August 30, 2019
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Oseltamivir for flu prophylaxis in health care personnel comes with challenges

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Westyn Branch-Elliman, MD, MMSc
Westyn Branch-Elliman

Oseltamivir for influenza prophylaxis is a consideration for health care workers at high risk for developing influenza, including those who decline vaccination, but it comes with some challenges, researchers reported in Infection Control & Hospital Epidemiology.

Reducing the transmission of influenza in the health care setting is a challenge, but not all institutions make influenza vaccinations compulsory. A previous study investigating the reasons some health care providers refuse the influenza vaccine showed that 5% of providers at an academic health system claimed a personal waiver for the declination of the vaccine in 2018.

According to Westyn Branch-Elliman, MD, MMSc, assistant professor of medicine at Harvard Medical School, and colleagues, illness due to influenza among health care workers can cause staffing shortages, thereby limiting the care offered by the hospital and putting patients at risk.

Oseltamivir as influenza prophylaxis “is a consideration when there is a severe or prolonged flu season, when there is poor vaccine matches, or in health care workers who decline or have medical contraindications to vaccination and get exposed in order to protect both the healthcare work force — to keep the hospital fully staffed — and to protect patients by reducing their potential flu exposures,” Branch-Elliman told Infectious Disease News. “Depending on the severity of the flu season and potential staffing shortages, many hospital systems could consider offering oseltamivir prophylaxis to health care workers.”

Branch-Elliman and colleagues conducted a cross-sectional survey among 144 health care providers who were exposed to influenza during one of two pandemic periods at a large tertiary-care academic medical center and who received oseltamivir for influenza prophylaxis. Of those who received prophylaxis, 98.6% completed the survey, and 66.9% completed 10 or more days of therapy and 30.3% completed 1 to 9 days of therapy.

Of those who discontinued medication, 34.8% said their reason was medication-related adverse effects, whereas 22.8% said they forgot to continue. The findings showed that 23.9% reported nausea, 15.8% reported insomnia, 12.3% reported abdominal pain, 5.9% reported headache and 5.1% reported diarrhea.

“When compared to other populations, we found a relatively high rate of side effects and medication discontinuation in health care workers,” Branch-Elliman said.

The researchers also said that many reported discontinuing because of the perception that they were no longer at risk for influenza acquisition.

“This finding suggests that if oseltamivir is used for influenza prevention in health care workers, it should be coupled with education about the duration of the at-risk period so that the medication is not stopped before flu risk has passed,” Branch-Elliman said. – by Marley Ghizzone

Disclosures: Branch-Elliman reports being supported by National Institutes of Health NHLBI 1K12HL138049-01. All other authors report no relevant financial disclosures.