Influenza vaccination and antiviral therapy: is there a role for concurrent administration in the institutionalised elderly?

A Review of Repurposed Cancer Drugs in Clinical Trials for Potential Treatment of COVID-19

The pandemic of the coronavirus disease 2019 (COVID-19) represents an unprecedented challenge to identify effective drugs for prevention and treatment. While the world’s attention is focused on news of COVID-19 vaccine updates, clinical management still requires improvement. Due to the similarity of cancer-induced inflammation, immune dysfunction, and coagulopathy to COVID-19, anticancer drugs, such as Interferon, Pembrolizumab or Bicalutamide, are already being tested in clinical trials for repurposing, alone or in combination. Given the rapid pace of scientific discovery and clinical data generated by the large number of people rapidly infected, clinicians need effective medical treatments for this infection.

The use of oseltamivir during an influenza B outbreak in a chronic care hospital

BACKGROUND

Residents of nursing homes and long-term care facilities are at a higher risk of outbreaks of influenza and of serious complications of influenza than those in the community. In late July 2005, a 90-bed chronic care psycho-geriatric hospital in Sydney, Australia, reported cases of influenza-like illness (ILI) occurring amongst its residents.

METHODS

An investigation to confirm the outbreak, and its cause, was undertaken. Influenza vaccination levels amongst residents, and the effects of antiviral drugs used for prevention and treatment, were assessed. Oseltamivir was only given to the residents, in the form of both treatment and prophylaxis.

RESULTS

A total of 22 out of 89 residents met the clinical case definition of ILI with onset on or after 27 July 2005. This represents an attack rate of 25%. Oseltamivir was commenced on day 9 of the outbreak. Influenza B was identified in six residents as the causative agent of the outbreak. No deaths or acute hospitalization were recorded for this outbreak and there were no further reported cases after the introduction of oseltamivir. Vaccine effectiveness was 75% and the strain of influenza B isolated was well matched to that year's vaccine.

CONCLUSIONS

There are few data on the use of oseltamivir in influenza B outbreaks. Early antiviral intervention appeared to curtail this outbreak of influenza B in a chronic care facility. We found high vaccine effectiveness in this frail, institutionalized population, highlighting the importance of influenza vaccination for residents of chronic care facilities.

Épidémie de grippe nosocomiale dans un service de gériatrie

OBJECTIVE

To describe a nosocomial influenza outbreak and the pharmacologic and nonpharmacologic control measures implemented in a hospital ward with beds for acute geriatric care and rehabilitation care.

METHODS

Descriptive survey conducted in the geriatrics department of a university hospital. An influenza outbreak occurred in February 2005 in 2 of the department's 3 separate units. The study concerned all patients in the 2 affected units (A and B) present during the outbreak, as well as all department staff. Once cases of influenza were confirmed, elderly patients in contact with influenza patients received chemoprophylaxis with oseltamivir when it became available.

RESULTS

Thirty-eight (76%) patients and 62 (38%) staff members had been vaccinated. The time from the initial symptoms of the first case until implementation of control measures was 7 days in unit A but only 1 day in unit B, -and chemoprophylaxis of contact patients began in 9 days and 24 hours respectively. The attack rate was 38% in the 38 vaccinated patients and 29% in the 14 unvaccinated patients (NS). All cases met the definition of nosocomial infection. No deaths imputable to influenza occurred during the outbreak. The implementation of the nonpharmacologic measures aimed at preventing spread of the outbreak presented no particular difficulty, except for compliance with geographic isolation of some patients with dementia and influenza. The difference between the attack rates for the two sectors (48% for unit A and 28% for unit B) suggests that the preventive measures were effective. Tolerance to chemoprophylaxis with oseltamivir was good.

CONCLUSION

This study confirmed that influenza can affect elderly hospital patients, even those in whom the vaccination rate is high, and that rapid detection of the outbreak and immediate implementation of pharmacologic and nonpharmacologic preventive measures can limit its spread.

Experience With the Rapid Directigen Test for Influenza

OBJECTIVE

To determine the sensitivity and positive predictive value of the Becton-Dickson Directigen AB performed on-site in a nursing home compared to viral culture.

SETTING

A 721-bed skilled nursing facility for veterans and spouses. DESIGN MEASUREMENTS: Nasopharyngeal specimens were obtained with a low clinical threshold from residents during 3 influenza seasons for rapid antigen testing in the nursing home. The specimens were then transported for viral culture by courier on ice to a laboratory 45 miles away.

RESULTS

A total of 327 samples were obtained; 36 were positive for influenza A by rapid test, and all but 2 grew the organism on tissue culture with a positive predictive value of 94%. Nineteen specimens were negative by rapid test, but grew influenza A on tissue culture with a sensitivity of 64%. Influenza prophylaxis was usually initiated the day the first positive rapid test was encountered when influenza was active in the community.

CONCLUSION

The Directigen AB is a reliable indicator of influenza when influenza has been culture-confirmed in the community. Although sensitivity is limited, a group of rapid tests provided early laboratory confirmation and facilitated the application of prophylaxis.