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OBJECTIVES: To determine if serum procalcitonin, an indicator of bacterial etiology in pneumonia in all ages and a predictor of severe pneumonia in adults, is associated with disease severity in children with community-acquired pneumonia. METHODS: We prospectively enrolled children 2 months to RESULTS: The study included 488 children with pneumonia; 30 (6%) were classified as very severe, 106 (22%) as severe, 327 (67%) as moderate, and 25 (5%) as mild. Median procalcitonin in the very severe group was 5.06 (interquartile range [IQR] 0.90–16.83), 0.38 (IQR 0.11–2.11) in the severe group, 0.29 (IQR 0.09–1.90) in the moderate group, and 0.21 (IQR 0.12–1.2) in the mild group. Increasing procalcitonin was associated with increasing severity (range of aORs: 1.03–1.25) and increased LOS (range of aORs: 1.04–1.36). All comparisons were statistically significant. CONCLUSIONS: Higher procalcitonin was associated with increased severity and LOS. Procalcitonin may be useful in helping clinicians evaluate pneumonia severity.

Background Respiratory Syncytial Virus (RSV) is one of the most common causes of childhood lower respiratory tract infection (LRTI) worldwide. While financial burdens have been documented, there are few data on parental psychological stress associated with RSV hospitalizations. We evaluated the psychological stress and anxiety of parents whose children were hospitalized with RSV. Methods During the 2019-2020 RSV season, parents with children < 5 years of age hospitalized with laboratory-confirmed RSV LRTI at Primary Children’s and Riverton Hospitals in Salt Lake City, Utah, were surveyed in person, and online after discharge. As part of the survey, parents completed the State-Trait Anxiety Inventory for Adults (STAIAD) instrument (short form) and the parental stressor scale (PSS). We evaluated the difference in parental stress and anxiety reported during hospitalization and at 2-weeks post-discharge using a paired t-test. Results Among 284 Salt Lake County resident children < 5 years, and hospitalized with RSV LRTI, 75 (26%) and 57 (20%) parents completed both surveys on admission and at 2-weeks post-discharge respectively. In 11 of 20 STAIAD items gauging stress and anxiety, parents reported higher levels of stress and anxiety whilst their children were admitted compared to post-discharge (Table 1). Parents’ average score on several items associated with a “positive outlook,” e.g. I feel calm, significantly improved (p < 0.05) at 2-weeks post-discharge. Similarly, several items associated with a “negative outlook,” e.g. I am worried, significantly decreased (p < 0.05) at 2-weeks post-discharge (Table 1). For the PSS items, ≥ 50% of parents rated 15 out of 25 as being “very or extremely stressful”, including: feeling helpless about how to help my baby; my baby’s unusual or abnormal breathing; and when my baby seemed to be in pain (Table 2). Estimates of Psychological Burden of RSV lower respiratory tract infection (LRTI) Hospitalization of Children Estimates of Psychological Burden of RSV lower respiratory tract infection (LRTI) Hospitalization of Children Conclusion RSV LRTI hospitalization among children < 5 years of age, imposed a significant psychological stress and anxiety on parents, which generally persisted up to 2-weeks post-discharge. Prevention of RSV infection through vaccines and immunoprophylaxis will help ease parental psychological burden associated with RSV hospitalization. Disclosures Krow Ampofo, MBChB, Merck (Grant/Research Support) Yoonyoung Choi, PhD, MS, RPh, Merck (Employee) Lyn Finelli, DrPH, MS, Merck & Co Inc, (Employee)

Background Respiratory Syncytial Virus (RSV) is one of the most common causes of childhood lower respiratory tract infection (LRTI) worldwide. Accurate data are critical to inform the rationale for RSV vaccine and immunoprophylaxis development. We evaluated the burden of laboratory-confirmed RSV from hospitalized children. Methods During the 2019-2020 RSV season, we prospectively identified children < 5 years of age hospitalized with laboratory-confirmed RSV LRTI at Primary Children’s and Riverton hospitals in Salt Lake City, Utah. Outcomes included Salt Lake county RSV hospitalization rates, adjusted for market share, health care resource utilization including intensive care unit (ICU) stays, mechanical ventilation, length of stay (LOS), and total hospital costs. Results A total of 284 children had laboratory-confirmed RSV LRTI hospitalizations during the 2019-2020 RSV season: 106 (37%) < 6 months of age; 67 (24%) had high-risk medical conditions (HMC); 70 (25%) children had an ICU stay; 18 (6%) required mechanical ventilation; 132 (46%) received antibiotics and median hospital LOS of 2.3 days (IQR 1.6- 3.6). Population-based incidence rates of RSV hospitalization were 4.6/1000 (range 0.7/1000 to 17/1000). The highest rates were in children < 6 months, and rates decreased with increasing age. The mean hospital cost was $12,974.6 (standard deviation: $19869.7), with a total for the cohort was $3.7 million; 42% was accounted for by children < 6 months. Median age of children with HMC’s were significantly older (18.7 mon vs. 12.7 mon; p=0.001) than healthy, but comparable mean hospital cost ($14208.5 vs. 12593.2) and median hospital LOS (2.4 vs. 2.3). Conclusion Hospitalized RSV LRTI among children < 5 years remains significant, and is associated with substantial HCRU, antibiotic use and morbidity. Nationwide, the mean hospital costs may total $1.1 billion. Our data support the need for RSV vaccines and immunoprophylaxis to prevent RSV hospitalization. Disclosures Krow Ampofo, MBChB, Merck (Grant/Research Support) Yoonyoung Choi, PhD, MS, RPh, Merck (Employee) Lyn Finelli, DrPH, MS, Merck & Co Inc, (Employee)

Background Seasonal respiratory syncytial virus (RSV) epidemics occur annually in temperate climates and result in significant pediatric morbidity and increased health care costs. Although RSV epidemics generally occur between October and April, the size and timing vary across epidemic seasons and are difficult to predict accurately. Prediction of epidemic characteristics would support management of resources and treatment. Methods The goals of this research were to examine the empirical relationships among early exponential growth rate, total epidemic size, and timing, and the utility of specific parameters in compartmental models of transmission in accounting for variation among seasonal RSV epidemic curves. RSV testing data from Primary Children's Medical Center were collected on children under two years of age (July 2001-June 2008). Simple linear regression was used explore the relationship between three epidemic characteristics (final epidemic size, days to peak, and epidemic length) and exponential growth calculated from four weeks of daily case data. A compartmental model of transmission was fit to the data and parameter estimated used to help describe the variation among seasonal RSV epidemic curves. Results The regression results indicated that exponential growth was correlated to epidemic characteristics. The transmission modeling results indicated that start time for the epidemic and the transmission parameter co-varied with the epidemic season. Conclusions The conclusions were that exponential growth was somewhat empirically related to seasonal epidemic characteristics and that variation in epidemic start date as well as the transmission parameter over epidemic years could explain variation in seasonal epidemic size. These relationships are useful for public health, health care providers, and infectious disease researchers.

Context During public health emergencies, office-based frontline clinicians are critical partners in the detection, treatment, and control of disease. Communication between public health authorities and frontline clinicians is critical, yet public health agencies, medical societies, and healthcare delivery organizations have all called for improvements. Objectives Describe communication processes between public health and frontline clinicians during the first wave of the 2009 novel influenza A(H1N1) pandemic; assess clinicians' use of and knowledge about public health guidance; and assess clinicians' perceptions and preferences about communication during a public health emergency. Design and methods During the first wave of the pandemic, we performed a process analysis and surveyed 509 office-based primary care providers in Utah. Setting and participants Public health and healthcare leaders from major agencies involved in emergency response in Utah and office-based primary care providers located throughout Utah. Main outcome measure(s) Communication process and information flow, distribution of e-mails, proportion of clinicians who accessed key Web sites at least weekly, clinicians' knowledge about recent guidance and perception about e-mail load, primary information sources, and qualitative findings from clinician feedback. Results The process analysis revealed redundant activities and messaging. The 141 survey respondents (28%) received information from a variety of sources: 68% received information from state public health; almost 100% received information from health care organizations. Only one-third visited a state public health or institutional Web site frequently enough (at least weekly) to obtain updated guidance. Clinicians were knowledgeable about guidance that did not change during the first wave; however, correct knowledge was lower after guidance changed. Clinicians felt overwhelmed by e-mail volume, preferred a single institutional e-mail for clinical guidance, and suggested that new information be concise and clearly identified. Conclusion : Communication between public health, health care organizations and clinicians was redundant and overwhelming and can be enhanced considering clinician preferences and institutional communication channels.

Objective: To determine whether sales of electrolyte products contain a signal of outbreaks of respiratory and diarrheal disease in children and, if so, how much earlier a signal relative to hospital diagnoses. Design: Retrospective analysis was conducted of sales of electrolyte products and hospital diagnoses for six urban regions in three states for the period 1998 through 2001. Measurements: Presence of signal was ascertained by measuring correlation between electrolyte sales and hospital diagnoses and the temporal relationship that maximized correlation. Earliness was the difference between the date that the exponentially weighted moving average (EWMA) method first detected an outbreak from sales and the date it first detected the outbreak from diagnoses. The coefficient of determination ( r 2) measured how much variance in earliness resulted from differences in sales' and diagnoses' signal strengths. Results: The correlation between electrolyte sales and hospital diagnoses was 0.90 (95% CI, 0.87–0.93) at a time offset of 1.7 weeks (95% CI, 0.50–2.9), meaning that sales preceded diagnoses by 1.7 weeks. EWMA with a nine-sigma threshold detected the 18 outbreaks on average 2.4 weeks (95% CI, 0.1–4.8 weeks) earlier from sales than from diagnoses. Twelve outbreaks were first detected from sales, four were first detected from diagnoses, and two were detected simultaneously. Only 26% of variance in earliness was explained by the relative strength of the sales and diagnoses signals ( r 2 = 0.26). Conclusion: Sales of electrolyte products contain a signal of outbreaks of respiratory and diarrheal diseases in children and usually are an earlier signal than hospital diagnoses.

Background Pediatric asthma affects 7.1 million American children incurring an annual total direct healthcare cost around 9.3 billion dollars. Asthma control in children is suboptimal, leading to frequent asthma exacerbations, excess costs, and decreased quality of life. Successful prediction of risk for asthma control deterioration at the individual patient level would enhance self-management and enable early interventions to reduce asthma exacerbations. We developed and tested the first set of models for predicting a child’s asthma control deterioration one week prior to occurrence. Methods We previously reported validation of the Asthma Symptom Tracker, a weekly asthma self-monitoring tool. Over a period of two years, we used this tool to collect a total of 2912 weekly assessments of asthma control on 210 children. We combined the asthma control data set with patient attributes and environmental variables to develop machine learning models to predict a child’s asthma control deterioration one week ahead. Results Our best model achieved an accuracy of 71.8 %, a sensitivity of 73.8 %, a specificity of 71.4 %, and an area under the receiver operating characteristic curve of 0.757. We also identified potential improvements to our models to stimulate future research on this topic. Conclusions Our best model successfully predicted a child’s asthma control level one week ahead. With adequate accuracy, the model could be integrated into electronic asthma self-monitoring systems to provide real-time decision support and personalized early warnings of potential asthma control deteriorations.