Reducing Influenza Virus Transmission: The Potential Value of Antiviral Treatment

Authors

Frederick G Hayden
Jason Asher
Benjamin J Cowling
Aeron C Hurt
Hideyuki Ikematsu
Klaus Kuhlbusch
Annabelle Lemenuel-Diot
Zhanwei Du
Lauren Ancel Meyers
Pedro A Piedra
Takahiro Takazono
Hui-Ling Yen
Arnold S Monto

Publication Date

2-11-2022

Journal

Clinical Infectious Diseases

DOI

10.1093/cid/ciab625

PMID

PMC8834654

PMCID

34245250

PubMedCentral® Posted Date

7-10-2021

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Animals, Antiviral Agents, Drug Resistance, Viral, Humans, Influenza, Human, Neuraminidase, Orthomyxoviridae, Oseltamivir, Virus Replication, influenza, transmission, antiviral, baloxavir, oseltamivir

Abstract

Prompt antiviral treatment has the potential to reduce influenza virus transmission to close contacts, but rigorous data on the magnitude of treatment effects on transmission are limited. Animal model data indicate that rapid reductions in viral replication after antiviral treatment reduce the risk of transmission. Observational and clinical trial data with oseltamivir and other neuraminidase inhibitors indicate that prompt treatment of household index patients seems to reduce the risk of illness in contacts, although the magnitude of the reported effects has varied widely across studies. In addition, the potential risk of transmitting drug-resistant variants exists with all approved classes of influenza antivirals. A controlled trial examining baloxavir treatment efficacy to reduce transmission, including the risk of transmitting virus with reduced baloxavir susceptibility, is currently in progress. If reduced transmission risk is confirmed, modeling studies indicate that early treatment could have major epidemiologic benefits in seasonal and pandemic influenza.