TOPLINE:

The rate of antiviral prescriptions in emergency departments (EDs) for children at a high risk for severe influenza decreased by more than half during the late pandemic vs pre-pandemic period, despite increased proportion of children undergoing clinical testing.

METHODOLOGY:

• Researchers conducted a cross-sectional study across seven US academic pediatric hospitals of the CDC’s New Vaccine Surveillance Network to assess trends in antiviral prescriptions for children at a high risk for severe influenza before the COVID pandemic (2016-2020) vs during the late pandemic period (2021-2023).
• Of 3378 children who tested positive for influenza (median age, 3.9 years; 53.2% boys), 2514 had a high risk for severe influenza, including 583 in the late pandemic period and 1931 in the pre-pandemic period, defined as being younger than 5 years or having respiratory, cardiovascular, renal, hepatic, hematologic, metabolic, or neurologic conditions or immunosuppression.
• Changes in the rate of antiviral prescriptions among high-risk children and associated factors were determined.

TAKEAWAY:

• The rate of antiviral prescriptions declined from 32.2% in the pre-pandemic period to 15.6% in the late pandemic period, representing a 53% relative drop.
• In the late pandemic period, children who were tested and seen within 2 days of symptom onset had much higher odds of receiving antivirals than those not tested (adjusted odds ratio [aOR], 17.20; 95% CI, 4.08-72.37) and those seen after 2 days of symptom onset (aOR, 4.08; 95% CI, 2.49-6.71).
• Clinical testing for influenza among high-risk children increased substantially during the late pandemic period compared with the pre-pandemic period.
• The odds of being prescribed antivirals were significantly lower in the late pandemic period than in the pre-pandemic period (aOR, 0.17; 95% CI, 0.12-0.24).

IN PRACTICE:

“These findings highlight that antiviral prescription management in the ED is lacking. Understanding reasons behind these trends is important to protect especially vulnerable pediatric patients from avoidable influenza morbidity,” the authors wrote.

“[The] discrepancy between testing and treatment underscores the need to promote guideline-concordant antiviral prescribing, since timely initiation of treatment has been shown to reduce the severity and duration of influenza illness, thus lowering the risk of complications and hospitalization,” they added.

SOURCE:

The study was led by Tess Stopczynski, MS, Vanderbilt University Medical Center, Nashville, Tennessee. It was published online on October 22, 2025, in JAMA Network Open.

LIMITATIONS:

The authors did not examine data on prescription fills or caregiver acceptance. Some sites had restrictions on age (< 5 years) and symptom duration (< 10 days of illness), and potential unmeasured confounders could have included pandemic misinformation, workload in the ED, medication costs, and parental concerns about adverse effects.

DISCLOSURES:

This study was supported by the cooperative agreement IP16-004 with the CDC. Several authors reported receiving personal fees, grants, and travel support from and serving on advisory boards of various pharmaceutical companies, institutions, and universities.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.