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Stefan Gravenstein, Initiating Influenza Chemoprophylaxis with the First Influenza Case: A New Institutional Standard?, Clinical Infectious Diseases, Volume 47, Issue 1, 1 July 2008, Pages 53–55, https://doi.org/10.1086/588659
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In this issue of Clinical Infectious Diseases, Rubin et al. [1] discuss postexposure chemoprophylaxis against influenza A in long-term care facilities (LTCFs). They report that amantadine chemoprophylaxis initiated ⩽5 days after the beginning of an influenza outbreak reduces outbreak duration, incidence of influenza symptoms, and case-fatality rate. Their findings make sense: the earlier the diagnosis, the quicker the introduction of barriers to transmission (such as speedier chemoprophylaxis initiation), the lower the number of new vectors, and the lower the impact and extent of an influenza outbreak. These findings also agree with a related study, in which earlier treatment of influenza lead to faster resolution of symptoms [2] and, presumably, to a shorter duration and quantity of viral shedding; these factors are likely to affect virus transmissibility, because some individuals with inapparent influenza infection will receive chemoprophylaxis. The authors identified influenza symptomatically by accepting influenza-like illness (ILI) as evidence of the disease. This method is likely to have substantially underestimated the prevalence of influenza and, therefore, is also likely to have underestimated the potential impact of chemoprophylaxis initiation ⩽5 days after outbreak onset.
