Oseltamivir in influenza outbreaks in care homes: challenges and benefits of use in the real world. Issue 4 (August 2015) - Millership, S.
Summary Background Respiratory virus infections, including influenza, are an important cause of potentially avoidable hospital admissions in the elderly. Although recent reviews have questioned the efficacy of oseltamivir in the prevention of transmission, it has been a central part of the authors' strategy to manage outbreaks in residential homes. Aim To evaluate the management of respiratory virus infection outbreaks in residential homes, with particular emphasis on the logistics and effectiveness of antiviral prophylaxis with oseltamivir. Methods A descriptive analysis was undertaken from a retrospective survey of records held on a local database for three northern hemisphere influenza seasons from 2010 to 2013. Results In total, 75 respiratory outbreaks were reported from 590 care homes during the study period; of these, the aetiological agent was confirmed as influenza in 35 outbreaks. Overall attack, hospital admission and death rates for influenza were 29.7%, 5.3% and 3.3%, respectively. A further 10 outbreaks were caused by parainfluenza, human metapneumovirus or respiratory syncytial virus in combination with each other or rhinovirus, and six outbreaks were caused by rhinovirus alone. No agent was identified for the remaining 24 outbreaks. Conclusions Early public health involvement can lead to rapid termination of outbreaks of respiratory virus infections in residential homes. Although the use of oseltamivir is expensive, the data suggest that it does have some benefits as prophylaxis in this setting. Trials are needed to determine the most clinically and cost-effective interventions to control outbreaks in residential homes and avoid hospital admissions.