537. Antiviral Treatment among Hospitalized Children and Adults with Laboratory-Confirmed Influenza, 2010-2014 Seasons
Session: Poster Abstract Session: Respiratory Viruses
Thursday, October 8, 2015
Room: Poster Hall

Background: Prompt antiviral therapy is recommended for hospitalized patients with suspected or confirmed influenza. Although use of antivirals during the 2009 influenza A (H1N1) pandemic was common, significant declines in antiviral use occurred during the 2010–2011 influenza season. Children <1 year old, a group at high risk for developing influenza-associated complications, were least often treated even though treatment for children aged <1 year was recommended by the CDC and American Academy of Pediatrics. In December 2012, the FDA expanded the approved use of oseltamivir to treat children younger than 1 year (and ≥2 weeks of age).  Data regarding antiviral use post-pandemic are limited.


Methods: The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance of patients hospitalized with laboratory-confirmed influenza. We evaluated patterns of antiviral treatment by age group (<1, 1, 2-4, 5-17, 18-64, and ≥ 65 years) and season (October 1 through April 30), from 2010-2014 using the Cochrane-Armitage test for trend.

Results: Of 30,600 patients, 24,358 (80%) received antiviral treatment over the four seasons: 72% in 2010-11, 73% in 2011-12, 81% in 2012-13, and 85% in 2013-14 (p-value for trend <0.0001). The proportion of patients treated with antivirals increased steadily across all age groups (p-value for trend <0.0001), except for age group 2 to 4 years, where treatment initially declined in the 2011-12 season (Figure 1). From the 2010-11 to 2013-14 season, children under 1 year had the greatest increase in antiviral treatment, from 51% to 82%. Treatment among adults remained above 70% across all four seasons. For all seasons, over 75% of treatment was initiated within one day of admission.

Conclusion: Antiviral use among all hospitalized patients with laboratory-confirmed influenza increased since the 2010-11 influenza season.  Antiviral use increased the most among children aged <1 year. Overall, 20% of hospitalized patients with lab-confirmed influenza were not treated and >20% had a ≥1 day delay in initiation of antiviral therapy. Additional strategies are needed to understand barriers to influenza antiviral treatment and increase antiviral therapy among hospitalized patients with influenza.


Grace D. Appiah, MD, MS1, Sandra S. Chaves, MD, MSc1, Pam Daily Kirley, MPH2, Lisa Miller, MD, MSPH3, James I. Meek, MPH4, Evan J. Anderson, MD5, Patricia Ryan, MS6, Seth Eckel, MPH7, Ruth Lynfield, MD, FIDSA8, Marisa Bargsten, MPH9, Shelley M. Zansky, PhD10, Nancy Bennett, MD, MS11, Krista Lung, BS12, Ann Thomas, MD, MPH13, Mary Lou Lindegren, MD, MPH14, Gregg M. Reed, MPH15, Alicia M. Fry, MD, MPH1 and Angela P. Campbell, MD, MPH, FPIDS1, (1)Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, (2)California Emerging Infections Program, Oakland, CA, (3)Colorado Department of Public Health and Environment, Denver, CO, (4)Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, (5)Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, (6)Maryland Emerging Infection Program, Baltimore, MD, (7)Communicable Disease Division, Michigan Department of Health and Human Services, Lansing, MI, (8)Minnesota Department of Health, St. Paul, MN, (9)New Mexico Department of Health, Santa Fe, NM, (10)New York State Department of Health, Albany, NY, (11)University of Rochester Medical Center, Rochester, NY, (12)Bureau of Infectious Diseases, Ohio Department of Health, Columbus, OH, (13)Emerging Infections Program Network, CDC, Portland, OR, (14)Vanderbilt University School of Medicine, Nashville, TN, (15)Bureau of Epidemiology, Utah Department of Health, Salt Lake City, UT


G. D. Appiah, None

S. S. Chaves, None

P. Daily Kirley, None

L. Miller, None

J. I. Meek, None

E. J. Anderson, Abbvie: Consultant , Consulting fee
MedImmune: Editorial assistance , Assistance in writing a manuscript
Roche: Editorial assistance , Assistance in writing a manuscript

P. Ryan, None

S. Eckel, None

R. Lynfield, None

M. Bargsten, None

S. M. Zansky, None

N. Bennett, None

K. Lung, None

A. Thomas, None

M. L. Lindegren, None

G. M. Reed, None

A. M. Fry, None

A. P. Campbell, None

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