Treatment of an Influenza A Outbreak in a Teaching Nursing Home

Abstract

The safety and efficacy of current ACIP guidelines for the prevention and control of influenza in nursing home populations are uncertain. An outbreak of influenza A/Sichuan (H3N2) in a teaching nursing home during 1988 gave us the opportunity to evaluate the effectiveness of an influenza vaccination and amantadine prophylaxis protocol. Over 13 days, 12 of 60 residents developed influenza. Prior influenza vaccination had been given to 94% of the residents. Protection from infection occurred in those tested who had antibody levels greater than or equal to 1:16 to the A/Leningrad (H3N2) antigen contained in the standard 1987-88 trivalent vaccine. However, five of 17 vaccinated residents who were tested had antibody levels less than or equal to 1:16 at the start of the outbreak. Amantadine (less than or equal to 100 mg/day) was given to all but one resident starting on the third day of the outbreak, and to employees starting on the sixth day of the outbreaks. Seven residents developed illness after the start of amantadine, although amantadine appeared to ameliorate their symptoms. Although amantadine was generally well tolerated by residents, employees receiving amantadine identified a high incidence of side effects and only 44% of employees took at least 70% of the prescribed amantadine. In our opinion, early detection and protocol-directed intervention probably abated a more severe influenza outbreak. Therefore we support existing recommendations that formal nursing home policies be established to ensure that residents and employees receive annual influenza vaccine and that chemoprophylaxis be used when outbreaks of influenza A are suspected.

Influenza outbreak control practices and the effectiveness of interventions in long‐term care facilities: a systematic review

“…Compliance with amantadine use was reported by one article, 25 which described staff prophylaxis as less than half of staff members taking ≥70% of the prophylactic regimen. Resident compliance was not reported by any articles.…”

“…Five articles (13%) reported discontinuation of amantadine by 11/111 (10%) residents reporting side effects. 14,26,7,25,27 Side effects were wide ranging with agitation, anorexia, depression, fatigue, and gastrointestinal symptoms most frequently reported.…”

Sequential Outbreak of Influenza A and B in a Nursing Home: Efficacy of Vaccine and Amantadine

“…When influenza A is suspected as the cause of an outbreak of febrile, respiratory illness in the nursing home, amantadine prophylaxis at the appropriate dosage should be used for most residents 20–22 . Caution must be exercised, however, as even at doses appropriately adjusted for age and renal disease, amantadine can have adverse effects (weakness, sodium retention, levido reticularis, nausea, falling, delirium) in some nursing home residents 23 .…”