A concerning trend emerged during the COVID-19 pandemic: the rate at which children at high risk of severe influenza received antiviral medications dropped significantly. Despite existing treatment guidelines remaining unchanged, the prescribing of these crucial drugs plummeted, raising serious questions about pediatric care.
This drop-off in antiviral prescriptions is a significant finding. A study published in JAMA Network Open revealed that in emergency departments (EDs), the prescription rate for children at risk of severe influenza decreased by half in the three years following the start of the COVID-19 pandemic.
Specifically, the study, led by Dr. Tess Stopczynski from Vanderbilt University Medical Center, found that only 15.6% of at-risk children received antivirals in EDs between 2021 and 2023. This is a stark contrast to the 32.2% rate observed in the pre-pandemic period of 2016-2020.
But here's where it gets controversial... the guidelines for treating influenza in these vulnerable children—those with underlying conditions like respiratory, cardiovascular, or neurological issues, or those under five years old—remained the same. The American Academy of Pediatrics (AAP), the Infectious Diseases Society of America (IDSA), and the CDC all recommend antiviral treatment as soon as possible for suspected or confirmed influenza in these cases.
The study analyzed data from 2,514 high-risk children out of 3,378 influenza-positive children seen in the EDs of seven U.S. pediatric academic hospitals participating in the CDC's New Vaccine Surveillance Network. These children had experienced acute respiratory illnesses (ARIs) for less than 14 days and presented with a fever and/or at least one other ARI symptom. The researchers examined medical records to determine if antivirals (oseltamivir, zanamivir, baloxavir, and/or peramivir) were prescribed, either administered in the ED or prescribed upon discharge. They also considered factors like the timing of symptoms, whether influenza testing was performed, and if it was peak flu season.
The research team reported a 53% relative decrease in antiviral prescriptions for this at-risk group during the late pandemic period. Interestingly, while treatment decreased, clinical testing for influenza actually increased. The investigators suggest this could be due to increased awareness of respiratory infections and the need to differentiate between influenza and COVID-19.
And this is the part most people miss... Dr. Stopczynski highlighted that clinicians may have prioritized identifying the specific cause of illness over immediately starting antiviral treatment. If SARS-CoV-2 or another virus was suspected, influenza-specific antivirals might not have been prescribed. Additionally, delays in receiving test results could have hindered timely treatment decisions.
The study also pointed out other potential factors contributing to the decline in antiviral prescriptions, including varying perceptions of antiviral effectiveness and potential side effects, differences in how influenza tests are interpreted, and misunderstandings of the treatment guidelines.
To bridge the gap between testing and treatment, Dr. Stopczynski emphasized the need for early testing and rapid availability of results to guide treatment decisions. She also stressed the importance of ensuring that recommended antivirals are both accessible and affordable.
What do you think? Were you surprised by this drop in antiviral prescriptions? Do you think the increased focus on differentiating between influenza and COVID-19 was justified, or did it come at the expense of timely treatment for some children? Share your thoughts in the comments below!
