Article ; Online: Modeling the impacts of influenza antiviral prophylaxis strategies in nursing homes
Antimicrobial Stewardship & Healthcare Epidemiology, Vol 3, Pp s18-s
2023 Volume 19
Abstract: Background: Antiviral chemoprophylaxis for influenza is recommended in nursing homes to prevent transmission and severe disease among residents with higher risk of severe influenza complications. Interim CDC guidance recommends that long-term care ... ...
Abstract | Background: Antiviral chemoprophylaxis for influenza is recommended in nursing homes to prevent transmission and severe disease among residents with higher risk of severe influenza complications. Interim CDC guidance recommends that long-term care facilities initiate antiviral chemoprophylaxis with oral oseltamivir for all non-ill residents living in the same unit following the start of an outbreak in a facility (ie, ≥2 patients ill within 72 hours and of whom at least 1 resident has laboratory-confirmed influenza). Prophylaxis continues for a minimum of 2 weeks and for at least 7 days after the last laboratory-confirmed case. However, facilities may not strictly adhere to this guidance, with 1 study showing up to 68% of facilities were nonadherent to national guidance (Silva et al 2020). Here, we model the potential impacts of different antiviral prophylaxis strategies. Methods: We developed a susceptible–exposed–asymptomatic–infected–recovered (SEAIR) compartmental model of an average-sized nursing home comprising short-stay residents, long-stay residents, and healthcare personnel (HCP). Persons treated with antiviral chemoprophylaxis were less susceptible to infection, had a lower probability of symptoms if infected, a reduced viral load, and a shortened duration of infectiousness. We included influenza vaccination for residents and HCP through reduced probability of symptomatic infection. Coverage rates were estimated from CDC FluVaxView and CMS COVID-19 nursing home data. As a base case, we modeled a scenario with prophylaxis implemented according to guidance. We varied uptake by residents and HCP (from 10% to 90%), case thresholds for prophylaxis initiation (1–5 cases identified), and timing of prophylaxis cessation: either time dependent (ie, 10–14 days of prophylaxis) or case-dependent (ie, continuing prophylaxis for 1–7 days with no cases). Results: In the scenario based on current guidance, prophylaxis reduced resident cases by 16% and resident hospitalizations by 45%, compared to no prophylaxis (Fig. ... |
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Keywords | Infectious and parasitic diseases ; RC109-216 ; Public aspects of medicine ; RA1-1270 |
Subject code | 610 ; 360 |
Language | English |
Publishing date | 2023-06-01T00:00:00Z |
Publisher | Cambridge University Press |
Document type | Article ; Online |
Database | BASE - Bielefeld Academic Search Engine (life sciences selection) |
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