1101. Antiviral Prescription in Children with Influenza in Emergency Departments (ED): New Vaccine Surveillance Network (NVSN), 2016–2020

• Published in: Open forum infectious diseases 2023-11, Vol.10 (Supplement_2)
• Main Authors: Stopczynski, Tess, Amarin, Justin Z, Antoon, James W, Hamdan, Olla, Stewart, Laura S, Chappell, James, Spieker, Andrew J, Klein, Eileen J, Englund, Janet A, Weinberg, Geoffrey A, Szilagyi, Peter G, Hickey, Robert, Michaels, Marian G, Munoz, Flor M, Boom, Julie A, Staat, Mary A, Schlaudecker, Elizabeth P, Schuster, Jennifer E, Selvarangan, Rangaraj, Campbell, Angela P, Moline, Heidi L, Burkel, Veronica, Olson, Samantha M, Halasa, Natasha B
• Format: Article
• Language: English
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofad500.074

Abstract Background Influenza virus infections are common in children and lead to numerous ED visits each year. The Infectious Diseases Society of America, American Academy of Pediatrics, and the Centers for Disease Control and Prevention recommend outpatient antiviral treatment for children at increased risk of severe influenza illness (e.g., those < 5 years old, but especially < 2 years, and those with certain underlying medical conditions) and recommend treatment within 48-hours of symptom onset. We describe antiviral prescription in children presenting to the ED with influenza from 2016-2020. Methods We analyzed data from NVSN, a prospective seven-site acute respiratory illness surveillance study. We enrolled children presenting to the ED with confirmed influenza by research molecular testing, stratified by children at increased risk of severe influenza and with symptom onset ≤ 48-hours. We compared characteristics of children who were prescribed antivirals to those who were not. We used logistic regression to compare the odds of prescription, adjusting for age, gastrointestinal symptoms, symptom duration, underlying conditions, clinical testing before antiviral prescription, and site. Results Of the 16,822 children presenting in the ED and tested for influenza, 2,387 (14%) tested positive. Among influenza positive cases, 1,873 (79%) were defined as children at increased risk of severe influenza, and 571 (30%) were prescribed an antiviral. Additionally, there were 281 (12%) children with symptom onset ≤ 48-hours, and only 70 (25%) were prescribed an antiviral (Table). Odds of prescription were higher for those clinically tested for influenza and for those with underlying respiratory and cardiovascular conditions, and lower for those who were younger, presented with diarrhea, and had longer duration since symptom onset (Figure). Table 1 Demographic and clinical characteristics of children with influenza, stratified by risk of severe influenza illness and antiviral prescription. Figure Adjusted odds ratios of antiviral prescription among children with influenza. Conclusion While clinical testing and duration since symptom onset predicted antiviral prescription in both children at increased risk of severe influenza and with symptom onset ≤ 48-hours, 70% of children at increased risk were not prescribed an antiviral. Further investigation into clinician perception of antiviral use in children could help identify barriers to antiviral prescription and time-