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

10.3201/eid1510.081129
Suggested citation for this article: Van den Dool C, Hak E, Bonten MJM, Wallinga J. A model-based assessment of oseltamivir prophylaxis strategies to prevent influenza in nursing homes. Emerg Infect Dis. 2009 Oct; [Epub ahead of print]
A Model-based Assessment of Oseltamivir Prophylaxis Strategies to Prevent Influenza in Nursing Homes
Carline van den Dool, Eelko Hak, Marc J.M. Bonten,1 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); and National Institute for Public Health and the Environment, Bilthoven, the Netherlands (J. Wallinga)
1These authors contributed equally to this article.

Prophylaxis with neuraminidase inhibitors is important for controlling seasonal influenza outbreaks in long-term care settings. We used a stochastic individual-based model that simulates influenza virus transmission in a long-term care nursing home department to study the protection offered to patients by different strategies of prophylaxis with oseltamivir and determined the effect of emerging resistance. Without resistance, postexposure and continuous prophylaxis reduced the patient infection attack rate from 0.19 to 0.13 (relative risk [RR] 0.67) and 0.05 (RR 0.23), respectively. Postexposure prophylaxis prevented more infections per dose (118 and 323 daily doses needed to prevent 1 infection, respectively) and required fewer doses per season than continuous prophylaxis. If resistance to oseltamivir was increased, both prophylaxis strategies became less efficacious and efficient, but postexposure prophylaxis posed a lower selection pressure for resistant virus strains. Extension of prophylaxis to healthcare workers offered little additional protection to patients.

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