Study: Antiviral use remains low in children with flu
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Key takeaways:
- Fewer than 40% of eligible children at high risk for influenza complications received an antiviral.
- The AAP, Infectious Diseases Society of America and CDC recommend antiviral treatment for kids with influenza.
Use of antivirals to treat influenza in children remains low despite their wide availability and guidelines recommending their use, according to a study published in Pediatrics.
The FDA has approved four influenza antivirals, including oral oseltamivir, inhaled zanamivir, oral baloxavir and intravenous peramivir, although oseltamivir remains the only oral influenza antiviral that is FDA-approved for use in children aged 5 years or younger.
Globally, one in 10 children acquire symptomatic influenza every year, according to study author James W. Antoon, MD, PhD, MPH, an assistant professor of pediatrics and hospital medicine at Vanderbilt University Medical Center.
“We know that antiviral medications can shorten duration of symptoms and prevent some common complications of influenza, such as ear infections, pneumonia, and hospitalization,” Antoon told Healio. “Prior work has shown that that there’s some variability in how often adults are prescribed antiviral medication, and so we wanted to investigate how often are these antivirals used in children for treatment and in what populations are they being used more than others?”
The AAP, CDC and Infectious Diseases Society of America all have strong recommendations supporting the use of antivirals in children who are at high risk for influenza complications, “meaning those that are less than 5 years of age and those with a certain underlying condition,” Antoon said.
“They also have recommendations about when you should consider treatment, and for those who are not high risk,” Antoon continued. “We wanted to investigate using the database that we had. Where are those guidelines being followed?”
Antoon and colleagues used Narrative MarketScan Commercial Claims, a large national pharmacy database that includes commercial insurance claims in all 50 states from 2010 to 2019, to find trends in dispensing of these antiviral medications. The entire analysis included 1,416,764 unique antiviral dispensations during that time period.
Children with risk factors for influenza complications accounted for 63.3% of the antiviral dispensations. Despite widely endorsed national guidelines that suggest all children aged younger than 2 years receive an antiviral, only 37% of children in this age group in the study with an influenza diagnosis were dispensed an antiviral. Oseltamivir was the most frequently prescribed antiviral treatment at 99.8%.
“Children [younger] than 2 years old should receive an antiviral, regardless of how long they’ve had symptoms,” Antoon said. “There was a large percentage of children who the guidelines say should be treated who are not being treated.”
Last year’s influenza season was “one of the worst for children,” according to Antoon.
“These antiviral medications have been very well studied. They are effective and they are extremely safe,” Antoon said. “Our findings from this study show that increasing appropriate antiviral use might be an easy target to improve outcomes for children who have influenza, that parents should be aware that these antivirals exist, and that they’re safe and effective.”
According to the authors, care for children with influenza can be improved with judicious use of available antivirals, especially for children at high risk for influenza complications.
“While these medications are safe and effective, the most powerful tool that we have to prevent poor influenza outcomes is vaccination,” Antoon said. “Vaccines both prevent influenza and lessen the severity of influenza when our child has it. So, while it’s great we have these medications [so that] after somebody gets the flu we could help them get better, the best thing we can do for children is to vaccinate them to prevent the flu in the first place.”
The study was accompanied by a commentary authored by Pia S. Pannaraj, MD, MPH, a researcher in the division of infectious diseases within the department of pediatrics at the University of California, San Diego, who wrote that there is an urgent need for better understanding of factors contributing to a lack of guideline adherence.
“As life and human behavior have returned to prepandemic norms, influenza will circulate at higher rates in the community once again,” Pannaraj wrote. “Influenza vaccine effectiveness is known to vary greatly each season, and vaccination rates in children decreased during the coronavirus disease 2019 pandemic.”
References:
- Antoon JW, et al. Pediatrics. 2023;doi:10.1542/peds.2023-061960.
- Pannaraj PS, et al. Pediatrics. 2023;doi:10.1542/peds.2023-063481.
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