1742. Predictors of Antiviral Receipt for Influenza in Hospitalized U.S. Children, New Vaccine Surveillance Network (NVSN), 2016–2020

• Published in: Open forum infectious diseases 2023-11, Vol.10 (Supplement_2)
• Main Authors: Amarin, Justin Z, Hamdan, Olla, Antoon, James W, Spieker, Andrew J, Stewart, Laura S, Michaels, Marian G, Williams, John V, Klein, Eileen J, Englund, Janet A, Weinberg, Geoffrey A, Szilagyi, Peter G, Schuster, Jennifer E, Selvarangan, Rangaraj, Boom, Julie A, Munoz, Flor M, Staat, Mary A, Schlaudecker, Elizabeth P, Chappell, James, Clopper, Benjamin R, Moline, Heidi L, Campbell, Angela P, Olson, Samantha M, Halasa, Natasha B
• Format: Article
• Language: English
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofad500.1573

Abstract Background Children hospitalized with suspected or confirmed influenza should promptly receive influenza antivirals, as recommended by the Infectious Diseases Society of America, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention (CDC). However, despite these recommendations, antiviral receipt remains suboptimal. We assessed predictors of antiviral receipt for influenza in hospitalized children. Methods We conducted active, population-based surveillance of children presenting with fever or respiratory symptoms from December 1, 2016, to March 31, 2020, at seven children’s hospitals in the CDC NVSN. The cohort consisted of children hospitalized with influenza confirmed by research molecular testing. We assessed predictors of antiviral receipt, selected a priori, using logistic regression, and included all in the final model. Results We enrolled and tested 16,853 hospitalized children for influenza, identifying 1,120 laboratory-confirmed cases (6.6%). Of these laboratory-confirmed cases, clinicians ordered influenza testing for 693/1,120 (61.9%), and among those tested, 599/693 (86.4%) tested positive by clinical assays. Overall, 545/1,120 children (48.7%) received influenza antivirals. Of those with a positive clinical test, 405/599 (67.6%) received antivirals. Factors associated with higher odds of antiviral receipt included an underlying oncologic or immunocompromising disorder, symptom onset ≤ 2 days, intensive care unit (ICU) admission at presentation, use of influenza antivirals for this illness prior to hospitalization, and a positive clinical test (Table). Additionally, we found that a negative clinical test was associated with lower odds of antiviral receipt, and receipt varied significantly by study site. Table Logistic regression model of influenza-specific antiviral receipt among hospitalized children testing positive for influenza by research testing, December 1, 2016, and March 31, 2020 (N=1,120). Conclusion More than half of children hospitalized with influenza in our surveillance population did not receive antivirals, despite treatment recommendations. Efforts to improve antiviral receipt are important for optimizing care in all children hospitalized with influenza, and clinician education should continue to highlight the use of antivirals across the full spectrum of children hospitalized with influenza, including children not admitted to the ICU and those without underlying conditions. Disclosures