Study reveals underuse of antivirals for children hospitalized with influenza

Vanderbilt University Medical CenterDec 17 2024

Despite national medical guidelines supporting the use of antiviral medications in young children diagnosed with influenza, a recent study reports an underuse of the treatment.

"Antiviral Use Among Children Hospitalized with Laboratory-Confirmed Influenza Illness: A Prospective, Multicenter Surveillance Study" was published in Clinical Infectious Diseases, the flagship journal of the Infectious Diseases Society of America.

Flu illness accounts for up to 10% of all pediatric hospitalizations during the winter season in the United States.

While guidelines recommend all hospitalized children with suspected or confirmed influenza receive prompt treatment with influenza-specific antivirals regardless of symptom duration or vaccination, study results show adherence to guidelines fall short.

Our findings of limited use of antivirals in hospitalized children with influenza illness is concerning. We found that almost half of hospitalized children did not receive antiviral therapy despite widely endorsed recommendations by the Centers for Disease Control (CDC), Infectious Diseases Society of America and American Academy of Pediatrics. Use of these antivirals reduce how long children have symptoms and prevent influenza complication."

James Antoon, MD, PhD, MPH, assistant professor of Pediatrics at Monroe Carell Jr. Children's Hospital at Vanderbilt

Antoon, along with Justin Amarin, MD, co-led a multicenter study of a cohort of children hospitalized with confirmed flu diagnosis at seven pediatric medical centers in the CDC New Vaccine Surveillance Network (NVSN) between Dec. 1, 2016 and March 31, 2020. A total of 1,213 children with lab-confirmed flu were included.

Among those with research or clinical influenza testing, only half received antiviral treatment and among those with clinical influenza testing by a physician, almost two-thirds received an antiviral.

Study findings also saw almost 37% of hospitalized infants younger than 6 months old, who are not eligible for flu vaccination, did not receive an antiviral.

"The low use of influenza antivirals shows the need for additional efforts to understand the barriers to treatment and improving clinical testing. Improved antiviral treatment is critical for optimizing care in this population of patients," said Antoon.

Natasha Halasa, MD, PhD, Craig Weaver Professor of Pediatrics in the Division of Pediatric Infectious Diseases at Monroe Carell, served as the site principal investigator.

"Data from two national influenza surveillance networks indicate that antiviral treatment of hospitalized children and adolescents with influenza has declined from 70%– 86% during the 2017–2018 season to less than 60% in 2023–2024," noted Halasa.

"Only 30% of children and adolescents at higher risk for influenza complications were prescribed antivirals during outpatient visits."

These findings mentioned by Halasa were published in the CDC digest Morbidity and Mortality Weekly Report (MMWR) on Nov. 14.

Antoon said that antiviral treatment results in shorter symptom duration, lower risk of developing subsequent pneumonia and sinusitis and otitis media infections. Some data suggests that use of antivirals is associated with decreases in hospital length of stay, use of mechanical ventilation and intensive care unit admissions.

"Future studies should also focus on improving influenza testing and prompt antiviral treatment for children with influenza-associated hospitalizations as well as standardizing care both within and across institutions," he said.