Racial and Ethnic Differences of Influenza-Associated Pediatric Hospitalizations and Deaths, 2008-2017.

Background: Influenza is one of the most common causes of acute respiratory infections in children; its complications are a leading cause of morbidity and mortality. There is a paucity of pediatric data on influenza disparities among racial/ethnic minorities. Our study assesses if there are racial/ethnic differences in hospitalizations and mortality in children infected with influenza. Methods: This was a retrospective cohort study using the National Inpatient Sample (NIS) from January 1, 2008 to December 31, 2017. We included children 18 years and younger hospitalized with a primary or secondary diagnosis of influenza or its subtypes. We generated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to evaluate the associations between patient characteristics and influenza hospitalizations and influenza-related mortality. Results: There were 226,535 (0.04%) influenza-associated hospitalizations. When compared with non-Hispanic (NH) White children, minority children were more likely to be hospitalized with an influenza diagnosis [Hispanics (aOR = 1.25; 95% CI, 1.17 to 1.33), NH-Blacks (aOR = 1.21, 95% CI, 1.17 to 1.33) and NH-Others group (aOR = 1.11; 95% CI, 1.04 to 1.19)]. There was no racial/ethnic difference in mortality. Conclusions: Minority children experienced a higher likelihood of influenza-associated hospitalizations but not mortality. Further research is needed to reduce the racial/ethnic disparities of influenza's impact.

Longitudinal evaluation of pediatric respiratory infections.

OBJECTIVE: Acute respiratory infections are the most common cause of under-five-year-old pediatric mortality worldwide. Due to a paucity of data, the impact of many respiratory viruses and their association with respiratory failure in children are unclear. We assessed single respiratory viral pathogens and their association with intubation, and secondly describe dual viral pathogens and viral-bacterial pathogens associations with intubation. PATIENT AND METHODS: This was a retrospective cross-sectional study of children (0-18 years old) admitted to the acute care unit and/or pediatric intensive care unit of an urban, quaternary children's hospital from November 1, 2013 to November 1, 2017. Patients with viral studies sent within 48 h of admission were included. Associations of viral pathogens and intubation status were calculated using odds ratios (OR), 95% confidence intervals (CI) and p-values. RESULTS: There were 15,923 hospitalization encounters, with 634 (3.9%) requiring intubation. RSV and hMPV had increased odds for intubation, (aOR 1.80, 95% CI 1.50-2.18) and (aOR 1.59, 95% CI 1.13-2.24) respectively. Coinfection with RSV and adenovirus had increased odds of requiring intubation, (aOR 3.48, 95% CI 1.21-10.01). Contrary, coinfection with influenza A and RSV had no intubations. In the viral-bacterial coinfections model, there was an increased association with intubations for RSV and Streptococcus (aOR 9.34, 95% CI 4.21-20.71) and hMPV and Streptococcus (aOR 8.98, 95% CI 1.62-49.88). CONCLUSION: RSV and hMPV corresponded to the highest rates of intubations, and dual infections with RSV and adenovirus, RSV and Streptococcus, and hMPV and Streptococcus were associated with mechanical ventilation, revealing differences amongst the groups.

Respiratory Virus Co-infection in Acute Respiratory Infections in Children.

PURPOSE OF REVIEW: This investigation aims to understand the role and burden of viral co-infections for acute respiratory illnesses in children. Co-infection can be either viral-viral or viral-bacterial and with new technology there is more information on the role they play on the health of children. RECENT FINDINGS: With the proliferation of multiplex PCR for rapid diagnosis of multiple viruses as well as innovations on identification of bacterial infections, research has been attempting to discover how these co-infections affect each other and the host. Studies are aiming to discern if the epidemiology of viruses seen at a population level is related to the interaction between different viruses on a host level. Studies are also attempting to discover the burden of morbidity and mortality of these viral-viral co-infections on the pediatric population. It is also becoming important to understand the interplay of certain viruses with specific bacteria and understanding the impact of viral-bacterial co-infections. RSV continues to contribute to a large burden of disease for pediatric patients with acute respiratory illnesses. However, recent literature suggests that viral-viral co-infections do not add to this burden and might, in some cases, be protective of severe disease. Viral-bacterial co-infections, on the other hand, are most likely adding to the burden of morbidity in pediatric patients because of the synergistic way they can infect the nasopharyngeal space. Future research needs to focus on confirming these conclusions as it could affect hospital cohorting, role of molecular testing, and therapeutic interventions.