Evidence of Aspergillosis among Patients with InfluenzaAssociated Hospitalizations—United States, 2005–2017

Mitsuru Toda, PhD,1 Karlyn Beer, PhD,1 Alissa O’Halloran, MSPH,2 Arthur Reingold, MD, FIDSA,3 Nisha Alden, MPH,4 Kimberly Yousey-Hindes, MPH, CPH,5 Evan J Anderson, MD,6 Susan Bohm, MS,7 Melissa McMahon, MPH,8 Lisa Butler, MPH,9 Eva Pradhan, MPH, MHA,10 Christina B Felsen, MPH,11 Laurie Billing, MPH,12 Ann Thomas, MD, MPH,13 Keipp Talbot, MD,14 Gregg M Reed, MPH,15 Tom Chiller, MD, MPH,1 Shikha Garg, MD, MPH,2 and Brendan R Jackson, MD, MPH1

Author address: 

1Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 2Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia 3University of California – Berkeley, Berkeley, California 4Colorado Department of Public Health and Environment, Denver, Colorado 5Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut 6Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia 7Michigan Department of Health and Human Services, Lansing, Michigan 8Minnesota Department of Health, St. Paul, Minnesota 9New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico 10New York State Department of Health, Albany, New York 11NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York 12Ohio Department of Health, Columbus, Ohio 13Emerging Infections Program, Oregon Public Health Division, Portland, Oregon 14Vanderbilt University Medical Center, Nashville, TN 15Bureau of Epidemiology, Utah Department of Health, Salt Lake City, Utah



Invasive aspergillosis primarily affects immunosuppressed persons, but it has also been observed in immunocompetent patients with severe influenza. Several case series suggest that severe influenza infection might be an under-recognized risk factor for aspergillosis. We examined the frequency of aspergillosis-related hospital discharge codes in a national surveillance database of influenza hospitalizations.


We analyzed laboratory-confirmed influenza-associated hospitalizations reported during 2005–2017 to Centers for Disease Control and Prevention (CDC)’s Influenza Hospitalization Surveillance Network (FluSurv-NET), which includes children and adults in 13 states. We obtained data on underlying conditions and clinical course through medical chart abstraction. We defined invasive aspergillosis cases as influenza hospitalizations with ≥1 of the following the International Classification of Diseases (ICD) 9th or 10th Clinical Modification discharge diagnosis codes: 117.3 (aspergillosis), 484.6 (pneumonia in aspergillosis), B44.0 (invasive pulmonary aspergillosis), B44.2 (tonsillar aspergillosis), and B44.7 (disseminated aspergillosis).


Among 92,671 influenza hospitalizations, we identified 94 cases (0.1%) that had invasive aspergillosis codes. Characteristics of patients were: 60% male (56/94), 72% white race (60/83), and median age 58 years [interquartile range (IQR) 41–67]. Influenza A accounted for 80% (75/94) of cases. Seventy-nine percent (74/94) received antiviral therapy. Underlying conditions included 63% (59/94) immunocompromising condition, 51% (48/94) chronic lung disease, 22% (21/94) renal disease, and 15% (14/94) asthma. Forty-eight percent of patients (45/94) required intensive care. At the time of discharge, 60% (56/94) were diagnosed with pneumonia and 14% (13/94) died.


Over one-third of patients with invasive aspergillosis did not have a documented immunosuppressive condition. ICD codes are likely an imperfect way to identify invasive aspergillosis, and further studies are needed to characterize risk factors and verify diagnoses for aspergillosis among patients with severe influenza.


E. J. Anderson, NovaVax: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. AbbVie: Consultant, Consulting fee. MedImmune: Investigator, Research support. PaxVax: Investigator, Research support. Micron: Investigator, Research support. K. Talbot, sanofi pasteur: Investigator, Research support. Gilead: Investigator, Research support. MedImmune: Investigator, Research support. Seqirus: Scientific Advisor, Consulting fee. MedImmune: Scientific Advisor, Consulting fee.


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Full conference title: 

ID week 2018
    • ID Week 2018