Antiviral use in US kids seeking care for flu fell to under 60% last year

The prescribing of antiviral medicine for US kids and adolescents receiving remedy for influenza was lower than 60% within the 2023-24 respiratory virus season, down from 70% to 86% in 2017-18, with solely 31% of high-risk sufferers receiving the medicine, a brand new Facilities for Illness Management and Prevention (CDC)–led research finds.

The researchers calculated charges of antiviral prescribing or receipt utilizing knowledge from two flu surveillance networks for kids and teenagers receiving flu remedy in the course of the 2017-18 to 2023-24 respiratory virus seasons.

The networks had been the Influenza Hospitalization Surveillance Community (FluSurv-NET) and the New Vaccine Surveillance Community (NVSN). Antiviral remedy was outlined as documentation of a prescription for or receipt of baloxavir (Xofluza), oseltamivir (Tamiflu), peramivir (Rapivab), or zanamivir (Relenza).

The findings had been revealed yesterday in Morbidity and Mortality Weekly Report.

“Yearly, seasonal influenza virus infections amongst kids and adolescents in the USA are estimated to lead to hundreds of thousands of medical visits, tens of 1000’s of hospitalizations, and a whole lot of deaths,” the investigators wrote. “Influenza vaccination and early initiation of antiviral remedy can cut back the danger for influenza issues.”

“Immediate antiviral remedy has additionally been related to decrease odds of intensive care unit (ICU) admission and demise amongst hospitalized kids and adolescents with influenza,” they added.

Prescribing highest for infants youthful than 6 months

Within the 2023-24 flu season, the analysis staff analyzed the 573 flu-related outpatient visits and 283 hospitalizations documented by NVSN and 1,846 hospitalizations from FluSurv-NET. The biggest proportion of sufferers in NVSN and FluSurv-NET had been 5 to 11 years outdated (42% and 39%, respectively) and White (36% and 33%).

Throughout the 2017-18 respiratory virus season, 70% (NVSN) to 86% (FluSurv-NET) of hospitalized kids with flu acquired antivirals, declining to 52% to 59% in 2023-24. Within the latter season, 31% of high-risk sufferers on this age-group seen outdoors of the hospital had been prescribed antivirals.

Amongst nonhospitalized sufferers, the biggest teams of contaminated kids (42%) had been 2 to 4 years outdated and Black (43%). Inside NVSN and FluSurv-NET, 58% and 47% of hospitalized kids, respectively, had no underlying medical circumstances. Bronchial asthma or reactive airway illness was frequent amongst kids in each networks and settings (21% in NVSN; 26% in FluSurv-NET).

The proportion of prescriptions (all for oseltamivir) for nonhospitalized kids was highest amongst kids youthful than 6 months (49%) and lowest amongst these 2 to 4 years outdated (21%).

Amongst hospitalized sufferers, 16% (NVSN) and 19% (FluSurv-NET) had been admitted to an ICU, and seven% to 13% (NVSN) and 4% to 7% (FluSurv-NET) required invasive or noninvasive mechanical air flow. Antiviral remedy prevalence on this group was highest amongst these youthful than 6 months (68% in NVSN; 73% in FluSurv-NET) and lowest amongst these 2 to 4 years outdated in NVSN (43%) and 12 to 17 years in FluSurv-NET (49%).

Practically all hospitalized antiviral recipients (99%) got oseltamivir, most of them (68% in NVSN; 60% in FluSurv-NET) acquired the drug on the day of admission, and 29% (NVSN) and 34% (FluSurv-NET) started remedy 1 or extra days later.

Underprescribing could also be as a result of adverse-event worries

The proportion of members in each settings who acquired antivirals rose with an rising variety of comorbid circumstances, from 28% of these with none to 57% amongst these with three or extra (outpatient) and, amongst hospitalized sufferers, from 45% to 75% (NVSN), respectively, and from 55% to 77% (FluSurv-NET), respectively.

Therapy of any individual with suspected or confirmed influenza who’s hospitalized; has extreme, sophisticated, or progressive sickness; or is at larger danger for influenza issues mustn’t await laboratory affirmation.

Amongst kids with bronchial asthma or reactive airway illness, 34% had been prescribed antivirals in outpatient settings, and 64% (NVSN) and 62% (FluSurv-NET) acquired them within the hospital.

In hospitalized members, the next share of these admitted to an ICU acquired antiviral remedy (84% in NVSN; 82% in FluSurv-NET), and 81% had been handled on the day of or after ICU admission. Amongst those that acquired noninvasive or invasive air flow, 89% to 94% in NVSN and 82% in FluSurv-NET got an antiviral.

“These findings exhibit that influenza antiviral remedy is underutilized amongst kids and adolescents who may benefit from remedy,” the authors wrote. “Antiviral remedy is really useful as quickly as potential, and remedy of any individual with suspected or confirmed influenza who’s hospitalized; has extreme, sophisticated, or progressive sickness; or is at larger danger for influenza issues mustn’t await laboratory affirmation.”

The researchers stated the underprescribing could also be partially as a result of issues about antiviral-linked adversarial occasions. In its flu antiviral steeragenonetheless, the CDC says, “Mother and father, in case your youngster will get sick with flu, antiviral medicine provide a secure and efficient remedy choice.”

“Growing entry to well timed care, figuring out potential obstacles to antiviral remedy within the hospital setting, and rising supplier training regarding the advantages of well timed remedy may result in will increase in antiviral remedy of individuals who’re really useful to obtain it,” they concluded.