507 - Population Based Incidence of Influenza-Associated Neuropsychiatric Hospitalizations
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 507 Publication Number: 507.221
James W. Antoon, Vanderbilt University Medical Center, Nashville, TN, United States; Mert Sekmen, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, Nashville, TN, United States; Jean L. Bruce, VUMC, Nashville, TN, United States; Yuwei Zhu, VUMC, Nashville, TN, United States; Kathryn M.. Edwards, Vanderbilt University School of Medicine, Nashville,, TN, United States; Derek J. Williams, Vanderbilt University School of Medicine, Nashville, TN, United States; Carlos Grijalva, Vanderbilt University School of Medicine, Nashville, TN, United States
Assistant Professor Vanderbilt University Medical Center Nashville, Tennessee, United States
Background: The incidence of serious influenza-associated neuropsychiatric events in children, and risk factors for these events, is unknown Objective: To determine the population-based incidence and risk factors for pediatric influenza-associated neuropsychiatric hospitalizations Design/Methods: We assembled a retrospective cohort of children (5-18 years) enrolled in Tennessee Medicaid with an outpatient ICD-10 diagnosis of influenza during the 2016-2020 influenza seasons. To maximize accuracy of influenza diagnosis, each season was restricted to the 13 consecutive weeks with highest influenza incidence in TN based on CDC Surveillance data. The study outcome was an influenza-associated neuropsychiatric event resulting in hospitalization within 10 days of an influenza diagnosis and was identified using a validated algorithm (PPV~90%). The algorithm includes those with a primary discharge diagnosis of a neuropsychiatric event or a secondary diagnosis where the primary diagnosis was not malignancy- or surgery-related.Neuropsychiatric events were classified as critical (self-harm), important (psychosis, encephalitis etc) or unclear clinical significance (dizziness etc) (Table 1). For each season, the incidence of influenza-associated neuropsychiatric hospitalizations was calculated by dividing the total number of influenza-associated neuropsychiatric hospitalizations by the total number of influenza episodes. Incidence was calculated overall and by age, sex, presence of a neuropsychiatric co-morbidity, presence of a risk factor for influenza complications, influenza strain, antiviral dispensing, influenza season, and clinical significance of the event. Results: A total of 156,661 outpatient influenza episodes were included (Table). The overall incidence of influenza-associated neuropsychiatric hospitalizations was 72.1 (95% CI 60.0, 86.7) per 100,000 influenza episodes. The most common neuropsychiatric events were seizures and mood disorders, and the least common was encephalitis (Figure 1). Incidence rates were highest in those with: neurologic conditions, psychiatric disorders, risk factor for influenza complications, and older children. Critical and important events were rare. Rates between oseltamivir exposed and unexposed were similar (Figure 2).
Conclusion(s): The incidence of influenza associated neuropsychiatric hospitalizations is low in the pediatric population but varies significantly based on age, co-morbid conditions, and other factors. Additional study is needed to evaluate whether immunization or oseltamivir use modifies the risk of these events.
.jpg)
