ETIDIOH - NEW

Abstract Background Baloxavir marboxil (baloxavir) rapidly reduces influenza virus shedding , which suggests that it may reduce transmission. Studies of treatment with neuraminidase inhibitors have not shown sufficient evidence that they prevent transmission to contacts. Methods We conducted a multicountry, phase 3b trial to assess the efficacy of single-dose baloxavir treatment to reduce influenza transmission from index patients to household contacts. Influenza-positive index patients 5 to 64 years of age were randomly assigned in a 1:1 ratio to receive baloxavir or placebo within 48 hours after symptom onset. The primary end point was transmission of influenza virus from an index patient to a household contact by day 5. The first secondary end point was transmission of influenza virus by day 5 that resulted in symptoms. Results Overall, 1457 index patients and 2681 household contacts were enrolled across the 2019–2024 influenza seasons; 726 index patients were assigned to the baloxa...

Abstract The effectiveness of antivirals in mitigating influenza outbreaks depends on both their ability to reduce the number of infections and the risk of drug resistance. We extended a previously developed mathematical model to investigate the impact of mitigation strategies , including mono or combination antiviral treatment or chemoprophylaxis and vaccination , on influenza transmission dynamics. Our findings indicate that chemoprophylaxis is more effective than treatment in reducing influenza burden, except when the resistant strain has a high transmission rate, in which case chemoprophylaxis may trigger a resistance-driven secondary infection wave. Combination therapy considerably reduces resistance emergence with similar infection numbers as mono-therapy. Vaccination coverage of at least 80% is required to prevent outbreaks; otherwise, antivirals can contribute to outbreak control provided drug resistance emergence is low. This analysis could inform public health decision-making...

Abstract Background Influenza is a pervasive respiratory infection which disproportionately burdens long-term care residents. To limit outbreaks, guidelines recommend antiviral prophylaxis, particularly oseltamivir or zanamivir , despite acknowledging the inadequate supporting evidence . Therefore, we aimed to review the literature on the efficacy of oseltamivir, zanamivir, and baloxavir prophylaxis for influenza in long-term care. Methods Medline, Embase, PubMed, and several other databases were searched from inception to August 16, 2023. For inclusion, observational studies or randomized controlled trials (RCTs) had to report influenza-like illness (ILI) or infection rates amongst adult long-term care populations receiving prophylaxis. Outcome values were meta-analyzed as intervention-specific pooled proportions (PPs) and risk ratios (RRs) when applicable. Risk of bias was assessed via the Cochrane risk of bias tool 2.0 and Joanna Briggs Institute checklist. Results In total, 14 stud...