Antiviral prescribing for children at higher risk of severe influenza dropped dramatically during the late COVID-19 pandemic period.
Tess Stopczynski, MS, senior biostatistician in the Department of Biostatistics at Vanderbilt Health, and colleagues documented this trend using data from the Centers for Disease Control and Prevention-sponsored New Vaccine Surveillance Network (NVSN).
“This decline suggests a concerning trend,” said Stopczynski. “We found a substantial gap between recommendations and real-world treatment practices in pediatric EDs (emergency departments) across the country. The low adherence to guidelines for the treatment of nonhospitalized children with influenza highlights the need for a better understanding of the factors contributing to these prescribing patterns.
“National recommendations call for the treatment of high-risk children. The treatment guidelines have not changed,” said Stopczynski. “We need to understand the reasons for the underuse of antiviral prescribing in EDs so that we can improve practice to impact outcomes and better protect vulnerable pediatric patients from avoidable influenza morbidity.”
Flu causes substantial morbidity and mortality, particularly in vulnerable populations such as young children and those with certain underlying medical conditions. Influenza-specific antiviral medications have been shown to reduce the duration and severity of influenza symptoms when used early in the course of illness, as well as reduce the risk of severe illness and intensive care unit stays.
The multicenter, cross-sectional study analyzed data from NVSN comparing prepandemic (2016-2020) and late pandemic (2021-2023) periods.
Results published in JAMA Network Open showed that among 3,378 influenza-positive children younger than 18 who were seen in the ED, roughly 75% were at increased risk for severe influenza illness during both prepandemic and late pandemic periods. For the children at higher risk of severe disease, antiviral prescribing fell from 32% before the pandemic to 16% late pandemic.
Other findings:
- Prescribing was more likely when clinical testing was performed.
- Prescribing was more likely when children presented within two days of symptom onset.
- Testing increased during the pandemic, but treatment decreased.
Stopczynski, lead author of the study, said the COVID-19 pandemic disrupted ED workflows and introduced diagnostic uncertainty, while the disparity in testing and treatment showed a disconnect between diagnosis and therapy.
Future efforts could explore factors contributing to underprescribing in the ED setting, including practitioner and patient knowledge, diagnostic decision-making and medication access, said Stopczynski.
Senior author and principal investigator of the study, Natasha Halasa, MD, MPH, Craig Weaver Professor of Pediatrics in the Division of Pediatric Infectious Diseases at Monroe Carell Jr. Children’s Hospital at Vanderbilt, emphasized the importance of identifying practical barriers contributing to low antiviral use.
“After reviewing these results, we worked directly with emergency department physicians to understand the challenges they face,” she said. “One key issue was that influenza test results were delayed because testing was performed off-site.
“This year, point-of-care testing is now available on-site, allowing results to return more quickly and improving the opportunity to initiate antiviral treatment,” she added.
Collaboration is crucial, she said, stressing, “it’s essential to work with colleagues on the front lines to understand their barriers and partner with them to overcome these challenges.”
Family awareness is also a key factor.
“It is important that parents know antivirals exist, that they are most effective early, and that they can reduce the severity and complications of influenza,” said Halasa. “Understanding these benefits empowers families to ask about treatment.”
This study was supported by a cooperative agreement with the Centers for Disease Control and Prevention.
