580 - Hantavirus Pulmonary Syndrome in Pediatric Patients in the United States (1993-2018)

Poster Number: 580

Lauren E. Thorp, UNM Health Sciences Center, Albuquerque, NM, United States; Lynne Fullerton, UNM Health Sciences Center, Albuquerque, NM, United States; Amy Whitesell, Centers for Disease Control and Prevention, Atlanta, GA, United States; Walter Dehority, The University of New Mexico School of Medicine, Albuquerque, NM, United States

Background: From 1993-2018, hantavirus infections have been reported in 39 states, with Hantavirus Pulmonary Syndrome (HPS) the most common and most fatal manifestation.

Objective: Our objective was to identify differences in the presentation of HPS between children and adults. We hypothesized that children with HPS would be diagnosed later in their illness course given the non-specific clinical features of HPS, which, early in disease, may mimic many benign respiratory infections commonly seen in childhood.

Design/Methods: We obtained data for HPS cases occurring in the United States from 1993, when surveillance began, to 2018 from the Centers for Disease Control and Prevention (CDC) and one state Department of Health (DOH). We contacted the DOH in the 34 states where HPS cases were reported for permission for the CDC to share each state’s data. Data were obtained from 32 of 34 states, comprising 97% of cases reported to the CDC over the 26-year period.

HPS case report forms included age, gender, date of symptom onset and specimen collection, highest temperature, lowest platelet count (platelets/mm3), highest hematocrit percentage, highest creatinine value (mg/dL) and mortality. We compared children (≤18 years) to adults using non-parametric (Wilcoxon rank sum) and parametric (t-test) analyses, with additional exploratory analyses to identify clinical variables associated with mortality. Time to diagnosis was assessed by calculating the time interval between the “date of symptom onset” and the “specimen acquisition date” on the case report form.

Results: Among 720 HPS cases, 69 (9.6%) were pediatric (≤18 years). Overall mortality was 35.4% and did not differ between children and adults (p=0.81). Contrary to our hypothesis, time between disease onset and diagnosis did not differ between adults and children (adults: n=263, mean ± SD = 8±8 days, median 6 days, IQR=4; children: n=27, mean ± SD = 11±21 days, median 4 days, IQR=5). Time between symptom onset and death differed by age group (Wilcoxon rank sum p-value=0.0007), with children (n=20) living an average of 3.8 (±2.3) days and adults (n=201) 7.3 (±6.6) days (p=0.02). Mean highest hematocrit and mean highest creatinine level were significantly associated with mortality in children but not adults (Table 1).Conclusion(s): In our nearly complete national dataset, we found that children with HPS die faster than adults and that elevated hematocrit and creatinine are specifically associated with death in children.
CV - Lauren ThorpCV - Lauren Thorp - December.pdf