Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-16T18:24:26.851Z Has data issue: false hasContentIssue false
  • English
  • Français

Zanamivir Use During Transmission of Amantadine-Resistant Influenza A in a Nursing Home

Published online by Cambridge University Press:  02 January 2015

Christine Lee ,
Mark Loeb ,
Anne Phillips ,
Judy Nesbitt ,
Karen Smith ,
Margaret Fearon ,
Margaret A. McArthur ,
Tony Mazzulli ,
Yan Li  and
Allison McGeer
Christine Lee
Affiliation:
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Toronto, Ontario
Mark Loeb
Affiliation:
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario
Anne Phillips
Affiliation:
Glaxo-Wellcome, Inc, Toronto, Ontario, Canada
Judy Nesbitt
Affiliation:
Aurora Resthaven Nursing Home, Aurora, Ontario
Karen Smith
Affiliation:
Aurora Resthaven Nursing Home, Aurora, Ontario
Margaret Fearon
Affiliation:
Ministry of Health and Long Term Care, Laboratory Branch, Ottawa, Ontario
Margaret A. McArthur
Affiliation:
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Toronto, Ontario
Tony Mazzulli
Affiliation:
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Toronto, Ontario
Yan Li
Affiliation:
Bureau of Microbiology, Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario
Allison McGeer*
Affiliation:
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Toronto, Ontario
*
Room 1460, Department of Microbiology, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario M5G 1X5, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe the use of zanamivir during an influenza A outbreak.

Population:

Residents of a 176-bed long-term-care facility for the elderly in Newmarket, Ontario, Canada, 90% of whom received influenza vaccine in the fall of 1998.

Outbreak:

When respiratory illness due to influenza A was confirmed, infection control measures and amantadine prophylaxis were initiated. Despite these measures, transmission of influenza A continued.

Intervention:

Zanamivir inhalations, 10 mg daily for prophylaxis and 10 mg twice daily for treatment of influenza.

Results:

There were 13 definite and 66 probable outbreak-associated cases of influenza A. Twelve (15%) cases developed pneumonia, 7 (9%) were hospitalized, and 2 (2.6%) died. All 12 culture-positive cases yielded influenza A/Sydney/H3N2/05/97-like virus, a 1998/99 vaccine component. The three isolates obtained prior to the initiation of amantadine were amantadine-susceptible; all nine obtained after prophylaxis was instituted were amantadine-resistant. One hundred twenty-nine (92%) of 140 residents who were offered zanamivir accepted it and were able to attempt inhalations. Of these 129, 78% (100) had no difficulty in complying with inhalations. Difficulty with inhalations was associated with decreased functional and mental status. Fifteen (58%) of 26 residents fully dependent in activities of daily living had difficulty compared to 14 (14%) of 100 others (P<.001). Twenty-two (45%) of 49 residents not oriented to person, place, or time had difficulty compared to 7 (10%) of 77 others (P<001). In the 2 weeks after zanamivir prophylaxis, only 2 new cases of respiratory illness occurred, neither confirmed as influenza. No side effects were identified in 128 zanamivir-treated residents.

Conclusion:

A minority of nursing home residents have difficulty following instructions for zanamivir inhalations. Zanamivir was well tolerated, and its use was temporally associated with termination of an outbreak that amantadine had failed to control.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 11 , November 2000 , pp. 700 - 704
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Stevenson, CG, McArthur, MA, Zivnickova, H, Naus, M, Abraham, E, McGeer, A. Progress in the control of influenza and pneumococcal disease in long term care facilities: where do we stand? Presented at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections; March 5-9, 2000; Atlanta, GA.Google Scholar
2.Henry, B. Summary report of the Ontario influenza 1998/9 season. Public Health and Epidemiology Report. Ontario. 1999;10:144–159.Google Scholar
3.Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48:(RR-4):1–28.Google Scholar
4.Statement on influenza vaccination for the 2000-2001 season. An Advisory Committee Statement (ASC). National Advisory Committee on Immunization. Can Commun Dis Rep 2000;26:1–16.Google Scholar
5.Aoki, FY. Amantadine and rimantadine. In: Nicholson, KG, Webster, RG, Hay, AJ, eds. Textbook of Influenza. Oxford, England: Blackwell Science, Ltd; 1998:457–476.Google Scholar
6.Atkinson, WL, Arden, NH, Patriarca, PALeslie, N, Lui, KJ, Gohd, R. Amantadine prophylaxis during an institutional outbreak of type A (H1N1) influenza. Arch Intern Med 1986;146:1751–1756.CrossRefGoogle ScholarPubMed
7.Mast, EE, Harmon, MW, Gravenstein, S, Wu, SP, Arden, NH, Circo, R, et al. Emergence and possible transmission of amantadine-resistant viruses during nursing home outbreaks of influenza A (H3N2). Am J Epidemiol 1991;134:988–997.CrossRefGoogle ScholarPubMed
8.Degelau, J, Somani, SKCooper, SL, Guay, DR, Crossley, KB. Amantadine-resistant influenza A in a nursing facility. Ardi Intern Med 1992;152:390–392.Google Scholar
9.Houck, P, Hemphill, M, LaCroix, S, Hirsh, D, Cox, N. Amantadine-resistant influenza A in a nursing homes. Identification of a resistant virus prior to drug use. Arch Intern Med 1995;155:533–537.CrossRefGoogle Scholar
10.Hayden, FG, Osterhaus, AD, Treanor, JJ, Fleming, DM, Aoki, FY, Nicholson, KG, et al. Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenzavirus infections. GG167 Influenza Study Group. N Engl J Med 1997;337:874–880.Google Scholar
11.Randomised trial of the efficacy and safety of inhaled zanamivir in treatment of influenza A and B virus infections. The MIST (Management of Influenza in the Southern Hemisphere Trialists) Study Group. Lancet 1998;352:1877–1881.Google Scholar
12.Monto, AS, Robinson, DP, Herlocher, ML, Hinson, JM Jr, Elliott, MJ, Crisp, AZanamivir in the prevention of influenza among healthy adults: a randomized controlled txial. JAMA 1999;282:31–35.CrossRefGoogle Scholar
13.Schilling, M, Povinelli, L, Krause, P, Gravenstein, M, Ambrozaitis A Jones, HH, et al. Efficacy of zanamivir for chemoprophylaxis of nursing home outbreaks. Vaccine 1998;16:1771–1774.CrossRefGoogle Scholar
14.McGeer, A, Campbell, B, Emori, TG, Hierholzer, WJ, Jackson, MM, Nicolle, LE, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 1991;19:1–7.Google Scholar
15.Katz, S, Downs, TD, Cash, HR, Frotz, RD. Progress in the development of the index of ADL. Gerontologist 1970;10:20–30.CrossRefGoogle ScholarPubMed
16.KUmov, AI, Rocha, E, Hayden, FG, Schult, RA, Roumillat, LF, Cox, NJ. Prolonged shedding of amantadine-resistant influenza A viruses by immunodeficient patients: detection by polymerase chain reaction-restriction analysis. J Infect Dis 1995;172:1352–1355.Google Scholar
17.Li, Y. 1998-1999 influenza season: Canadian laboratory diagnoses and strain characterization. Can Commun Dis Rep 1999;25-21:177–181.Google Scholar
18.Patriarca, PAWeber, JAParker, RAHall, WN, Kendal, AP, Bregman, DJ, et al. Efficacy of influenza vaccines in nursing homes. Reduction in illness and complications during an influenza A (H3N2) epidemic. JAMA 1985;253:1136–1139.CrossRefGoogle ScholarPubMed
19.Arden, NH, Patriarca, PAKendal, AP. Experiences in the use and efficacy of inactivated influenza vaccine in nursing homes. Options for the Control of Influenza. New York, NY: Alan R. Liss; 1986:155–168.Google Scholar
20.Potter, J, Stott, DJ, Roberts, MAElder, AG, O'Donnell, B, Knight, PV, et al. Influenza vaccination of health care workers in long-term-care hospitals reduces mortality of elderly patients. J Infect Dis 1997;175:1–6.Google Scholar
21.Carman, WF, Elder, AG, Wallace, LA, McAulay, K, Walker A Murray, GD, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355:93–97.CrossRefGoogle ScholarPubMed
22.Goevart, TM, Thijs, CT, Masurel, N, Sprenger, JJ, Dinant, GJ, Knottnerus, JAThe efficacy of influenza vaccination in elderly individuals. A randomized double-blind placebo-controlled trial. JAMA 1994;272:1661–1665.Google Scholar
23.Gross, PAHermogenes, AW, Sacks, HS, Lau, J, Levandowski, RA The efficacy of influenza vaccine in elderly persons. A meta-analysis and review of the literature. Ann Intern Med 1995;123:518–527.CrossRefGoogle ScholarPubMed
24.Strassburg, MA, Greenland, S, Sondilo, FJ, Lieb, LE, Habel, LAInfluenza in the elderly: report of an outbreak and a review of vaccine effectiveness reports. Vaccine 1986;4:38–44.CrossRefGoogle Scholar
25.Ohmit, SE, Arden, NH, Monto, AS. Effectiveness of inactivated influenza vaccine among nursing home residents during an influenza type A (H3N2) epidemic. J Am Geriatr Soc 1999;47:165–71.Google Scholar
26.Staynor, K, Foster, G, McArthur, M, McGeer, APetric, M, Simor, AE. Influenza A outbreak in a nursing home: the value of early diagnosis and the use of amantadine hydrochloride. Can J Infect Control 1994;9:109–111.Google Scholar
27.Dolin, R, Reichman, RC, Madore, HP, Maynard, R, Linton, PN, Webber-Jones, J. A controlled trial of amantadine and rimantadine in the prophylaxis of influenza A infection. N Engl J Med 1982;307:580–584.Google Scholar
28.Hayden, FG. Antivirals for pandemic influenza. J Infect Dis 1997;176(suppl 1):S56–S61.Google Scholar
29.Arden, NH, Patriarca, PA, Fasano, MB, Lui, KJ, Harmon, MW, Kendal, AP, et al. The roles of vaccination and amantadine prophylaxis in controlling an outbreak of influenza A (H3N2) in a nursing home. Arch Intern Med 1988;148:865–868.CrossRefGoogle ScholarPubMed
30.Peters, NL, Oboler, S, Hair, C, Laxson, L, Kost, J, Meiklejohn, G. Treatment of an influenza A outbreak in a teaching nursing home. Effectiveness of a protocol for prevention and control. J Am Geriatr Soc 1989;37:210–218.Google Scholar
31.Centers for Disease Control and Prevention. Control of influenza A outbreaks in nursing homes: amantadine as an adjunct to vaccine—Washington, 1989-90. MMWR 1991;40:841–844.Google Scholar
32.Hayden, HG, Belshe, RB, Clover, RD, Hay, AJ, Oakes, MJ, Soo, W. Emergence and apparent transmission of rimantadine-resistant influenza A virus in families. N Engl J Med 1989;321:1696–1702.Google Scholar
33.Hayden, FG, Atmar, RL, Schilling, M, Johnson, C, Poretz, D, Paar, D, et al. Use of the selective oral neuraminidase inhibitor oseltamivir to prevent influenza. N Engl J Med 1999;341:1336–1343.CrossRefGoogle ScholarPubMed
34.Lee, W, McArthur, M, Kam, AFriedman, RPhillips, ASimor, Aet al. Use of zanamivir to control an outbreak of influenza A in a nursing home. Presented at the Community and Hospital Infection Control Association of Canada; May 29-31, 2000; Toronto, Ontario, Canada. Abstract 11.Google Scholar
35.Gubareva, LV, Kaiser, L, Hayden, FG. Influenza virus neuraminidase inhibitors. Lancet 2000;355:827–835.Google Scholar