title: Treatment of an influenza A outbreak in a teaching nursing home. Effectiveness of a protocol for prevention and control.
abstract: The safety and efficacy of current ACIP guidelines for the prevention and control of influenza in nursing home populations are uncertain. An outbreak of influenza A/Sichuan (H3N2) in a teaching nursing home during 1988 gave us the opportunity to evaluate the effectiveness of an influenza vaccination and amantadine prophylaxis protocol. Over 13 days, 12 of 60 residents developed influenza. Prior influenza vaccination had been given to 94% of the residents. Protection from infection occurred in those tested who had antibody levels greater than or equal to 1:16 to the A/Leningrad (H3N2) antigen contained in the standard 1987-88 trivalent vaccine. However, five of 17 vaccinated residents who were tested had antibody levels less than or equal to 1:16 at the start of the outbreak. Amantadine (less than or equal to 100 mg/day) was given to all but one resident starting on the third day of the outbreak, and to employees starting on the sixth day of the outbreaks. Seven residents developed illness after the start of amantadine, although amantadine appeared to ameliorate their symptoms. Although amantadine was generally well tolerated by residents, employees receiving amantadine identified a high incidence of side effects and only 44% of employees took at least 70% of the prescribed amantadine. In our opinion, early detection and protocol-directed intervention probably abated a more severe influenza outbreak. Therefore we support existing recommendations that formal nursing home policies be established to ensure that residents and employees receive annual influenza vaccine and that chemoprophylaxis be used when outbreaks of influenza A are suspected.
authors.affiliation: Nursing Home Care Unit, Denver Veterans Administration Medical Center, CO 80220.
authors.forename: N L
authors.initials: NL
authors.lastname: Peters
authors.forename: S
authors.initials: S
authors.lastname: Oboler
authors.forename: C
authors.initials: C
authors.lastname: Hair
authors.forename: L
authors.initials: L
authors.lastname: Laxson
authors.forename: J
authors.initials: J
authors.lastname: Kost
authors.forename: G
authors.initials: G
authors.lastname: Meiklejohn
mesh_terms: D000368:Aged; D000488:Allied Health Personnel; D000547:Amantadine / Q000009:adverse effects / Q000627:therapeutic use; D003120:Colorado; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D009740:Nursing Staff; D011795:Surveys and Questionnaires
chemical_list: D007252:Influenza Vaccines; D000547:Amantadine