2658. Mortality among children hospitalized with suspected pneumonia during the COVID-19 pandemic in India (PREVAIL study)

Abstract Background COVID-19 has indirectly led to excess deaths attributable to other illnesses. Pre-pandemic studies in India have shown mortality rates of 3-12% amongst young children hospitalized with suspected pneumonia. Here, we describe mortality among young children hospitalized with pneumonia during the COVID-19 pandemic. Methods Children aged 1-35 months hospitalized with suspected pneumonia were enrolled prospectively across six sites in India. Demographic and clinical information were obtained, and children were followed until 90 days after hospital discharge. Results Between October 2020 and November 2022, 4,517 children with suspected pneumonia were enrolled and 4,443 (98.4%) with known mortality status were included in this analysis. Monthly average enrollment was 104 before and during the SARS-CoV-2 peak Delta period (April–June 2021) and 213 post-peak-Delta period (July 2021–November 2022). 71% had WHO-defined severe pneumonia, 26% had SpO2< 90% at admission, 39 of 3000 tested were SARS-CoV-2 positive, and 17% left against medical advice (LAMA). Of 723 total deaths (case fatality ratio (CFR)=16%), 42% were detected in-hospital, 23% occurred within 48 hours after discharge/LAMA, and 35% occurred 2-90 days after discharge/LAMA. CFR was higher among children before and during than post Delta peak (28% vs. 11%, p< 0.001) but average number of deaths per month was similar (28.2 vs. 27.6). Mortality was higher in LAMA cases (32% vs. 5.3%, p< 0.001) and accounted for most (57%) post-hospitalization deaths. Conclusion A high CFR (16%) was observed for young children hospitalized for pneumonia in India, with 58% of deaths occurring after discharge. Deaths were higher during the-Delta and Delta wave wave of the COVID-19 pandemic. Although very few children had COVID-19, pandemic-related restrictions and late presentation to healthcare may have contributed to high mortality from pneumonia. Disclosures All Authors: No reported disclosures