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Open Access Highly Accessed Research article

Oseltamivir for treatment and prevention of pandemic influenza A/H1N1 virus infection in households, Milwaukee, 2009

Edward Goldstein1*, Benjamin J Cowling2, Justin J O'Hagan1, Leon Danon13, Vicky J Fang2, Angela Hagy4, Joel C Miller16, David Reshef5, James Robins1, Paul Biedrzycki4 and Marc Lipsitch1

Author Affiliations

1 Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston MA, USA

2 School of Public Health, The University of Hong Kong, Hong Kong, China

3 Mathematics Institute and the Department of Biology, Warwick University, Coventry, UK

4 Milwaukee Health Department, Milwaukee WI, USA

5 University of Oxford, Oxford, UK

6 Fogarty International Center, National Institutes of Health, Bethesda, Maryland 20892, USA

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BMC Infectious Diseases 2010, 10:211  doi:10.1186/1471-2334-10-211

Published: 20 July 2010

Abstract

Background

During an influenza pandemic, a substantial proportion of transmission is thought to occur in households. We used data on influenza progression in individuals and their contacts collected by the City of Milwaukee Health Department (MHD) to study the transmission of pandemic influenza A/H1N1 virus in 362 households in Milwaukee, WI, and the effects of oseltamivir treatment and chemoprophylaxis.

Methods

135 households had chronological information on symptoms and oseltamivir usage for all household members. The effect of oseltamivir treatment and other factors on the household secondary attack rate was estimated using univariate and multivariate logistic regression with households as the unit of analysis. The effect of oseltamivir treatment and other factors on the individual secondary attack rate was estimated using univariate and multivariate logistic regression with individual household contacts as the unit of analysis, and a generalized estimating equations approach was used to fit the model to allow for clustering within households.

Results

Oseltamivir index treatment on onset day or the following day (early treatment) was associated with a 42% reduction (OR: 0.58, 95% CI: 0.19, 1.73) in the odds of one or more secondary infections in a household and a 50% reduction (OR: 0.5, 95% CI: 0.17, 1.46) in the odds of a secondary infection in individual contacts. The confidence bounds are wide due to a small sample of households with early oseltamivir index usage - in 29 such households, 5 had a secondary attack. Younger household contacts were at higher risk of infection (OR: 2.79, 95% CI: 1.50-5.20).

Conclusions

Early oseltamivir treatment may be beneficial in preventing H1N1pdm influenza transmission; this may have relevance to future control measures for influenza pandemics. Larger randomized trials are needed to confirm this finding statistically.