Early flu antiviral treatment can shorten hospital stays in children with flu, new CDC study shows

September 1, 2021 – A new CDC study shows that early flu antiviral treatment was associated with significantly shorter hospitalizations in children with laboratory-confirmed flu and higher-risk medical conditions or children with laboratory-confirmed flu in an intensive care unit (ICU).

Compared with those not receiving flu antiviral drugs, length of stay was shorter for children who were treated within 2 days of illness onset, with antiviral treatment increasing the probability of hospital discharge by:

• 37% per day for hospitalized children with underlying medical conditions,
• and 46% per day for children in the ICU.

For children with underlying medical conditions, median length of hospital stay was 2 days for those who received early flu antiviral treatment (within 2 days of illness onset) compared to 3 days for those not treated with antivirals.

The study included 608 children hospitalized with laboratory-confirmed flu identified through the U.S. Influenza Hospitalization Surveillance Network (FluSurv-NET). The children were grouped into two cohorts:

• The first cohort included 309 children with at least one underlying medical condition not admitted to the intensive care unit (ICU).
• The second cohort included 299 children admitted to an ICU with and without underlying conditions.

The children were treated almost exclusively with oseltamivir.

Influenza causes thousands of hospitalizations and deaths every season in the United States, with children representing a substantial portion of those hospitalized with flu. Antiviral medications are an important adjunct to flu vaccine in the control of flu.

Antiviral treatment is already recommended for hospitalized patients with suspected and confirmed flu. However, evidence for this recommendation in children was previously limited. This study serves to strengthen the body of evidence behind the recommendation for early antiviral treatment in children who are hospitalized with flu.

There are four U.S. Food and Drug Administration (FDA) approved flu antiviral drugs that are recommended by CDC for use in children this flu season:

• Oseltamivir (available as a generic version or under the trade name Tamiflu®) is approved for treatment of flu in children 2 weeks old or older. Oral oseltamivir comes in the form of pills and liquid. Although not part of the FDA-approved indications, use of oral oseltamivir for treatment of flu in infants younger than 14 days old.
• Zanamivir (trade name Relenza®) is approved for treatment of flu in children 7 years and older. It is not recommended for use in children with underlying respiratory disease, including those with asthma and other chronic lung diseases.  Inhaled zanamivir is given via a special inhaler (Diskhaler®).
• Peramivir (trade name Rapivab®) is given intravenously and recommended for use in children 2 years and older.
• Baloxavir (trade name Xofluza®) is a pill that is given as a single dose by mouth and is approved for early outpatient treatment of children with flu who are aged 12 years and older.

Families of children at higher risk for serious flu complications should seek care early in the course of flu illness. Your child’s health care provider can help decide whether your child should take antiviral drugs if they become sick with flu this season. Flu signs and symptoms include fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose and muscle aches. It’s important to note that some children with flu will not have a fever.

For more information about flu antivirals and children, visit https://www.cdc.gov/flu/highrisk/children-antiviral.htm.