Early
antiviral
therapy
at
home
for
kids
with
influenza
lowered
the
risk
of
related
hospitalization,
a
retrospective
case-control
study
from
Taiwan
indicated.

Among
1,492
children,
receiving
antiviral
therapy
within
48
hours
of
symptom
onset
was
associated
with
an
81%
lower
risk
of
hospitalization
(adjusted
OR
0.19,
95%
CI
0.14-0.27),
reported
Chi-Tai
Fang,
MD,
PhD,
of
National
Taiwan
University
in
Taipei,
and
colleagues

in

Pediatrics.

The
protective
association
appeared
similar
among
children
5
years
and
younger
(aOR
0.19,
95%
CI
0.12-0.31)
—
an
especially
vulnerable
group
—
and
older
kids
(aOR
0.15,
95%
CI
0.09-0.25).

Hospitalizations
from
influenza

remain
a
significant
burden
globally
and
in
the
U.S.,
Fang
and
colleagues
noted.

The
World
Health
Organization
and
the
Infectious
Diseases
Society
of
America
(IDSA)
recommend
early
administration
of
antivirals
after
illness
onset
for
both
severe
and
nonsevere
cases
of
confirmed
or
suspected
influenza
in
community
settings
based
on
efficacy
in
shortening
symptom
duration
and
preventing
influenza
complications,
such
as
otitis
media.
However,
“evidence
on
the
effectiveness
of
early
antiviral
therapy
in
preventing
influenza-related
severe
illnesses
in
young
children
is
scarce,”
Fang
and
colleagues
noted.

Indeed,
a

recent
nationwide
survey
of
U.S.
clinicians
suggested
that
fewer
than
half
of
respondents
would
prescribe
the
antiviral
oseltamivir
(Tamiflu)
for
children
with
influenza
in
the
outpatient
setting,
“highlighting
substantial
uncertainty
regarding
its
effectiveness
in
pediatric
outpatients,”
according
to
the
researchers.

“Early
antiviral
therapy
should
not
be
used
in
lieu
of
vaccination
but
rather
as
a
supplement
to
vaccination,
particularly
in
children
younger
than
6
months
who
are
not
eligible
for
influenza
vaccination,”
Fang
and
co-authors
emphasized.

“With
greater
public
hesitancy
regarding
vaccines,

declining
seasonal
influenza
vaccination
rates,
and
recent
influenza
seasons
with
record
pediatric
deaths
and
hospitalizations,
providers
should
strongly
consider
the
use
of
antivirals
in
high-risk
and
hospitalized
patients,”
wrote
James
Antoon,
MD,
PhD,
MPH,
and
Kathryn
Edwards,
MD,
both
of
Vanderbilt
University
Medical
Center
in
Nashville,
Tennessee,
in
an

accompanying
editorial.

Beyond
hospitalization,
“benefits
of
antivirals
also
include

reduced
household
transmission
of
influenza,

decreased
influenza
complications,
and
faster
return
to
school
for
patients
and
work
for
parents,”
they
noted.

“The
CDC,
[American
Academy
of
Pediatrics],
IDSA,
and
influenza
experts
all
recommend
prompt
antiviral
treatment
of
influenza
as
soon
as
possible
after
symptom
onset
in
persons
who
are
at
increased
risk
of
influenza
complications,
including
children
aged
under
2
years
and
those
with
high-risk
comorbidities,”
Antoon
and
Edwards
further
emphasized.
“The
time
has
come
for
antivirals
to
be
used
in
children
with
influenza.”

The
study
from
Fang
and
co-authors
analyzed
all
pediatric
outpatients
with
laboratory-confirmed
influenza
who
sought
care
at
a
hospital
system
in
northern
Taiwan
—
the
“major
providers
of
primary
pediatric
care
in
the
region”
—
from
2020
through
2023.

Overall,
there
were
354
hospitalized
cases
and
1,138
non-hospitalized
controls
with
influenza.
The
mean
age
of
study
participants
was
7.1
years,
just
shy
of
44%
were
girls,
and
most
(about
87%)
were
infected
with
influenza
A.
No
deaths
occurred
among
study
participants.

Of
the
nearly
1,500
children
included
in
the
study,
80.8%
received
early
antiviral
therapy,
18%
received
late
antiviral
therapy,
and
1.1%
did
not
receive
antiviral
therapy.

Compared
with
children
who
received
late
or
no
antiviral
therapy,
those
who
received
early
antiviral
therapy
had
significantly
lower
rates
of
hospitalization
(16.1%
vs
55.9%,

P<0.001)
and
severe
illness
(0.7%
vs
3.1%,

P<0.01).

Stratified
analyses
comparing
the
effectiveness
of
early
oseltamivir
and
zanamivir
(Relenza)
therapy
in
preventing
hospitalization
showed
consistent
results
across
both
antivirals,
Fang
and
colleagues
found.
Additionally,
the
estimated
effect
of
early
antiviral
therapy
in
preventing
influenza-related
hospitalization
“remained
robust
(80%-82%)
across
sensitivity
analyses
comparing
early
vs
late
antiviral
administration,”
they
reported.

Limitations
included
that
the
observational
nature
of
the
study
made
it
subject
to
confounding,
and
that
the
study
was
hospital-based
rather
than
population-based,
potentially
limiting
generalizability,
Fang
and
colleagues
noted.

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