Effectiveness of Oseltamivir in Hospitalized Children With Laboratory-Confirmed Influenza, 2014-2023.
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Rytlewski Kacie, Dunn Angela, O'Halloran Alissa, Habeck Jennifer, Armistead Isaac, Alden Nisha B, Sachdev Darpun, Daily Kirley Pam, Meek James, Yousey-Hindes Kimberly, Kamidani Satoshi, Openo Kyle P, Ryan Patricia A, Monroe Maya, Kim Sue, Urlaub Elizabeth, Lynfield Ruth, McMahon Melissa, Smelser Chad B, Shaw Yomei, Barney Grant, Rowlands Jemma V, Tesini Brenda, Felsen Christina, Lung Krista, Sutton Melissa, Thomas Ann, Talbot H Keipp, Schaffner William, George Andrea, Staten Holly, Cataldi Jessica R, Dominguez Samuel R, Bozio Catherine H, Rao Suchitra
Аннотация
OBJECTIVE: To assess the association between oseltamivir receipt and intensive care unit (ICU) admission and hospital length of stay (LOS) among pediatric influenza-associated hospitalizations.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data that were obtained from the Influenza Hospitalization Surveillance Network (FluSurv-NET), which conducts US population-based surveillance for laboratory-confirmed influenza hospitalizations for all ages across 13 states. The study data include seasons 2014 to 2015 through 2022 to 2023, excluding 2020 to 2021. Participants included children aged younger than 18 years who were hospitalized with laboratory-confirmed influenza and for whom a respiratory symptom onset date was available. These data were analyzed from October 2024 through May 2026.
EXPOSURES: Oseltamivir receipt as a time-dependent exposure.
MAIN OUTCOME(S) AND MEASURE(S): The primary outcome was time from symptom onset to ICU admission. Secondary outcome was time from admission to discharge (LOS). Adjusted Cox proportional hazard models (aHR) with oseltamivir receipt as a time-dependent exposure were used.
RESULTS: After exclusions, 6044 influenza cases were included in the primary ICU analysis, of whom 4240 (70.2%) received oseltamivir, and 7103 cases were included in the secondary LOS analysis, of whom 5746 (80.9%) received oseltamivir. In the ICU analysis, the median (IQR) age was 3 (1-7) years, 3382 (56%) were male and 3721 (44%) were female, and 2937 (49%) had 1 or more medical comorbidity-the most common of which was asthma in 1547 children (26%). In adjusted models, compared with untreated children, oseltamivir treatment reduced the hazard of ICU admission (aHR, 0.69; 95% CI, 0.60-0.80) and shortened LOS (analyzed as hazard of hospital discharge; aHR, 1.13; 95% CI, 1.06-1.21).
CONCLUSIONS AND RELEVANCE: In this cohort of children hospitalized with influenza, oseltamivir treatment was significantly associated with a reduced risk of ICU admission by 31% and decreased hospital LOS. These findings demonstrate the benefits of oseltamivir receipt and support current national recommendations for oseltamivir treatment as soon as possible in children hospitalized with suspected or laboratory-confirmed influenza.