Zanamivir in the prevention of influenza among healthy adults: a randomized controlled trial.
BACKGROUND
The neuraminidase inhibitor zanamivir, a sialic acid analog administered directly to the respiratory tract, has been demonstrated in clinical studies to be effective in treatment of type A and B influenza. It has also been shown to prevent influenza infection and disease in an experimental model.


OBJECTIVE
To examine the efficacy of zanamivir, administered once daily, in the prevention of influenza infection and disease.


METHODS
Double-blind, randomized, placebo-controlled trial.


METHODS
Two midwestern university communities.


METHODS
A total of 1107 healthy adults (mean age [range], 29 [18-69] years) were recruited in November 1997, before the influenza season.


METHODS
At the start of the influenza outbreak, 554 subjects were randomized to receive placebo and 553 to receive zanamivir. The drug, 10 mg once per day, or identical placebo was administered by oral inhalation for a 4-week period.


METHODS
Illness occurrence was recorded by participants daily and records were evaluated weekly. Specimens were collected for viral isolation when symptoms were reported within 3 days of illness onset. Infection was also identified by testing paired serum samples for rise in antibody titer against the circulating influenza viruses.


RESULTS
Zanamivir was 67% efficacious (95% confidence interval [CI], 39%-83%; P<.001) in preventing laboratory-confirmed clinical influenza meeting the case definition and 84% efficacious (95% CI, 55%-94%; P=.001) in preventing laboratory-confirmed illnesses with fever. All influenza infections occurring during the season, with or without symptoms, were prevented with an efficacy of 31% (95% CI, 4%-50%; P=.03). The nature and incidence of adverse events in the zanamivir group did not differ from placebo. Compliance with the once-daily dosage was high.


CONCLUSIONS
Zanamivir administered once daily is efficacious and well tolerated in the prevention of influenza for a 4-week period in healthy adults.
School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA. asmonto@umich.edu
A S
AS
Monto
D P
DP
Robinson
M L
ML
Herlocher
J M
JM
Hinson
M J
MJ
Elliott
A
A
Crisp
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006146:Guanidines; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009439:Neuraminidase / Q000037:antagonists & inhibitors*; D011714:Pyrans; D012621:Seasons; D012794:Sialic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D053243:Zanamivir
D000998:Antiviral Agents; D004791:Enzyme Inhibitors; D006146:Guanidines; D011714:Pyrans; D012794:Sialic Acids; D009439:Neuraminidase; D053243:Zanamivir