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Antiviral prophylaxis prevented spread of H1N1 in summer camp setting
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Comprehensive hand sanitization, surface decontamination and the targeted use of oseltamivir phosphate was effective in containing influenza A (H1N1) at an Alabama boys’ summer camp, according to study results.
David W. Kimberlin, MD, of the department of pediatrics at the University of Alabama, Birmingham, and his colleagues examined the efficacy of an aggressive antiviral prophylaxis program during the summer of 2009 at Camp Laney in Mentone, Ala.
Interventions at the camp were initiated after 12 campers presented with influenza-like illness, with at least four testing positive for influenza A using QuickVue Influenza A and B rapid diagnostic test (Quidel) during the camp’s third two-week session, according to the researchers.
The researchers said preventive measures began before the fourth session in mid-July and included oseltamivir (Tamiflu, Roche) prophylaxis for counselors and staff; the use of alcohol-based hand sanitizer by campers 13 times a day; and daily disinfecting of community equipment or shared spaces.
If a child exhibited influenza-like symptoms and/or had a positive influenza test result, oseltamivir therapy was initiated and the child left camp until he completed four days of treatment and was symptom-free for 24 hours, the researchers said. All children who shared the boy’s cabin, an adjoining cabin or bathroom were also administered a 10-day prophylactic course of oseltamivir.
The researchers reported that three campers out of 171 tested positive for influenza A during the fourth session, indicating an attack rate of 1.8%. If the attack rate was 12% — similar to household transmission and military recruits — the probability of observing three or fewer campers with influenza was less than one in 10,000,000, results indicated.
Staff, counselors and families of boys attending the camp also completed surveys after conclusion of the fourth session. The researchers noted that 57% of counselors and staff experienced nausea or stomach discomfort that they attributed to oseltamivir, and 31% of campers reported nausea after initiating treatment. These adverse events did not lead to discontinuation of medication, although the median number of missed doses was one for college-aged counselors and the somewhat older staff.
No campers tested positive for influenza A after returning home, according to the researchers.
Kimberlin DW. Arch Pediatr Adolesc Med. 2010;164:323-327.
PERSPECTIVE
This is an interesting article about controlling the spread of novel H1N1 influenza virus infection in a summer camp. The researchers stressed that by prophylaxing only campers who were bunkmates of those with H1N1 infection, plus a few others with underlying health conditions, they were able to control spread of the virus while limiting those who took oseltamivir. An outcome of having H1N1 infection in only three campers out of 171 suggested that control measures were very effective. However, there might have been more cases because they used a rapid diagnostic test, which was not optimally sensitive. The camp instituted other interventions including alcohol-based hand sanitizers, special decontamination of bunks and limiting contact with individuals outside of the camp, so it is difficult to assess how much of their success was due to prophylaxis with oseltamivir and how much was due to other hygiene measures. Camps facing the risk for an influenza outbreak should look at the successful bundle of measures these researchers instituted.
– Robert Baltimore, MD
Yale University School of Medicine, Yale-New Haven Children's Hospital
New Haven, Connecticut