Administering antiviral medications quickly to nursing home residents during influenza outbreaks can significantly reduce hospitalizations, according to a study led by researchers from Brown's School of Public Health and announced on Mar. 31.
The findings are important for managing influenza in nursing homes, where the virus can spread rapidly among vulnerable older adults. National guidelines advise treating all eligible residents with antivirals at the start of an outbreak, but there has been limited evidence on how quickly action is needed and what proportion of residents must be treated to achieve results.
Andrew Zullo, associate professor of epidemiology and health services at Brown, led the research team that found giving oseltamivir (Tamiflu) within two days of an outbreak to at least 70% of residents reduced hospitalization risk by 21%. "While the study doesn't mean that every single resident should get prophylaxis automatically, because clinical judgment still matters, it's definitely important to treat fast and extensively," Zullo said. "Not every resident necessarily has to receive it for there to be a benefit. It's similar to vaccination in that you can limit viral transmission if enough people get oseltamivir."
The retrospective cohort study examined 404 outbreaks across 318 nursing homes involving about 30,000 residents. Facilities were grouped based on whether they provided intensive treatment—defined as starting oseltamivir prophylaxis for at least 70% of eligible residents within two days—or followed a less intensive approach.
Researchers used statistical methods designed to account for delays between outbreak detection and facility response. While no difference was observed in mortality rates between groups after either two or four weeks, those receiving early intensive treatment saw fewer hospitalizations.
Zullo said previous studies did not fully account for timing when analyzing outcomes: "Some of the prior methods that researchers had used hadn't accounted for the fact that this unfolds over time, and so they had introduced some bias... In this study, we use methods that account for the need to dynamically wait and see how a facility responds." The results suggest prompt action could help protect medically complex older adults during flu season.
