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Question 14#

You are a physician in charge of patients who reside in a nursing home. Several of the patients have developed influenza-like symptoms, and the community is in the midst of influenza A outbreak. None of the nursing home residents have received the influenza vaccine. Which course of action is most appropriate?

A. Give the influenza vaccine to all residents who do not have a contraindication to the vaccine (ie, allergy to eggs)
B. Give the influenza vaccine to all residents who do not have a contraindication to the vaccine; also give oseltamivir for 2 weeks to all residents
C. Give amantadine alone to all residents
D. Give azithromycin to all residents to prevent influenza-associated pneumonia
E. Do not give any prophylactic regimen, but treat with oseltamivir if a clinical outbreak should occur

Correct Answer is B

Comment:

Influenza A is a potentially lethal disease in the elderly and chronically debilitated patient. In institutional settings such as nursing homes, outbreaks are likely to be particularly severe. Thus, prophylaxis is extremely important in this setting. All residents should receive the influenza vaccine unless they have known egg allergy (patients can choose to decline the vaccine). Since protective antibodies to the vaccine will not develop for 2 weeks, oseltamivir can be used for protection against influenza A during the interim 2-week period. Because of increasing resistance, amantadine is no longer recommended for prophylaxis. The best way to prevent influenza-associated pneumonia is to prevent the outbreak in the first place.