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KEEPING THE FLU AT BAY WITH A SPRAY
The inhaled neuraminidase inhibitor zanamivir prevents influenza
infection under laboratory conditions (see JW Aug 15 1999, p. 126, and JAMA
1999; 282:31). In this manufacturer-sponsored trial, investigators confirm
zanamivir's efficacy in the field.
Researchers in Iceland, the U.S., the U.K., and Canada followed 799 families,
each including at least 1 school-aged child, for flu symptoms from fall of 1998
through the spring of 1999. Once influenza was confirmed in the community, the
first sign of a flu like illness in a family member prompted researchers to initiate
either zanamivir or placebo treatment for the entire family.
Laboratory-confirmed influenza among household members was diagnosed
significantly more often among the 158 families that received placebo than among
the 163 that received zanamivir (19% vs. 4%). When influenza was confirmed in an
index case, family contacts developed confirmed influenza in 29% of placebo
families and 8% zanamivir families. The frequency of adverse events was similar
in the 2 groups.
Comments: These researchers confirm that zananivir treatment and phylaxis
together may limit influenza transmission within families. An editorialist
calculated that 10 courses of phylaxis would be required to prevent 1 case of
influenza but made no comment on the cost-effectiveness of this intervention.
Clinicians should note that this drug might exacerbate respiratory symptoms in
people with asthma or other chronic pulmonary conditions.
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