Influenza clinical testing and oseltamivir treatment in hospitalized children with acute respiratory illness, 2015-2016

Lubna Hamdan; Varvara Probst; Zaid Haddadin; Herdi Rahman; Andrew J Spieker; Simon Vandekar; Laura S Stewart; John V Williams; Julie A Boom; Flor Munoz; Janet A Englund; Rangaraj Selvarangan; Mary A Staat; Geoffrey A Weinberg; Parvin H Azimi; Eileen J Klein; Monica McNeal; Leila C Sahni; Monica N Singer; Peter G Szilagyi; Christopher J Harrison; Manish Patel; Angela P Campbell; Natasha B Halasa

doi:10.1111/irv.12927

Influenza clinical testing and oseltamivir treatment in hospitalized children with acute respiratory illness, 2015-2016

Influenza Other Respir Viruses. 2022 Mar;16(2):289-297. doi: 10.1111/irv.12927. Epub 2021 Oct 26.

Authors

Lubna Hamdan¹, Varvara Probst¹, Zaid Haddadin¹, Herdi Rahman¹, Andrew J Spieker², Simon Vandekar², Laura S Stewart¹, John V Williams³, Julie A Boom⁴, Flor Munoz⁵, Janet A Englund⁶, Rangaraj Selvarangan⁷, Mary A Staat⁸, Geoffrey A Weinberg⁹, Parvin H Azimi¹⁰, Eileen J Klein¹¹, Monica McNeal⁸, Leila C Sahni¹², Monica N Singer¹⁰, Peter G Szilagyi¹³, Christopher J Harrison¹⁴, Manish Patel¹⁵, Angela P Campbell¹⁶, Natasha B Halasa¹

Affiliations

¹ Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³ Pediatric Infectious Diseases, Institute for Infection, Inflammation, and Immunity in Children, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴ Primary Care Practice at Palm Center, Immunization Project, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
⁵ Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
⁶ Department of Pediatrics, Division of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington, USA.
⁷ Pathology & Laboratory Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA.
⁸ Pediatric Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA.
⁹ Pediatric Infectious Diseases, University of Rochester Medical Center, Rochester, New York, USA.
¹⁰ Pediatric Infectious Diseases, Children's Hospital and Research Center, Oakland, California, USA.
¹¹ Department of Pediatrics, Division of Emergency Medicine, Seattle Children's Hospital, Seattle, Washington, USA.
¹² Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
¹³ Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital, Los Angeles, California, USA.
¹⁴ Pediatric Infectious Diseases, Children's Mercy Hospital, Kansas City, Missouri, USA.
¹⁵ National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
¹⁶ Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Abstract

Background: Antiviral treatment is recommended for all hospitalized children with suspected or confirmed influenza, regardless of their risk profile. Few data exist on adherence to these recommendations, so we sought to determine factors associated with influenza testing and antiviral treatment in children.

Methods: Hospitalized children <18 years of age with acute respiratory illness (ARI) were enrolled through active surveillance at pediatric medical centers in seven cities between 11/1/2015 and 6/30/2016; clinical information was obtained from parent interview and chart review. We used generalized linear mixed-effects models to identify factors associated with influenza testing and antiviral treatment.

Results: Of the 2299 hospitalized children with ARI enrolled during one influenza season, 51% (n = 1183) were tested clinically for influenza. Clinicians provided antiviral treatment for 61 of 117 (52%) patients with a positive influenza test versus 66 of 1066 (6%) with a negative or unknown test result. In multivariable analyses, factors associated with testing included neuromuscular disease (aOR = 5.35, 95% CI [3.58-8.01]), immunocompromised status (aOR = 2.88, 95% CI [1.66-5.01]), age (aOR = 0.93, 95% CI [0.91-0.96]), private only versus public only insurance (aOR = 0.78, 95% CI [0.63-0.98]), and chronic lung disease (aOR = 0.64, 95% CI [0.51-0.81]). Factors associated with antiviral treatment included neuromuscular disease (aOR = 1.86, 95% CI [1.04, 3.31]), immunocompromised state (aOR = 2.63, 95% CI [1.38, 4.99]), duration of illness (aOR = 0.92, 95% CI [0.84, 0.99]), and chronic lung disease (aOR = 0.60, 95% CI [0.38, 0.95]).

Conclusion: Approximately half of children hospitalized with influenza during the 2015-2016 influenza season were treated with antivirals. Because antiviral treatment for influenza is associated with better health outcomes, further studies of subsequent seasons would help evaluate current use of antivirals among children and better understand barriers for treatment.

Keywords: clinical testing; hospitalization; influenza; nucleic acid amplification tests (NAAT); oseltamivir; rapid influenza testing.

Publication types

Research Support, U.S. Gov't, P.H.S.
Research Support, N.I.H., Extramural

MeSH terms

Antiviral Agents / therapeutic use
Child
Child, Hospitalized
Hospitalization
Humans
Influenza, Human* / diagnosis
Influenza, Human* / drug therapy
Influenza, Human* / epidemiology
Lung Diseases*
Oseltamivir / therapeutic use

Substances

Antiviral Agents
Oseltamivir

Abstract

Publication types

MeSH terms

Substances

Grants and funding