Influenza Antiviral Use in Hospitalized Children Before and During the COVID-19 Pandemic.
Document Type
Article
Publication Date
2-1-2026
Identifier
DOI: 10.1542/peds.2025-071898
Abstract
OBJECTIVE: The COVID-19 pandemic may have affected the care of patients with influenza. We investigated influenza antiviral use and associated factors in children hospitalized with influenza before and during the late COVID-19 pandemic.
METHODS: We conducted active surveillance among US children with acute respiratory illness at 7 sites in the New Vaccine Surveillance Network before the COVID-19 pandemic (December 1, 2016 to March 31, 2020) and during the late pandemic period (July 1, 2021 to June 30, 2023). We included children hospitalized within 10 days of symptom onset who had positive test results for influenza by clinical or research testing. Research swabs were collected from all enrolled children; clinical testing was provider-directed. We used mixed-effects Poisson regression to compare incidence proportions of influenza antiviral use in the late pandemic with those of the prepandemic period. We determined factors associated with antiviral use during the late pandemic period using a mixed-effects logistic regression model.
RESULTS: Among 1560 children hospitalized with influenza, antiviral use ranged between 48.3% and 56.8% prepandemic but declined to 38.1% in 2021 to 2022 and 46.1% in 2022 to 2023. The estimated antiviral use was 23% lower in the late pandemic (incidence proportion ratio, 0.77; 95% CI, 0.68-0.87) compared with the prepandemic period. During the late pandemic, factors associated with higher odds of antiviral use included an underlying medical condition presence, current season influenza vaccination, clinical influenza testing, intensive care unit admission, and site.
CONCLUSIONS: Influenza antiviral use in children hospitalized with influenza remained suboptimal following the COVID-19 pandemic. Our study highlights the need to improve antiviral use in children hospitalized with influenza.
Journal Title
Pediatrics
Volume
157
Issue
2
MeSH Keywords
Humans; Influenza, Human; Antiviral Agents; Child; COVID-19; Male; Female; Child, Preschool; Infant; Hospitalization; Adolescent; United States; Pandemics; Child, Hospitalized
PubMed ID
41529813
Keywords
Human Influenza; Antiviral Agents; COVID-19; Hospitalization; United States; Pandemics; Hospitalized Child
Recommended Citation
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
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