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Hospital-acquired influenza in the United States, FluSurv-NET, 2011–2012 through 2018–2019

Published online by Cambridge University Press:  05 October 2021

Charisse N. Cummings*
Affiliation:
Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Abt Associates, Rockville, Maryland
Alissa C. O’Halloran
Affiliation:
Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Tali Azenkot
Affiliation:
Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
Arthur Reingold
Affiliation:
University of California Berkeley, Berkeley, California
Nisha B. Alden
Affiliation:
Colorado Department of Public Health and Environment, Denver, Colorado
James I. Meek
Affiliation:
Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
Evan J. Anderson
Affiliation:
Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia Atlanta Veterans’ Affairs Medical Center, Atlanta, Georgia
Patricia A. Ryan
Affiliation:
Maryland Department of Health, Baltimore, Maryland
Sue Kim
Affiliation:
Michigan Department of Health and Human Services, Lansing, Michigan
Melissa McMahon
Affiliation:
Minnesota Department of Health, St Paul, Minnesota
Chelsea McMullen
Affiliation:
New Mexico Department of Health, Santa Fe, New Mexico
Nancy L. Spina
Affiliation:
New York State Health Department, Albany, New York
Nancy M. Bennett
Affiliation:
University of Rochester School of Medicine and Dentistry, Rochester, New York
Laurie M. Billing
Affiliation:
Ohio Department of Health, Columbus, Ohio
Ann Thomas
Affiliation:
Oregon Health Authority, Portland, Oregon
William Schaffner
Affiliation:
Vanderbilt University School of Medicine, Nashville, Tennessee
H. Keipp Talbot
Affiliation:
Vanderbilt University School of Medicine, Nashville, Tennessee
Andrea George
Affiliation:
Salt Lake County Health Department, Salt Lake City, Utah
Carrie Reed
Affiliation:
Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Shikha Garg
Affiliation:
Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Author for correspondence: Charisse Cummings, E-mail: yta8@cdc.gov

Abstract

Objective:

To estimate population-based rates and to describe clinical characteristics of hospital-acquired (HA) influenza.

Design:

Cross-sectional study.

Setting:

US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2011–2012 through 2018–2019 seasons.

Methods:

Patients were identified through provider-initiated or facility-based testing. HA influenza was defined as a positive influenza test date and respiratory symptom onset >3 days after admission. Patients with positive test date >3 days after admission but missing respiratory symptom onset date were classified as possible HA influenza.

Results:

Among 94,158 influenza-associated hospitalizations, 353 (0.4%) had HA influenza. The overall adjusted rate of HA influenza was 0.4 per 100,000 persons. Among HA influenza cases, 50.7% were 65 years of age or older, and 52.0% of children and 95.7% of adults had underlying conditions; 44.9% overall had received influenza vaccine prior to hospitalization. Overall, 34.5% of HA cases received ICU care during hospitalization, 19.8% required mechanical ventilation, and 6.7% died. After including possible HA cases, prevalence among all influenza-associated hospitalizations increased to 1.3% and the adjusted rate increased to 1.5 per 100,000 persons.

Conclusions:

Over 8 seasons, rates of HA influenza were low but were likely underestimated because testing was not systematic. A high proportion of patients with HA influenza were unvaccinated and had severe outcomes. Annual influenza vaccination and implementation of robust hospital infection control measures may help to prevent HA influenza and its impacts on patient outcomes and the healthcare system.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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