Abstract
BackgroundMultiple observational studies have associated antiviral treatment of patients hospitalized with influenza with improved outcome, including reduced mortality. During the 2009–2010 H1N1 pandemic increased use of antiviral treatment of hospital patients was reported. We have carried out prospective surveillance for influenza in patients in a large network of Canadian hospitals since 2006. We wished to assess trends in antiviral use in the two seasons (2010–2011 and 2011–2012) since the end of the pandemic.FindingsAdults (>16 years) testing positive for influenza at the time of or during admission to participating Canadian hospitals were prospectively reviewed. In 2009–2010 there were 1132 confirmed cases, 1107 in 2010–2011 and 631 in 2011–2012. Information on antiviral therapy was available in >95% in each year. Rising to 89.6% in 2009, the proportion of adult patients treated with antiviral therapy fell to 79.9% and 65.7% in the two subsequent seasons (p < 0.001). Oseltamivir was the antiviral agent used in >98% of cases in each year. The median time from onset of symptoms to initiation of antiviral therapy was three days. The treatment proportion fell across all age groups, co-morbid conditions and disease severity.ConclusionDespite evidence for benefit of antiviral therapy, and clinical practice guidelines recommending treatment of this population, antiviral therapy of Canadian adults hospitalized with influenza has progressively fallen in the two seasons since the end of the 2009–2010 influenza pandemic.
Highlights
Multiple observational studies have associated antiviral treatment of patients hospitalized with influenza with improved outcome, including reduced mortality
Despite evidence for benefit of antiviral therapy, and clinical practice guidelines recommending treatment of this population, antiviral therapy of Canadian adults hospitalized with influenza has progressively fallen in the two seasons since the end of the 2009–2010 influenza pandemic
In the 2011–2012 season, there was a significant decline in antiviral use in patients >65 years of age compared to 2009–2010 season
Summary
In the two seasons following the 2009 pandemic, the proportion of patients hospitalized with influenza treated with antiviral therapy in Canada has markedly declined. 8. Doshi S, Kamimoto L, Finelli L, Perez A, Reingold A, Gershman K, et al: Description of antiviral treatment among adults hospitalized with influenza before and during the 2009 pandemic: United States, 2005–2009. Garg S, Chaves S, Perez A, D’Mello T, Gersham K, Meek J, et al: Reduced influenza antiviral treatment among children and adults hospitalized with laboratory confirmed influenza in the year after the 2009 pandemic. Doi:10.1186/2047-2994-3-2 Cite this article as: Taylor et al.: Trends in antiviral therapy of adults hospitalized with influenza in Canada since the end of the 2009 pandemic. Author details 1University of Alberta Hospital, Edmonton, Alberta, Canada. 2Public Health Agency of Canada, Centre for Communicable Diseases and Infection Control, Ottawa, Ontario, Canada. 3Mount Sinai Hospital, Toronto, Ontario, Canada. 4McGill University Health Centre, Montreal, Quebec, Canada. 5The Ottawa Hospital, Ottawa, Ontario, Canada. 6Royal University Hospital, Saskatoon, Saskatchewan, Canada. 7North York General Hospital, Toronto, Ontario, Canada. 8Jewish General Hospital, Montreal, Quebec, Canada
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