Abstract
Influenza outbreaks in Aged Care Facilities (ACFs) can lead to hospitalizations and deaths. Influenza can spread rapidly through ACFs if precautionary measures are not taken. Along with influenza vaccination and precautionary hygiene measures, Oseltamivir Prophylaxis (OP) may be effective in reducing the attack rate of influenza by preventing new cases. A cohort study was carried out to investigate the effectiveness of OP use during influenza outbreaks in ACFs located within South Western Sydney Local Health District from 1 January 2015 to 31 December 2018. The main outcome assessed was the rate of OP failure (new cases of influenza in patients treated with OP) among ACF residents. Subgroups and various predictors of OP failure were investigated including presence of a dementia ward, high care ward, and days to Public Health Unit (PHU) notification. The cohort consisted of 86 ACF outbreaks involving 10,064 residents. OP prevented 90% of influenza cases during influenza outbreaks [0.1 RR (95% confidence interval (CI): 0.08–0.12); P < 0.0001]. ACFs with dementia wards had a 44% (0.56 relative risk (RR) (95% CI: 0.34–0.93); P < 0.05) lower OP failure rate. ACFs with high level care had an 87% (0.13 RR (95% CI: 0.05–0.38); P < 0.05) lower OP failure rate. OP is highly effective in preventing new cases of influenza during outbreaks in ACFs, especially in ACFs with dementia or high care wards. Mandatory reporting of influenza outbreaks to PHUs would ensure that ACFs are supported throughout the outbreak, which will facilitate reductions in hospitalizations and mortality.
Highlights
Influenza is a respiratory virus that can lead to deaths and hospitalizations in the elderly, especially during influenza outbreaks in Aged Care Facilities (ACFs) [1]
This study found that when used as prophylaxis, oseltamivir was highly effective in preventing new clinical cases at an individual level in influenza outbreaks in dementia-specific units and high care settings when compared with nondementia-specific wings and low care settings
This study found that Oseltamivir Prophylaxis (OP) failure was 6.5 times higher in ACFs that had a higher OP utilization rate, which appears contradictory to the previous statement on the effectiveness of OP to prevent new cases of illness at the individual level
Summary
Influenza is a respiratory virus that can lead to deaths and hospitalizations in the elderly, especially during influenza outbreaks in Aged Care Facilities (ACFs) [1]. Residents in ACFs are vulnerable to influenza given their age (over 65 years) and multiple comorbidities including impaired oral intake, limited dexterity, and altered consciousness [1]. It must be noted that while influenza is notifiable, influenza outbreak reporting by ACFs is not mandatory, but highly recommended by NSW Health. ACFs are encouraged by NSW Public Health Units (PHUs) to implement timely sourcing of antiviral medications for both influenza treatment and prophylaxis. PHUs provide ACFs with advice and support to implement other outbreak control measures [3]. In the absence of early reporting and prevention strategies, influenza spreads rapidly throughout ACFs causing high attack rates. The window of opportunity to implement control strategies is often variable; and early detection and management of influenza in ACFs enables a prompt public health response
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