Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Influenza Other Respir Viruses. 2022 Mar;16(2):289-297. doi: 10.1111/irv.12927. Epub 2021 Oct 26.
Antiviral treatment is recommended for all hospitalized children with suspected or confirmed influenza, regardless of their risk profile. Few data exist on adherence to these recommendations, so we sought to determine factors associated with influenza testing and antiviral treatment in children.
Hospitalized children <18 years of age with acute respiratory illness (ARI) were enrolled through active surveillance at pediatric medical centers in seven cities between 11/1/2015 and 6/30/2016; clinical information was obtained from parent interview and chart review. We used generalized linear mixed-effects models to identify factors associated with influenza testing and antiviral treatment.
Of the 2299 hospitalized children with ARI enrolled during one influenza season, 51% (n = 1183) were tested clinically for influenza. Clinicians provided antiviral treatment for 61 of 117 (52%) patients with a positive influenza test versus 66 of 1066 (6%) with a negative or unknown test result. In multivariable analyses, factors associated with testing included neuromuscular disease (aOR = 5.35, 95% CI [3.58-8.01]), immunocompromised status (aOR = 2.88, 95% CI [1.66-5.01]), age (aOR = 0.93, 95% CI [0.91-0.96]), private only versus public only insurance (aOR = 0.78, 95% CI [0.63-0.98]), and chronic lung disease (aOR = 0.64, 95% CI [0.51-0.81]). Factors associated with antiviral treatment included neuromuscular disease (aOR = 1.86, 95% CI [1.04, 3.31]), immunocompromised state (aOR = 2.63, 95% CI [1.38, 4.99]), duration of illness (aOR = 0.92, 95% CI [0.84, 0.99]), and chronic lung disease (aOR = 0.60, 95% CI [0.38, 0.95]).
Approximately half of children hospitalized with influenza during the 2015-2016 influenza season were treated with antivirals. Because antiviral treatment for influenza is associated with better health outcomes, further studies of subsequent seasons would help evaluate current use of antivirals among children and better understand barriers for treatment.
建议对所有疑似或确诊流感的住院患儿进行抗病毒治疗，无论其风险状况如何。关于这些建议的遵循情况的数据很少，因此我们试图确定与儿童流感检测和抗病毒治疗相关的因素。
在 2015 年 11 月 1 日至 2016 年 6 月 30 日期间，通过在七个城市的儿科医疗中心进行主动监测，对<18 岁的因急性呼吸道疾病（ARI）住院的患儿进行了研究；通过父母访谈和病历回顾获得临床信息。我们使用广义线性混合效应模型来确定与流感检测和抗病毒治疗相关的因素。
在一个流感季节中，对 2299 名因 ARI 住院的患儿进行了研究，其中 51%（n=1183）接受了临床流感检测。临床医生对 117 例流感检测阳性患者中的 61 例（52%）给予了抗病毒治疗，而对 1066 例流感检测阴性或未知结果患者中的 66 例（6%）给予了治疗。在多变量分析中，与检测相关的因素包括神经肌肉疾病（aOR=5.35，95%CI[3.58-8.01]）、免疫功能低下状态（aOR=2.88，95%CI[1.66-5.01]）、年龄（aOR=0.93，95%CI[0.91-0.96]）、私人保险与仅公共保险（aOR=0.78，95%CI[0.63-0.98]）和慢性肺病（aOR=0.64，95%CI[0.51-0.81]）。与抗病毒治疗相关的因素包括神经肌肉疾病（aOR=1.86，95%CI[1.04-3.31]）、免疫功能低下状态（aOR=2.63，95%CI[1.38-4.99]）、疾病持续时间（aOR=0.92，95%CI[0.84-0.99]）和慢性肺病（aOR=0.60，95%CI[0.38-0.95]）。
在 2015-2016 流感季节期间，约有一半因流感住院的患儿接受了抗病毒治疗。由于抗病毒治疗流感可改善健康结局，因此对后续季节的进一步研究将有助于评估目前儿童使用抗病毒药物的情况，并更好地了解治疗障碍。
