Influenza outbreaks were shorter and resulted in fewer cases and fewer deaths at long-term care facilities that started residents on preventive antiviral medications within five days of the first case, compared to those that started later, according to a new study in the July 1 issue of Clinical Infectious Diseases.
Long-term care facilities housing elderly people are vulnerable to influenza outbreaks. Once an outbreak has occurred at a facility, antiviral medications are generally given to the residents to prevent more people from getting sick. This preventive administration of medication is known as chemoprophylaxis.
Common sense suggests that the sooner antiviral medications are given to long-term care residents who were potentially exposed to influenza, the more likely it would be that influenza infection could be prevented and facility outbreaks controlled. The new study confirms this by showing significant differences in outcomes when administering chemoprophylaxis within five days of detecting an influenza outbreak versus initiating medications more than five days after influenza outbreaks were identified.
"Prompt initiation of chemoprophylaxis after identification of influenza A in a long-term care facility can decrease the severity of influenza outbreaks in those settings," said Marcie Rubin, MPH, MPA, of the Columbia University Mailman School of Public Health.
Ms. Rubin and personnel from the New York City Department of Health and Mental Hygiene's Bureau of Communicable Diseases looked at data from 52 outbreaks of influenza A in New York City long-term care facilities over the course of three influenza seasons. An outbreak was defined as either a single laboratory-confirmed case or a cluster of two or more cases of influenza-like illness.
Facilities that began prophylaxis within five days of the influenza outbreak's detection had outbreaks that lasted only about a third as long as those institutions that took longer to begin treating people (6.7 vs. 18.3 days). Early intervention also led to far fewer cases (6.2 cases/100 residents vs. 10.5 cases/100 residents) and deaths (0.45 deaths/100 ill residents vs. 3.3 deaths/100 ill residents).
Given the striking benefits of a quick response, the authors recommend the development of strategies that might hasten an intervention. They suggest that facility staff increase their vigilance for diagnosing influenza cases. They also recommend that the process for collecting respiratory specimens for influenza detection be streamlined, with rapid testing and efficient communication of results from the laboratory to the staff.
The outbreaks the researchers studied occurred between 2001-2004, at which time amantadine was the frontline therapy for treatment and prophylaxis of influenza A. Since 2004, there has been increasing influenza resistance to amantadine and neuraminidase inhibitors have become the newest antivirals of choice. Further study is needed to determine whether rapid initiation of chemoprophylaxis with this class of antiviral drugs will result in similar positive impacts.
Source: Infectious Diseases Society of America
Related stories:
Study outlines measures to limit effects of pandemic flu on nursing homes
The greatest danger in a pandemic flu outbreak is that it could spread quickly and devastate a broad swath of people across the United States before there is much of a chance to react. The result could be a nation brought to its knees by a disease run rampant.
'Deadly dozen' reports diseases worsened by climate change
Health experts from the Wildlife Conservation Society today released a report that lists 12 pathogens that could spread into new regions as a result of climate change, with potential impacts to both human and wildlife health and global economies. Called The Deadly Dozen: Wildlife Diseases in the Age of Climate Change, the new report provides examples of diseases that could spread as a result of changes in temperatures and precipitation levels. The best defense, according to the report's authors, is a good offense in the form of wildlife monitoring to detect how these diseases are moving so health professionals can learn and prepare to mitigate their impact.
Bacterial pneumonia caused most deaths in 1918 influenza pandemic
The majority of deaths during the influenza pandemic of 1918-1919 were not caused by the influenza virus acting alone, report researchers from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Instead, most victims succumbed to bacterial pneumonia following influenza virus infection. The pneumonia was caused when bacteria that normally inhabit the nose and throat invaded the lungs along a pathway created when the virus destroyed the cells that line the bronchial tubes and lungs.
1918 flu antibodies resurrected from elderly survivors
Ninety years after the sweeping destruction of the 1918 flu pandemic, researchers at Monroe Carell Jr. Children's Hospital at Vanderbilt have recovered antibodies to the virus – from elderly survivors of the original outbreak.
Pandemic flu: Most nursing homes don't have a plan
If an influenza pandemic hits the United States, acute care hospitals are likely to be overwhelmed. Nursing homes may then be expected to assist with the patient overflow, but a new study in the
Journal of the American Medical Association suggests that many are not prepared for such a task.
Flu pandemic medical help left in the waiting room
GPs are not an integral part of Australian influenza planning, despite the important role they will play in limiting deaths in the event of a pandemic hitting the country, according to research from The Australian National University.
Battling bird flu by the numbers
A pair of Los Alamos National Laboratory theorists have developed a mathematical tool that could help health experts and crisis managers determine in real time whether an emerging infectious disease such as avian influenza H5N1 is poised to spread globally.
Web tool puts wildlife diseases on the map
A new online map makes it possible, for the first time, to track news of disease outbreaks around the world that threaten the health of wildlife, domestic animals, and people.