Influenza Antiviral Treatment Underutilized Among Vulnerable Youth: Daily Dose

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On November 20, 2024, we reported on a new study published in the CDC's Morbidity and Mortality Weekly Report that examined antiviral treatment patterns among US children and adolescents with laboratory-confirmed influenza during the 2023 to 2024 influenza season.

The study

Researchers analyzed treatment patterns during the 2023 to 2024 influenza season, focusing on children and adolescents with laboratory-confirmed influenza, specifically those hospitalized and those at higher risk for complications in the outpatient setting. They collected data from 2 US influenza surveillance networks: the Influenza Hospitalization Surveillance Network (FluSurv-NET) and the New Vaccine Surveillance Network (NVSN). The researchers then analyzed eligible patients from both networks with recorded data between October 1, 2023, to April 30, 2024.

Eligible FluSurv-NET patients were those residing in the surveillance catchment area and hospitalized with laboratory-confirmed influenza. Data were collected through medical records reviews using a standardized case report form, focusing on a random sample of cases stratified by age, site, and month of admission from 12 sites. All sampled patients younger than 18 years were included in the study. Conversely, eligible NVSN patients were younger than 18 years, lived in the catchment area, and were diagnosed with acute respiratory illness and laboratory-confirmed influenza. Data were collected through medical chart reviews and parent or guardian interviews. All hospitalized patients were included, but those in the outpatient setting were included only if they met the CDC guidelines for influenza antiviral treatment.

The researchers defined influenza antiviral treatment as the documented prescription or receipt of baloxavir, peramivir, oseltamivir, or zanamivir. They calculated treatment rates by dividing the number of patients treated with or prescribed antivirals by the total number recommended for antiviral treatment. For historical context, they also assessed antiviral treatment trends from the 2017 to 2018 season through the 2023 to 2024 season.

The findings

Antiviral treatment of children and adolescents hospitalized for influenza declined significantly from 70%– 86% during the 2017–2018 respiratory virus season to less than 60% (52%-59%) in 2023–2024, according to the results.

Also, the researchers found that 31% of those in the outpatient setting who were recommended antiviral treatments were prescribed them, all of whom were prescribed oseltamivir. Prescriptions were most prevalent among those younger than 6 months (49%) and lowest among those aged 2 to 4 years (21%).

Authors' comment

"The decrease in influenza antiviral use among children and adolescents with laboratory-confirmed influenza since the COVID-19 pandemic is concerning. Health care providers are reminded that children and adolescents with suspected or confirmed influenza who are hospitalized or have higher risk for influenza complications should receive prompt antiviral treatment."

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