Compliance and side effects of prophylactic oseltamivir treatment in a school in South West England

Abstract

School closure along with mass prophylactic oseltamivir treatment of pupils have been used in England and elsewhere to contain school outbreaks of influenza A(H1N1)v. We evaluated the protective effect, compliance with and side effects of oseltamivir chemoprophylactic treatment with a ten-day course of 1x 75mg given to 11-12-year-old pupils in one school year in a secondary school in South West England closed for ten days in response to a symptomatic laboratory-confirmed pupil. We distributed a questionnaire to pupils in the affected school year in class after the school had re-opened. Questions included symptoms of flu-like illness, compliance with chemoprophylaxis and side effects. All present on the day, 248 (93.2%) participated. Compliance with chemoprophylaxis was high, 77% took the full course, 91% took at least seven days. Fifty-one percent experienced symptoms such as feeling sick (31.2%), headaches (24.3%) and stomach ache (21.1%). Although some children were ill with flu-like symptoms, those tested did not have A(H1N1)v infection. Compliance with oseltamivir chemoprophylaxis was high, although likely side effects were common. The burden of side effects needs to be considered when deciding on mass oseltamivir chemoprophylaxis in children especially given that the symptoms of A(H1N1)v influenza are generally mild.

Clinical and epidemiological characteristics of patients with influenza A (H1N1) 2009 attended to at the emergency room of a children's hospital

“…Only 8.7% of patients who received oseltamivir presented mild side effects, mainly gastrointestinal. These data concur with those of other studies in which behavioural alterations were also described [19,29,32]. We are unable to provide information regarding the safety of this drug in children under 1 year of age.…”

Social and economic impact of school closure resulting from pandemic influenza A/H1N1

“…12 In South West England, 33% of the students did not complete the full course of mass prophylactic treatment with oseltamivir. 13 In our survey, the adherence to the "stay home" policy appeared to be higher and compliance with chemoprophylaxis was excellent. This might have been associated with the uncertainties in pH1N1 severity, exaggerated reporting of associated fatalities reported by the mass media at the time, and daily check up by homeroom teachers.…”

Transmisión comunitaria de gripe pandémica (H1N1) 2009 a partir de brotes en centros escolares de la Comunidad de Madrid: Mayo-junio de 2009

“…Este abandono de medidas tales como la cuarentena y la quimioprofilaxis generalizada de los contactos, impide valorar cómo se habría comportado la transmisión comunitaria si dichas medidas hubiesen permanecido vigentes. Si bien es cierto que existen estudios que demuestran la pobre adherencia de la población escolar a este tipo de recomendaciones y la importancia de aparición de efectos adversos 15,16 . Todo ello constituyó un reto importante para la salud pública madrileña, porque era muy difícil poder mantener la vigilancia individualizada de los casos y la investigación adecuada y oportuna de todos los brotes, cuando el número de declaraciones diarias era muy elevado.…”