389. PediCoViral: Clinical Outcomes of COVID-related Co-viral infections in Children

BACKGROUND: During the earlier phase of the COVID-19 pandemic, published reports demonstrated low rates of COVID co-viral infections. Upon relaxing public health measures, the epidemiology of known respiratory viral pathogens had dramatically shifted as the pandemic evolved. Little is known about the clinical impact of co-viral infections in children post-Omicron wave. This study investigates the clinical outcomes among children, adolescents, and young adults who test positive for SARS-CoV-2 [COVID] alone compared to those with COVID co-viral infection with either RSV or Influenza [Flu] A/B [denoted as COVID+] METHODS: We conducted a retrospective study of subjects ≤ 21 years of age who tested positive for SAR-CoV-2 presenting to the Children’s Hospital at Montefiore, Bronx, NY from 12/1/2021 to 1/15/2023. Laboratory confirmation was established using a multi-target PCR assay for influenza A/B, RSV, and SARS-CoV-2. The primary outcomes were hospitalization, need for invasive mechanical ventilation (IMV), and mortality. Demographic and patient outcomes were extracted using ATLAS database. RESULTS: Among 8307 subjects who tested positive for COVID alone, 8.5% (708) were hospitalized with a mean age of 8.7 years (SD=7.8) while mean age of those with COVID+ was 5.0 years (SD=4.4). Hospitalization rates for COVID alone, COVID+Flu, and COVID+RSV were 6.4%, 32.2%, and 57.7%, respectively (p< 0.001). COVID positive children ≤ 5 years of age with or without a second virus were more likely to be hospitalized than other age group (p< 0.001). When comparing COVID+Flu vs. Flu alone (32.2% vs. 4.3%, p< 0.001) or COVID+RSV vs. RSV alone (57.7% vs. 15.8%, p< 0.001), hospitalization rates were higher for those with COVID co-viral infections. No increase in mortality was observed. [Figure: see text] [Figure: see text] [Figure: see text] CONCLUSION: This single center retrospective study demonstrates that SARS-CoV-2 coinfection with RSV or Influenza is associated with increased risk for hospitalization compared to SARS-CoV-2, RSV or influenza alone. Hospitalization rates were higher in younger children. Further studies are needed to identify the mechanisms driving the increased morbidity associated with these coinfections. DISCLOSURES: All Authors: No reported disclosures