Use of oseltamivir during influenza outbreaks in Ontario nursing homes, 1999-2000.
OBJECTIVE
To describe the experience of Ontario long-term care facilities that used oseltamivir during influenza outbreaks in 1999/2000.


METHODS
Case series.


METHODS
Ten Ontario long-term care facilities for older people and their residents.


METHODS
Older residents of long-term care facilities.


METHODS
Oseltamivir for treatment or prophylaxis during 11 influenza outbreaks in 1999/2000.


METHODS
Control of outbreaks; pneumonia, hospitalization, and death complicating acute influenza.


RESULTS
All outbreaks were due to influenza A//H3N2/Sydney/05/97. One facility elected to use oseltamivir for treatment and amantadine for prophylaxis. The remaining nine facilities (10 outbreaks) recommended oseltamivir for treatment and prophylaxis (after amantadine failure in five and as primary prophylaxis in five). Use of oseltamivir was associated with termination of the outbreak in all eight evaluable outbreaks. Overall, 178/185 (96%) case-residents met the case definition of influenza and had complete data for evaluation. Of these, 63 (35%) were treated with antibiotics, 37 (21%) were diagnosed with pneumonia, 19 (11%) were hospitalized, and 16 (9%) died. Compared with residents receiving no therapy or who became ill while taking amantadine, residents who received oseltamivir within 48 hours of the onset of symptoms were less likely to be prescribed antibiotics, to be hospitalized, or to die (P <.05 for each outcome). These differences persisted and remained statistically significant when corrected for influenza immunization status. A total of 730 residents received oseltamivir prophylaxis for a median of 9 days (range 5-12). Of these, side effects were identified in 30 (4.1%), the most common being diarrhea (12 residents, 1.6%), cough (5, 0.7%), confusion (4, 0.5%) and nausea (4, 0.5%).


CONCLUSIONS
Oseltamivir is safe and appears to be effective when used as treatment or prophylaxis to control outbreaks of influenza in older nursing home residents.
Bowles
Susan K
SK
Department of Pharmacy, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario.
Lee
Wayne
W
Simor
Andrew E
AE
Vearncombe
Mary
M
Loeb
Mark
M
Tamblyn
Susan
S
Fearon
Margaret
M
Li
Yan
Y
McGeer
Allison
A
D000081:Acetamides / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000547:Amantadine / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D009864:Ontario / Q000453:epidemiology; D053139:Oseltamivir; D016896:Treatment Outcome
D000081:Acetamides; D000998:Antiviral Agents; D007252:Influenza Vaccines; D053139:Oseltamivir; D000547:Amantadine