Rates of influenza antiviral medication given to U.S. children from 2010 to 2019 varied widely and were low across all age groups, but especially among children younger than 2 years old, according to a study published today. Pediatrics,
The Vanderbilt University-led study included national commercial insurance claims for 1,416,764 antiviral drug prescriptions for children and adolescents who were seen in an outpatient clinic, urgent care, or emergency department (ED) within 2 days of symptom onset. and who were at high risk for flu complications. The antivirals studied were oseltamivir (Tamiflu), baloxavir (Zoflusa), and zanamivir (Relenza); Oseltamivir is the only medicine approved for children under 5 years of age.
The average patient age was 9 years, and boys and older children were most likely to receive antivirals. Children with risk factors for flu complications were 63.3% of the study population.
Guideline-compliant delivery for youngest children only 37%
Almost all prescriptions (99.8%) were for oseltamivir. The overall prescribing rate was 20.6 per 1,000 children per session (range, 4.35 to 48.6 per 1,000) and increased during the study period. The overall prevalence rate was 606 per 1,000 flu diagnoses (range, 494 to 673 per flu season).
Antiviral distribution in children with flu diagnosis and prophylactic (preventive) treatment varies by age, with children 12 years of age and older receiving more antiviral treatment and children 2 to 11 years of age receiving more prophylactic treatment.
Antiviral prescriptions in flu patients younger than 2 years were 367 per 1,000 diagnoses (prophylactic distribution, 233 per 1,000). National guideline-concurrent antiviral prescribing in children younger than 2 years at high risk of flu complications was 37%.
These findings are particularly worrisome because influenza disproportionately affects young children and results in a greater number of clinical visits, emergency department visits, and hospitalizations for influenza in children under 5 years of age than in older children and adolescents. There is a possibility of complications and hospitalization.
there were wide geographic variations, For example, during In the 2018–19 season, there was a threefold difference in antiviral prescribing rates, ranging from 25 per 1,000 in the Pacific region to 78 per 1,000 in the East South Central region. The weighted average percentage of influenza-like illness visits in these regions was 2.48 in the Pacific region and 3.39 in the East South Central region, a difference of 37%.
The total inflation-adjusted cost for antivirals across all seasons studied was more than $208 million (average, $138), and the average inflation-adjusted cost ranged from $111 to $151 per course. The 2017–18 season had the highest cost ($46.3 million), and the 2011–12 season had the lowest ($7.8 million).
“These findings are particularly worrying given that influenza disproportionately affects young children and results in a greater number of clinical visits, emergency department visits, and hospitalizations in children under 5 years of age than in older children and adolescents.” “Influenza complications and hospitalization are likely.” wrote.
The Infectious Diseases Society of America, the US Centers for Disease Control and Prevention (CDC), and the American Academy of Pediatrics recommend that providers consider oseltamivir for children within 48 hours after flu symptoms begin and those with complications or household exposures. Strongly recommend it to people. exposure.
“Treatment of children in the outpatient setting reduced symptom duration, household transmission, antibiotic use, and influenza-associated complications such as ear infections,” lead author James Antoon, MD, PhD, MPH, said in a Vanderbilt news release.
Antivirals are important adjuvants for vaccines
in a related vaccinePiya Pannaraj, Some providers and parents may not understand that the flu is a serious threat to children, said MD, MPH, of the University of California at San Diego.
,“Bacterial infections of the upper respiratory tract, such as otitis media and sinusitis, may occur in 20% to 50% of healthy individuals, and lower tract complications including bronchitis and pneumonia may lead to hospitalization,” they wrote. Importantly, it is under-recognized that 50% of deaths from pediatric influenza occur in otherwise healthy children.”
Pannaraj called for research into the concerns of providers and parents about the use of antivirals in children with the flu. “Are there factors affecting clinical practices related to cost, insurance coverage, knowledge of antiviral options, perception of benefits, shortage of antivirals, regional climate, culture, media coverage and/or social media?” she wrote.
Because flu vaccine effectiveness varies from season to season, and fewer children have received vaccines since the COVID-19 pandemic began, antivirals have an important role in preventing flu complications. “When it comes to influenza, we must use all the tools in our toolbox,” he concluded.