Use of neuraminidase inhibitors for rapid containment of influenza: a systematic review and meta-analysis of individual and household transmission studies

PLoS One. 2014 Dec 9;9(12):e113633. doi: 10.1371/journal.pone.0113633. eCollection 2014.

Abstract

Objectives: To assess the effectiveness of neuraminidase inhibitors for use in rapid containment of influenza.

Method: We conducted a systematic review and meta-analysis in accordance with the PRISMA statement. Healthcare databases and sources of grey literature were searched up to 2012 and records screened against protocol eligibility criteria. Data extraction and risk of bias assessments were performed using a piloted form. Results were synthesised narratively and we undertook meta-analyses to calculate pooled estimates of effect, statistical heterogeneity and assessed publication bias.

Findings: Nine randomised controlled trials (RCTs) and eight observational studies met the inclusion criteria. Neuraminidase inhibitors provided 67 to 89% protection for individuals following prophylaxis. Meta-analysis of individual protection showed a significantly lower pooled odds of laboratory confirmed seasonal or influenza A(H1N1)pdm09 infection following oseltamivir usage compared to placebo or no therapy (n = 8 studies; odds ratio (OR) = 0.11; 95% confidence interval (CI) = 0.06 to 0.20; p<0.001; I2 = 58.7%). This result was comparable to the pooled odds ratio for individual protection with zanamivir (OR = 0.23; 95% CI 0.16 to 0.35). Similar point estimates were obtained with widely overlapping 95% CIs for household protection with oseltamivir or zanamivir. We found no studies of neuraminidase inhibitors to prevent population-wide community transmission of influenza.

Conclusion: Oseltamivir and zanamivir are effective for prophylaxis of individuals and households irrespective of treatment of the index case. There are no data which directly support an effect on wider community transmission.

Protocol registry: PROSPERO registration number: CRD42013003880.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Communicable Disease Control / methods*
  • Enzyme Inhibitors / pharmacology*
  • Housing*
  • Humans
  • Influenza, Human / drug therapy
  • Influenza, Human / enzymology
  • Influenza, Human / prevention & control*
  • Influenza, Human / transmission*
  • Neuraminidase / antagonists & inhibitors*
  • Time Factors

Substances

  • Enzyme Inhibitors
  • Neuraminidase

Grants and funding

This study was commissioned and funded by the World Health Organization (WHO) with the purpose of informing the review of its Pandemic Influenza Risk Management Guidance on pandemic influenza preparedness. The University of Nottingham Health Protection and Influenza Research Group is an official WHO Collaborating Centre for pandemic influenza and research. It receives limited funding from the WHO in support of specific activities. The funders contributed towards specifying the research questions but had no role in methodological design, data collection and analysis, or preparation of this manuscript.