Life-Threatening Complications of Influenza vs Coronavirus Disease 2019 (COVID-19) in US Children

Natasha B Halasa; Andrew J Spieker; Cameron C Young; Samantha M Olson; Margaret M Newhams; Justin Z Amarin; Kristin L Moffitt; Mari M Nakamura; Emily R Levy; Vijaya L Soma; Rana Talj; Scott L Weiss; Julie C Fitzgerald; Elizabeth H Mack; Aline B Maddux; Jennifer E Schuster; Bria M Coates; Mark W Hall; Stephanie P Schwartz; Adam J Schwarz; Michele Kong; Philip C Spinella; Laura L Loftis; Gwenn E McLaughlin; Charlotte V Hobbs; Courtney M Rowan; Melania M Bembea; Ryan A Nofziger; Christopher J Babbitt; Cindy Bowens; Heidi R Flori; Shira J Gertz; Matt S Zinter; John S Giuliano; Janet R Hume; Natalie Z Cvijanovich; Aalok R Singh; Hillary A Crandall; Neal J Thomas; Melissa L Cullimore; Manish M Patel; Adrienne G Randolph; Pediatric Intensive Care Influenza; Overcoming COVID-19 Investigators

doi:10.1093/cid/ciac477

Life-Threatening Complications of Influenza vs Coronavirus Disease 2019 (COVID-19) in US Children

Clin Infect Dis. 2023 Feb 8;76(3):e280-e290. doi: 10.1093/cid/ciac477.

Authors

Natasha B Halasa¹, Andrew J Spieker², Cameron C Young³, Samantha M Olson⁴, Margaret M Newhams³, Justin Z Amarin¹, Kristin L Moffitt^{5

6}, Mari M Nakamura^{5

6

7}, Emily R Levy⁸, Vijaya L Soma⁹, Rana Talj¹, Scott L Weiss¹⁰, Julie C Fitzgerald¹⁰, Elizabeth H Mack¹¹, Aline B Maddux¹², Jennifer E Schuster¹³, Bria M Coates¹⁴, Mark W Hall¹⁵, Stephanie P Schwartz¹⁶, Adam J Schwarz¹⁷, Michele Kong¹⁸, Philip C Spinella¹⁹, Laura L Loftis²⁰, Gwenn E McLaughlin²¹, Charlotte V Hobbs²², Courtney M Rowan²³, Melania M Bembea²⁴, Ryan A Nofziger²⁵, Christopher J Babbitt²⁶, Cindy Bowens²⁷, Heidi R Flori²⁸, Shira J Gertz²⁹, Matt S Zinter³⁰, John S Giuliano³¹, Janet R Hume³², Natalie Z Cvijanovich³³, Aalok R Singh³⁴, Hillary A Crandall³⁵, Neal J Thomas³⁶, Melissa L Cullimore³⁷, Manish M Patel⁴, Adrienne G Randolph^{3

6

38}; Pediatric Intensive Care Influenza; Overcoming COVID-19 Investigators

Collaborators

Michele Kong, Mary Glas Gaspers, Katri V Typpo, Ronald C Sanders, Irby Katherine, Mourani Peter, Adam J Schwarz, Christopher J Babbitt, Harvey Helen, Natalie Z Cvijanovich, Matt S Zinter, Aline B Maddux, Christina M Osborne, Shankman Sara, Peter M Mourani, Port Emily, Kevin A Van, Christopher L Carroll, John S Giuliano, Gwenn E McLaughlin, Keiko M Tarquinio, Kelly N Michelson, Bria M Coates, Courtney M Rowan, Kari Wellnitz, Guru Bhoojhawon, Janice E Sullivan, Vicki L Montgomery, Kevin M Havlin, Tamara T Bradford, Becky J Riggs, Melania M Bembea, Adrienne G Randolph, Margaret M Newhams, Sabrina R Chen, Cameron C Young, Kristin L Moffitt, Mari M Nakamura, Ryan W Carroll, Phoebe H Yager, Neil D Fernandes, Heidi R Flori, Sabrina M Heidemann, Janet R Hume, Emily R Levy, Charlotte V Hobbs, Lora Martin, Lacy Malloch, Kengo Inagaki, Anita Dhanrajani, Jennifer E Schuster, Abigail Kietzman, Shannon Hill, Philip C Spinella, Melissa L Cullimore, Russell J McCulloh, Katharine N Clouser, Shira J Gertz, Lawrence C Kleinman, Simon Li, Steven M Horwitz, Adam J Ratner, Heda Dapul, Vijaya L Soma, Michael A Keenaghan, Aalok R Singh, Ilana Harwayne-Gidansky, Saul R Hymes, Sule Doymaz, Stephanie P Schwartz, Tracie C Walker, Mark W Hall, Steven L Shein, Amanda N Lansell, Ryan A Nofziger, Mary A Staat, Julie C Fitzgerald, Scott Weiss, Neal J Thomas, Ericka L Fink, Joseph A Carcillo, Elizabeth H Mack, Laura S Smallcomb, Natasha B Halasa, Laura Stewart, Yesenia Romero, Haya Hayek, Laura L Loftis, Alvaro Coronado Munoz, Cindy Bowens, Mia Maamari, Hillary Crandall, Lincoln S Smith, John K McGuire

Affiliations

¹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³ Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
⁴ COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁵ Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA.
⁶ Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Antimicrobial Stewardship Program, Boston Children's Hospital, Boston, Massachusetts, USA.
⁸ Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁹ Department of Pediatrics, Division of Infectious Diseases, New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, New York, USA.
¹⁰ Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹¹ Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
¹² Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
¹³ Division of Pediatric Infectious Disease, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.
¹⁴ Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁵ Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
¹⁶ Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁷ Division of Critical Care Medicine, Children's Hospital Orange County (CHOC), Orange, California, USA.
¹⁸ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁹ Division of Critical Care, Department of Pediatrics, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA.
²⁰ Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA.
²¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.
²² Department of Pediatrics, Department of Microbiology, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi, USA.
²³ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.
²⁴ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²⁵ Division of Critical Care Medicine, Akron Children's Hospital, Akron, Ohio, USA.
²⁶ Miller Children's and Women's Hospital of Long Beach, Long Beach, California, USA.
²⁷ Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children's Medical Center, Dallas, Texas, USA.
²⁸ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital and University of Michigan, Ann Arbor, Michigan, USA.
²⁹ Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA.
³⁰ Department of Pediatrics, Division of Critical Care, University of California-San Francisco, San Francisco, California, USA.
³¹ Department of Pediatrics, Division of Critical Care, Yale University School of Medicine, New Haven, Connecticut, USA.
³² Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA.
³³ Division of Critical Care Medicine, University of California-San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA.
³⁴ Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla, New York, USA.
³⁵ Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
³⁶ Department of Pediatrics, Penn State Hershey Children's Hospital, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
³⁷ Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA.
³⁸ Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA.

Abstract

Background: Clinical differences between critical illness from influenza infection vs coronavirus disease 2019 (COVID-19) have not been well characterized in pediatric patients.

Methods: We compared demographics, clinical characteristics, and outcomes of US children (aged 8 months to 17 years) admitted to the intensive care or high-acuity unit with influenza or COVID-19. Using mixed-effects models, we assessed the odds of death or requiring life support for influenza vs COVID-19 after adjustment for age, sex, race and Hispanic origin, and underlying conditions including obesity.

Results: Children with influenza (n = 179) were younger than those with COVID-19 (n = 381; median, 5.2 years vs 13.8 years), less likely to be non-Hispanic Black (14.5% vs 27.6%) or Hispanic (24.0% vs 36.2%), and less likely to have ≥1 underlying condition (66.4% vs 78.5%) or be obese (21.4% vs 42.2%), and a shorter hospital stay (median, 5 days vs 7 days). They were similarly likely to require invasive mechanical ventilation (both 30.2%), vasopressor support (19.6% and 19.9%), or extracorporeal membrane oxygenation (2.2% and 2.9%). Four children with influenza (2.2%) and 11 children with COVID-19 (2.9%) died. The odds of death or requiring life support in children with influenza vs COVID-19 were similar (adjusted odds ratio, 1.30; 95% confidence interval, .78-2.15; P = .32).

Conclusions: Despite differences in demographics and clinical characteristics of children with influenza or COVID-19, the frequency of life-threatening complications was similar. Our findings highlight the importance of implementing prevention measures to reduce transmission and disease severity of influenza and COVID-19.

Keywords: COVID-19; SARS-CoV-2; children; influenza; intensive care units.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

COVID-19* / epidemiology
Child
Hospitalization
Humans
Influenza, Human* / complications
Influenza, Human* / epidemiology
Obesity
Respiration, Artificial
Retrospective Studies
SARS-CoV-2

Abstract

Publication types

MeSH terms

Grants and funding