1511 - Influenza antiviral use in patients hospitalized with laboratory-confirmed influenza in the United States, FluSurv-NET, 2015 – 2019

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Presenting Author(s)

MT

Mark W. Tenforde

Epidemic Intelligence Service Officer
US Centers for Disease Control and Prevention
Decatur, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

CC

Charisse N. Cummings

Epidemiologist
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MS

Melissa Sutton

Medical Director Respiratory Viral Pathogens
Oregon Health Authority
Portland, Oregon
Disclosure: CDC funding (Emerging Infections Program) (Grant/Research Support)
SK

Sue Kim

Epidemiologist
Michigan Department of Health and Human Services
Lansing, Michigan
Disclosure: Council of State and Territorial Epidemiologists (CSTE) (Grant/Research Support)
AM

Amber Maslar

Epidemiologist
Yale Emerging Infections Program
New Haven, Connecticut
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
NA

Nisha B. Alden

Respiratory and Invasive Bacterial Disease Program Manager
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: CDC (Grant/Research Support)
NS

Nancy L. Spina

Public Health Representative
New York State Department of Health
Albany, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AP

Andrea Price

Epidemiologist
Salt Lake County Health Department
SLC, Utah
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MM

Maya Monroe

Epidemiologist-Respiratory Program Administrator
Maryland Department of Health
Baltimore, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GR

Gretchen Rothrock

Associate Director
California Emerging Infections Program
Oakland, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MM

Melissa McMahon

Surveillance Officer
Minnesota Department of Health
St. Paul, Minnesota
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
HT

Helen Talbot

Associate Professor
Vanderbuilt University
Nashville, Tennessee
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KO

Kyle P. Openo

Viral Respiratory Surveillance Coordinator
Georgia Emerging Infections Program and Atlanta VA Medical Center
Decatur, GA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CM

Chelsea L. McMullen

Respiratory Disease Surveillance Coordinator
New Mexico Department of Health
Santa Fe, New Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LB

Laurie M. Billing

Epidemiologist
Ohio Department of Health
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Shikha Garg

Medical Officer
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Antiviral therapy is recommended for all patients hospitalized with influenza to reduce morbidity and mortality. We used data from the population-based Influenza Hospitalization Surveillance Network (FluSurv-NET) to evaluate trends in influenza antiviral use in patients hospitalized with influenza over 4 seasons in the United States.

Methods: We included cases residing within the FluSurv-NET catchment area and hospitalized with laboratory-confirmed influenza from October 1 – April 30 during 2015-16 through 2018-19 seasons. For 2015-16 and 2016-17, chart abstraction of demographic and clinical characteristics and antiviral use was performed on all cases; for 2017-18 and 2018-19, all patients < 50-years and an age-stratified random sample of older adults were sampled. Data were weighted to reflect the probability of selection. We assessed the frequency of treatment, by season and age group, and evaluated trends by season using the Cochran-Armitage test. Among those receiving antivirals, we used multivariable logistic regression to assess the association between the days from symptom onset to admission and receipt of early (0-2 days from symptom onset) versus late ( > 2 days) treatment, adjusting for age, sex, race/ethnicity, and underlying medical conditions.

Results: Over 4 seasons, we sampled 62,182 patients; 54% female and 63% non-Hispanic white. Overall, 92% of patients received antivirals, increasing from 86% in 2015-16 to 94% in 2018-19; use increased by season in all age strata (p < 0.001) [Figure]. Most received oseltamivir (99%); in 2018-19, 2% received baloxavir. Of those who received antivirals, 38% received early treatment. The median days from symptom onset to admission was 1 day (interquartile range [IQR] 1-3) for those who received early treatment and 4 days (IQR 3-6) for those who received late treatment. Ninety-three percent who received antivirals started within 1 day of admission. For each additional day from symptom onset to admission, the adjusted odds of late treatment was 8.56 (95% confidence interval: 7.83-9.35). Figure. Weighted percentage of hospitalized patients receiving influenza antivirals by influenza season and age strata, FluSurv-NET, 2015-16 through 2018-19.

Conclusion: In patients hospitalized with influenza, most received antiviral treatment within 1 day of admission. However, a majority had delays from symptoms onset to initiation, due to late presentation of illness.