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Rimantadine prophylaxis in children: a follow-up study
S A Crawford1, R D Clover, T D Abell
1Department of Family Medicine, College of Medicine, University of Oklahoma, Oklahoma City.
Insights
Rimantadine prophylaxis effectively prevented influenza A infection and illness in children during a clinical trial. This antiviral treatment also reduced transmission to family members, demonstrating its prophylactic value.
Area of Science:
- Virology
- Epidemiology
- Pediatric Infectious Diseases
Background:
- Influenza A poses a significant health risk to children, necessitating effective prophylactic strategies.
- Antiviral medications are crucial for managing and preventing influenza outbreaks, particularly in vulnerable populations.
- Understanding transmission dynamics within families is key to controlling community spread.
Purpose of the Study:
- To evaluate the prophylactic effectiveness of rimantadine in children against influenza A (H3N2) infection and illness.
- To assess rimantadine's role in preventing influenza A transmission from infected children to their adult family members.
- To determine the safety and tolerability of rimantadine in pediatric populations.
Main Methods:
- A randomized, double-blind, placebo-controlled clinical trial involving 110 children (ages 1-18) and their families during an influenza A (H3N2) outbreak.
- Influenza infection was confirmed by viral throat culture or a 4-fold increase in antibody titer.
- Clinical illness was assessed in conjunction with laboratory-confirmed influenza, and adverse effects were monitored.
Main Results:
- Influenza A infections occurred in significantly fewer children receiving rimantadine (7.4%) compared to placebo (31.0%) (P = 0.026).
- No children in the rimantadine group experienced clinical illness with laboratory-confirmed influenza, versus 24.1% in the placebo group (P = 0.007).
- Combined analysis with a prior study showed significantly lower influenza A infection and illness rates in families where children received rimantadine.
Conclusions:
- Rimantadine prophylaxis is an effective strategy for preventing influenza A (H1N1 and H3N2) infection and associated illness in children.
- The study supports the use of rimantadine in children to reduce both individual illness and intrafamilial transmission of influenza A.
- Rimantadine was well-tolerated in children, with no significant difference in adverse effects compared to placebo.
Abstract:
In a randomized, double-blind placebo-controlled clinical trial, we evaluated the prophylactic effectiveness of rimantadine in children (ages 1 to 18 years) against infection with influenza A (H3N2) and associated illness and the prevention of transmission of infection to adult members of the child's family. One hundred ten volunteers from 29 families completed this study during a naturally occurring outbreak of influenza A (H3N2). Influenza infections, defined as a positive viral throat culture or a 4-fold increase in antibody titer, occurred in 31.0% of children in the placebo group and 7.4% in the rimantadine group (P = 0.026). Clinical illness with laboratory evidence of influenza infection occurred in 24.1% of children in the placebo group and none in the rimantadine group (P = 0.007). Rimantadine was well-tolerated by the children, with no significant difference in reported adverse effects between the placebo and rimantadine groups. A combined analysis by families of these data and those of our similarly designed 1984 study, revealed that families in whom the children were given rimantadine had a significantly lower rate of influenza A infection and influenza-like illness compared with the families in whom the children were given placebo (68.8% vs. 18.8%, P less than 0.001) and (56.3% vs. 12.5%, P less than 0.001), respectively. We conclude that rimantadine prophylaxis of children appears to be an effective method to prevent influenza A (either H1N1 or H3N2) infection and illness in children.