Research Summary

Decline in Influenza Antiviral Use in Hospitalized US Children Persists After COVID-19 Pandemic

Edited by:
Kate Young

Key Highlights

  • Analysis of 1,560 US children hospitalized with laboratory-confirmed influenza showed antiviral use declined during the late pandemic compared with prepandemic years.
  • Antiviral prescribing was 23% lower in the late pandemic period (2021–23) versus prepandemic levels.
  • Higher likelihood of antiviral use was linked to underlying medical conditions, influenza vaccination, clinical testing, ICU admission, and treatment site.
  • Study underscores ongoing suboptimal implementation of influenza antiviral therapy in hospitalized pediatric patients.

A new study published in Pediatrics reports that influenza antiviral use in children hospitalized with laboratory-confirmed influenza in the United States declined during the late COVID-19 pandemic compared with prepandemic seasons, despite clinical guidelines recommending prompt antiviral treatment for all hospitalized influenza cases.

Researchers conducted active surveillance within the New Vaccine Surveillance Network across seven pediatric centers in the United States, comparing periods before the COVID-19 pandemic (December 1, 2016–March 31, 2020) with the late pandemic period (July 1, 2021–June 30, 2023). Children <18 years hospitalized within 10 days of symptom onset who tested positive for influenza by clinical or research testing were included. Mixed-effects Poisson regression compared incidence proportions of antiviral use between periods, and mixed-effects logistic regression identified factors associated with antiviral treatment during the late pandemic.

Study Findings

Among 1,560 hospitalized children with influenza, antiviral use ranged from 48.3% to 56.8% in prepandemic seasons but declined to 38.1% in the 2021–22 season and 46.1% in 2022–23. Overall antiviral use was estimated to be 23% lower in the late pandemic period compared with the prepandemic years (incidence proportion ratio, 0.77; 95% CI, 0.68–0.87). During the late pandemic, higher odds of receiving antivirals were observed among children with an underlying medical condition, current-season influenza vaccination, clinically directed influenza testing, admission to intensive care units (ICUs), and varied by hospital site.

Clinical Implications

The study findings highlight persistent underuse of influenza antivirals among hospitalized pediatric patients despite established guidelines advocating early antiviral therapy for all such cases. The observed decline in antiviral use during and after the COVID-19 pandemic suggests gaps in guideline adherence that could affect clinical outcomes, particularly for high-risk children and those with severe illness. Improving implementation of influenza antiviral treatment strategies remains a priority to ensure that hospitalized children receive evidence-based care.

Expert Commentary
“In this multicenter CDC-sponsored study of 1,560 children hospitalized with laboratory-confirmed influenza as part of the New Vaccine Surveillance Network (NVSN), we aimed to assess changes in antiviral use before and during the late COVID-19 pandemic period,” study author Olla Hamdan, Pharm, MPH, told Consultant360. “Antiviral use was estimated to be 23% lower in the late pandemic (incidence proportion ratio, 0.77; 95% CI, 0.68–0.87) compared with the pre-pandemic period, which was concerning given the continued recommendations of prompt antiviral treatment for hospitalized children with suspected or laboratory-confirmed influenza. Timely and appropriate testing and treatment for influenza and ongoing surveillance, education, and initiatives to optimize care for children hospitalized with influenza are needed.”

Reference
Hamdan O, Amarin JZ, Antoon JW, et al. Influenza antiviral use in hospitalized children before and during the covid-19 pandemic. Pediatrics. 2026;157(2):e2025071898. doi:10.1542/peds.2025-071898