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Oseltamivir ring prophylaxis for containment of 2009 H1N1 influenza outbreaks.
N Engl J Med 2010; 362(23):2166-74NEJM

Abstract

BACKGROUND

From June 22 through June 25, 2009, four outbreaks of infection with the pandemic influenza A (H1N1) virus occurred in Singapore military camps. We report the efficacy of ring chemoprophylaxis (geographically targeted containment by means of prophylaxis) with oseltamivir to control outbreaks of 2009 H1N1 influenza in semiclosed environments.

METHODS

All personnel with suspected infection were tested and clinically isolated if infection was confirmed. In addition, we administered postexposure ring chemoprophylaxis with oseltamivir and segregated the affected military units to contain the spread of the virus. All personnel were screened three times weekly both for virologic infection, by means of nasopharyngeal swabs and reverse-transcriptase-polymerase-chain-reaction assay with sequencing, and for clinical symptoms, by means of questionnaires.

RESULTS

A total of 1175 personnel were at risk across the four sites, with 1100 receiving oseltamivir prophylaxis. A total of 75 personnel (6.4%) were infected before the intervention, and 7 (0.6%) after the intervention. There was a significant reduction in the overall reproductive number (the number of new cases attributable to the index case), from 1.91 (95% credible interval, 1.50 to 2.36) before the intervention to 0.11 (95% credible interval, 0.05 to 0.20) after the intervention. Three of the four outbreaks showed a significant reduction in the rate of infection after the intervention. Molecular analysis revealed that all four outbreaks were derived from the New York lineage of the 2009 H1N1 virus and that cases within each outbreak were due to transmission rather than unrelated episodes of infection. Of the 816 personnel treated with oseltamivir who were surveyed, 63 (7.7%) reported mild, nonrespiratory side effects of the drug, with no severe adverse events.

CONCLUSIONS

Oseltamivir ring chemoprophylaxis, together with prompt identification and isolation of infected personnel, was effective in reducing the impact of outbreaks of 2009 H1N1 influenza in semiclosed settings.

Authors+Show Affiliations

Biodefence Centre, Ministry of Defence, Department of Epidemiology and Public Health, National University of Singapore. vernonljm@hotmail.com

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20558367

Citation

Lee, Vernon J., et al. "Oseltamivir Ring Prophylaxis for Containment of 2009 H1N1 Influenza Outbreaks." The New England Journal of Medicine, vol. 362, no. 23, 2010, pp. 2166-74.
Lee VJ, Yap J, Cook AR, et al. Oseltamivir ring prophylaxis for containment of 2009 H1N1 influenza outbreaks. N Engl J Med. 2010;362(23):2166-74.
Lee, V. J., Yap, J., Cook, A. R., Chen, M. I., Tay, J. K., Tan, B. H., ... Tambyah, P. A. (2010). Oseltamivir ring prophylaxis for containment of 2009 H1N1 influenza outbreaks. The New England Journal of Medicine, 362(23), pp. 2166-74. doi:10.1056/NEJMoa0908482.
Lee VJ, et al. Oseltamivir Ring Prophylaxis for Containment of 2009 H1N1 Influenza Outbreaks. N Engl J Med. 2010 Jun 10;362(23):2166-74. PubMed PMID: 20558367.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oseltamivir ring prophylaxis for containment of 2009 H1N1 influenza outbreaks. AU - Lee,Vernon J, AU - Yap,Jonathan, AU - Cook,Alex R, AU - Chen,Mark I, AU - Tay,Joshua K, AU - Tan,Boon Huan, AU - Loh,Jin Phang, AU - Chew,Seok Wei, AU - Koh,Wee Hong, AU - Lin,Raymond, AU - Cui,Lin, AU - Lee,Charlie W H, AU - Sung,Wing-Kin, AU - Wong,Christopher W, AU - Hibberd,Martin L, AU - Kang,Wee Lee, AU - Seet,Benjamin, AU - Tambyah,Paul A, PY - 2010/6/19/entrez PY - 2010/6/19/pubmed PY - 2010/6/23/medline SP - 2166 EP - 74 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 362 IS - 23 N2 - BACKGROUND: From June 22 through June 25, 2009, four outbreaks of infection with the pandemic influenza A (H1N1) virus occurred in Singapore military camps. We report the efficacy of ring chemoprophylaxis (geographically targeted containment by means of prophylaxis) with oseltamivir to control outbreaks of 2009 H1N1 influenza in semiclosed environments. METHODS: All personnel with suspected infection were tested and clinically isolated if infection was confirmed. In addition, we administered postexposure ring chemoprophylaxis with oseltamivir and segregated the affected military units to contain the spread of the virus. All personnel were screened three times weekly both for virologic infection, by means of nasopharyngeal swabs and reverse-transcriptase-polymerase-chain-reaction assay with sequencing, and for clinical symptoms, by means of questionnaires. RESULTS: A total of 1175 personnel were at risk across the four sites, with 1100 receiving oseltamivir prophylaxis. A total of 75 personnel (6.4%) were infected before the intervention, and 7 (0.6%) after the intervention. There was a significant reduction in the overall reproductive number (the number of new cases attributable to the index case), from 1.91 (95% credible interval, 1.50 to 2.36) before the intervention to 0.11 (95% credible interval, 0.05 to 0.20) after the intervention. Three of the four outbreaks showed a significant reduction in the rate of infection after the intervention. Molecular analysis revealed that all four outbreaks were derived from the New York lineage of the 2009 H1N1 virus and that cases within each outbreak were due to transmission rather than unrelated episodes of infection. Of the 816 personnel treated with oseltamivir who were surveyed, 63 (7.7%) reported mild, nonrespiratory side effects of the drug, with no severe adverse events. CONCLUSIONS: Oseltamivir ring chemoprophylaxis, together with prompt identification and isolation of infected personnel, was effective in reducing the impact of outbreaks of 2009 H1N1 influenza in semiclosed settings. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/20558367/Oseltamivir_ring_prophylaxis_for_containment_of_2009_H1N1_influenza_outbreaks_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa0908482?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -