In nursing homes, influenza spreads quickly. Even in facilities with separate wings, staff move throughout the home, caring for medically complex older adults who often share rooms. In this way, a single case of influenza can rapidly become a facility-wide outbreak.
National guidelines recommend treating all eligible nursing home residents with antiviral medications at the start of an outbreak to reduce the spread of disease and prevent serious outcomes. But the evidence is limited on how fast nursing homes need to act, and how many of their residents need to be treated.
A new study led by researchers from Brown’s School of Public Health could inform real-world outbreak management and clarify key guidelines for nursing home staff and clinicians.
Led by Andrew Zullo, associate professor of epidemiology and of health services, policy and practice at Brown, the team found that administering antiviral chemoprophylaxis—oseltamivir (also known by the brand name Tamiflu)—within the first two days of an outbreak, to at least 70% of residents, reduces the risk of hospitalization by 21%.
“The practical message here is that you’re in a race against time to treat an outbreak and so facilities have to remember to pursue using prophylaxis,” Zullo said. “After they’ve made that decision, the key is to do it as rapidly as possible and to reach the greatest number of eligible residents within the facility.”
National guidelines recommend that 100% of eligible residents receive antivirals at the start of an outbreak. The research team arrived at 70% because they found it more feasible for nursing homes to achieve since some residents have contraindications, refuse treatment, are receiving comfort-focused care, or are temporarily offsite.
