Early antiviral therapy linked to 81% lower influenza hospitalization risk in children

Early antiviral treatment of influenza was associated with a substantially lower risk of hospitalization among pediatric outpatients, according to findings from a multicenter study published in Pediatrics. Children who began antiviral therapy within 48 hours of symptom onset had an 81% lower adjusted risk of influenza-related hospitalization compared with those who received delayed or no antiviral treatment.¹

The findings address limited evidence regarding whether early antiviral treatment can prevent severe influenza outcomes in children. Previous randomized trials have shown that prompt oseltamivir treatment can shorten influenza illness by approximately 30 hours and reduce acute otitis media among children aged 1 to 5 years, but data on hospitalization have remained limited.^2-4

“Early antiviral therapy initiated within 48 hours of symptom onset was associated with an 81% reduction in influenza-related hospitalization among pediatric outpatients, including those aged 5 years old or younger,” the investigators stated.

Study evaluates nearly 1500 children with influenza

Investigators conducted a retrospective, age- and influenza season–matched case-control study within a hospital system in northern Taiwan. The analysis included children younger than 18 years with laboratory-confirmed influenza diagnosed between January 2020 and October 2023.

Overall, 1492 children were included, consisting of 354 hospitalized patients and 1138 nonhospitalized controls. Mean age was 7.1 years, and 86.7% of participants had influenza A. Cases and controls were matched according to the year and month of the initial visit and age group.

Early antiviral therapy was defined as treatment initiated within 48 hours of symptom onset. The primary outcome was influenza-related hospitalization or death within 14 days of symptom onset. Investigators adjusted analyses for factors including age, sex, comorbidities, early antibiotic and corticosteroid use, coinfections, influenza vaccination status, and previous health care use.

Early treatment associated with lower hospitalization risk

Early antiviral therapy was associated with an 81% lower risk of hospitalization overall (adjusted odds ratio [aOR], 0.19; 95% CI, 0.14-0.27). The association remained among children aged 5 years or younger, who had an 81% lower risk (aOR, 0.19; 95% CI, 0.12-0.31). Children older than 5 years had an 85% lower risk (aOR, 0.15; 95% CI, 0.09-0.25).

Among the 1492 children, 1206 received antiviral treatment within 48 hours. The study reported lower rates of severe influenza-related illness among children receiving early treatment compared with those receiving late or no treatment. No deaths occurred during the study. Sensitivity analyses showed estimated reductions in hospitalization of 80% to 82%, including analyses excluding the COVID-19 period and patients treated with intravenous peramivir.

The investigators also found consistent results when examining oseltamivir and zanamivir separately, with no significant difference between the 2 agents. They wrote, “Therefore, the timely initiation of antiviral therapy may be more critical than agent selection, particularly given variations in pediatric prescribing practices across countries.”

Findings support prompt treatment alongside vaccination

The authors emphasized that antiviral therapy should complement rather than replace influenza vaccination. Influenza vaccination was independently associated with a lower risk of hospitalization (aOR, 0.62; 95% CI, 0.42-0.90).

Study limitations included its observational and retrospective design, possible confounding related to treatment decisions, unavailable data on self-paid influenza vaccinations, and the hospital-based population in northern Taiwan, which may limit generalizability. However, the association remained after adjustment for health care use and in sensitivity analyses excluding the COVID-19 period.

“Our findings demonstrate that the benefits of antiviral therapy prescribed within 48 hours of symptom onset extend beyond symptom shortening,” the investigators concluded.

References

1. Huang Y-N, Chang C-J, Dai Y-L, et al. Early antiviral therapy in pediatric outpatients and risk of influenza-related hospitalization. Pediatrics. 2026;158(3).

2. Malosh RE, Martin ET, Heikkinen T, Brooks WA, Whitley RJ, Monto AS. Efficacy and safety of oseltamivir in children: systematic review and individual patient data meta-analysis of randomized controlled trials. Clin Infect Dis. 2018;66(10):1492–1500. doi: 10.1093/cid/cix1040

3. Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet. 2015;385(9979):1729–1737. doi: 10.1016/S0140-6736(14)62449-1

4. Whitley RJ, Hayden FG, Reisinger KS, et al. Oral oseltamivir treatment of influenza in children. Pediatr Infect Dis J. 2001;20(2):127–133. doi: 10.1097/00006454-200102000-00002