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Characteristics and Outcomes of Young Children Hospitalized With Laboratory-confirmed Influenza or Respiratory Syncytial Virus in Ontario, Canada, 2009–2014

Buchan, Sarah A., PhD*,†; Chung, Hannah, MPH; Karnauchow, Timothy, PhD§,¶; McNally, J. Dayre, MD, PhD§; Campitelli, Michael A., MPH; Gubbay, Jonathan B., MD†,‖,**; Katz, Kevin, MD‖,††; McGeer, Allison J., MD*,‖,‡‡; Richardson, David C., MD§§; Richardson, Susan E., MD‖,**; Simor, Andrew, MD‖,¶¶; Smieja, Marek, MD PhD‖‖; Zahariadis, George, MD***,†††; Tran, Dat, MD**,‡‡‡; Crowcroft, Natasha S., MD(Cantab)*,†,‖; Rosella, Laura C., PhD, MHSc*,†,‡; Kwong, Jeffrey C., MD, MSc*,†,‡,§§§,¶¶¶

The Pediatric Infectious Disease Journal: April 2019 - Volume 38 - Issue 4 - p 362–369
doi: 10.1097/INF.0000000000002164
Original Studies

Background: Respiratory illnesses are a major contributor to pediatric hospitalizations, with influenza and respiratory syncytial virus (RSV) causing substantial morbidity and cost each season. We compared the characteristics and outcomes of children 0–59 months of age who were hospitalized with laboratory-confirmed influenza or RSV between 2009 and 2014 in Ontario, Canada.

Methods: We included hospitalized children who were tested for influenza A, influenza B and RSV and were positive for a single virus. We characterized individuals by their demographics and healthcare utilization patterns and compared their hospital outcomes, in-hospital cost and postdischarge healthcare use by virus type and by presence of underlying comorbidities.

Results: We identified and analyzed 7659 hospitalizations during which a specimen tested positive for influenza or RSV. Children with RSV were the youngest whereas children with influenza B were the oldest [median ages 6 months (interquartile range: 2–17 months) and 25 months (interquartile range: 10–45 months), respectively]. Complex chronic conditions were more prevalent among children with all influenza (sub)types than RSV (31%–34% versus 20%). In-hospital outcomes were similar by virus type, but in children with comorbidities, postdischarge outcomes varied. We observed no differences in in-hospital cost between viruses or by presence of comorbidities [overall median cost: $4150 Canadian dollars (interquartile range: $3710–$4948)].

Conclusions: Influenza and RSV account for large numbers of pediatric hospitalizations. RSV and influenza were similar in terms of severity and cost in hospitalized children. Influenza vaccination should be promoted in pregnant women and young children, and a vaccine against RSV would mitigate the high burden of RSV.

From the *Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

Public Health Ontario, Toronto, ON, Canada

Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

§Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada

Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

**The Hospital for Sick Children, Toronto, ON, Canada

††North York General Hospital, Toronto, ON, Canada

‡‡Sinai Health System, Toronto, ON, Canada

§§William Osler Health System, Brampton, ON, Canada

¶¶Sunnybrook Health Sciences Centre, Toronto, ON, Canada

‖‖McMaster University, Hamilton, ON, Canada

***London Health Sciences Centre, London, ON, Canada

†††Newfoundland & Labrador Public Health Laboratory, St. John’s, NF&L, Canada

‡‡‡Department of Paediatrics

§§§Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada

¶¶¶University Health Network, Toronto, ON, Canada.

Accepted for publication June 8, 2018.

This work was supported by an operating grant from the Canadian Institutes of Health Research (CIHR MOP 130568). S.A.B.’s doctoral training is supported by a Canadian Immunization Research Network Trainee Award and an Ontario Graduate Scholarship. J.C.K. is supported by a New Investigator Salary Award from the Canadian Institutes of Health Research and a Clinician Scientist Award from the University of Toronto Department of Family and Community Medicine. L.C.R. is supported by a Canada Research Chair in Population Health Analytics.

J.B.G. has received research grants from GSK and Hoffmann-LaRoche for antiviral resistance studies and from Pfizer Inc. to conduct microbiologic surveillance of Streptococcus pneumoniae. A.J.M. has received research funds from GSK and Sanofi-Pasteur. M.S. has received research grants from Janssen Canada for respiratory virus clinical trials. D.T. has received research grants from GSK for influenza burden studies and payment for the development of an online course on influenza immunization from Family Physician Airways Group of Canada. All other authors have no conflicts of interest or funding to disclose.

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Address for correspondence: Sarah A. Buchan, PhD, Public Health Ontario, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada. E-mail:

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