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Underutilization of Influenza Antiviral Treatment Among Children and Adolescents at Higher Risk for Influenza-Associated Complications - United States, 2023-2024

Aaron M Frutos et al. MMWR Morb Mortal Wkly Rep. .

Abstract

Annually, tens of thousands of U.S. children and adolescents are hospitalized with seasonal influenza virus infection. Both influenza vaccination and early initiation of antiviral treatment can reduce complications of influenza. Using data from two U.S. influenza surveillance networks for children and adolescents aged <18 years with medically attended, laboratory-confirmed influenza for whom antiviral treatment is recommended, the percentage who received treatment was calculated. Trends in antiviral treatment of children and adolescents hospitalized with influenza from the 2017-18 to the 2023-2024 influenza seasons were also examined. Since 2017-18, when 70%-86% of hospitalized children and adolescents with influenza received antiviral treatment, the proportion receiving treatment notably declined. Among children and adolescents with influenza during the 2023-24 season, 52%-59% of those hospitalized received antiviral treatment. During the 2023-24 season, 31% of those at higher risk for influenza complications seen in the outpatient setting in one network were prescribed antiviral treatment. These findings demonstrate that influenza antiviral treatment is underutilized among children and adolescents who could benefit from treatment. All hospitalized children and adolescents, and those at higher risk for influenza complications in the outpatient setting, should receive antiviral treatment as soon as possible for suspected or confirmed influenza.

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Conflict of interest statement

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Janet A. Englund reports institutional support from AstraZeneca, Pfizer, Moderna, and GlaxoSmithKline; receipt of consulting fees from AstraZeneca, GlaxoSmithKline, Merck, Meissa Vaccines, Moderna, Pfizer, and Sanofi Pasteur; and receipt of honoraria from Pfizer. Natasha B. Halasa reports institutional support from Merck, and receipt of an honorarium from CSL Seqirus for service on an advisory board. Sue Kim reports grants from the Michigan Department of Health and Human Services. Ruth Lynfield reports receipt of a fee for serving as an Associate Editor for the American Academy of Pediatrics Redbook, which was then donated to the Minnesota Department of Health. Leila C. Sahni reports travel support from the Gates Foundation. Elizabeth P. Schlaudecker reports institutional support from Pfizer; receipt of an honorarium from Sanofi Pasteur for service on an advisory board; and travel support for meeting attendance from the World Society for Pediatric Infectious Diseases, the European Society for Paediatric Infectious Diseases, and Pediatric Infectious Diseases Society; uncompensated membership of a National Institutes of Health Data Safety Monitoring Board; and membership on the board of the World Society for Pediatric Infectious Diseases. Jennifer E. Schuster reports institutional support from the National Institutes of Health, the Food and Drug Administration and the State of Missouri; receipt of a consulting fee from the Association of Professionals in Infection Control and Epidemiology and a speaking honorarium from the Missouri Chapter of the American Academy of Pediatrics; membership on the Association of American medical Colleges advisory board. Rangaraj Selvarangan reports institutional support from Abbot, Cepheid, Biomerieux, Hologic, BioRad, Qiagen, Diasorin, and Merck; receipt of payment from GlaxoSmithKline, Baebies Biomerieux and Abbot; and travel support from Biomerieux and Hologic. Mary A. Staat reports institutional support from the National Institutes of Health, Cepheid, and Merck; royalties from UpToDate; and consulting fees from Merck. Dawud Ujamaa reports consulting fees from Goldbelt, Inc. Geoffrey A. Weinberg reports institutional support from the New York State Department of Health; consulting fees from the New York State Department of Health, Inhalon Biopharma, and ReViral; honorarium from Merck; and participation on an Emory University Data Safety Monitoring Board. No other potential conflicts of interest were disclosed.

Figures

FIGURE
FIGURE
Antiviral treatment among children and adolescents aged <18 years hospitalized with laboratory-confirmed influenza, overall and by age group — two multistate surveillance networks, United States, 2017–18 to 2023–24 influenza seasons, Abbreviations: FluSurv-NET = Influenza Hospitalization Surveillance Network; NVSN = New Vaccine Surveillance Network. * Data presented overall for NVSN, and overall and by age groups for FluSurv-NET. Unless indicated, data included are from FluSurv-NET. † Clinical data were available on sampled FluSurv-NET cases for persons admitted during October 1–April 30 each season. This includes 8,907 children and adolescents in total, with 1,827 from 2017–18; 1,797 from 2018–19; 1,864 from 2019–20; 337 from 2021–22; 1,236 from 2022–23; and 1,846 from 2023–24. The 2020–21 influenza season was excluded because of minimal influenza activity. § Clinical influenza positive inpatient data were available from children and adolescents in NVSN admitted from October 1 through April 30 each season. This includes 1,175 children and adolescents in total, with 186 from 2017–18; 169 from 2018–19; 268 from 2019–20; 65 from 2021–22; 204 from 2022–23; and 283 from 2023–24. The 2020–21 influenza season was excluded because of minimal influenza activity.
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