title: Oseltamivir for control of influenza at mass gatherings.
abstract: The use of oseltamivir at mass gatherings (MGs) or other crowded settings has not previously been systematically examined to synthesise the evidence of its usefulness. Here we have evaluated its effectiveness by reviewing the published literature. The effectiveness of oseltamivir at MGs is controversial because published clinical trials evaluating this are lacking. Its use, to date, has been predominantly therapeutic, i.e. to treat patients with confirmed or suspected influenza. There are some examples of its use in mass prophylaxis at MGs and other crowded settings like schools and camps, and closed settings such as prisons and aged care facilities. Most of the available studies indicate that oseltamivir use, whether therapeutic or prophylactic, is effective in containing influenza outbreaks in those settings though there are some reports of moderately high side effects, particularly among young children. Targeted prophylaxis of oseltamivir seems to help contain an outbreak of influenza at MG. A combination of 'treatment of cases' and 'ring prophylaxis of contacts' appears to be a feasible and economically sustainable strategy. Further research needs to be directed to uncertainties (e.g. how, when and for whom oseltamivir should be used) over oseltamivir's place in influenza control at mass gatherings.
authors.affiliation: National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Australia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Tashani
authors.forename: Harunor
authors.initials: H
authors.lastname: Rashid
authors.forename: Iman
authors.initials: I
authors.lastname: Ridda
authors.forename: Leon
authors.initials: L
authors.lastname: Heron
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Haworth
authors.forename: Robert
authors.initials: R
authors.lastname: Booy
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D004196:Disease Outbreaks / Q000517:prevention & control*; D024882:Drug Resistance, Viral; D004791:Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006707:Homes for the Aged; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000187:drug effects* / Q000201:enzymology / Q000254:growth & development / Q000302:isolation & purification; D007251:Influenza, Human / Q000188:drug therapy / Q000517:prevention & control* / Q000821:virology; D009439:Neuraminidase / Q000037:antagonists & inhibitors; D053139:Oseltamivir / Q000009:adverse effects / Q000627:therapeutic use*; D011330:Prisons; D012574:Schools; D014764:Viral Proteins / Q000037:antagonists & inhibitors
chemical_list: D000998:Antiviral Agents; D004791:Enzyme Inhibitors; D014764:Viral Proteins; D053139:Oseltamivir; C487630:NA protein, influenza A virus; D009439:Neuraminidase