Effectiveness of post-exposition prophylaxis with oseltamivir in nursing homes: a randomised controlled trial over four seasons

Emerging Themes in Epidemiology

For the Peppie study group³  Marie-José Veldman-Ariessen²  José M Ferreira³  Piet Overduin²  Herman JM Cools¹  Remko Enserink⁴  Fatmagül Şen-Kerpiclik²  Adam Meijer²  Marianne AB van der Sande⁴ 

[1] Department Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands;Centre Infectious Disease Control, RIVM, PO Box 1-pb75, 3720BA, Bilthoven, the Netherlands;RIO, RIVM, Bilthoven, Netherlands;Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands

关键词: Oseltamivir;    RCT;    Nursing homes;    Post-exposition prophylaxis;    Influenza outbreaks;   

Others  :  1092976
DOI  :  10.1186/1742-7622-11-13

 received in 2014-04-10, accepted in 2014-08-20,  发布年份 2014

【 摘 要 】

Background

Oseltamivir has been registered for use as post-exposition prophylaxis (PEP) following exposure to influenza, based on studies among healthy adults. Effectiveness among frail elderly nursing home populations still needs to be properly assessed.

Methods

We conducted a randomised double-blind placebo-controlled trial of PEP with either oseltamivir (75 mg once daily) or placebo among nursing home units where influenza virus was detected; analysis was unblinded. The primary outcome was laboratory-confirmed influenza among residents in units on PEP; the secondary outcome was clinical diagnosis of influenza-like illness (ILI).

Results

42 nursing homes were recruited, in which 17 outbreaks occurred from 2009 through 2013, two caused by influenza virus B, the others caused by influenza virus A(H3N2). Randomisation was successful in 15 outbreaks, with a few chance differences in baseline indicators. Six outbreaks were assigned to oseltamivir and nine to placebo. Influenza virus positive secondary ILI cases were detected in 2/6 and 2/9 units respectively (ns); secondary ILI cases occurred in 2/6 units on oseltamivir, and 5/9 units on placebo (ns). Logistical challenges in ensuring timely administration were considerable.

Conclusion

We did not find statistical evidence that PEP with oseltamivir given to nursing home residents in routine operational settings exposed to influenza reduced the risk of new influenza infections within a unit nor that of developing ILI. Power however was limited due to far fewer outbreaks in nursing homes than expected since the 2009 pandemic. (RCT nr NL92738)

【 授权许可】

   
2014 van der Sande et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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