Emergence and transmission of amantadine-resistant influenza A in a nursing home.
OBJECTIVE
To prospectively detect amantadine-resistant influenza when amantadine was used for influenza A outbreak control.


METHODS
Prospective clinical surveillance and viral culture of all new respiratory illnesses during the course of amantadine prophylaxis.


METHODS
A 721-bed, 14-ward nursing home for veterans and spouses during an influenza A outbreak (1993-94).


METHODS
Residents of a veterans hospital and their spouses.


METHODS
Nasopharyngeal and throat viral culture. All residents with positive cultures who developed new respiratory symptoms while receiving or residing on a unit receiving amantadine prophylaxis had antiviral-resistance testing and polymerase chain reaction restriction analyses performed.


RESULTS
Amantadine prophylaxis was administered sequentially on nine of 14 wards to all well residents for 14 to 31 days/ward to control influenza outbreaks between December 9, 1993, and January 28, 1994. Amantadine treatment was simultaneously provided to 29 ill residents. Between December 3, 1993, and January 22, 1994, 68 culture-positive cases of influenza A were detected. Twenty subjects were receiving or residing on units receiving amantadine prophylaxis. Amantadine sensitivity testing could be performed on 16 residents; 12 residents had amantadine resistant strains. Four of the 12 had not received any antiviral treatment. Illness onset ranged from 1 to 22 days after amantadine prophylaxis was begun on the individual's unit. Two ribonucleic acid (RNA) mutations in the gene coding the M2 protein transmembrane region were observed that were clustered in time and space. Isolates from two roommates, one receiving amantadine for 18 days and one on no antiviral, had identical RNA sequences.


CONCLUSIONS
Antiviral resistance may be responsible for failure of prophylaxis in nursing home outbreaks. Strategies that use different classes of antivirals for prophylaxis and treatment may limit emergence and transmission of resistant virus.
Schilling
Margo
M
University of Iowa, Iowa City, USA. margo-schilling@uiowa.edu <margo-schilling@uiowa.edu>
Gravenstein
Stefan
S
Drinka
Paul
P
Cox
Nancy
N
Krause
Peggy
P
Povinelli
Laura
L
Shult
Peter
P
D000547:Amantadine / Q000494:pharmacology* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000494:pharmacology* / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control*; D024882:Drug Resistance, Viral; D006801:Humans; D009980:Influenza A virus / Q000187:drug effects; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D008826:Microbial Sensitivity Tests; D009735:Nursing Homes; D011446:Prospective Studies; D014728:Veterans; D014922:Wisconsin / Q000453:epidemiology
D000998:Antiviral Agents; D000547:Amantadine