Antiviral Use Among Children Hospitalized With Laboratory-Confirmed Influenza Illness: A Prospective, Multicenter Surveillance Study

James W Antoon; Justin Z Amarin; Olla Hamdan; Tess Stopczynski; Laura S Stewart; Marian G Michaels; John V Williams; Eileen J Klein; Janet A Englund; Geoffrey A Weinberg; Peter G Szilagyi; Jennifer E Schuster; Rangaraj Selvarangan; Christopher J Harrison; Julie A Boom; Leila C Sahni; Flor M Muñoz; Mary Allen Staat; Elizabeth P Schlaudecker; James D Chappell; Benjamin R Clopper; Heidi L Moline; Angela P Campbell; Andrew J Spieker; Samantha M Olson; Natasha B Halasa

doi:10.1093/cid/ciae573

Antiviral Use Among Children Hospitalized With Laboratory-Confirmed Influenza Illness: A Prospective, Multicenter Surveillance Study

Clin Infect Dis. 2024 Dec 17:ciae573. doi: 10.1093/cid/ciae573. Online ahead of print.

Authors

James W Antoon¹, Justin Z Amarin^{1

2}, Olla Hamdan¹, Tess Stopczynski¹, Laura S Stewart¹, Marian G Michaels³, John V Williams^{3

4}, Eileen J Klein⁵, Janet A Englund⁵, Geoffrey A Weinberg⁶, Peter G Szilagyi^{6

7}, Jennifer E Schuster⁸, Rangaraj Selvarangan⁸, Christopher J Harrison⁸, Julie A Boom⁹, Leila C Sahni⁹, Flor M Muñoz⁹, Mary Allen Staat¹⁰, Elizabeth P Schlaudecker¹⁰, James D Chappell¹, Benjamin R Clopper¹¹, Heidi L Moline¹¹, Angela P Campbell¹¹, Andrew J Spieker¹, Samantha M Olson¹², Natasha B Halasa¹

Affiliations

¹ Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Epidemiology Doctoral Program, Vanderbilt University, Nashville, Tennessee, USA.
³ UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴ Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
⁵ Seattle Children's Research Institute, Seattle, Washington, USA.
⁶ University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
⁷ UCLA Mattel Children's Hospital and Department of Pediatrics, University of California at Los Angeles, Los Angeles, California, USA.
⁸ Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri, USA.
⁹ Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
¹⁰ Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
¹¹ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
¹² Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

PMID: 39688383
DOI: 10.1093/cid/ciae573

Abstract

Background: Guidelines state that all hospitalized children with suspected or confirmed influenza receive prompt treatment with influenza-specific antivirals. We sought to determine the frequency of, and factors associated with, antiviral receipt among hospitalized children.

Methods: We conducted active surveillance of children presenting with fever or respiratory symptoms from 1 December 2016 to 31 March 2020 at 7 pediatric medical centers in the New Vaccine Surveillance Network. The cohort consisted of children hospitalized with influenza A or B confirmed by clinical or research testing. The primary outcome was frequency of antiviral receipt during hospitalization. We used logistic regression to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with antiviral receipt.

Results: A total of 1213 children with laboratory-confirmed influenza were included. Overall, 652 children (53.8%) received an antiviral. Roughly 63.0% of children received clinical influenza testing. Among those with clinical testing, 67.4% received an antiviral. Factors associated with higher odds of antiviral receipt included hematologic (aOR = 1.76; 95% CI = 1.03-3.02) or oncologic/immunocompromising (aOR = 2.41; 95% CI = 1.13-5.11) disorders, prehospitalization antiviral receipt (aOR = 2.34; 95% CI = 1.49-3.67), clinical influenza testing (aOR = 3.07; 95% CI = 2.28-4.14), and intensive care unit admission (aOR = 1.53; 95% CI = 1.02-2.29). Symptom duration >2 days was associated with lower odds of antiviral treatment (aOR = 0.40; 95% CI = .30-.52). Antiviral receipt varied by site with a 5-fold difference across sites.

Conclusions: Almost half of children hospitalized with influenza did not receive antivirals. Additional efforts to understand barriers to guideline adherence are crucial for optimizing care in children hospitalized with influenza.

Keywords: antivirals; guideline-concordant; influenza; oseltamivir; pediatrics.

Abstract

Grants and funding