STATE DEPARTMENT OF HEALTH, Albany, NY, (10)NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY, (11)Ohio Department of Health, Columbus, OH, (12)Oregon Public Health Division, Portland, OR, (13)Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, (14)Salt Lake County Health Department, Salt Lake City, UT, (15)Minnesota Department of Health, St. Paul, MN


    S. Garg, None

    A. O'Halloran, None

    C. Nitura Cummings, None

    S. J. Chai, None

    N. Alden, None

    K. Yousey-Hindes, None

    E. J. Anderson, NovaVax: Grant Investigator , Research grant . Pfizer: Grant Investigator , Research grant . AbbVie: Consultant , Consulting fee . MedImmune: Investigator , Research support . PaxVax: Investigator , Research support . Micron: Investigator , Research support .

    P. Ryan, None

    J. Collins, None

    C. Smelser, None

    D. Blog, None

    C. B. Felsen, None

    L. Billing, None

    A. Thomas, None

    H. K. Talbot, Sanofi Pasteur: Investigator , Research grant . Gilead: Investigator , Research grant . MedImmune: Investigator , Research grant . Vaxinnate: Safety Board , none . Seqirus: Safety Board , none .

    M. Spencer, None

    R. Lynfield, None

    C. Reed, None

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