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Andrew Hayward, Does Treatment with Oseltamivir Prevent Transmission of Influenza to Household Contacts?, Clinical Infectious Diseases, Volume 50, Issue 5, 1 March 2010, Pages 715–716, https://doi.org/10.1086/650459
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In this issue of Clinical Infectious Diseases, Ng et al [1] report an analysis of the effect of oseltamivir on symptom duration, viral shedding, and secondary household transmission of influenza. The study was performed in 2007 and 2008 before the emergence of the 2009 influenza A (H1N1) pandemic. The work is a secondary analysis of a trial of nonpharmaceutical interventions to minimize household transmission [2, 3]. An unexpectedly high use of antivirals was found in this trial, enabling this secondary analysis. The work demonstrates that early administration of oseltamivir reduces symptom duration but more importantly suggests that treatment of index patients can reduce household transmission. The reported trend in household secondary attack rates is highly consistent with the hypothesis that oseltamivir treatment of an index patient can reduce onward transmission to their household contacts and that the benefit is greatest when the index patient is treated early. In households where the index patient was treated within 24 h of symptom onset, the secondary attack rate was 4.7%, increasing to 6.0% if treatment was initiated at 24–48 h, 7% if treatment was initiated at >48 h, and 8.7% if no antivirals were used. A test for trend yielded a P value <.001. The introduction of additional confounders into the analyses reduced the power of the study to find a significant association. After adjusting for these confounding variables, the authors found the same trend remained but did not reach statistical significance. This research also demonstrated a nonsignificant reduction in the duration of viral shedding [1].
