Publications
| Influenza A Outbreak In A Chronic Care Facility For Children: The Value Of Antiviral Prophylaxis. |
Authors: E. Rosebrugh, S. Cox, J. Kobyashi, R. Curtis, M. Fearon, I. Guglielmi, M. Pritchard, A. McGeer.
Background:
Objective:To assess the impact of vaccine and antiviral prophylaxis in the management of an influenza A outbreak in a pediatric chronic care facility.
Design: Investigation of an influenza A outbreak in a 60 bed pediatric chronic care facility.
Method: Definite influenza was defined as respiratory illness associated with a positive culture or antigen test for influenza A. Probable influenza was defined as febrile illness associated with at least one respiratory symptom in children, and associated with a least two of cough, coryza, sore throat, or malaise in adults. Charts were reviewed and staff interviewed to assess symptoms, to document prior immunization, and to identify adverse effect of amamtadine.
Results: Six of 60 children developed definite or probable influenza; two requiring hospitalization. Sixteen of 220 patient care staff developed probable influenza. The index case occurred in a staff member who cared for three of the case children prior to their illness. The influenza A strain was A/H3N2/Sydney/05/97, a vaccine component. Vaccine efficacy could not be calculated for children, and was 6% (95%confidence limits - 150%, 65%) in staff. Use of amantadine was associated with a sharp decline in the number of new cases. None of 100 staff receiving amantadine developed influenza-like illness, compared to five of 109 not receiving amantadine (P=0.06). Ten of 57 children (18%) developed neurologic adverse effects while on amantadine: two required hospitalization. Nineteen of 33 (58%) staff on amantadine complained of side effects and 10 (30%) discontinued the medication.
Conclusions: Amantadine was effective in controlling the transmission of influenza A, but was associated with a significant risk of adverse neurologic reactions in children in chronic care. Neuraminidase inhibitors should be evaluated for outbreak management in this setting.
Presented At:
Community and Hospital Infection Control Assocation - Canada Conference, Toronto, Ontario, 5/29/2000.
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©Copyright
1999 Microbiology Department, Mount Sinai Hospital, Toronto, ON, Canada.
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