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. 2025 Jun;19(6):e70124.
doi: 10.1111/irv.70124.

Antiviral Prescription in Children With Influenza in US Emergency Departments: New Vaccine Surveillance Network (NVSN), 2016-2020

Tess Stopczynski  1 , Justin Z Amarin  2 , James W Antoon  2 , Olla Hamdan  2 , Laura S Stewart  2 , James Chappell  2 , Andrew J Spieker  1 , Eileen J Klein  3 , Janet A Englund  3 , Geoffrey A Weinberg  4 , Peter G Szilagyi  4   5 , John V Williams  6   7 , Marian G Michaels  7 , Julie A Boom  8 , Leila C Sahni  8 , Mary Allen Staat  9 , Elizabeth P Schlaudecker  9 , Jennifer E Schuster  10 , Rangaraj Selvarangan  10 , Christopher J Harrison  10 , Heidi L Moline  11 , Ariana P Toepfer  11 , Angela P Campbell  11 , Samantha M Olson  11 , Natasha B Halasa  2
Affiliations

Antiviral Prescription in Children With Influenza in US Emergency Departments: New Vaccine Surveillance Network (NVSN), 2016-2020

Tess Stopczynski et al. Influenza Other Respir Viruses. 2025 Jun.

Abstract

Background: Influenza contributes to a high burden of pediatric emergency department (ED) visits annually. Guidelines recommend outpatient antiviral treatment for children at higher risk of severe influenza and recommend considering treatment for those who present within 2 days of symptom onset. We describe antiviral prescription in children with influenza presenting to the ED.

Methods: We analyzed data from the New Vaccine Surveillance Network (2016-2020), including children presenting to the ED and enrolled with confirmed influenza at one of seven pediatric academic centers. We compared characteristics of children prescribed antivirals to those who were not, using generalized estimating equations models to identify predictors of antiviral prescription. Children were considered at higher risk of severe influenza if they were < 5 years old or had an underlying condition.

Results: Overall, 2472 (15%) of 16,915 enrolled children tested positive for influenza virus. Among these, 1931 (78%) were at higher risk of severe influenza; only 622 (32%) received an antiviral. Among 233 (9%) children not at high risk with symptom onset ≤ 2 days, 62 (27%) were prescribed an antiviral. Children prescribed an antiviral had a shorter duration of illness prior to presenting to the ED. For children at higher risk of severe influenza, odds of antiviral prescription were higher for those clinically tested for influenza and with underlying conditions.

Conclusion: Clinical testing and having an underlying condition were associated with antiviral prescription in children at higher risk of severe influenza. However, only 1/3 of those at higher risk were prescribed an antiviral. Strategies to increase antiviral use for children at higher risk for influenza in the ED are needed.

Keywords: antivirals; influenza; pediatrics.

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Conflict of interest statement

J.W.A. previously served as a member of the Scientific Advisory Board for AstraZeneca. G.A.W. has received honoraria from Merck & Company for writing and revising chapters in the Merck Manual EPS, and M.A.S. receive research funding from Pfizer and honoraria from Sanofi Pasteur for vaccine consultation. J.A.E. reports work as a consultant to Abbvie, Astra Zeneca, Meissa Vaccines, Pfizer, Moderna, and Sanofi Pasteur and research to support university from AstraZeneca, GlaxoSmithKline, Merck, and Pfizer. M.G.M. reports research to support university from Merk Sharpe & Dohme and non‐financial research grant from Viracor. J.E.S. reports work as a consultant at AAMC. J.V.W. previously served as a member of the Scientific Advisory Board for Quidel and on an Independent Data Monitoring Committee for GlaxoSmithKline. S.M.O. reports travel support from the Gates Foundation. N.B.H. received grant support from Sanofi and Quidel, received current grant support from Merck, and served on an advisory board for CSL Seqirus.

Figures

FIGURE 1
FIGURE 1
Flow diagram of study participants between 12/01/2016 and 03/31/2020.
FIGURE 2
FIGURE 2
Adjusted odds ratios of antiviral prescription among children at higher risk of severe influenza illness presenting to the emergency departments of seven children's hospitals within the New Vaccine Surveillance Network (N = 1931). We used a generalized estimating equations model with a logistic link to compare the odds of antiviral prescription for each of the following variables adjusting for all other variables in the model: age, gastrointestinal symptoms, symptom duration, clinical influenza testing (rapid antigen or PCR) before antiviral prescription, influenza season, influenza season peak, underlying medical condition, receipt of current season influenza vaccine, study site, and individual level identifier.
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