Lee C, Loeb M, Phillips A, Nesbitt J, Smith K, Fearon M, McArthur M A, Mazzulli T, Li Y, McGeer A
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Ontario, Canada.
Infect Control Hosp Epidemiol. 2000 Nov;21(11):700-4. doi: 10.1086/501727.
To describe the use of zanamivir during an influenza A outbreak.
Residents of a 176-bed long-term-care facility for the elderly in Newmarket, Ontario, Canada, 90% of whom received influenza vaccine in the fall of 1998.
When respiratory illness due to influenza A was confirmed, infection control measures and amantadine prophylaxis were initiated. Despite these measures, transmission of influenza A continued.
Zanamivir inhalations, 10 mg daily for prophylaxis and 10 mg twice daily for treatment of influenza.
There were 13 definite and 66 probable outbreak-associated cases of influenza A. Twelve (15%) cases developed pneumonia, 7 (9%) were hospitalized, and 2 (2.6%) died. All 12 culture-positive cases yielded influenza A/Sydney/H3N2/05/97-like virus, a 1998/99 vaccine component. The three isolates obtained prior to the initiation of amantadine were amantadine-susceptible; all nine obtained after prophylaxis was instituted were amantadine-resistant. One hundred twenty-nine (92%) of 140 residents who were offered zanamivir accepted it and were able to attempt inhalations. Of these 129, 78% (100) had no difficulty in complying with inhalations. Difficulty with inhalations was associated with decreased functional and mental status. Fifteen (58%) of 26 residents fully dependent in activities of daily living had difficulty compared to 14 (14%) of 100 others (P<.001). Twenty-two (45%) of 49 residents not oriented to person, place, or time had difficulty compared to 7 (10%) of 77 others (P<.001). In the 2 weeks after zanamivir prophylaxis, only 2 new cases of respiratory illness occurred, neither confirmed as influenza. No side effects were identified in 128 zanamivir-treated residents.
A minority of nursing home residents have difficulty following instructions for zanamivir inhalations. Zanamivir was well tolerated, and its use was temporally associated with termination of an outbreak that amantadine had failed to control.
描述扎那米韦在甲型流感暴发期间的使用情况。
加拿大安大略省纽马克特一家拥有176张床位的老年长期护理机构的居民，其中90%在1998年秋季接种了流感疫苗。
当确诊甲型流感引起的呼吸道疾病时，启动了感染控制措施和金刚烷胺预防措施。尽管采取了这些措施，甲型流感仍持续传播。
扎那米韦吸入治疗，预防剂量为每日10毫克，治疗流感剂量为每日两次，每次10毫克。
确诊13例、可能与疫情暴发相关的甲型流感病例66例。12例（15%）患者发生肺炎，7例（9%）住院，2例（2.6%）死亡。所有12例培养阳性病例均分离出甲型/悉尼/H3N2/05/97样病毒，这是1998/99年流感疫苗的一个组分。在开始使用金刚烷胺之前分离出的3株病毒对金刚烷胺敏感；在采取预防措施后分离出的9株病毒均对金刚烷胺耐药。140名接受扎那米韦治疗的居民中有129名（92%）接受了该药物并能够尝试吸入治疗。在这129名居民中，78%（100名）在进行吸入治疗时没有困难。吸入困难与功能和精神状态下降有关。在日常生活活动完全依赖他人的26名居民中，15名（58%）存在吸入困难，而在其他100名居民中，有14名（14%）存在吸入困难（P<0.001）。在49名对人物、地点或时间定向障碍的居民中，22名（45%）存在吸入困难，而在其他77名居民中，有7名（10%）存在吸入困难（P<0.001）。在扎那米韦预防治疗后的2周内，仅出现2例新的呼吸道疾病病例，均未确诊为流感。128名接受扎那米韦治疗的居民未发现副作用。
少数疗养院居民在遵循扎那米韦吸入治疗的指示方面存在困难。扎那米韦耐受性良好，其使用在时间上与金刚烷胺未能控制的疫情暴发的终止相关。
