714. Predictors of Influenza-Associated Hospitalization and Pneumonia in a Pediatric Population in Bangkok, Thailand
Session: Poster Abstract Session: Respiratory Infections: Viral
Thursday, October 4, 2018
Room: S Poster Hall
Background: Influenza infection in children can be severe, resulting in complications such as pneumonia, but may be mitigated by early recognition and administration of antivirals. In this study, we identified risk factors for hospitalization and pneumonia in a pediatric population presenting with influenza-like illness (ILI) in Thailand.

Methods: Our study included pediatric patients (age < 18 years) presenting with ILI to inpatient and outpatient departments at a public hospital in Bangkok, Thailand, from 2009 to 2016. ILI was defined as fever plus cough or sore-throat, and pneumonia was defined as either lung radiographic or pulmonary exam abnormalities. Demographic and clinical data, as well as nasal and throat swabs, were collected during a one-time interview with patients presenting with ILI. Influenza infections were confirmed via RT-PCR testing of respiratory specimens. Retrospective chart review was used to collect data on individuals with influenza admitted for inpatient care.

Results: 5,968 children (33.6%) were enrolled with ILI, of whom 1,530 (25.6%) were confirmed to be influenza by RT-PCR, of which 25.5% were influenza A(H1N1)pdm09, 31.5% influenza A(H3N2), and 43.0% influenza B. 124 (8.1%) patients were admitted, and 41 of these children (33.1%) developed pneumonia. Predictors of hospitalization included younger age (4.1 yrs for inpatients vs 5.6 yrs) and higher presenting temperature (38.6C for inpatient vs 38.0C) (both p<0.05). Among children hospitalized with influenza, influenza subtype was not associated with pneumonia risk. Co-detection of Klebsiella pneumoniae was associated with an increased risk of pneumonia (p<0.05. Patients with pneumonia were younger (4.1 yrs with vs 6.4 yrs, p=NS), had a longer interval from fever onset to presentation at the hospital, and required longer hospital stays. Risk of pneumonia was decreased in patients who received oseltamivir within 48 hours of fever onset (odds ratio 0.36, 95% confidence interval 0.16-0.91).

Conclusion: Post viral pneumonia is a potentially serious complication of influenza, requiring longer hospitalization stay and affecting more than one third of hospitalized pediatric patients with influenza. The risk of pneumonia can be reduced with early presentation for clinical care and prompt administration of oseltamivir following fever onset.

Ali Sawani, BS1, Detchvijitr Suwanpakdee, MD2, Veerachai Watanaveeradej, MD2, Alden Weg, MD3, Damon Ellison, PhD3, Chonticha Klungthong, PhD3, Thipwipha Phonpakobsin, PhD3, Phirangkul Kerdpanich, MD2, Danabhand Phiboonbanakit, MD2, Robert Gibbons, MD3, Stefan Fernandez, PhD3, Louis Macareo, MD, JD, MPH3, In Kyu Yoon, MD3,4, Rick Jarman, PhD5, Sriluck Simasthien, MD2 and Kathryn Anderson, MD, PhD, MSPH3,6, (1)Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, (2)Phramongkutklao Hospital, Bangkok, Thailand, (3)Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand, (4)International Vaccine Institute, Seoul, Korea, Republic of (South), (5)Walter Reed Army Institute of Research, Silver Spring, MD, (6)University of Minnesota, Minneapolis, MN

Disclosures:

A. Sawani, None

D. Suwanpakdee, None

V. Watanaveeradej, None

A. Weg, None

D. Ellison, None

C. Klungthong, None

T. Phonpakobsin, None

P. Kerdpanich, None

D. Phiboonbanakit, None

R. Gibbons, None

S. Fernandez, None

L. Macareo, None

I. K. Yoon, None

R. Jarman, None

S. Simasthien, None

K. Anderson, None

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