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J Infect Dis. (2011) doi: 10.1093/infdis/jir648 First published online: October 19, 2011
Description of Antiviral Treatment Among Adults Hospitalized With Influenza Before and During the 2009 Pandemic: United States, 2005?2009
Saumil Doshi1,2,
Laurie Kamimoto2,
Lyn Finelli2,
Alejandro Perez2,
Arthur Reingold4,
Ken Gershman5,
Kimberly Yousey-Hindes6,
Kathryn Arnold3,
Patricia Ryan7,
Ruth Lynfield8,
Craig Morin8,
Joan Baumbach9,
Emily B. Hancock9,
Nancy M. Bennett10,
Shelley Zansky11,
Ann Thomas12,
William Schaffner13 and
Alicia M. Fry2
1Epidemic Intelligence Service and
2Influenza Division, Centers for Disease Control and Prevention, and
3Georgia Emerging Infections Program, Atlanta
4School of Public Health, University of California, Berkeley
5Colarado Department of Public Health and Environment, Denver
6Connecticut Emerging Infections Program, New Haven
7Maryland Department of Health and Mental Hygiene, Baltimore
8Minnesota Department of Health, St Paul
9New Mexico Department of Health, Santa Fe
10University of Rochester, New York
11New York State Department of Health, Albany
12Oregon Public Health Division, Portland
13Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Correspondence: Alicia Fry, MD, MPH, Influenza Division, Centers for Disease Control and Prevention, CDC MS A-38, 1600 Clifton Rd NE, MS A34, Atlanta, GA 30333 (afry{at}cdc.gov).
Abstract
Background. The 2009 influenza pandemic led to guidelines emphasizing antiviral treatment for all persons hospitalized with influenza, including pregnant women. We compared antiviral use among adults hospitalized with influenza before and during the pandemic.
Methods. The Emerging Infections Program conducts active population-based surveillance for persons hospitalized with community-acquired, laboratory-confirmed influenza in 10 states. We analyzed data collected via medical record review of patients aged ≥18 years admitted during prepandemic (1 October 2005 through 14 April 2009) and pandemic (15 April 2009 through 31 December 2009) time frames.
Results. Of 5943 adults hospitalized with influenza in prepandemic seasons, 3235 (54%) received antiviral treatment, compared with 4055 (82%) of 4966 during the pandemic. Forty-one (22%) of 187 pregnant women received antiviral treatment in prepandemic seasons, compared with 369 (86%) of 430 during the pandemic. Pregnancy was a negative predictor of antiviral treatment before the pandemic (adjusted odds ratio [aOR], 0.24; 95% confidence interval [CI], .16?.35) but was independently associated with treatment during the pandemic (aOR, 1.97; 95% CI, 1.32?2.96). Antiviral treatment among adults hospitalized >2 days after illness onset increased from 43% before the pandemic to 79% during the pandemic (P < .001).
Conclusions. Antiviral treatment of hospitalized adults increased during the pandemic, especially among pregnant women. This suggests that many clinicians followed published guidance to treat hospitalized adults with antiviral agents. However, compliance with antiviral recommendations could be improved.
Description of Antiviral Treatment Among Adults Hospitalized With Influenza Before and During the 2009 Pandemic: United States, 2005?2009
Saumil Doshi1,2,
Laurie Kamimoto2,
Lyn Finelli2,
Alejandro Perez2,
Arthur Reingold4,
Ken Gershman5,
Kimberly Yousey-Hindes6,
Kathryn Arnold3,
Patricia Ryan7,
Ruth Lynfield8,
Craig Morin8,
Joan Baumbach9,
Emily B. Hancock9,
Nancy M. Bennett10,
Shelley Zansky11,
Ann Thomas12,
William Schaffner13 and
Alicia M. Fry2
1Epidemic Intelligence Service and
2Influenza Division, Centers for Disease Control and Prevention, and
3Georgia Emerging Infections Program, Atlanta
4School of Public Health, University of California, Berkeley
5Colarado Department of Public Health and Environment, Denver
6Connecticut Emerging Infections Program, New Haven
7Maryland Department of Health and Mental Hygiene, Baltimore
8Minnesota Department of Health, St Paul
9New Mexico Department of Health, Santa Fe
10University of Rochester, New York
11New York State Department of Health, Albany
12Oregon Public Health Division, Portland
13Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Correspondence: Alicia Fry, MD, MPH, Influenza Division, Centers for Disease Control and Prevention, CDC MS A-38, 1600 Clifton Rd NE, MS A34, Atlanta, GA 30333 (afry{at}cdc.gov).
Abstract
Background. The 2009 influenza pandemic led to guidelines emphasizing antiviral treatment for all persons hospitalized with influenza, including pregnant women. We compared antiviral use among adults hospitalized with influenza before and during the pandemic.
Methods. The Emerging Infections Program conducts active population-based surveillance for persons hospitalized with community-acquired, laboratory-confirmed influenza in 10 states. We analyzed data collected via medical record review of patients aged ≥18 years admitted during prepandemic (1 October 2005 through 14 April 2009) and pandemic (15 April 2009 through 31 December 2009) time frames.
Results. Of 5943 adults hospitalized with influenza in prepandemic seasons, 3235 (54%) received antiviral treatment, compared with 4055 (82%) of 4966 during the pandemic. Forty-one (22%) of 187 pregnant women received antiviral treatment in prepandemic seasons, compared with 369 (86%) of 430 during the pandemic. Pregnancy was a negative predictor of antiviral treatment before the pandemic (adjusted odds ratio [aOR], 0.24; 95% confidence interval [CI], .16?.35) but was independently associated with treatment during the pandemic (aOR, 1.97; 95% CI, 1.32?2.96). Antiviral treatment among adults hospitalized >2 days after illness onset increased from 43% before the pandemic to 79% during the pandemic (P < .001).
Conclusions. Antiviral treatment of hospitalized adults increased during the pandemic, especially among pregnant women. This suggests that many clinicians followed published guidance to treat hospitalized adults with antiviral agents. However, compliance with antiviral recommendations could be improved.
