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Volume 15, Number 10—October 2009
Research

A Model-based Assessment of Oseltamivir Prophylaxis Strategies to Prevent Influenza in Nursing Homes

Carline van den DoolComments to Author , Eelko Hak, Marc J.M. Bonten1, and Jacco Wallinga1
Author affiliations: University Medical Center, Utrecht, the Netherlands (C. van den Dool, E. Hak, M.J.M. Bonten, J. Wallinga); University Medical Center, Groningen, the Netherlands (E. Hak); National Institute for Public Health and the Environment, Bilthoven, the Netherlands (J. Wallinga)

Main Article

Table 1

Parameter values baseline scenario*

Parameter Value Reference
No. beds 30
No. HCWs 30
Time step (= shift), h 8 (18)
Minimum duration of simulation, d 80
Discharge/mortality rate, per d 1/425 (16,17)
Rate of becoming infectious after infection, per d 1/1/4 (20,21)
Infection recovery rate, per d 1/1/4 (20,21)
Prior immunity HCWs 0.3 (22)
Prior immunity patients 0
Vaccine uptake patients 75% (25)
Vaccine uptake HCWs 40% (2)
Vaccine efficacy (against infection)
Patients 25% (28)
HCWs 73% (27)
Transmission probability per casual contact 0.13 (18)
Close/casual transmission probability ratio 2
Mean visitor frequency/patient/d 0.7 (31)
Minimum duration of postexposure prophylaxis, d 14 (2)
Minimum duration of postexposure prophylaxis after last detected case, d
8
(2)
Parameters in uncertainty analyses
Probability of disease developing after infection (range) 0.5 (0.30–0.7) (4)
Probability of disease developing after infection, during prophylaxis (range) 0.2 (0.05–0.4) (4)
Oseltamivir efficacy against infection (range) 0.53 (0.2–0.8) (4)
Oseltamivir reduction in infectiousness (range) 0.2 (0–0.5) (4)

*HCW, healthcare worker.

Main Article

References
  1. Cools  HJ, van Essen  GA. Practice guideline “Influenza prevention in nursing homes and care homes,” issued by the Dutch Society of Nursing Home Specialists; division of tasks between nursing home specialist, general practitioner and company doctor [in Dutch]. Ned Tijdschr Geneeskd. 2005;149:11924.PubMedGoogle Scholar
  2. Fiore  AE, Shay  DK, Broder  K, Iskander  JK, Uyeki  TM, Mootrey  G, Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. MMWR Recomm Rep. 2008;57:160.PubMedGoogle Scholar
  3. Cooper  NJ, Sutton  AJ, Abrams  KR, Wailoo  A, Turner  D, Nicholson  KG. Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: systematic review and meta-analyses of randomised controlled trials. BMJ. 2003;326:1235. DOIPubMedGoogle Scholar
  4. Halloran  ME, Hayden  FG, Yang  Y, Longini  IM Jr, Monto  AS. Antiviral effects on influenza viral transmission and pathogenicity: observations from household-based trials. Am J Epidemiol. 2007;165:21221. DOIPubMedGoogle Scholar
  5. Hayden  FG, Belshe  R, Villanueva  C, Lanno  R, Hughes  C, Small  I, Management of influenza in households: a prospective, randomized comparison of oseltamivir treatment with or without postexposure prophylaxis. J Infect Dis. 2004;189:4409. DOIPubMedGoogle Scholar
  6. Welliver  R, Monto  AS, Carewicz  O, Schatteman  E, Hassman  M, Hedrick  J, Effectiveness of oseltamivir in preventing influenza in household contacts: a randomized controlled trial. JAMA. 2001;285:74854. DOIPubMedGoogle Scholar
  7. Peters  PH, Jr., Gravenstein  S, Norwood  P, De  B, V, Van Couter A, Gibbens M, et al. Long-term use of oseltamivir for the prophylaxis of influenza in a vaccinated frail older population. J Am Geriatr Soc. 2001;49:102531. DOIPubMedGoogle Scholar
  8. Monto  AS, Rotthoff  J, Teich  E, Herlocher  ML, Truscon  R, Yen  HL, Detection and control of influenza outbreaks in well-vaccinated nursing home populations. Clin Infect Dis. 2004;39:45964. DOIPubMedGoogle Scholar
  9. Bowles  SK, Lee  W, Simor  AE, Vearncombe  M, Loeb  M, Tamblyn  S, Use of oseltamivir during influenza outbreaks in Ontario nursing homes, 1999–2000. J Am Geriatr Soc. 2002;50:60816. DOIPubMedGoogle Scholar
  10. Parker  R, Loewen  N, Skowronski  D. Experience with oseltamivir in the control of a nursing home influenza B outbreak. Can Commun Dis Rep. 2001;27:3740.PubMedGoogle Scholar
  11. Lackenby  A, Hungnes  O, Dudman  SG, Meijer  A, Paget  WJ, Hay  AJ, Emergence of resistance to oseltamivir among influenza A(H1N1) viruses in Europe. Euro Surveill. 2008;13:8026.
  12. Moscona  A. Global transmission of oseltamivir-resistant influenza. N Engl J Med. 2009;360:9536. DOIPubMedGoogle Scholar
  13. Enserink  M. Infectious disease. Old drugs losing effectiveness against flu; could statins fill gap? Science. 2005;309:19767. DOIPubMedGoogle Scholar
  14. Stilianakis  NI, Perelson  AS, Hayden  FG. Emergence of drug resistance during an influenza epidemic: insights from a mathematical model. J Infect Dis. 1998;177:86373.PubMedGoogle Scholar
  15. Longini  IM Jr, Halloran  ME, Nizam  A, Yang  Y. Containing pandemic influenza with antiviral agents. Am J Epidemiol. 2004;159:62333. DOIPubMedGoogle Scholar
  16. CTG ZAio. Doelmatigheid verpleeghuizen in relatie tot verantwoorde zorg onderzocht. 21-6-2006. Utrecht, CTG/ZAio [Dutch Healthcare Authority] [cited 2009 Jul 29]. Available from http://www.nza.nl/7113/10118/10124
  17. Tekstproducties  JCM. Arcares jaarverslag 2005. Utrecht (the Netherlands): Arcares; 2006.
  18. van den Dool  C, Bonten  MJ, Hak  E, Heijne  JC, Wallinga  J. The effects of influenza vaccination of health care workers in nursing homes: insights from a mathematical model. PLoS Med. 2008;5:e200. DOIPubMedGoogle Scholar
  19. Anderson  R, May  RM. Infectious diseases of humans: dynamics and control. New York: Oxford University Press; 1991.
  20. Hirotsu  N, Ikematsu  H, Iwaki  N, Kawai  N, Shigematsu  T, Kunishima  O, Effects of antiviral drugs on viral detection in influenza patients and on the sequential infection to their family members—serial examination by rapid diagnosis (Capilia) and virus culture. Int Congr Ser. 2004;1263:1058. DOIGoogle Scholar
  21. Wallinga  J, Lipsitch  M. How generation intervals shape the relationship between growth rates and reproductive numbers. Proc Biol Sci. 2007;274:599604. DOIPubMedGoogle Scholar
  22. Cauchemez  S, Valleron  AJ, Boelle  PY, Flahault  A, Ferguson  NM. Estimating the impact of school closure on influenza transmission from sentinel data. Nature. 2008;452:7504. DOIPubMedGoogle Scholar
  23. Webster  RG. Immunity to influenza in the elderly. Vaccine. 2000;18:16869. DOIPubMedGoogle Scholar
  24. Targonski  PV, Jacobson  RM, Poland  GA. Immunosenescence: role and measurement in influenza vaccine response among the elderly. Vaccine. 2007;25:30669. DOIPubMedGoogle Scholar
  25. Hayward  AC, Harling  R, Wetten  S, Johnson  AM, Munro  S, Smedley  J, Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ. 2006;333:1241. DOIPubMedGoogle Scholar
  26. Lipsitch  M, Cohen  T, Murray  M, Levin  BR. Antiviral resistance and the control of pandemic influenza. PLoS Med. 2007;4:e15. DOIPubMedGoogle Scholar
  27. Jefferson  TO, Rivetti  D, Di Pietrantonj  C, Rivetti  A, Demicheli  V. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev. 2007;CD001269.PubMedGoogle Scholar
  28. Jefferson  T, Rivetti  D, Rivetti  A, Rudin  M, Di Pietrantonj  C, Demicheli  V. Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review. Lancet. 2005;366:116574. DOIPubMedGoogle Scholar
  29. Nichol  KL, Nordin  JD, Nelson  DB, Mullooly  JP, Hak  E. Effectiveness of influenza vaccine in the community-dwelling elderly. N Engl J Med. 2007;357:137381. DOIPubMedGoogle Scholar
  30. Chik  KW, Li  CK, Chan  PK, Shing  MM, Lee  V, Tam  JS, Oseltamivir prophylaxis during the influenza season in a paediatric cancer centre: prospective observational study. Hong Kong Med J. 2004;10:1036. DOIPubMedGoogle Scholar
  31. de Klerk  M. Ouderen in Instellingen. Landelijk overzicht van de leefsituatie van oudere tehuisbewoners (7), 26–29. 2005. Den Haag, Sociaal en Cultureel Planbureau [The Netherlands Institute for Social Research] [cited 2009 Jul 29]. Available from http://www.scp.nl/dsresource?objectid=20740&type=org
  32. Kingston  BJ, Wright  CV Jr. Influenza in the nursing home. Am FamPhysician. 2002;65:75–8, 72.
  33. Looijmans-van den Akker  I, van Delden  JJ, Hak  E. Uptake of influenza vaccination in Dutch nursing home personnel following national recommendations. J Am Geriatr Soc. 2007;55:14867. DOIPubMedGoogle Scholar
  34. Finkelman  BS, Viboud  C, Koelle  K, Ferrari  MJ, Bharti  N, Grenfell  BT. Global patterns in seasonal activity of influenza A/H3N2, A/H1N1, and B from 1997 to 2005: viral coexistence and latitudinal gradients. PLoS One. 2007;2:e1296. DOIPubMedGoogle Scholar
  35. Kaiser  L, Wat  C, Mills  T, Mahoney  P, Ward  P, Hayden  F. Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Arch Intern Med. 2003;163:166772. DOIPubMedGoogle Scholar
  36. Meijer  A, Lackenby  A, Hungnes  O, Lina  B, van der Werf  S, Schwieger  B, Oseltamivir-resistant influenza A (H1N1), Europe, 2007–08 season. Emerg Infect Dis. 2009;15:55260. DOIPubMedGoogle Scholar
  37. Moscona  A. Oseltamivir resistance—disabling our influenza defenses. N Engl J Med. 2005;353:26336. DOIPubMedGoogle Scholar
  38. Wu  JT, Leung  GM, Lipsitch  M, Cooper  BS, Riley  S. Hedging against antiviral resistance during the next influenza pandemic using small stockpiles of an alternative chemotherapy. PLoS Med. 2009;6:e1000085. DOIPubMedGoogle Scholar

Main Article

1These authors contributed equally to this article.

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