Incidence of Healthcare-Associated Influenza-Like Illness After a Primary Care Encounter Among Young Children.

TitleIncidence of Healthcare-Associated Influenza-Like Illness After a Primary Care Encounter Among Young Children.
Publication TypeJournal Article
Year of Publication2018
AuthorsFeemster K, Localio R, Grundmeier R, Metlay JP, Coffin SE
JournalJ Pediatric Infect Dis Soc
Date Published2018 Mar 22
ISSN2048-7207
Abstract

Background: Despite potential respiratory virus transmission in pediatric clinics, little is known about the risk of healthcare-associated viral infections attributable to outpatient encounters. We evaluated whether exposure to a pediatric clinic visit was associated with subsequent influenza-like illness (ILI).

Methods: Using electronic health record data, we conducted a retrospective cohort study of all children aged <6 years who presented to a provider in a 29-clinic pediatric primary care network for a non-ILI-related encounter over 2 respiratory virus seasons (September 1, 2012, to April 30, 2014). We defined a risk period for potential healthcare-associated (HA) ILI of 1 to 8 days after a non-ILI clinic visit and identified all cases of ILI to compare the incidences of ILI visits 1 to 8 days after a non-ILI encounter and those of visits >8 days after a non-ILI encounter.

Results: Among 149987 children <6 years of age (mean age, 2.5 years) with ≥1 non-ILI visit during the study period, 531928 total encounters and 13951 (2.9%) ILI encounters were identified; 1941 (13.9%) occurred within the HA-ILI risk window. The incidence rate ratios (IRRs) for ILI 1 to 8 days after compared with ILI >8 days after a non-ILI visit during season 1 were 1.36 (95% confidence interval, 1.22-1.52) among children ≥2 years of age and 1.01 (95% confidence interval, 0.93-1.09) among children <2 years of age. Estimates remained consistent during season 2 and with a risk window of 3, 4, or 9 days.

Conclusions: Pediatric clinic visits during a respiratory virus season were significantly associated with an increased incidence of subsequent ILI among children aged 2 to 6 years but not among those aged <2 years. These findings support the hypothesis that respiratory virus transmission in a pediatric clinic can result in HA ILI in young children.

DOI10.1093/jpids/piy023
Alternate JournalJ Pediatric Infect Dis Soc
PubMed ID29579251