From 2017-2018, antiviral treatment of hospitalized children with influenza ranged from 70%-86%. In the 2023-2024 season, it was less than 60%.
Antiviral treatment for hospitalized influenza pediatric patients decliningLatest revision | Image Credit: © Rido - © Rido - stock.adobe.com.
Every year, tens of thousands of children and adolescents are hospitalized with influenza in the United States, according to a recently-published Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention.1
It is known that both vaccination and treatment with antivirals can reduce the risk for influence complications among pediatric patients. However, antiviral treatment trends among hospitalized children with influenza and those at higher risk for influenza complications have demonstrated underutilization.1
According to study authors, the overall percentage of hospitalized patients aged younger than 18 years with laboratory-confirmed influenza who were treated with antiviral medications was 70% in the New Vaccine Surveillance Network (NVSN) and 86% in the Influenza Hospitalization Surveillance Network (FluSurv-NET). Since the 2019-2020 influenza season, percentage of children treated with antivirals has declined and remained lower than it was before the COVID-19 pandemic. During the 2023-2024 influenza season, between 52%-59% of those hospitalized with influenza received antiviral treatment.1
In the 2023-2024 influenza season, there were 573 influenza-associated outpatient visits and 283 influenza-associated hospitalizations in NVSN, an active, population-based surveillance network that collects data from children and adolescents aged <18 years with acute respiratory illness (ARI) in outpatient (outpatient clinics, urgent care clinics, and emergency departments) and hospital settings at seven sites, according to the MMWR.1
Additionally, there were 1846 influenza-associated hospitalizations in FluSurv-NET, which defined a confirmed case as a hospitalization of a person of any age residing in the surveillance catchment area with laboratory-confirmed influenza from a clinically ordered test.1
Among hospitalized children and adolescents in NVSN and FluSurv-NET, the largest percentages (42% and 39%, respectively) were aged 5 to 11 years, and were non-Hispanic White persons (36% and 33%, respectively). Most children (42%) with influenza were aged 2 to 4 years and most (43%) were non-Hispanic Black or African American persons.1
"Within NVSN and FluSurv-NET, 58% and 47% of hospitalized children and adolescents with influenza, respectively, did not have any underlying medical condition," wrote the study authors.1
During the 2023-2024 influenza season, of the children and adolescents in the outpatient setting who were recommended to receive antiviral treatment, 31% were prescribed antivirals. Among those who were hospitalized with influenza 52% in the NVSN group and 59% in the FluSurv-NET group received antiviral treatment, with the highest prevalence among those aged younger than 6 months of age (68% [NVSN]; 73% [FluSurv-NET]) and lowest among those aged 2–4 years in NVSN (43%) and 12–17 years in FluSurv-NET (49%), according to study results. The investigators noted nearly all patients who were treated received oseltamivir (99%).1
In a previous interview conducted at the 2024 National Association of Pediatric Nurse Practitioners National Conference of Pediatric Health Care held in March, Ashley Gyura, DNP, CPNP-PC, a pediatric nurse practitioner who specializes in infectious diseases at Children's Minnesota, highlighted providers' concerns regarding oseltamivir and neuropsychiatric effects.2
"One of the things that we initially focused on was influenza and the antivirals that are available, which are oseltamivir, or Tamiflu, and baloxavir. One of the questions I received from several people was the neuropsychiatric effects that can happen with oseltamivir," Gyura told Contemporary Pediatrics in March 2024.2
"I think that, especially in social media, we certainly know that oseltamivir can have neuropsychiatric side effects, but there was also a study done in 2023 [that] looked at how many serious neuropsychiatric events happened in kids who have influenza, both with and without antivirals," said Gyura. "It was interesting because these events do happen in kids who aren't taking antivirals and so I think that will help us know how to move forward looking at the events with oseltamivir."2
Click play on the above video for more comments from Gyura, or click here to open the video interview in a new window.
The MMWR also revealed that, "in both outpatient and inpatient settings, the percentage of children and adolescents who received antiviral treatment for laboratory-confirmed influenza rose with an increasing number of underlying medical conditions, from 28% of those with no underlying conditions to 57% among those with three or more (outpatient) and, among hospitalized patients, from 45% to 75% (NVSN), respectively, and from 55% to 77% (FluSurv-NET), respectively," according to results.1
The investigative team expressed concerns regarding the decrease in influenza antiviral use among children and adolescents with confirmed influenza since the COVID-19 pandemic.1
"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," concluded the study authors.1
References:
1. Frutos AM, Ahmad HM, Ujamaa D, et al. Underutilization of Influenza Antiviral Treatment Among Children and Adolescents at Higher Risk for Influenza-Associated Complications — United States, 2023–2024. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention. November 14, 2024. Accessed November 21, 2024. https://www.cdc.gov/mmwr/volumes/73/wr/mm7345a2.htm?s_cid=mm7345a2_e&ACSTrackingID=USCDC_921-DM140436&ACSTrackingLabel=This%20Week%20in%20MMWR%3A%20Vol.%2073%2C%20November%2014%2C%202024&deliveryName=USCDC_921-DM140436
2. Fitch, J. Antiviral therapeutics for pediatric influenza, COVID-19, herpes. Contemporary Pediatrics. March 26, 2024. Accessed November 21, 2024. https://www.contemporarypediatrics.com/view/antiviral-therapeutics-for-pediatric-influenza-covid-19-herpes
