(183) Prevalence and Factors Associated with Guideline Concordant Antiviral Treatment in Children at High Risk for Influenza Complications

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1228

Presenting Author(s)

James W. Antoon, MPH, MD, PhD
– Assistant Professor of Pediatrics, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Co-Author(s)

Matthew Hall, PhD
– Children's Hospital Association, United States
James Feinstein, MD MPH
– Associate Professor of Pediatrics, University of Colorado, Aurora, United States
Kathryn Kyler, MD, MS
– Children's Mercy Kansas City, United States
Samir Shah, MD, MSCE, MHM
– Cincinnati Children's Hospital, United States
Sonya Tang Girdwood, MD, PhD
– Assistant Professor of Pediatrics, Cincinnati Children's Hospital Medical Center, United States
Jennifer Goldman, MD, PhD
– Mercy Children's Hospital, United States
Carlos Grijalva, MD, MPH
– Professor, Health Policy, Vanderbilt University Medical Center, TN, United States
Derek Williams, MD, MPH
– Associate Professor, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States

Background: The American Academy of Pediatrics (AAP) and Centers for Disease Control (CDC) recommends offering antiviral treatment to children with influenza at high risk for complications regardless of symptom duration. Little is known about concordance with this recommendation within this vulnerable population.

Objectives: To determine prevalence and factors associated with antiviral treatment in children with influenza who are at high risk for complications

Methods: We performed a cross-sectional study of outpatient children (1-18 years) with an ICD-10 diagnosis of influenza at high risk for complications during the 2016-2017 - 2018-2019 influenza seasons using the Truven Medicaid database. High-risk status as defined by the CDC included: age < 5 years, ICD-10 diagnoses consistent with asthma, children with any complex chronic condition including immunosuppression, pregnancy or post-partum state, living in a chronic care facility, or a high-intensity neurologic co-morbidity.. The primary outcome was prevalence of AAP/CDC guideline concordant antiviral treatment, defined as a pharmacy dispensing claim for oseltamivir, zanamivir, peramivir, or baloxavir within two days of influenza diagnosis. We determined patient and provider level factors associated with guideline concordant treatment using multivariable logistic regression.

Results: A total of 363,490 high-risk children with influenza were included. The prevalence of guideline concordant treatment was 58.4% (n = 212,155). Oseltamivir accounted for nearly all antiviral prescriptions (n = 212,142, 99.9%). Prevalence of concordant treatment varied by influenza season, ranging from 51.7-62.9%. Hispanic ethnicity (aOR 1.48, 95% CI 1.44, 1.52), non-Hispanic Black race (aOR 1.08, 95% CI 1.06, 1.10), concurrent asthma diagnosis (aOR 1.13, 95% CI 1.11, 1.15), immunosuppression (aOR 1.11, 95% CI 1.05, 1.16), and urgent care location (aOR 1.48, 95% CI 1.44, 1.52), were associated with a higher adjusted odds of guideline concordant treatment. Age < 5 (aOR 1.48, 95% CI 1.44, 1.52), living in a chronic care facility (aOR 0.62, 95% CI 0.46, 0.83), being evaluated in an emergency department (aOR 0.64, 95% CI 0.63, 0.65), and diagnosis of a concurrent lower respiratory infection (aOR 0.69, 95% CI 0.66, 0.73) were associated with a lower adjusted odds of guideline concordant treatment.

Conclusions: Among children with influenza and at high risk for complications, 42% did not receive antiviral treatment. Antiviral treatment varied according to a number of patient- and provider-level factors. Further study is needed to elucidate the role of provider and parent.