457. Use and Effectiveness of Neuraminidase Inhibitor Treatment of Influenza in Healthy Adults and Children in a Military Population
Session: Poster Abstract Session: Prevention and Treatment of Viral Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Despite the widespread use of Neuraminidase Inhibitors (NI), data is still lacking on its effectiveness particularly in healthy patients. Cochran reviews have documented significant bias in published trials. Information on the frequency of NI treatment in healthy patients is also incomplete. We report the frequency and effects of NI treatment in a healthy military population.

Methods: Healthy subjects 0-65 years enrolled in the Acute Respiratory Infections Consortium Natural History Study of Influenza like illness at 5 military medical treatment centers 2009-2013 had nasopharyngeal swabs tested by nucleic acid amplification on enrollment for influenza. Severity of 20 symptoms was recorded for 11 days using a 4 point severity scoring system. Fever, duration of illness and NI use were recorded.

Results: Of 1271 patients, 229(18%) were Flu+ (70,30%pH1N1;94,41%H3N2;48,21%B). Flu+ patients were 47% > age 18 yrs, 60% male, 68.6% Caucasian, 19% African American, and 10% Asian. NI were prescribed in 44(19.2%). Patients older than 18 (p=0.0001) and Native Americans (p=0.01) were more likely to be treated. FluA was treated more often than FluB (p=0.025), and FluA subtypes had similar treatment frequencies. A majority (59.1%) of NI recipients were treated within 48 hours.

 

NI<48 hours
after onset
(n=24)

NI>=48 hours
(n=12)

NI at any time
(n=36)

No NI
(n=182)

Number days reduced activity (Median(Min-Max))

2(1-4)

2(1-4)

2(1-4)

2(0-6)

Number of days symptom rated 'Moderate' (Median(Min-Max)

1(1-6)

2(2-5)

2(1-6)

2(1-7)

Number of days symptom rated 'Severe' (Median(Min-Max)

1(1-6)

2(2-5)

2(1-6)

2(1-7)

Antibiotics

0(0%)

2(16.7%)

2(5.6%)

14(7.7%)

Secondary household illness

0(0%)

0(0%)

0(0%)

3(1.7%)

Conclusion: Nearly 20% of FLU+ subjects received NI. Adults and Native Americans were more likely to receive treatment. NI use did not differ between pH1N1 versus seasonal Flu A. NI therapy, including early use, had no effect on illness or fever duration, but early use did reduce both moderate and severe symptom duration by one day.

Mary Fairchok, MD1, John Arnold, MD2, Christina Schofield, MD FACP3, Patrick Danaher, MD4, Karl Kronmann, MD, MPH5, Michael Rajnik, MD6, Erin McDonough, BS7, Christopher Myers, PhD7, Deepika Mor, MS8, Michelande Ridore, BA9, Mark Kortepeter, MD, MPH1,10, Timothy Burgess, MD, MPH6 and Eugene Millar, PhD11, (1)Infectious Disease Clinical Research Program, Tacoma, WA, (2)Department of Pediatrics, Naval Medical Center San Diego, San Diego, CA, (3)Madigan Army Medical Center, Tacoma, WA, (4)San Antonio Military Health System, Fort Sam Houston, TX, (5)Naval Medical Center Portsmouth, Portsmouth, VA, (6)Walter Reed National Military Medical Center, Bethesda, MD, (7)Naval Health Research Center, San Diego, CA, (8)Data Coordination Center, Infectious Disease Clinical Research Program, Rockville, MD, (9)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD, (10)Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Rockville, MD, (11)Infectious Disease Clinical Research Program (IDCRP), Uniformed Services University of the Health Sciences (USU), Rockville, MD

Disclosures:

M. Fairchok, None

J. Arnold, None

C. Schofield, None

P. Danaher, None

K. Kronmann, None

M. Rajnik, None

E. McDonough, None

C. Myers, None

D. Mor, None

M. Ridore, None

M. Kortepeter, None

T. Burgess, None

E. Millar, None

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