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The effect of timing of oseltamivir chemoprophylaxis in controlling influenza A H3N2 outbreaks in long-term care facilities in Manitoba, Canada, 2014-2015: a retrospective cohort study

Published online by Cambridge University Press:  12 June 2018

Davinder Singh ,
Depeng Jiang ,
Paul Van Caeseele  and
Carla Loeppky
Davinder Singh*
Affiliation:
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
Depeng Jiang
Affiliation:
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
Paul Van Caeseele
Affiliation:
Department of Medical Microbiology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
Carla Loeppky
Affiliation:
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
*
Author for correspondence: Dr Davinder Singh, Department of Community Health Sciences, University of Manitoba, S111-750 Bannatyne Avenue, Winnipeg, MB, Canada, R3E 0W3. E-mail: [email protected]
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Abstract

Objective

This study examined the effect of the timing of administration of oseltamivir chemoprophylaxis for the control of influenza A H3N2 outbreaks among residents in long-term care facilities (LTCFs) in Manitoba, Canada, during the 2014–2015 influenza season.

Methods

A retrospective cohort study was conducted of all LTCF influenza A H3N2 outbreaks (n=94) using a hierarchical logistic regression analysis. The main independent variable was how many days passed between the start of the outbreak and commencement of oseltamivir chemoprophylaxis. The dependent variable was whether each person in the institution developed influenza-like illness (yes or no).

Results

Delay of oseltamivir chemoprophylaxis was associated with increased odds of infection in both univariate (t=5·41; df=51; P<·0001) and multivariable analyses (t=6·04; df=49; P<·0001) with an adjusted odds ratio of 1.3 (95% confidence interval [CI], 1·2–1·5) per day for influenza A H3N2.

Conclusions

The sooner chemoprophylaxis is initiated, the lower the odds of secondary infection with influenza in LTCFs during outbreaks caused by influenza A H3N2 in Manitoba. For every day that passed from the start of the outbreak to the initiation of oseltamivir, the odds of a resident at risk of infection in the facility developing symptomatic infection increased by 33%.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 8 , August 2018 , pp. 955 - 960
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

1. National Advisory Committee on Immunization. Statement on Seasonal Influenza Vaccine for 2015–2016. Government of Canada website. https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/statement-on-seasonal-influenza-vaccine-2015-2016.html. Published 2015. Accessed May 1, 2018.Google Scholar
2. Jefferson, T, Di Pietrantonj, C, Al-Ansary, LA, Ferroni, E, Thorning, S, Thomas, RE. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev 2010;17:CD004876.Google Scholar
3. Last, JM. A Dictionary of Epidemiology. 2nd ed. Toronto, ON: Oxford University Press; 1988.Google Scholar
4. Canadian Institute for Health Information. Health Care in Canada, 2011: A Focus on Seniors and Aging. Ottawa, ON: CIHI; 2011.Google Scholar
5. Booy, R, Lindley, RI, Dwyer, DE, et al. Treating and preventing influenza in aged care facilities: a cluster randomised controlled trial. PloS One 2012;7:e46509.Google Scholar
6. Bowles, SK, Lee, W, Simor, AE, et al. Use of oseltamivir during influenza outbreaks in Ontario nursing homes, 1999–2000. J Am Geriatr Soc 2002;50:608–616.Google Scholar
7. Gorisek Miksic, N, Ursic, T, Simonovic, Z, et al. Oseltamivir prophylaxis in controlling influenza outbreak in nursing homes: a comparison between three different approaches. Infection 2015;43:73–81.Google Scholar
8. Peters, PH Jr., Gravenstein, S, Norwood, P, et al. Long-term use of oseltamivir for the prophylaxis of influenza in a vaccinated frail older population. J Am Geriatr Soc 2001;49:1025–1031.Google Scholar
9. Communicable disease management protocol: seasonal influenza. Manitoba Public Health Branch website. http://www.gov.mb.ca/health/publichealth/cdc/protocol/influenza1.pdf. Published August 2016. Accessed May 1, 2018.Google Scholar
10. Harper, SA, Bradley, JS, Englund, JA, et al. Seasonal influenza in adults and children--diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1003–1032.Google Scholar
11. Hayden, FG, Belshe, R, Villanueva, C, et al. Management of influenza in households: a prospective, randomized comparison of oseltamivir treatment with or without postexposure prophylaxis. J Infect Dis 2004;189:440–449.Google Scholar
12. van der Sande, MA, Meijer, A, Sen-Kerpiclik, F, et al. Effectiveness of post-exposition prophylaxis with oseltamivir in nursing homes: a randomised controlled trial over four seasons. Emerg Themes Epidemiol 2014;11:13.Google Scholar
13. Manitoba Health, Seniors and Active Living. Influenza surveillance weekly report: week 22. Government of Canada website. https://www.gov.mb.ca/health/publichealth/surveillance/influenza/docs/150606.pdf Published June 6, 2015. Accessed May 1, 2018.Google Scholar
14. Estevez, E. (Manitoba Health, Seniors and Active Living, Winnipeg, MB). Conversation with: Davinder Singh (University of Manitoba, Winnipeg, MB). Aug 17, 2016.Google Scholar
15. Monto, AS, Rotthoff, J, Teich, E, et al. Detection and control of influenza outbreaks in well-vaccinated nursing home populations. Clin Infect Dis 2004;39:459–464.Google Scholar
16. van der Sande, MA, Ruijs, WL, Meijer, A, Cools, HJ, van der Plas, SM. Use of oseltamivir in Dutch nursing homes during the 2004–2005 influenza season. Vaccine 2006;24:6664–6669.Google Scholar
17. Welliver, R, Monto, AS, Carewicz, O, et al. Effectiveness of oseltamivir in preventing influenza in household contacts: a randomized controlled trial. JAMA 2001;285:748–754.Google Scholar
18. Millership, S, Cummins, A. Oseltamivir in influenza outbreaks in care homes: challenges and benefits of use in the real world. J Hosp Infect 2015;90:299–303.Google Scholar
19. Ye, M, Jacobs, A, Khan, MN, et al. Evaluation of the use of oseltamivir prophylaxis in the control of influenza outbreaks in long-term care facilities in Alberta, Canada: a retrospective provincial database analysis. BMJ Open 2016;6:e011686.Google Scholar
20. Canadian Institute for Health Information. Health Workforce Database, 2015: Methodology Guide. Ottawa, ON: CIHI; 2016.Google Scholar
21. Gregg, M. Field Epidemiology. 3rd ed. Toronto, ON: Oxford University Press; 2008.Google Scholar
22. Singh, D, Robinson, K, Hilderman, T. The effect of timing of oseltamivir chemoprophylaxis in controlling influenza A H3N2 outbreaks in long term care facilities in Eastern Manitoba, Canada, 2014–2015: a retrospective cohort study. Can J Infect Control 2016;31:221–224.Google Scholar
23. Gilca, R, Skowronski, DM, Douville-Fradet, M, et al. Mid-season estimates of influenza vaccine effectiveness against influenza A(H3N2) hospitalization in the elderly in Quebec, Canada, January 2015. PloS One 2015;10:e0132195.Google Scholar
24. Smith, PW, Bennett, G, Bradley, S, et al. SHEA/APIC Guideline: infection prevention and control in the long-term care facility. Am J Infect Control 2008;36:504–535.Google Scholar
25. The Regional Office for Europe of the World Health Organization. Prevention and Control of Outbreaks of Seasonal Influenza in Long-Term Care Facilities: A Review of the Evidence and Best-Practice Guidelines. Copenhagen, Denmark: World Health Organization; 2017.Google Scholar