title: Evaluation of the use of oseltamivir prophylaxis in the control of influenza outbreaks in long-term care facilities in Alberta, Canada: a retrospective provincial database analysis.
abstract: To evaluate the impact of oseltamivir prophylaxis in the management and control of influenza outbreaks in long-term care facilities in Alberta, Canada.
  
  
  
  Long-term care facilities where 127 influenza outbreaks were reported to public health authorities in Alberta, Canada, during two influenza seasons from 2013 to 2015.
  
  
  
  Using routinely collected surveillance and administrative data, we examined the association between decision-making time for oseltamivir recommendation as prophylaxis strategy for influenza outbreaks in long-term care facilities (explanatory variable) and the duration of an influenza outbreak, the postprophylaxis risk of influenza-like illness and hospitalisation among residents of long-term care facilities in Alberta (outcome variables) using multivariable linear and Poisson regression models.
  
  
  
  Oseltamivir prophylaxis decision-making time was positively associated with the postintervention duration of an outbreak, with a 1-day delay in making decision on oseltamivir prophylaxis associated with 2.22 (95% CI 1.37 to 3.06) more days of the duration of an outbreak after controlling for potential confounding effect of the number of residents at risk at intervention, outbreak progression time, prevalence of influenza-like illness during outbreak progression, facility location, presence of mixed strain and based on optimal timing of oseltamivir prophylaxis. Although not statistically significant, a 1-day delay in making decision on oseltamivir prophylaxis was associated with a 5% (95% CI -1% to 11%) increase in the postintervention risk of influenza-like illness, and a 6% (95% CI -8% to 22%) increase in the postintervention risk of hospitalisation after controlling for the same potential confounders.
  
  
  
  Our study demonstrated benefits of using oseltamivir prophylaxis to shorten the duration of influenza outbreaks; however, there were no significant differences in the influenza-like illness and hospitalisation risk occurring after the intervention. Surveillance data may offer means of rapid evaluation of oseltamivir prophylaxis in long-term care facilities as a public health measure.
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ming
authors.initials: M
authors.lastname: Ye
authors.affiliation: Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Jacobs
authors.affiliation: Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Muhammad Naeem
authors.initials: MN
authors.lastname: Khan
authors.affiliation: Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Joy
authors.initials: J
authors.lastname: Jaipaul
authors.affiliation: Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Joanna
authors.initials: J
authors.lastname: Oda
authors.affiliation: Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Marcia
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Alberta Health Services, Edmonton, Alberta, Canada Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Doroshenko
mesh_terms: D000328:Adult; D000416:Alberta / Q000453:epidemiology; D000998:Antiviral Agents / Q000627:therapeutic use*; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D008134:Long-Term Care; D008297:Male; D053139:Oseltamivir / Q000627:therapeutic use*; D011050:Policy Making; D015397:Program Evaluation; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007252:Influenza Vaccines; D053139:Oseltamivir
keywords: influenza; long-term care facility; oseltamivir; outbreak; prophylaxis