P-1188. Mortality among U.S. Children Aged < 18 Years Hospitalized with Laboratory-confirmed Respiratory Syncytial Virus (RSV) Infection, 12 States, 2018–2019, 2021–2022, 2022–2023

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Abstract Background Pediatric RSV-associated hospitalizations are well-described but mortality data are limited. Methods RSV Hospitalization Surveillance Network (RSV-NET), a 12-state population-based surveillance system, captured laboratory-confirmed RSV hospitalizations among catchment-area residents during October–April in 2018–19 and October–September in 2021–22 (excluding May–June) and 2022–23. Medical charts were reviewed for children who died in-hospital and for those who died ≤30 days post-discharge in 2018–19 via matching case and death certificate data. We described in-hospital and 2018–19 post-discharge mortality among RSV-NET children aged < 18 years. 2019–21 and 2020–21 data were excluded due to COVID-19. Results During 2018–19, 2021–22, and 2022–23, 18,511 pediatric RSV hospitalizations were reported with 32 (0.2%) in-hospital deaths among 10, 17, and 5 children aged < 1, 1–4, and 5–17 years, respectively (Table 1). Among 28 children with race and ethnicity data, 9 were non-Hispanic (NH) Black, 8 were NH White, 4 were NH Asian, 5 were Hispanic, and 2 were another race or ethnicity. Almost all (83%) children with medical chart review had ≥ 1 underlying medical condition (UMC); 72% had ≥ 2 UMCs. UMCs included chronic lung disease (CLD) (53%), neurologic disorders (37%), and cardiovascular disease (23%). In all, 33% of children had CLD of prematurity; prematurity, only collected for those < 2 years (n=18 deaths), was noted for 5 (28%) children. Co-detections, including 9 bacterial from respiratory or sterile sites and 11 respiratory viral detections, were noted for 16 (55%) children who died (Table 2). In 2018–19, 8 in-hospital and 4 post-discharge deaths occurred; the median age at death was 1.5 and 6.5 years, respectively, and the median length of stay was 5.5 and 11.5 days, respectively. All (100%) children had ≥ 1 UMC; ≥ 2 UMCs were noted among 50% and 100% of children with in-hospital and post-discharge deaths, respectively. An RSV-specific cause of death was listed on 4 (33%) of 12 death certificates from 2018–19. Conclusion Almost all RSV-NET children who died had ≥ 1 UMC; bacterial or viral co-detections were common. RSV-attributable pediatric deaths are likely underestimated if limited to in-hospital deaths or death certificates with RSV-specific causes. Disclosures All Authors: No reported disclosures

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