Ohio Department of Health

BACKGROUND:Influenza predisposes individuals to bacterial co-infections, which can result in disseminated infection and bacteremia. We describe the epidemiology and outcomes of blood culture co-detections among persons hospitalized with influenza over two influenza seasons. METHODS:We sampled individuals of all ages from FluSurv-NET, a U.S. population-based surveillance network of persons hospitalized with laboratory-confirmed influenza, during the 2022-2023 and 2023-2024 seasons. Surveillance staff collected information on bacterial blood cultures within 3 days before or 3 days following admission. We described patient characteristics and in-hospital outcomes, stratified by culture positivity, number of positive cultures, and type of co-detection, using unweighted counts and weighted percentages to account for the complex survey design. RESULTS:Overall, 14,316 patients were included, with a median (interquartile range) age of 57 (14-74) years, 53.6% female, 52.0% non-Hispanic white, and 25.6% with ≥4 categories of underlying medical conditions. Of these, 50.8% had ≥1 blood cultures obtained and 5.2% overall had ≥1 bacterial co-detections. Intensive care unit admission occurred for 9.6%, 19.2%, 31.2%, and 47.9% among patients with no blood cultures, negative cultures, 1 co-detection, and >1 co-detection documented, respectively; in-hospital mortality occurred in 1.5%, 3.3%, 9.4%, and 14.5%, respectively. Among patients with positive cultures, 22.1% had Staphylococcus aureus and 7.5% had Streptococcus pneumoniae co-detections; both were associated with severe illness (with 22.4% in-hospital mortality each). DISCUSSION:Bacterial co-detections in persons hospitalized with influenza were associated with poor in-hospital outcomes. Efforts to prevent severe influenza and bacterial co-infections, including through vaccination, may reduce substantial morbidity and mortality from influenza.

What is considered ‘evidence’ in maternal and child health (MCH) has major implications for which organizations and initiatives receive funding. Despite growing recognition of the importance of community-rooted work, state and jurisdictional MCH agencies, (Title V) operate from an evidence framework that typically prioritizes empirical research and large-scale evaluations over community-rooted evidence (CRE). This study sought to examine how CRE informs decision-making within Title V agencies, understand capacity-building needs of community-based organizations (CBOs), and explore strengthening relationships between CBOs and Title V. This qualitative study interviewed Title V and CBO staff to explore current CRE perceptions and funder/CBO relationships. 16 CBO and 11 Title V staff participated in compensated interviews from February to July 2024. Interviews were conducted, transcribed, coded, and analyzed using a thematic analysis approach. CBO interviewees stressed the need to reimagine misaligned funder and CBO relationships to be rooted in trust, allow CBOs agency to define metrics of success for their work, recognize the credibility of CRE including qualitative data and storytelling, and introduce more flexibility into funding opportunities and reporting structures. Title V respondents expressed capacity building needs around how to operationalize CRE in their work and decision-making practices, as well as build CBO capacity. Funders including Title V can support tailored, innovative, and community-driven solutions to MCH challenges through uplifting CRE in evidence frameworks, investing in trust-based relationships with CBOs, and supporting CBO capacity building. Recommendations for how Title V can operationalize CRE in their work are also provided. The findings of this study reinforce trends in the behavioral health, child welfare, and tribal health fields that have recognized the validity and importance of CRE in demonstrating an initiative’s impact, cultural appropriateness, and alignment with community preferences. State agencies, like Title V, can uplift and value CRE when considering the evidence informing funding decisions to create opportunities for state and federal investments in community-rooted solutions. This work also emphasizes the opportunity for Title V to reimagine relationships with funded CBOs in accordance with trust-based accountability principles to establish more symbiotic, collaborative, and innovative partnerships.

Importance National organizations recommend antiviral treatment for hospitalized children with influenza; however, use in this setting has recently declined. Studies of oseltamivir effectiveness in children are limited by misclassification bias, unknown symptom onset date, and incomplete capture of antiviral use prior to admission. Objective To assess the association between oseltamivir receipt and intensive care unit (ICU) admission and hospital length of stay (LOS) among pediatric influenza-associated hospitalizations. Design, Setting, and Participants This cohort study used data that were obtained from the Influenza Hospitalization Surveillance Network (FluSurv-NET), which conducts US population-based surveillance for laboratory-confirmed influenza hospitalizations for all ages across 13 states. The study data include seasons 2014 to 2015 through 2022 to 2023, excluding 2020 to 2021. Participants included children aged younger than 18 years who were hospitalized with laboratory-confirmed influenza and for whom a respiratory symptom onset date was available. These data were analyzed from October 2024 through May 2026. Exposures Oseltamivir receipt as a time-dependent exposure. Main Outcome(s) and Measure(s) The primary outcome was time from symptom onset to ICU admission. Secondary outcome was time from admission to discharge (LOS). Adjusted Cox proportional hazard models (aHR) with oseltamivir receipt as a time-dependent exposure were used. Results After exclusions, 6044 influenza cases were included in the primary ICU analysis, of whom 4240 (70.2%) received oseltamivir, and 7103 cases were included in the secondary LOS analysis, of whom 5746 (80.9%) received oseltamivir. In the ICU analysis, the median (IQR) age was 3 (1-7) years, 3382 (56%) were male and 3721 (44%) were female, and 2937 (49%) had 1 or more medical comorbidity—the most common of which was asthma in 1547 children (26%). In adjusted models, compared with untreated children, oseltamivir treatment reduced the hazard of ICU admission (aHR, 0.69; 95% CI, 0.60-0.80) and shortened LOS (analyzed as hazard of hospital discharge; aHR, 1.13; 95% CI, 1.06-1.21). Conclusions and Relevance In this cohort of children hospitalized with influenza, oseltamivir treatment was significantly associated with a reduced risk of ICU admission by 31% and decreased hospital LOS. These findings demonstrate the benefits of oseltamivir receipt and support current national recommendations for oseltamivir treatment as soon as possible in children hospitalized with suspected or laboratory-confirmed influenza.

Potosi virus (POTV), an orthobunyavirus first isolated in 1989, has been detected in multiple mosquito species across the United States, but its pathogenic potential in humans remains uncertain. Here we report the first in-depth pathological and pathogenetic characterization of POTV central nervous system (CNS) infection manifesting as rapidly progressive dementia in a woman receiving long-term rituximab therapy. Antemortem metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid detected POTV in the setting of progressive brain volume loss on longitudinal neuroimaging, culminating in death almost a year after symptom onset. Comprehensive postmortem neuropathological examination demonstrated diffuse meningoencephalitis with widespread spongiform neurodegeneration and evidence of POTV infection throughout all evaluated CNS subregions (n = 75), with detectable viral replication in 80% of subregions. Quantitative spatial and machine learning–based analyses demonstrated marked regional heterogeneity in viral burden, with the highest genomic POTV RNA levels in the cerebellum (p < 0.0001), where viral RNA density correlated with spongiosis and severe Purkinje and granule cell loss (ρ up to 0.39; p < 0.001). Hierarchical clustering identified distinct CNS compartments characterized by chronic infection and progressive neurodegeneration, while comparative sequencing demonstrated intrahost viral variation with region-specific mutations. Collectively, these findings demonstrate that POTV can cause persistent CNS infection associated with progressive neurodegeneration in B-cell–depleted hosts, raising the possibility that chronic viral infection may underlie a subset of transmissible dementia-like syndromes and highlighting the need to consider emerging arboviruses in unexplained neurodegenerative disease.

Antiviral treatment has been shown to lower risk of intensive care unit (ICU) admission in children with influenza, though data are limited. National U.S. guidelines recommend antiviral treatment for all hospitalized patients with influenza; however, use has declined since 2019-20, particularly in pediatrics. Our objective was to assess the association between oseltamivir receipt and clinical outcomes among pediatric influenza-associated hospitalizations.Figure 1.Flow Chart of children with laboratory-confirmed influenza hospitalizations within FluSurv-NETTable 1:Patient Characteristics, Overall and Stratified by Oseltamivir Receipt and Timing for ICU analysis This retrospective cohort study used data from FluSurv-NET, which conducts population-based seasonal surveillance for laboratory-confirmed influenza hospitalizations for all ages across 13 US states. Surveillance staff completed chart abstractions using a standard case report form. We included children < 18 years old hospitalized with influenza during 2014/2015-2022/2023. Adjusted Cox proportional hazard models with oseltamivir receipt as a time-dependent exposure were used to estimate the hazard of intensive care unit (ICU) admission and hospital length of stay (LOS) (see table 2 and 3 for time variable definitions). Covariates for model adjustment were selected from univariate Cox regression analysis (p< 0.2) or a priori.Table 2:Adjusted Cox Models of Oseltamivir Receipt on Hazard of Intensive Care Unit (ICU) Admission Multivariate model with adjusted hazard ratios and p-values for ICU outcome (time from symptom onset to ICU admission with patients censored at discharge). Covariates selected from univariate Cox regression analysis with hazard ratio p-value <0.2 include medical complexity, neurological symptoms, constitutional symptoms, and state. A priori covariates include race/ethnicity, predominant influenza A virus subtype circulating within included seasons, influenza vaccination status, and age. Sensitivity analysis performed classifying patients with same-day treatment as ICU admission as not treated.Table 3:Adjusted Cox Model for Oseltamivir Receipt on Hazard of Hospital Discharge Multivariate model with adjusted hazard ratios and p-values for LOS outcome (time from admission to discharge). Covariates selected from univariate Cox regression analysis with hazard ratio p-value <0.2 include medical complexity, constitutional symptoms, and state. A priori covariates include race/ethnicity, seasons grouped by predominant influenza A subtype circulating within included seasons, influenza vaccination status, age, and number of days from symptom onset to admission. Thirty-two patients were censored at time of death. After applying exclusions (Figure 1), 7103 children were included in the LOS analysis (80.9% of whom received oseltamivir) and 6044 in the ICU analysis (of whom 77.6% received oseltamivir). In the ICU analysis, the median age was 3 years, 56% were male, 31% were non-Hispanic (NH) white, 29% were NH black and 49% had medical comorbidities (Table 1). In adjusted models, oseltamivir treatment reduced the hazard of ICU admission (aHR 0.69, 95% CI 0.60-0.80), compared with untreated children. A sensitivity analysis including those treated on the same day as ICU admission categorized as not treated strengthened this association (aHR 0.30, 95% CI 0.26-0.34). Treatment did not have a significant impact on the hazard of time to discharge (aHR 1.00, 95% CI 0.94-1.06) (Tables 2 and 3). In this national cohort of children hospitalized with influenza, oseltamivir treatment significantly reduced the hazard of ICU admission by 31%, but did not impact hospital LOS. These findings support current national guidelines to treat children hospitalized with influenza with oseltamivir. All Authors: No reported disclosures