Schilling M, Povinelli L, Krause P, Gravenstein M, Ambrozaitis A, Jones H H, Drinka P, Shult P, Powers D, Gravenstein S
Eastern Virginia Medical School, Norfolk, VA, USA.
Vaccine. 1998 Nov;16(18):1771-4. doi: 10.1016/s0264-410x(98)00141-8.
Despite vaccination, influenza remains a common of morbidity in nursing homes. Chemoprophylaxis of residents with currently available antivirals is not always effective and new agents effective against both influenza A and B are needed. In a randomized, unblinded pilot study, we compared 14 day chemoprophylaxis with zanamivir, an antiviral which inhibits influenza neuraminidase, to standard of care during sequential influenza A and influenza B outbreaks in a 735 bed nursing home. Influenza A outbreaks were declared on 6/14 epidemic units. Sixty-five volunteers on four epidemic units were randomized to zanamivir and on two epidemic units, 23 volunteers were randomized to rimantadine. During the 14 days of prophylaxis, only four new febrile respiratory illnesses were detected. One volunteer receiving rimantadine prophylaxis developed laboratory-confirmed influenza. Influenza B outbreaks were declared on 3/14 epidemic units. Thirty-five volunteers on two epidemic units were randomized to zanamivir and 18 volunteers on one epidemic unit were randomized to no drug. During the 14 days of prophylaxis, only one new febrile respiratory illness was detected. One volunteer randomized to receive no drug developed laboratory-confirmed influenza. Zanamivir appears comparably effective to standard of care in preventing influenza-like illness and laboratory-confirmed influenza in nursing homes, but requires further testing.
尽管接种了疫苗，但流感在养老院中仍是一种常见的发病原因。使用目前可用的抗病毒药物对居民进行化学预防并不总是有效，因此需要对甲型和乙型流感均有效的新型药物。在一项随机、非盲法的试点研究中，我们在一家拥有735张床位的养老院中，在甲型流感和乙型流感相继爆发期间，将14天的扎那米韦化学预防（扎那米韦是一种抑制流感神经氨酸酶的抗病毒药物）与标准护理进行了比较。在6个病区宣布出现甲型流感疫情。4个病区的65名志愿者被随机分配接受扎那米韦治疗，2个病区的23名志愿者被随机分配接受金刚烷胺治疗。在预防的14天里，仅检测到4例新的发热性呼吸道疾病。一名接受金刚烷胺预防的志愿者出现了实验室确诊的流感。在3个病区宣布出现乙型流感疫情。2个病区的35名志愿者被随机分配接受扎那米韦治疗，1个病区的18名志愿者被随机分配不接受药物治疗。在预防的14天里，仅检测到1例新的发热性呼吸道疾病。一名被随机分配不接受药物治疗的志愿者出现了实验室确诊的流感。扎那米韦在预防养老院中流感样疾病和实验室确诊流感方面似乎与标准护理效果相当，但需要进一步测试。
