To assess medical costs of hospitalizations and emergency department (ED) care associated with respiratory syncytial virus (RSV) disease in children enrolled in the New Vaccine Surveillance Network.
...We used accounting and prospective surveillance data from 6 pediatric health systems to assess direct medical costs from laboratory-confirmed RSV-associated hospitalizations (n = 2007) and ED visits (n = 1267) from 2016 through 2019 among children aged <5 years. We grouped costs into categories relevant to clinical care and administrative billing practices. We examined RSV-associated medical costs by care setting using descriptive and bivariate analyses. We assessed associations between known RSV risk factors and hospitalization costs and length of stay using χ
tests of association.
The median cost was $7100 (IQR $4006-$13 355) per hospitalized child and $503 (IQR $387-$930) per ED visit. Eighty percent (n = 2628) of our final sample were children aged younger than 2 years. Fewer weeks' gestational age was associated with greater median costs in hospitalized children (P < .001, ≥37 weeks of gestational age: $6840 $3905-$12 450; 29-36 weeks of gestational age: $7721 $4362-$15 274; <29 weeks of gestational age: $9131 $4518-$19 924). Infants born full term accounted for 70% of the total expenditures in our sample. Almost three quarters of the health care dollars spent originated in children younger than 12 months of age, the primary age group targeted by recommended RSV prophylactics.
Reducing the cost burden for RSV-associated medical care in young children will require prevention of RSV in all young children, not just high-risk infants. Newly available maternal vaccine and immunoprophylaxis products could substantially reduce RSV-associated medical costs.
We piloted a methodology for collecting and interpreting root cause-or environmental deficiency (ED)-information from Legionnaires' disease (LD) outbreak investigation reports. The methodology ...included a classification framework to assess common failures observed in the implementation of water management programs (WMPs). We reviewed reports from fourteen CDC-led investigations between 1 January 2015 and 21 June 2019 to identify EDs associated with outbreaks of LD. We developed an abstraction guide to standardize data collection from outbreak reports and define relevant parameters. We categorized each ED according to three criteria: ED type, WMP-deficiency type, and source of deficiency. We calculated the prevalence of EDs among facilities and explored differences between facilities with and without WMPs. A majority of EDs identified (81%) were classified as process failures. Facilities with WMPs (
= 8) had lower prevalence of EDs attributed to plumbed devices (9.1%) and infrastructure design (0%) than facilities without WMPs (
= 6; 33.3% and 24.2%, respectively). About three quarters (72%) of LD cases and 81% of the fatalities in our sample originated at facilities without a WMP. This report highlights the importance of WMPs in preventing and mitigating outbreaks of LD. Building water system process management is a primary obstacle toward limiting the root causes of LD outbreaks. Greater emphasis on the documentation, verification, validation, and continuous program review steps will be important in maximizing the effectiveness of WMPs.
Abstract
Background
Respiratory pathogen panels (RPP) are multiplex PCR platforms that detect several respiratory viruses from one specimen. For most children hospitalized with acute respiratory ...illness (ARI), management is supportive, and detection of a specific virus from RPP does not impact clinical care. Therefore, clinical RPP use is not standardized, and ordering is at the discretion of the clinician. We sought to understand factors associated with RPP utilization among pediatric patients hospitalized with ARI.
Methods
From October 2017 to September 2021, participants < 18 years hospitalized with ARI were enrolled at a single site in the New Vaccine Surveillance Network (NVSN). Eligible patients were residents of Jackson County, MO, had one or more ARI symptoms (e.g., cough, fever, nasal congestion) lasting < 14 days, and were enrolled within 48 hours of admission. Parent interviews and medical chart reviews were conducted. All participants had a research RPP, but results were not available to the clinical providers. Clinical providers were able to order a clinical RPP (cRPP), for which they received test results. Characteristics of NVSN enrollees hospitalized with ARI with and without a cRPP are described. Lastly, medical complexity was assessed via the pediatric complex chronic conditions classification system (CCC) then analyzed via chi- square test between groups.
Results
During the study period, 1,038 participants were enrolled, and 555 (53.4%) received a cRPP. Most, 299 (53%), cRPPs were ordered in the emergency department or urgent care before admission. Age was a significant factor associated with cRPP use (Table 1). cRPP participants were more likely to have complex chronic conditions, and/or technology dependence. No difference in cRPP use was observed by race/ethnicity, payer status, or sex. More participants were enrolled in 2020-2021, but the overall usage of cRPP is similar between years (Table 2).
Conclusion
In this large cohort of children hospitalized with ARI, medical complexity, technological dependence, and age < 2 months were associated with increased utilization of cRPPs. Understanding the impact of cRPP on clinical care requires further investigation to better understand the utility of these tests.
Disclosures
Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Honoraria|Altona Diagnostics: Grant/Research Support|Baebies Inc: Advisor/Consultant|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|Bio-Rad: Grant/Research Support|Cepheid: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Lab Simply: Advisor/Consultant|Luminex: Grant/Research Support
Respiratory syncytial virus (RSV) is the leading cause of hospitalization among infants in the United States. In August 2023, CDC's Advisory Committee on Immunization Practices recommended ...nirsevimab, a long-acting monoclonal antibody, for infants aged <8 months to protect against RSV-associated lower respiratory tract infection during their first RSV season and for children aged 8-19 months at increased risk for severe RSV disease. In phase 3 clinical trials, nirsevimab efficacy against RSV-associated lower respiratory tract infection with hospitalization was 81% (95% CI = 62%-90%) through 150 days after receipt; post-introduction effectiveness has not been assessed in the United States. In this analysis, the New Vaccine Surveillance Network evaluated nirsevimab effectiveness against RSV-associated hospitalization among infants in their first RSV season during October 1, 2023-February 29, 2024. Among 699 infants hospitalized with acute respiratory illness, 59 (8%) received nirsevimab ≥7 days before symptom onset. Nirsevimab effectiveness was 90% (95% CI = 75%-96%) against RSV-associated hospitalization with a median time from receipt to symptom onset of 45 days (IQR = 19-76 days). The number of infants who received nirsevimab was too low to stratify by duration from receipt; however, nirsevimab effectiveness is expected to decrease with increasing time after receipt because of antibody decay. Although nirsevimab uptake and the interval from receipt of nirsevimab were limited in this analysis, this early estimate supports the current nirsevimab recommendation for the prevention of severe RSV disease in infants. Infants should be protected by maternal RSV vaccination or infant receipt of nirsevimab.
SARS-CoV-2 infection in young children is often mild or asymptomatic; however, some children are at risk for severe disease. Data describing the protective effectiveness of COVID-19 mRNA vaccines ...against COVID-19-associated emergency department (ED) visits and hospitalization in this population are limited. Data from the New Vaccine Surveillance Network, a prospective population-based surveillance system, were used to estimate vaccine effectiveness using a test-negative, case-control design and describe the epidemiology of SARS-CoV-2 in infants and children aged 6 months-4 years during July 1, 2022-September 30, 2023. Among 7,434 children included, 5% received a positive SARS-CoV-2 test result, and 95% received a negative test result; 86% were unvaccinated, 4% had received 1 dose of any vaccine product, and 10% had received ≥2 doses. When compared with receipt of no vaccines among children, receipt of ≥2 COVID-19 mRNA vaccine doses was 40% effective (95% CI = 8%-60%) in preventing ED visits and hospitalization. These findings support existing recommendations for COVID-19 vaccination of young children to reduce COVID-19-associated ED visits and hospitalization.
What is already known about this topic? Mycoplasma pneumoniae is a common cause of mild respiratory illness, though severe infection can lead to pneumonia. Resistance to macrolides, the recommended ...treatment, is widespread in Asia though uncommon in the United States. M. pneumoniae infections decreased globally during the COVID-19 pandemic. What is added by this report? Data from the National Syndromic Surveillance Program and the New Vaccine Surveillance Network showed an increase in M. pneumoniae in the United States beginning in fall 2023, though below prepandemic levels. What are the implications for public health practice? Providers might consider M. pneumoniae during fall and winter respiratory illness seasons. Macrolides remain the first-line treatment for M. pneumoniae infections in the United States.
In the United States, annual influenza vaccination is recommended for all persons aged ≥6 months. Using data from four vaccine effectiveness (VE) networks during the 2023-24 influenza season, interim ...influenza VE was estimated among patients aged ≥6 months with acute respiratory illness-associated medical encounters using a test-negative case-control study design. Among children and adolescents aged 6 months-17 years, VE against influenza-associated outpatient visits ranged from 59% to 67% and against influenza-associated hospitalization ranged from 52% to 61%. Among adults aged ≥18 years, VE against influenza-associated outpatient visits ranged from 33% to 49% and against hospitalization from 41% to 44%. VE against influenza A ranged from 46% to 59% for children and adolescents and from 27% to 46% for adults across settings. VE against influenza B ranged from 64% to 89% for pediatric patients in outpatient settings and from 60% to 78% for all adults across settings. These findings demonstrate that the 2023-24 seasonal influenza vaccine is effective at reducing the risk for medically attended influenza virus infection. CDC recommends that all persons aged ≥6 months who have not yet been vaccinated this season get vaccinated while influenza circulates locally.
Abstract
Background
Children with underlying medical conditions are at higher risk for developing severe influenza illness. Annual influenza vaccination is recommended for all children ≥ 6 months and ...can protect against severe influenza. Limited studies have examined if vaccine effectiveness (VE) against influenza illness differs in children with underlying conditions compared to those without.
Methods
We used a test-negative design to assess VE against laboratory-confirmed influenza-associated ED visits or hospitalizations in children 6 months-17 years of age with and without underlying conditions. Children were enrolled at 7 medical centers within NVSN, a prospective respiratory viral surveillance platform in 7 states, during each influenza season from 2015-2016 through 2019-2020. Influenza vaccination was assessed using documentation from state registries or providers. Underlying conditions were abstracted from medical records. We estimated VE by comparing the odds of vaccination ≥ 14 days prior to symptom onset in case patients with influenza compared to test-negative control patients with non-influenza respiratory illness. VE was adjusted for age, study site, and calendar time.
Results
A total of 15,739 children were included (2,800 cases and 12,939 controls). Among cases, 48% had an underlying condition, and about half (51%) of those conditions were respiratory (Table). Cases with underlying conditions were more likely to be hospitalized (53%) compared to cases without (26%). Among patients with underlying conditions, 38% of cases and 56% of controls were vaccinated (Figure). Overall (ED or hospitalization) VE was 48% (95% CI: 41%, 54%) among children with underlying conditions and 57% (95% CI: 50%, 62%) among children without. VE against hospitalization was 46% (95% CI: 36%, 54%) among children with underlying medical conditions and 59% (95% CI: 48%, 68%) among children without.
Conclusion
Vaccination reduced the odds of influenza illness in children with and without underlying conditions. VE was similar in children regardless of presence of conditions. Vaccination was sub-optimal in children with and without underlying conditions and continued efforts are needed to improve vaccination uptake in all children ≥ 6 months.
Disclosures
Marian G. Michaels, MD, MPH, Merck: Grant/Research Support|Viracor: Grant/Research Support John V. Williams, MD, Merck: Grant/Research Support|Quidel: Board Member Janet A. Englund, MD, Ark Biopharma: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Mary A. Staat, MD, MPH, CDC: Grant/Research Support|Cepheid: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|Pfizer: Grant/Research Support|Up-To-Date: Honoraria Elizabeth P. Schlaudecker, MD, MPH, Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Honoraria|Altona Diagnostics: Grant/Research Support|Baebies Inc: Advisor/Consultant|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|Bio-Rad: Grant/Research Support|Cepheid: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Lab Simply: Advisor/Consultant|Luminex: Grant/Research Support Geoffrey A. Weinberg, MD, Merck & Co: Honoraria Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support|Quidell: Grant/Research Support|Quidell: donation of kits|Sanofi: Grant/Research Support|Sanofi: vaccine support
Abstract
Background
Children hospitalized with suspected or confirmed influenza should promptly receive influenza antivirals, as recommended by the Infectious Diseases Society of America, the ...American Academy of Pediatrics, and the Centers for Disease Control and Prevention (CDC). However, despite these recommendations, antiviral receipt remains suboptimal. We assessed predictors of antiviral receipt for influenza in hospitalized children.
Methods
We conducted active, population-based surveillance of children presenting with fever or respiratory symptoms from December 1, 2016, to March 31, 2020, at seven children’s hospitals in the CDC NVSN. The cohort consisted of children hospitalized with influenza confirmed by research molecular testing. We assessed predictors of antiviral receipt, selected a priori, using logistic regression, and included all in the final model.
Results
We enrolled and tested 16,853 hospitalized children for influenza, identifying 1,120 laboratory-confirmed cases (6.6%). Of these laboratory-confirmed cases, clinicians ordered influenza testing for 693/1,120 (61.9%), and among those tested, 599/693 (86.4%) tested positive by clinical assays. Overall, 545/1,120 children (48.7%) received influenza antivirals. Of those with a positive clinical test, 405/599 (67.6%) received antivirals. Factors associated with higher odds of antiviral receipt included an underlying oncologic or immunocompromising disorder, symptom onset ≤ 2 days, intensive care unit (ICU) admission at presentation, use of influenza antivirals for this illness prior to hospitalization, and a positive clinical test (Table). Additionally, we found that a negative clinical test was associated with lower odds of antiviral receipt, and receipt varied significantly by study site.
Table
Logistic regression model of influenza-specific antiviral receipt among hospitalized children testing positive for influenza by research testing, December 1, 2016, and March 31, 2020 (N=1,120).
Conclusion
More than half of children hospitalized with influenza in our surveillance population did not receive antivirals, despite treatment recommendations. Efforts to improve antiviral receipt are important for optimizing care in all children hospitalized with influenza, and clinician education should continue to highlight the use of antivirals across the full spectrum of children hospitalized with influenza, including children not admitted to the ICU and those without underlying conditions.
Disclosures
Marian G. Michaels, MD, MPH, Merck: Grant/Research Support|Viracor: Grant/Research Support John V. Williams, MD, Merck: Grant/Research Support|Quidel: Board Member Janet A. Englund, MD, Ark Biopharma: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Geoffrey A. Weinberg, MD, Merck & Co: Honoraria Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Honoraria|Altona Diagnostics: Grant/Research Support|Baebies Inc: Advisor/Consultant|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|Bio-Rad: Grant/Research Support|Cepheid: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Lab Simply: Advisor/Consultant|Luminex: Grant/Research Support Flor M. Munoz, MD, MSc, CDC respiratory virus surveillance: Grant/Research Support|Gilead: Grant/Research Support|Moderna, sanofi, aztra zeneca, Merck, GSK: Advisor/Consultant|NIH: DSMB|NIH COVID-19 vaccines in pregnancy: Grant/Research Support|Pfizer Pediatric COVID-19 vaccines: Grant/Research Support|Pfizer, Dynavax, Monderna, Meissa, NIH: DSMB Mary A. Staat, MD, MPH, CDC: Grant/Research Support|Cepheid: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|Pfizer: Grant/Research Support|Up-To-Date: Honoraria Elizabeth P. Schlaudecker, MD, MPH, Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support|Quidell: Grant/Research Support|Quidell: donation of kits|Sanofi: Grant/Research Support|Sanofi: vaccine support
Abstract
Background
Respiratory viruses are a substantial cause of hospitalization in infants and young children; less is known about their contribution to ARI-associated hospitalizations in children ...≥ 5 years of age.
Methods
We conducted prospective, active surveillance among children ages 5–17 years hospitalized for acute respiratory illness (ARI) at 7 pediatric medical institutions comprising the New Vaccine Surveillance Network (NVSN) during December 1, 2016 through April 1, 2020. Children hospitalized for fever and/or respiratory symptoms were consented for enrollment. Demographic and clinical data were collected through parent/guardian interviews and chart abstraction. Mid-turbinate nasal and/or throat specimens were collected and tested using molecular methods for respiratory syncytial virus (RSV), influenza, parainfluenza viruses 1–4 (PIV), human metapneumovirus (HMPV), rhinovirus/enterovirus (RV/EV), adenovirus (AdV), and seasonal coronaviruses (CoV).
Results
Of 6,992 eligible children, 4,011 (57%) were enrolled and 3,953 (99%) had respiratory specimens obtained. Median age of enrolled children was 8.9 years (IQR: 6.6, 12.2), 55% were male, 38% were non-Hispanic White, and 76% had ≥ 1 underlying medical condition (Table). Respiratory viruses were detected in 54% of patients hospitalized with ARI: RV/EV occurred most frequently (32%), followed by influenza (11%) and RSV (5%) (Figure). Respiratory virus coinfections were detected in 133 (3%) patients. Common symptoms reported included cough, congestion/runny nose, and fever, and a majority of children experienced dyspnea and wheezing. Median length of hospitalization was 2 days (IQR: 1,3); 687 (17%) patients were admitted to an intensive care unit, of whom 119 (17%) required intubation.
Figure. Detection and seasonality of respiratory viruses in hospitalized children 5–17 years, 2016–2020
Conclusion
Respiratory viruses were detected in more than half of ARI-related hospitalizations in children aged ≥ 5 years. This multi-center, multi-year, pre-pandemic assessment provides baseline data to evaluate for possible changing epidemiology of respiratory viruses after the onset of the COVID-19 pandemic.
Disclosures
Mary A. Staat, MD, MPH, CDC: Grant/Research Support|Cepheid: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|Pfizer: Grant/Research Support|Up-To-Date: Honoraria Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Honoraria|Altona Diagnostics: Grant/Research Support|Baebies Inc: Advisor/Consultant|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|Bio-Rad: Grant/Research Support|Cepheid: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Lab Simply: Advisor/Consultant|Luminex: Grant/Research Support Marian G. Michaels, MD, MPH, Merck: Grant/Research Support|Viracor: Grant/Research Support John V. Williams, MD, Merck: Grant/Research Support|Quidel: Board Member Geoffrey A. Weinberg, MD, Merck & Co: Honoraria Janet A. Englund, MD, Ark Biopharma: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Flor M. Munoz, MD, MSc, CDC respiratory virus surveillance: Grant/Research Support|Gilead: Grant/Research Support|Moderna, sanofi, aztra zeneca, Merck, GSK: Advisor/Consultant|NIH: DSMB|NIH COVID-19 vaccines in pregnancy: Grant/Research Support|Pfizer Pediatric COVID-19 vaccines: Grant/Research Support|Pfizer, Dynavax, Monderna, Meissa, NIH: DSMB Pedro A. Piedra, MD, Ark Bioscience: Advisor/Consultant|Ark Bioscience: Grant/Research Support|GSK: Grant/Research Support|Icosavax: Advisor/Consultant|Icosavax: Grant/Research Support|Mapp Biologics: Grant/Research Support|Meissa Vaccines: Grant/Research Support|Moderna: Advisor/Consultant|Novavax: Advisor/Consultant|Novavax: Grant/Research Support|Sanofi-Pasteur: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Takeda: Advisor/Consultant Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support|Quidell: Grant/Research Support|Quidell: donation of kits|Sanofi: Grant/Research Support|Sanofi: vaccine support
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