title: Effectiveness of post-exposition prophylaxis with oseltamivir in nursing homes: a randomised controlled trial over four seasons.
abstract: BACKGROUND
  Oseltamivir has been registered for use as post-exposition prophylaxis (PEP) following exposure to influenza, based on studies among healthy adults. Effectiveness among frail elderly nursing home populations still needs to be properly assessed.
  
  
  METHODS
  We conducted a randomised double-blind placebo-controlled trial of PEP with either oseltamivir (75 mg once daily) or placebo among nursing home units where influenza virus was detected; analysis was unblinded. The primary outcome was laboratory-confirmed influenza among residents in units on PEP; the secondary outcome was clinical diagnosis of influenza-like illness (ILI).
  
  
  RESULTS
  42 nursing homes were recruited, in which 17 outbreaks occurred from 2009 through 2013, two caused by influenza virus B, the others caused by influenza virus A(H3N2). Randomisation was successful in 15 outbreaks, with a few chance differences in baseline indicators. Six outbreaks were assigned to oseltamivir and nine to placebo. Influenza virus positive secondary ILI cases were detected in 2/6 and 2/9 units respectively (ns); secondary ILI cases occurred in 2/6 units on oseltamivir, and 5/9 units on placebo (ns). Logistical challenges in ensuring timely administration were considerable.
  
  
  CONCLUSIONS
  We did not find statistical evidence that PEP with oseltamivir given to nursing home residents in routine operational settings exposed to influenza reduced the risk of new influenza infections within a unit nor that of developing ILI. Power however was limited due to far fewer outbreaks in nursing homes than expected since the 2009 pandemic. (RCT nr NL92738).
authors.affiliation: Centre Infectious Disease Control, RIVM, PO Box 1-pb75, 3720BA, Bilthoven, the Netherlands ; Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands.
authors.forename: Marianne Ab
authors.initials: MA
authors.lastname: van der Sande
authors.affiliation: Centre Infectious Disease Control, RIVM, PO Box 1-pb75, 3720BA, Bilthoven, the Netherlands.
authors.forename: Adam
authors.initials: A
authors.lastname: Meijer
authors.affiliation: Centre Infectious Disease Control, RIVM, PO Box 1-pb75, 3720BA, Bilthoven, the Netherlands.
authors.forename: Fatmagül
authors.initials: F
authors.lastname: Sen-Kerpiclik
authors.affiliation: Centre Infectious Disease Control, RIVM, PO Box 1-pb75, 3720BA, Bilthoven, the Netherlands ; Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands.
authors.forename: Remko
authors.initials: R
authors.lastname: Enserink
authors.affiliation: Department Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.
authors.forename: Herman Jm
authors.initials: HJ
authors.lastname: Cools
authors.affiliation: Centre Infectious Disease Control, RIVM, PO Box 1-pb75, 3720BA, Bilthoven, the Netherlands.
authors.forename: Piet
authors.initials: P
authors.lastname: Overduin
authors.affiliation: RIO, RIVM, Bilthoven, Netherlands.
authors.forename: José M
authors.initials: JM
authors.lastname: Ferreira
authors.affiliation: Centre Infectious Disease Control, RIVM, PO Box 1-pb75, 3720BA, Bilthoven, the Netherlands.
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Veldman-Ariessen
keywords: Influenza outbreaks; Nursing homes; Oseltamivir; Post-exposition prophylaxis; RCT