Abstract
BackgroundEvidence of an oseltamivir treatment effect on influenza A(H3N2) virus infections in hospitalised patients is incomplete.AimsThis cohort study aimed to evaluate risk factors for death among PCR-confirmed hospitalised cases of seasonal influenza A(H3N2) of all ages and the impact of oseltamivir.MethodsParticipants included all 332 PCR-confirmed influenza A(H3N2) cases diagnosed between 30 August 2016 and 17 March 2017 in an English university teaching Hospital. Oseltamivir treatment effect on odds of inpatient death was assessed by backward stepwise multivariable logistic regression analysis.ResultsThe odds of death were reduced by two thirds (odds ratio (OR): 0.32; 95% confidence interval (CI): 0.11–0.93), in inpatients treated with a standard course of oseltamivir 75 mg two times daily for 5 days – compared with those untreated with oseltamivir, after adjustment for age, sex, current excess alcohol intake, receipt of 2016/17 seasonal influenza vaccine, serum haemoglobin and hospital vs community attribution of acquisition of influenza.ConclusionsOseltamivir treatment given according to National Institutes of Clinical Excellence (NICE); United States Centres for Disease Control and Prevention (CDC); Infectious Diseases Society of America (IDSA) and World Health Organization (WHO) guidelines was shown to be effective in reducing the odds of mortality in inpatients with PCR-confirmed seasonal influenza A(H3N2) after adjustment in a busy routine English hospital setting. Our results highlight the importance of hospitals complying with relevant guidelines for prompt seasonal influenza PCR testing and ensuring standard oseltamivir treatment to all PCR-confirmed cases of seasonal influenza.
Highlights
Seasonal influenza, which recurs annually in winter, remains a leading cause of morbidity and mortality worldwide and a major challenge to hospitals, which face severe pressures during this period of the year [1,2]
This study of a large cohort of laboratory-confirmed seasonal influenza A (H3N2) cases admitted to a United Kingdom (UK) National Health Service (NHS) hospital measured the odds of allcause inpatient mortality
Our study has chronicled the effectiveness of oseltamivir in reducing inpatient mortality in a hospital typical of the UK NHS in winter season 2016/17 for the influenza A(H3N2) virus strain and that a proportion of patients had not received oseltamivir treatment at standard British National Formulary (BNF) dose according to National Institutes of Clinical Excellence (NICE) and World Health Organization (WHO) guidelines for several operational reasons, some of which were amenable to improvement
Summary
Seasonal influenza, which recurs annually in winter, remains a leading cause of morbidity and mortality worldwide and a major challenge to hospitals, which face severe pressures during this period of the year [1,2]. Other factors associated with mortality include underlying comorbidities [5,8], delay in presentation to medical care [8] and viral subtype, with infection with influenza A(H3N2) virus strains being of highest risk [3,5,7]. Aims: This cohort study aimed to evaluate risk factors for death among PCRconfirmed hospitalised cases of seasonal influenza A(H3N2) of all ages and the impact of oseltamivir. Conclusions: Oseltamivir treatment given according to National Institutes of Clinical Excellence (NICE); United States Centres for Disease Control and Prevention (CDC); Infectious Diseases Society of America (IDSA) and World Health Organization (WHO) guidelines was shown to be effective in reducing the odds of mortality in inpatients with PCR-confirmed seasonal influenza A(H3N2) after adjustment in a busy routine English hospital setting. Our results highlight the importance of hospitals complying with relevant guidelines for prompt seasonal influenza PCR testing and ensuring standard oseltamivir treatment to all PCR-confirmed cases of seasonal influenza
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