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Speed, scale of antiviral prevention may cut hospitalizations during flu outbreaks in nursing homes
Laine Bergeson
Today at 2:31 p.m.
Influenza, General Prompt administration of preventive antiviral treatment to a large share of nursing home residents during flu outbreaks was associated with significantly fewer hospitalizations, according to a new study in JAMA Internal Medicine.
In the retrospective cohort study, researchers from Brown University School of Public Health analyzed 404 influenza outbreaks across 318 US nursing homes with almost 30,000 residents. The team compared facilities that administered oseltamivir (Tamiflu) prophylactically (to prevent flu) to at least 70% of residents within 2 days of outbreak detection with those that did not meet that threshold.
The researchers found that prompt administration of oseltamivir was associated with a 21% reduction in hospitalization (a risk reduction of 0.79). The intervention was not associated with a significant difference in mortality.
‘Important to treat fast and extensively’
Influenza can spread rapidly in nursing homes, where residents often require frequent hands-on care. Although national guidelines recommend offering antiviral prophylaxis to all eligible residents during outbreaks, practical implementation can be challenging owing to contraindications, refusals, comfort-focused care, or residents who are temporarily offsite.
In an editor’s note that accompanied the study, Justin J. Choi, MD, Sharon K. Inouye, MD, MPH, and Lona Mody, MD, note that the proportion of residents who should receive postexposure prophylaxis to reduce complications hadn’t previously been studied.
“While the study doesn’t mean that every single resident should get prophylaxis automatically, because clinical judgment still matters, it’s definitely important to treat fast and extensively,” senior author Andrew R. Zullo, PharmD, PhD, said in a Brown University news release. “Not every resident necessarily has to receive it for there to be a benefit. It’s similar to vaccination in that you can limit viral transmission if enough people get oseltamivir.”
Not every resident necessarily has to receive it for there to be a benefit. It’s similar to vaccination in that you can limit viral transmission if enough people get oseltamivir.
How quickly facilities can administer the antiviral medication also matters, the study suggests. “The practical message here is that you’re in a race against time to treat an outbreak, and so facilities have to remember to pursue using prophylaxis,” Zullo added. “After they’ve made that decision, the key is to do it as rapidly as possible and to reach the greatest number of eligible residents within the facility.”
Findings can help inform infection-control decisions
The findings should be interpreted with caution, the author of the editor’s note argue. One factor that was not captured in the analyzed data was that some facilities might be better equipped to administer preventive medications rapidly because they have stronger staffing levels, more training, and up-to-date policies on the use of personal protective equipment, which could influence outcomes.
Despite these limitations, the study could help guide infection-control decisions in care facilities. “These findings could strengthen evidence-based recommendations to inform best practices in managing influenza outbreaks in [nursing homes],” write the study authors. “Clinicians, administrators, and staff should consider rapid widespread chemoprophylaxis, including for residents in nonaffected units, as a strategy for containing future influenza outbreaks.”
Speed, scale of antiviral prevention may cut hospitalizations during flu outbreaks in nursing homes
Laine Bergeson
Today at 2:31 p.m.
Influenza, General Prompt administration of preventive antiviral treatment to a large share of nursing home residents during flu outbreaks was associated with significantly fewer hospitalizations, according to a new study in JAMA Internal Medicine.
In the retrospective cohort study, researchers from Brown University School of Public Health analyzed 404 influenza outbreaks across 318 US nursing homes with almost 30,000 residents. The team compared facilities that administered oseltamivir (Tamiflu) prophylactically (to prevent flu) to at least 70% of residents within 2 days of outbreak detection with those that did not meet that threshold.
The researchers found that prompt administration of oseltamivir was associated with a 21% reduction in hospitalization (a risk reduction of 0.79). The intervention was not associated with a significant difference in mortality.
‘Important to treat fast and extensively’
Influenza can spread rapidly in nursing homes, where residents often require frequent hands-on care. Although national guidelines recommend offering antiviral prophylaxis to all eligible residents during outbreaks, practical implementation can be challenging owing to contraindications, refusals, comfort-focused care, or residents who are temporarily offsite.
In an editor’s note that accompanied the study, Justin J. Choi, MD, Sharon K. Inouye, MD, MPH, and Lona Mody, MD, note that the proportion of residents who should receive postexposure prophylaxis to reduce complications hadn’t previously been studied.
“While the study doesn’t mean that every single resident should get prophylaxis automatically, because clinical judgment still matters, it’s definitely important to treat fast and extensively,” senior author Andrew R. Zullo, PharmD, PhD, said in a Brown University news release. “Not every resident necessarily has to receive it for there to be a benefit. It’s similar to vaccination in that you can limit viral transmission if enough people get oseltamivir.”
Not every resident necessarily has to receive it for there to be a benefit. It’s similar to vaccination in that you can limit viral transmission if enough people get oseltamivir.
How quickly facilities can administer the antiviral medication also matters, the study suggests. “The practical message here is that you’re in a race against time to treat an outbreak, and so facilities have to remember to pursue using prophylaxis,” Zullo added. “After they’ve made that decision, the key is to do it as rapidly as possible and to reach the greatest number of eligible residents within the facility.”
Findings can help inform infection-control decisions
The findings should be interpreted with caution, the author of the editor’s note argue. One factor that was not captured in the analyzed data was that some facilities might be better equipped to administer preventive medications rapidly because they have stronger staffing levels, more training, and up-to-date policies on the use of personal protective equipment, which could influence outcomes.
Despite these limitations, the study could help guide infection-control decisions in care facilities. “These findings could strengthen evidence-based recommendations to inform best practices in managing influenza outbreaks in [nursing homes],” write the study authors. “Clinicians, administrators, and staff should consider rapid widespread chemoprophylaxis, including for residents in nonaffected units, as a strategy for containing future influenza outbreaks.”