Work

Influenza Antiviral Use Among High-Risk Outpatients During Four Recent Influenza Seasons—United States, 2011–2015

Year: 2016

Type: article

Abstract: Background. Influenza is a contagious respiratory illness that results in 115,000–630,000 hospitalizations in the US annually. Early antiviral treatment can reduce the risk of complications, including hospitalization and death, and is recommended by CDC for all outpatients at increased risk of influenza-associated complications due to age or comorbidities. However, previous studies suggest that antiviral prescribing is low. We examined four recent influenza seasons to assess the frequency of influenza antiviral prescriptions among high-risk outpatients and to determine which characteristics predict receipt of an antiviral medication. Methods. We analyzed antiviral prescription data for outpatients aged ≥6 months who presented with respiratory illness of ≤7 days duration and were enrolled in the US Influenza Vaccine Effectiveness Network in five states during the 2011–12 to 2014–15 influenza seasons. We obtained clinical information from interviews and medical record extraction. All patients had respiratory specimens that were tested for influenza by RT-PCR. We used multivariable logistic regression to identify predictors of antiviral prescribing. Early presentation was defined as presenting to care within 2 days of symptom onset. Results. During four seasons, 898 (7%) of 12,194 high-risk outpatients were prescribed antiviral medications, including 4% of those aged ≤2 years, 9% aged ≥65 years, 8% with ≥1 underlying medical condition, and 16% of pregnant women. Among 3794 high-risk outpatients who presented early, 593 (16%) were prescribed antivirals. Of those, 1083 had PCR-confirmed influenza infection and 399 (37%) were prescribed antiviral treatment. Early presentation to care was significantly associatedwith receipt of an antiviral prescription (OR = 8.26, CI: 6.4–10.7), as was testing positive for influenza (OR = 4.79, CI: 4.1–5.6) and the presence of an underlying medical condition (OR = 1.32, CI: 1.1–1.7) among other factors. Conclusion. In this multi-state study, influenza antiviral medications were consistently under-prescribed for high-risk outpatients. Further efforts are needed to better understand barriers to antiviral prescribing and to improve use in order to reduce influenza-associated complications. Disclosures. M. Gaglani, Centers for Disease Control and Prevention: Investigator, Grant recipient. MedImmune/AstraZeneca: Investigator, Grant recipient. Novartis: Investigator, Grant recipient; R. K. Zimmerman, Sanofi Pasteur: Investigator, Grant recipient Pfizer: Investigator, Grant recipient. Merck: Investigator, Grant recipient; L. A. Jackson, Inviragen: Investigator, Research support. Pfizer: Investigator, Research support and travel support. Novartis: Investigator, Research support. Sanofi: Investigator, Research support; J. G. Petrie, Centers for Disease Control and Prevention: Investigator, Grant recipient; H. Q. McLean, Novavax Inc.: Investigator, Research support. Medimmune, LLC.: Investigator, Research support. Centers for Disease Control and Prevention: Investigator, Research support; A. S. Monto, Sanofi Pasteur: Consultant and Grant Investigator, Consulting fee and Grant recipient. GSK: Consultant, Consulting fee. Novavax: Consultant, Consulting fee. Novartis: Consultant, Consulting fee. Centers for Disease Control and Prevention: Investigator, Research support. Roche: Consultant, Consulting fee. Biocryst: Consultant, Consulting fee; E. Belongia, MedImmune: Investigator, Research support. Novavax: Investigator, Research support. Centers for Disease Control and Prevention: Investigator, Research support

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw194.135