586 - Prevalence and Factors Associated with Guideline Concordant Antiviral Treatment in Children at High Risk for Influenza Complications

Poster Number: 586
Publication Number: 586.417

James W. Antoon, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Matthew Hall, Children's Hospital Association, Lenexa, Kansas, KS, United States; James A. Feinstein, University of Colorado, Aurora, CO, United States; Kathryn Kyler, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Samir S. Shah, Journal of Hospital Medicine, Cincinnati, OH, United States; Sonya Tang Girdwood, Cincinnati Children's Hospital Medical Center, Fort Thomas, KY, United States; Jennifer Goldman, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Carlos Grijalva, Vanderbilt University Medical Center, Nashville, TN, United States; Derek Williams, Vanderbilt, 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.

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

Design/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. Those with influenza diagnoses within the prior 30 days were excluded. 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 (Table 1). 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, non-Hispanic Black race, certain high-risk co-morbidities, and urgent care location were associated with a higher adjusted odds of guideline concordant treatment (Table 2).  Age < 5, living in a chronic care facility, being evaluated in an emergency department, and diagnosis of a concurrent lower respiratory infection were associated with a lower adjusted odds of guideline concordant treatment.Conclusion(s): 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 perceptions and preferences and other determinants to improve appropriate use of antivirals in this vulnerable population.
Table 1. Cohort Demographic and Clinical Characteristics
Table 2. Adjusted Odds of Receiving Guideline Concordant Antiviral Treatment