Journal
CLINICAL MICROBIOLOGY AND INFECTION
Volume 29, Issue 7, Pages 924-932Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.cmi.2023.04.001
Keywords
Canada; Children; Disease severity; Hospitalized; Immunocompromised; Immunode ficiency; Immunosuppression; In fluenza; Intensive care; Mortality
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This study evaluated immunocompromising conditions and subgroups of immunocompromise as risk factors for severe outcomes among children admitted for influenza. The results showed that immunocompromised children had a decreased risk of ICU admission, mechanical ventilation, and mortality. Therefore, immunocompromised children require special attention and protection.
Objectives: To evaluate immunocompromising conditions and subgroups of immunocompromise as risk factors for severe outcomes among children admitted for influenza. Methods: We performed active surveillance for laboratory-confirmed influenza hospitalizations among children <16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, during 2010-2021. Logistic regression analyses were used to compare outcomes between immunocompromised and non-immunocompromised children, and for different subgroups of immunocompromise. The primary outcome was intensive care unit (ICU) admission; the secondary outcomes were mechanical ventilation and death. Results: Among 8982 children, 892 (9.9%) were immunocompromised; these patients were older (median, 5.6 (IQR, 3.1-10.0) vs. 2.4 (1-6) years; p < 0.001) than non-immunocompromised children, had a similar frequency of comorbidities, excluding immunocompromise and/or malignancy (38% (340/892) vs. 40% (3272/8090); p 0.2), but fewer respiratory symptoms, such as respiratory distress (20% (177/892) vs. 42% (3424/8090), p < 0.001). In multivariable analyses, immunocompromise (adjusted odds ratio (aOR), 0.19; 95% CI, 0.14-0.25) and its subcategories immunodeficiency (aOR, 0.16; 95% CI, 0.10-0.23), immunosuppression (aOR, 0.17; 95% CI, 0.12-0.23), chemotherapy (aOR, 0.07; 95% CI, 0.03-0.13), and solid organ transplantation (aOR, 0.17; 95% CI, 0.06-0.37) were associated with decreased probability of ICU admission in children admitted for influenza. Immunocompromise was also associated with a decreased probability of mechanical ventilation (aOR, 0.26; 95% CI, 0.16-0.38) or death (aOR, 0.22; 95% CI, 0.03-0.72). Conclusion: Immunocompromised children are overrepresented among hospitalizations for influenza, but have a decreased probability of ICU admission, mechanical ventilation, and mortality following
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