1337. Medically Attended (MA) Illness Due to Respiratory Syncytial Virus (RSV) Infection among Infants in the United States during the 2016–17, 2017–18, 2018–19, and 2019–20 RSV Seasons: The Need for All-Infant Protection

Abstract Background RSV-associated lower respiratory tract infection (LRTI) is the leading cause of infant hospitalization. Most studies of RSV have focused on infants with underlying comorbidities, including prematurity. The purpose of this analysis is to describe the burden of RSV LRTI across all medical settings and in all infants experiencing their first RSV season. Methods Using de-identified claims data from two commercial (MarketScan Commercial, MSC; Optum Clinformatics, OC) and one public (MarketScan Medicaid, MSM) insurance database, we estimated the prevalence of MA RSV LRTI among infants born between April 1, 2016 and June 30, 2019 in their first RSV season. Estimates were made by gestational age, presence/absence of comorbidities, and setting (inpatient, emergency department and outpatient). Due to limited laboratory testing, we defined MA RSV LRTI using two sets of ICD-10-CM diagnosis codes: a specific definition (identifying RSV explicitly) and a sensitive definition that included unspecified bronchiolitis. The first specific diagnosis triggered a search for another MA RSV LRTI diagnosis (either specific or sensitive) within the next 7 days. In the sensitive analysis, the first diagnosis was allowed to meet the sensitive definition. Setting was recorded as the highest level of care attached to a MA RSV LRTI diagnosis within this 7-day period. Results Using the specific (sensitive) definitions, 4.2% (12.2%), 6.8% (16.8%), and 2.7% (7.2%) of newborns had an MA RSV LRTI diagnosis during their first respiratory season across the MSC, MSM, and OC datasets (Table 1). Term infants without comorbidities accounted for 77% (83%), 79% (86%), and 80 (81%) of all MA RSV LRTI, and 21% (10%), 19% (10%), and 21% (10%) of all infants with MA RSV LRTI had an inpatient hospital stay (Table 2). Term infants without comorbidities accounted for 69% (68%), 67% (79%), and 73% (73%) of all MA RSV LRTI inpatients (Table 2). Conclusion In commercial and public claims data, during their first RSV season, term infants without comorbidities accounted for a sizable majority of inpatient, emergency room, and outpatient encounters for RSV LRTI in the US. To address the burden of RSV LRTI, future RSV prevention efforts should target all infants. Funding Sanofi Pasteur, AstraZeneca Disclosures Jason Gantenberg, MPH, Sanofi Pasteur (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Nicole Zimmerman, MS, IBM Watson Health (Employee, Nicole Zimmerman is an employee of IBM, which was compensated by Sanofi to complete this work.)Sanofi (Other Financial or Material Support, Nicole Zimmerman is an employee of IBM, which was compensated by Sanofi to complete this work.) Andrew R. Zullo, PharmD, PhD, ScM, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Brendan Limone, PharmD, PharmD, Sanofi Pasteur (Other Financial or Material Support, IBM was contracted by Sanofi to perform analysis) Clarisse Demont, n/a, Sanofi Pasteur (Employee, Shareholder) Sandra S. Chaves, MD, MSc, Sanofi Pasteur (Employee) William V. La Via, MD, AstraZeneca (Shareholder)Sanofi Pasteur (Employee) Christopher Nelson, PhD, Epidemiology, Sanofi Pasteur (Employee) Christopher Rizzo, MD, Sanofi (Employee) David A. Savitz, PhD, Sanofi Pasteur (Grant/Research Support) Robertus Van Aalst, MSc, Sanofi Pasteur (Employee, Shareholder)

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735. Severity and Healthcare Costs of Respiratory Syncytial Virus Hospitalizations in US Preterm Infants Born at 29–34 Weeks Gestation: 2014–2016

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.742 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S264-S264

Author(s):

Mitchell Goldstein ◽

Leonard R Krilov ◽

Jaime Fergie ◽

Christopher S Ambrose ◽

Sally Wade ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Healthcare Costs ◽

Economic Value ◽

Research Support ◽

Term Infants ◽

Diagnosis Codes ◽

Chi Squared ◽

Syncytial Virus ◽

Age Category ◽

Research Grant

Abstract Background In 2014, the American Academy of Pediatrics recommended against the use of respiratory syncytial virus (RSV) immunoprophylaxis in infants 29–34 weeks gestational age (wGA) at birth without chronic lung disease/bronchopulmonary dysplasia (CLD/BPD) or congenital heart disease (CHD). To inform discussions of the clinical and economic value of RSV immunoprophylaxis in these infants, we compared RSV hospitalization (RSVH) severity and costs incurred by infants hospitalized from 2014–2016 at <6 months chronologic age (CA) for two groups: 29–34 wGA infants without CLD/BPD or CHD and term infants (≥37 wGA) without major health problems. Methods Births were identified in the MarketScan Commercial (COM) and Multistate Medicaid (MED) databases. Term and 29–34 wGA infants without CLD/BPD or CHD were selected using DRG and ICD-9/10-CM diagnosis codes. RSVH occurring from Julu 1, 2014 to June 30, 2016 while infants were <6 months CA (the period of highest RSVH incidence) were identified by ICD-9/10-CM diagnosis codes. Severity measures were length of stay (LOS) in days, intensive care unit (ICU) admissions, and healthcare costs (paid amounts on reimbursed hospital claims in 2016 US$). Comparisons between term and 29–34 wGA infants were made with t-tests and chi-squared tests. Results There were 1,114 RSVH in the COM data and 3,167 RSVH in the MED data during the study period. Mean LOS was longer for 29–34 wGA infants than term infants for each age category (P < 0.05) and tended to be longer for MED infants vs. COM infants (Figure 1). Thirty-eight percent of COM 29–34 wGA infants and 52% of MED 29–34 wGA infants hospitalized for RSV at <3 months CA were admitted to the ICU (Figure 2). RSVH costs for 29–34 wGA infants were greater than term RSVH costs for each age category (P < 0.05) and were greatest among 29–34 wGA infants hospitalized at <3 months CA: $41,104 for 29–34 wGA COM infants and $24,049 for 29–34 wGA MED infants (Figure 3). Conclusion RSVH severity and costs were significantly higher for 29–34 wGA infants without CLD/BPD or CHD relative to term infants. Infants hospitalized at <3 months CA experienced the most severe hospitalizations and incurred the highest costs. This study was funded by AstraZeneca. Disclosures M. Goldstein, AstraZeneca/MedImmune: Consultant, Research grant and Research support. L. R. Krilov, AstraZeneca/MedImmune: Consultant, Research grant and Research support. J. Fergie, AstraZeneca/MedImmune: Consultant and Speaker’s Bureau, Research grant and Research support. C. S. Ambrose, AstraZeneca: Employee, Salary and Stocks. S. Wade, Wade Outcomes Research and Consulting: Employee, Salary. A. Kong, Truven Health Analytics, an IBM Company: Employee, Salary. L. Brannman, AstraZeneca: Employee, Salary and Stocks.

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740. Impact of the 2014 American Academy of Pediatrics Guidance on Respiratory Syncytial Virus Hospitalization Rates for Preterm Infants <29 Weeks Gestational Age at Birth: 2012–2016

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.747 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S265-S266

Author(s):

Mitchell Goldstein ◽

Leonard R Krilov ◽

Jaime Fergie ◽

Lance Brannman ◽

Christopher S Ambrose ◽

...

Keyword(s):

American Academy ◽

Preterm Infants ◽

Gestational Age ◽

Research Support ◽

Term Infants ◽

Medical Claims ◽

American Academy Of Pediatrics ◽

Syncytial Virus ◽

Rate Ratios ◽

Research Grant

Abstract Background In 2014, the American Academy of Pediatrics stopped recommending RSV immunoprophylaxis (RSV IP) for otherwise healthy infants 29–34 weeks gestational age (wGA), while continuing to recommend RSV IP for infants born at <29 wGA. The decline in RSV IP and associated increase in RSV hospitalizations (RSVH) among infants 29–34 wGA have been described previously, but potential effects of the 2014 guidance change on preterm infants <29 wGA are unknown. This study compared 2012–2014 and 2014–2016 outpatient RSV IP use as well as RSVH rates relative to term infants among otherwise healthy <29 wGA infants. Methods Infants born from July 1, 2011 to June 30, 2016 were followed from birth hospitalization discharge through their ﬁrst year of life in the MarketScan Commercial (COM) and Multistate Medicaid (MED) databases. DRG and ICD codes identified term and <29 wGA infants at birth. RSV IP receipt was derived from pharmacy and outpatient medical claims (inpatient RSV IP data were unavailable). RSVH were derived from inpatient medical claims. RSVH IP use and RSVH were assessed across three chronologic age (CA) groups: <3 months, 3–<6 months, and 6–<12 months. RSVH rate ratios for 2012–2014 and 2014–2016 were calculated for <29 wGA infants using healthy term infants 0–<12 months of age as a reference category. Results Outpatient RSV IP receipt fell after 2014 for <29 wGA infants across all CA categories, with the greatest decline observed among infants <3 months CA (Table 1). Greater RSVH rates for <29 wGA infants relative to term infants were observed after 2014 (Figures 1 and 2), with infants <3 months CA experiencing the greatest percentage increases in relative RSVH risks. Conclusion Outpatient RSV IP decreased and RSVH relative to term infants increased among otherwise healthy <29 wGA infants following the 2014 policy change, even though RSV IP continued to be recommended. The effects were greatest for infants <3 months CA and those insured by Medicaid. Funded by AstraZeneca Disclosures M. Goldstein, AstraZeneca/MedImmune: Consultant, Research grant and Research support. L. R. Krilov, AstraZeneca/MedImmune: Consultant, Research grant and Research support. J. Fergie, AstraZeneca/MedImmune: Consultant and Speaker’s Bureau, Research grant and Research support. L. Brannman, AstraZeneca: Employee, Salary and Stocks. C. S. Ambrose, AstraZeneca: Employee, Salary and Stocks. S. Wade, Wade Outcomes Research and Consulting contracted by Truven: Consultant, Consulting fee. A. Kong, Truven Health Analytics, an IBM Company: Employee, Salary.

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1413. Trends in Risk of Respiratory Syncytial Virus Hospitalizations in Preterm Infants Over a 10-Year Period

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1595 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S713-S714

Author(s):

Amanda M Kong ◽

Isabelle H Winer ◽

david diakun ◽

Adam Bloomfield ◽

Tara Gonzales

Keyword(s):

Respiratory Syncytial Virus ◽

Research Support ◽

Term Infants ◽

Major Health ◽

Hospitalization Rates ◽

American Academy Of Pediatrics ◽

Ibm Watson ◽

Syncytial Virus ◽

Rate Ratios

Abstract Background The American Academy of Pediatrics (AAP) recommended respiratory syncytial virus (RSV) immunoprophylaxis (RSV-IP) to reduce the risk of severe RSV hospitalization (RSVH) for certain infants < 35 weeks gestational age (wGA) until 2014, when the AAP no longer recommended use among infants born >29 wGA without other medical conditions. Studies have shown that RSV-IP utilization subsequently decreased among these infants, as well as infants born < 29 wGA from whom RSV-IP is still currently recommended. We described RSVH rates among preterm (PT) infants < 35 wGA compared to term infants from 2008-2019. Methods We identified infants born between 7/1/2008 and 7/30/2019 in the MarketScan® Commercial and Multi-State Medicaid claims databases. Infants with a code for birth at < 35 wGA were classified by wGA. Those with a code for full-term without major health problems were classified as term. Infants contributed follow-up time during the RSV season (November to March) while < 6 months old, summarized as infant-seasons (days of follow-up during the RSV season divided by 151 [number of days in an RSV season]) (Table 1). Using diagnoses codes, we identified RSVH during each RSV season for infants < 6 months. Unadjusted rate ratios comparing PT infants to term infants were calculated to account for seasonal variation in virus circulation. Number of Infants and Follow-up Time Results The number of infants contributing time at < 6 months old during the RSV season and their follow-up time are shown in Table 1. There were 796 RSVH among Commercial PT infants, 6,486 RSVH among Commercial term infants, 2,501 RSVH among Medicaid PT infants, and 13,962 RSVH among Medicaid term infants during the 10 seasons in the database. RSVH rates for PT infants tended to increase over time, with the exception of the 2009-2010 season for Medicaid infants (Table 2). Rate ratios comparing PT to term infants also increased after the 2014 guidance change (Figure 1 and 2). The risk of 29-34 wGA infants compared to term infants approximately doubled in the 5 years after the guidance change (Table 2). Comparisons of RSV Hospitalization Rates for Preterm vs. Term Infants < 6 Months Old Rate Ratios for RSV Hospitalization Rates for Commercial Infants < 6 Months Old Rate Ratios for RSV Hospitalization Rates for Medicaid Infants < 6 Months Old Conclusion After the change in AAP recommendations for RSV-IP, increases in RSVH rates for infants born at 29-34 wGA compared to term were found. This was also true for < 29 wGA infants for whom RSV-IP is recommended, although the effect sizes were smaller. Disclosures Amanda M. Kong, DrPH, Sobi (Other Financial or Material Support, I am an employee of IBM Watson Health which received funding from Sobi to conduct this analysis.) david diakun, BS, Sobi (Grant/Research Support) Adam Bloomfield, MD, Sobi NA (Employee) Tara Gonzales, MD, Sobi, Inc. (Employee)

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743. Severity and Costs of Respiratory Syncytial Virus and Bronchiolitis Hospitalization in Commercially Insured Preterm and Term Infants Before and After the 2014 American Academy of Pediatrics Guidance Change on Immunoprophylaxis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.750 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S267-S267

Author(s):

Leonard R Krilov ◽

Jaime Fergie ◽

Mitchell Goldstein ◽

Christopher Rizzo ◽

Lance Brannman ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

American Academy ◽

Health Problems ◽

Research Database ◽

Research Support ◽

Term Infants ◽

American Academy Of Pediatrics ◽

Hospitalization Costs ◽

Syncytial Virus ◽

Research Grant

Abstract Background In 2014, the American Academy of Pediatrics (AAP) stopped recommending respiratory syncytial virus (RSV) immunoprophylaxis in infants 29–34 weeks gestational age (wGA) without chronic lung disease (CLD) or congenital heart disease (CHD). This study examined the impact of this guidance change on the severity and costs of first year of life RSV hospitalizations (RSVH) and all-cause bronchiolitis hospitalizations (BH) among preterm (PT) vs. term infants in the 2014–2016 seasonal years relative to the 2011–2014 seasonal years. Methods Infants aged <1 year between July 1, 2011 and June 31, 2016 were identified from commercial insurance claims in the Optum Research Database. Diagnosis codes identified births of term and 29–34 wGA infants without CLD, CHD, or other health problems, RSVH, and BH. Length of stay (LOS), admission to the intensive care unit (ICU), and use of mechanical ventilation (MV) captured RSVH and BH severity. Costs were adjusted to 2015 USD. Results A total of 362,382 births (29–34 wGA and term without major health problems) were identified, of which 13,666 (3.8%) were PT. RSVH and BH were more severe among PT infants in 2014–2016 vs. 2011–2014, with a greater mean LOS (RSVH: 6.8 vs. 4.7 days, P = 0.008; BH: 7.2 vs. 4.6, P = 0.021), a higher proportion of infants admitted to the ICU (RSVH: 42.4% vs. 25.3%, P = 0.014; BH: 39.1% vs. 23.7%, P = 0.009), and increased use of MV (RSVH: 14.1% vs. 6.1%, P = 0.067; BH: 14.8% vs. 5.3%, P = 0.013). Among term infants, LOS and ICU admissions were similar between 2014–2016 and 2011–2014 (P > 0.05), but there was an increased use of MV in the 2014–2016 season (RSVH: 6.9% vs. 4.2%, P = 0.009; BH: 6.3% vs. 3.7%, P = 0.003). Mean costs per hospitalization were greater for PT infants in 2014–2016 compared with 2011–2014 (RSVH: $29,382 vs. $16,572, P = 0.059; BH: $26,101 vs. $15,896, P = 0.047), whereas mean term hospitalization costs were similar (RSVH: $15,011 vs. $15,472, P = 0.705; BH: $14,555 vs. $14,603, P = 0.957). Conclusion RSVH and BH severity and per-hospitalization costs (higher among PT infants relative to term infants) increased following the 2014 AAP immunoprophylaxis guidance change. The increases are likely explained by more frequent RSV hospitalizations among higher-risk 29–34 wGA infants in 2014–2016. Funded by AstraZeneca Disclosures L. R. Krilov, AstraZeneca/MedImmune: Consultant, Research grant and Research support. J. Fergie, AstraZeneca/MedImmune: Consultant and Speaker’s Bureau, Research grant and Research support. M. Goldstein, AstraZeneca/MedImmune: Consultant, Research grant and Research support. C. Rizzo, AstraZeneca: Employee, Salary and Stocks. L. Brannman, AstraZeneca: Employee, Salary and Stocks. J. McPheeters, Optum: Employee, Salary. AstraZeneca: Research Contractor, Consulting fee. S. Korrer, Optum: Employee, Salary. AstraZeneca: Research Contractor, Consulting fee. T. Burton, Optum: Consultant and Employee, Salary. AstraZeneca: Research Contractor, Consulting fee. L. Sharpsten, Optum: Employee, Salary. AstraZeneca: Research Contractor, Consulting fee.

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1104. Risk Factors and Outcomes of Refractory and/or Resistant Cytomegalovirus (CMV) Infection after Allogeneic Hematopoietic Stem Cell Transplantation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1290 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S582-S583

Author(s):

Eleni Karantoni ◽

Yiqi Su ◽

Anat Stern ◽

Phaedon D Zavras ◽

Sergio Giralt ◽

...

Keyword(s):

Risk Factors ◽

Overall Survival ◽

T Cell ◽

Panel Member ◽

Multivariable Model ◽

Research Support ◽

Review Panel ◽

Material Support ◽

Advisory Boards ◽

Research Grant

Abstract Background The epidemiology of CMV end-organ disease (EOD) after Hematopoietic Cell Transplant (HCT) in the era of preemptive therapy (PET) is defined. In contrast, less data exists on refractory and/or resistant (R/R) CMV. We report on 1) the incidence; 2) risk factors and outcomes of R/R CMV by 1-year post HCT. Methods Retrospective review of 167 CMV seropositive (R+) recipients of first marrow or peripheral blood HCT from 1/2014 - 12/2017 managed by PET. Refractory CMV was defined as failure to achieve >1 log10 decrease in CMV viral load (VL) and having VL >1,000 IU/mL after ≥14 day of PET. Resistant CMV required genotypic confirmation of resistance mutation(s) in UL54 and/or UL97 genes. End organ disease (EOD) was defined by standard criteria. Patients (pts) were followed through 1-year post HCT and were categorized in two mutually exclusive groups as R/R and no R/R. Demographics, clinical characteristics and outcomes were extracted from medical records and hospital databases. Univariable and multivariable logistic models were used to identify risk factors for R/R CMV. Results Of 167 PET recipients, 91 (54.5%) received ex vivo T cell depleted (TCD) HCT; 40 (24.0%) had mismatched donor; and 26 (15.6%) had multiple myeloma. 66/167 (39.5%) pts developed refractory CMV (6 pts also had resistant CMV). Time from HCT to CMV viremia was shorter in R/R group: median (IQR) 21.5 (17.2-27.8) days compared to no R/R group: 26 (19-32) days (p=0.031). Maximum VL was higher for R/R compared to no R/R: median (IQR) 9,118 (2,849-18,456) and 868 (474-1,908), respectively (p< 0.001). In multivariable model, risk factors for R/R included TCD HCT (p< 0.0001) and higher VL at PET initiation (p=0.0002). In contrast, CMV seropositive donor (p=0.035) was protective (Figure 1). CMV EOD developed in 28.2% of R/R and 16.2% of no R/R groups (p=0.085) (Figure 2). Overall survival at 1 year was 59.1% for R/R compared to 83.1% for no R/R group (p=0.00027) (Figure 3). Figure 1. Adjusted odds ratio (OR) and 95% confidence interval (CI) from multivariable model evaluating risk factors of refractory/resistant (R/R) CMV. Figure 2. Cumulative incidence curves of CMV end-organ disease (EOD) at 1-year post HCT Figure 3. Kaplan-Meier survival curves of overall survival (OS) at 1-year post HCT Conclusion 1) Refractory and/or resistant CMV occurred in 39,5% of PET recipients. 2) T-cell depletion and higher CMV VL at PET initiation were risk factors for R/R CMV in multivariable models. 3) R/R CMV was associated with more EOD and worse overall survival. Disclosures Sergio Giralt, MD, Amgen (Advisor or Review Panel member, Research Grant or Support, Served an advisory board for Amgen, Actinuum, Celgene, Johnson & Johnson, JAZZ pharmaceutical, Takeda, Novartis, KITE, and Spectrum pharma and has received research support from Amgen, Actinuum, Celgene, Johnson & Johnson, and Miltenyi, Takeda.) Miguel-Angel Perales, MD, Abbvie (Other Financial or Material Support, Honoraria from Abbvie, Bellicum, Celgene, Bristol-Myers Squibb, Incyte, Merck, Novartis, Nektar Therapeutics, Omeros, and Takeda.)ASTCT (Other Financial or Material Support, Volunteer member of the Board of Directors of American Society for Transplantation and Cellular Therapy (ASTCT), Be The Match (National Marrow Donor Program, NMDP), and the CIBMTR Cellular Immunotherapy Data Resource (CIDR) Committee)Cidara Therapeutics (Advisor or Review Panel member, Other Financial or Material Support, Serve on DSMBs for Cidara Therapeutics, Servier and Medigene, and the scientific advisory boards of MolMed and NexImmune.)Kite/Gilead (Research Grant or Support, Other Financial or Material Support, Received research support for clinical trials from Incyte, Kite/Gilead and Miltenyi Biotec.) Genovefa Papanicolaou, MD, Chimerix (Research Grant or Support)Merck&Co (Research Grant or Support, Investigator and received funding and consulting fees from Merck, Chimerix, Shire and Astellas)

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720. Respiratory and Nonrespiratory Complications Among Patients Hospitalized with Influenza, FluSurv-NET, 2016–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.727 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S258-S259

Author(s):

Shikha Garg ◽

Charisse Nitura Cummings ◽

Alissa O’Halloran ◽

Pam Daily Kirley ◽

Rachel Herlihy ◽

...

Keyword(s):

Respiratory Failure ◽

Chronic Renal Disease ◽

Age Groups ◽

Respiratory Complications ◽

Research Support ◽

Surveillance Network ◽

Wide Range ◽

History Of ◽

Syncytial Virus ◽

Research Grant

Abstract Background Influenza is most commonly associated with respiratory complications; however, nonrespiratory complications occur frequently among patients hospitalized with influenza. We used data from the Influenza Hospitalization Surveillance Network (FluSurv-NET) to describe complications recorded on discharge summaries of patients hospitalized with influenza. Methods We included children (0–17 years) and adults (≥18 years), who resided within a FluSurv-NET catchment area and were hospitalized with laboratory-confirmed influenza during 2016–2017. We abstracted data on underlying conditions and discharge diagnoses from medical charts. We calculated the frequency of respiratory and nonrespiratory complications in all age groups and used univariate and multivariable logistic regression to examine factors associated with select complications among adults. Results Among 17,489 patients, the most common respiratory complications were pneumonia (26%) and acute respiratory failure (23%) and the most common nonrespiratory complications were sepsis (16%) and acute renal failure (ARF) (12%). Complications varied by age group (figure). Pneumonia was the most common respiratory complication in all age groups except 0–4 years; among children aged 0–4 years bronchiolitis was most common (104/712; 15%). Among 97 children aged 0–4 years with bronchiolitis who underwent testing for respiratory syncytial virus (RSV), 37% had RSV. The most common nonrespiratory complication was seizures in children aged 0–17 years (17% had a history of prior seizures) and sepsis in adults. Among adults (n = 16,057), factors most strongly associated with ARF included chronic renal disease (adjusted odds ratio (AOR) 2.5; 95% confidence interval (95% CI) 2.2–2.8), male sex (AOR 1.5 95% CI 1.4–1.7) and age ≥65 years (AOR 1.4 95% CI 1.2–1.7); the factor most strongly associated with sepsis was chronic neuromuscular disease (AOR 1.5 95% CI 1.3–1.8). Conclusion Influenza hospitalizations are associated with a broad spectrum of complications including pneumonia, respiratory failure, sepsis, ARF and seizures. During the influenza season, astute clinicians should keep influenza in the differential diagnosis for patients with a wide range of presentations. :Disclosures. H. K. Talbot, sanofi pasteur: Investigator, Research grant. Gilead: Investigator, Research grant. MedImmune: Investigator, Research grant. Vaxinnate: Safety Board, none. Seqirus: Safety Board, 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.

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746. Characteristics of Respiratory Syncytial Virus (RSV) Infection Among Hospitalized Adults, United States, 2014–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.753 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S268-S268 ◽

Cited By ~ 1

Author(s):

Lindsay Kim ◽

Bryanna Cikesh ◽

Pam Daily Kirley ◽

Evan J Anderson ◽

Seth Eckel ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Syncytial Virus ◽

Case Series ◽

Chronic Obstructive ◽

Medical Conditions ◽

Research Support ◽

Catchment Population ◽

Icd Codes ◽

Syncytial Virus ◽

Research Grant

Abstract Background Respiratory syncytial virus (RSV) vaccines are in clinical development for older adults. We described RSV infections among adults requiring hospitalization and risk factors for severe outcomes using a population-based platform, the Influenza Hospitalization Surveillance Network (FluSurv-NET). Methods Surveillance occurred October 1–April 30 (2014–2017) at sites located in seven states (California, Georgia, Michigan, Minnesota, New York, Oregon, and Tennessee) covering an annual catchment population of up to 13 million adults ≥18 years. Laboratory-confirmed RSV cases were identified using hospital and state public health laboratories, hospital infection preventionists, and/or reportable condition databases. Medical charts were reviewed for demographic and clinical data. International Classification of Diseases (ICD) discharge codes were abstracted. Odds ratios (Oregon) and 95% confidence intervals (CIs) were determined to assess risk factors for ICU hospitalization and deaths. Results A total of 2,326 hospitalized RSV cases were identified. Over half were ≥65 years (62%, n = 1,438/2,326), female (59%, n = 1,362/2,326), white (70%, n = 1,301/1,855), and had ≥3 underlying medical conditions (52%, n = 1,204/2,326). 20% (n = 398/2,000) were hospitalized in the ICU (median length of stay, 3 days; interquartile range, 1–6 days), and 5% (n = 96/2,001) died in the hospital. Congestive heart failure (CHF; OR: 1.4, 95% CI: 1.1–1.8) and chronic obstructive pulmonary disease (COPD; OR: 1.3, 95% CI: 1.1–1.7) were associated with ICU admission, while age ≥80 years (OR: 4.1, 95% CI: 1.8–12.1) and CHF (OR: 2.4, 95% CI: 1.6–3.6) were associated with in-hospital deaths. RSV-specific ICD codes were listed in the first 9 positions in only 44% (879/1,987) of cases. Conclusion To our knowledge, this is the largest US case series of RSV-infected hospitalized adults. Most cases were ≥65 years and had multiple underlying medical conditions. Older age, CHF, and COPD were associated with the most severe outcomes. Few cases had RSV-specific ICD codes, suggesting that administrative data underestimate adult RSV-related hospitalizations. Continued surveillance is needed to understand the epidemiology of RSV among adults as vaccine products move toward licensure. Disclosures 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. H. K. Talbot, sanofi pasteur: Investigator, Research grant. Gilead: Investigator, Research grant. MedImmune: Investigator, Research grant. Vaxinnate: Safety Board, none. Seqirus: Safety Board, none.

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The prevalence of localised scleroderma in childhood assessed in the administrative claims data from the United States

Journal of Scleroderma and Related Disorders ◽

10.1177/2397198318798588 ◽

2018 ◽

Vol 4 (1) ◽

pp. 77-78

Author(s):

Timothy Beukelman ◽

Fenglong Xie ◽

Ivan Foeldvari

Keyword(s):

United States ◽

Systemic Sclerosis ◽

Claims Data ◽

International Classification Of Diseases ◽

The United States ◽

Administrative Claims ◽

Administrative Claims Data ◽

Diagnosis Codes ◽

Classification Of Diseases

Juvenile localised scleroderma is believed an orphan autoimmune disease, which occurs 10 times more often than systemic sclerosis in childhood and is believed to have a prevalence of 1 per 100,000 children. To gain data regarding the prevalence of juvenile localised scleroderma, we assessed the administrative claims data in the United States using the International Classification of Diseases, Ninth Revision diagnosis codes. We found an estimated prevalence in each year ranging from 3.2 to 3.6 per 10,000 children. This estimate is significantly higher as found in previous studies.

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717. Cumulative Incidence of Asthma/Wheezing Among Neonates/Infants/Toddlers Clinically Diagnosed with Respiratory Syncytial Virus Infection in the United States: A Retrospective Database Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.724 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S257-S258

Author(s):

Veronique Wyffels ◽

Maartje Smulders ◽

Sandra Gavart ◽

Debasish Mazumder ◽

Rohit Tyagi ◽

...

Keyword(s):

Logistic Regression ◽

Respiratory Syncytial Virus ◽

Cumulative Incidence ◽

The United States ◽

Term Infants ◽

Increased Risk ◽

Study Results ◽

Syncytial Virus ◽

Time Required

Abstract Background The role of respiratory syncytial virus (RSV) in the development of asthma/wheezing (AW) has been evaluated in several studies, mostly among pre-term infants or among infants after developing severe RSV-related disease. We describe the cumulative incidence (CI) of AW among hospitalized/ambulatory neonates/infants/toddlers after RSV/bronchiolitis infection diagnosis, in a large clinical database. Methods Using deidentified Optum Integrated commercial claims and electronic medical records, we identified patients (0–<3 years old) with a first clinical diagnosis of RSV/bronchiolitis infection from 01 January 2008–31 March 2016. Patients with a diagnosis of asthma/wheezing ≤30 days after first RSV/bronchiolitis diagnosis were excluded. Three cohorts were created with 1/3/5 years of follow-up time required, respectively. Patients were grouped by specific high-risk factors (HRF+/−), including pre-term births and predefined pre-existing disease. Descriptive statistics are reported, with comparisons made by logistic regression analyses. Results 9,811/4,524/1,788 patients with RSV/bronchiolitis infection and HRF− were included in the 1/3/5-years follow-up cohorts. 14.9%/28.2%/36.3% had AW events by the end of follow-up in the three cohorts. 6.5%/6.9%/5.8% were hospitalized for RSV/bronchiolitis. 3,030/1,378/552 patients with RSV/bronchiolitis infection and HRF+ were included in the 1/3/5-years follow-up cohorts. 18.1%/32.9%/37.9% had AW events by the end of follow-up in the three cohorts. 11.4%/11.1%/11.6% were hospitalized for RSV/bronchiolitis. The CI rates of AW in the 1/3/5-year HRF+/− cohorts, stratified by hospitalized for RSV/bronchiolitis Y/N, are shown in Figure 1. Logistic regression confirmed that hospitalization for RSV/bronchiolitis was associated with an increased (P < 0.05) likelihood of AW, for HRF+ and HRF− patients at each follow-up year. Conclusion Thirty-eight percent of RSV/bronchiolitis infants/neonates/toddlers HRF+, and 36% among infants/neonates/toddlers HRF−, developed AW in the 5 years after first RSV/bronchiolitis diagnosis. RSV/bronchiolitis hospitalization was associated with a significantly increased risk of AW development in 1/3/5 years of follow-up; confirming previous observational study results. Disclosures V. Wyffels, Janssen: Employee, Salary. M. Smulders, SmaertAnalyst: Consultant, Consulting fee. S. Gavart, Janssen: Employee, Salary. D. Mazumder, SmartAnalyst: Consultant, Consulting fee. R. Tyagi, SmartAnalyst: Consultant, Consulting fee. N. Gupta, SmartAnalyst: Consultant, Consulting fee. R. Fleischhackl, Janssen: Employee, Salary.

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Assessing the prevalence of juvenile systemic sclerosis in childhood using administrative claims data from the United States

Journal of Scleroderma and Related Disorders ◽

10.1177/2397198318763701 ◽

2018 ◽

Vol 3 (2) ◽

pp. 189-190 ◽

Cited By ~ 4

Author(s):

Timothy Beukelman ◽

Fenglong Xie ◽

Ivan Foeldvari

Keyword(s):

United States ◽

Systemic Sclerosis ◽

Claims Data ◽

International Classification Of Diseases ◽

The United States ◽

Administrative Claims ◽

Administrative Claims Data ◽

Diagnosis Codes ◽

Classification Of Diseases ◽

Juvenile Systemic Sclerosis

Juvenile systemic sclerosis is a very rare orphan disease. To date, only one publication has estimated the prevalence of juvenile systemic sclerosis using a survey of specialized physicians. We conducted a study of administrative claims data in the United States using the International Classification of Diseases, Ninth Revision diagnosis codes and found a prevalence of approximately 3 per 1,000,000 children. This estimate will inform the planning of prospective studies.

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