Guidelines for preventing respiratory illness in older adults aged 60 years and above living in long-term care: A rapid review of clinical practice guidelines

Patricia Rios; Amruta Radhakrishnan; Sonia M. Thomas; Nazia Darvesh; Sharon E. Straus; Andrea C. Tricco

2. Antiviral drug prophylaxis i. Residents: a. Upon diagnosis of an influenza outbreak, all residents becoming ill should be treated (vide supra) while all non-ill residents regardless of whether they have received the current seasonal vaccine should be started on chemoprophylaxis with either oseltamivir or zanamivir b. Generally, it is preferable to wait to initiate chemoprophylaxis until laboratory confirmation has been received. c. The prophylactic doses are oseltamivir 75 mg PO once daily or zanamivir two inhalations once daily for adults. d. Prophylaxis should be continued for 14 days minimum or until the outbreak has been declared over (see section D above). ii. Staff: a. In the context of significant antigenic drift and/or vaccine mismatch for which suboptimal VE may reasonably be anticipated, and in particular in relation to H3N2 viruses this season, it is recommended that staff who provide resident care or conduct activities where they may have the potential to acquire or transmit influenza (21) should also take prophylactic antiviral medication during the outbreak, regardless of whether they have received the current season's influenza vaccine. This is because, despite some vaccine protection anticipated, a substantial proportion of vaccinated individuals, including healthy working-age adults, are anticipated to remain susceptible to drifted H3N2 viruses. b. Antiviral prophylaxis recommendations should be reinstituted whenever an outbreak is declared even for the same subtype and within the same setting and season. The maximum duration of continuous prophylaxis should be eight weeks, but outbreaks managed with antivirals should generally be terminated well within this period. In the unusual event that the outbreak is more prolonged, control measures should be reassessed in consultation with the local Medical Officer of Health and other experts. c. Doses and durations should be as in section E2ic above.