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Influenza Antiviral Use in Hospitalized Children Before and During the COVID-19 Pandemic
Olla Hamdan1, Justin Z Amarin1, James W Antoon1
1Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Influenza antiviral use in hospitalized children decreased during the COVID-19 pandemic. This study highlights the need for improved antiviral treatment for pediatric influenza patients.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Public health
Background:
- The COVID-19 pandemic significantly impacted healthcare delivery, potentially affecting management of other infectious diseases like influenza.
- Understanding changes in influenza antiviral use during the pandemic is crucial for pediatric patient care.
Purpose of the Study:
- To investigate trends in influenza antiviral use among children hospitalized with influenza before and after the emergence of COVID-19.
- To identify factors associated with antiviral use in pediatric influenza patients during the late pandemic period.
Main Methods:
- Active surveillance was conducted at 7 US sites within the New Vaccine Surveillance Network.
- Data included children hospitalized with influenza from pre-pandemic (2016-2020) and late pandemic (2021-2023) periods.
- Statistical analyses included mixed-effects Poisson and logistic regression to compare antiviral use and identify associated factors.
Main Results:
- Overall influenza antiviral use in hospitalized children decreased by 23% during the late pandemic compared to the prepandemic period.
- Antiviral use declined from 48.3%-56.8% prepandemic to 38.1% in 2021-2022 and 46.1% in 2022-2023.
- Factors associated with higher antiviral use included underlying medical conditions, vaccination, clinical testing, and ICU admission.
Conclusions:
- Influenza antiviral use in hospitalized children remains suboptimal post-COVID-19 pandemic.
- There is a critical need to enhance influenza antiviral prescribing practices for pediatric patients.
- Improved management strategies are necessary to ensure timely and appropriate antiviral treatment for children with influenza.
Objective:
The COVID-19 pandemic may have affected the care of patients with influenza. We investigated influenza antiviral use and associated factors in children hospitalized with influenza before and during the late COVID-19 pandemic.
Methods:
We conducted active surveillance among US children with acute respiratory illness at 7 sites in the New Vaccine Surveillance Network before the COVID-19 pandemic (December 1, 2016 to March 31, 2020) and during the late pandemic period (July 1, 2021 to June 30, 2023). We included children hospitalized within 10 days of symptom onset who had positive test results for influenza by clinical or research testing. Research swabs were collected from all enrolled children; clinical testing was provider-directed. We used mixed-effects Poisson regression to compare incidence proportions of influenza antiviral use in the late pandemic with those of the prepandemic period. We determined factors associated with antiviral use during the late pandemic period using a mixed-effects logistic regression model.
Results:
Among 1560 children hospitalized with influenza, antiviral use ranged between 48.3% and 56.8% prepandemic but declined to 38.1% in 2021 to 2022 and 46.1% in 2022 to 2023. The estimated antiviral use was 23% lower in the late pandemic (incidence proportion ratio, 0.77; 95% CI, 0.68-0.87) compared with the prepandemic period. During the late pandemic, factors associated with higher odds of antiviral use included an underlying medical condition presence, current season influenza vaccination, clinical influenza testing, intensive care unit admission, and site.
Conclusions:
Influenza antiviral use in children hospitalized with influenza remained suboptimal following the COVID-19 pandemic. Our study highlights the need to improve antiviral use in children hospitalized with influenza.
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