Adherence with oseltamivir chemoprophylaxis among workers exposed to poultry during avian influenza outbreaks in southern Israel

Objectives: To determine adherence with recommended pre- and post-exposure oseltamivir prophylaxis (OP) among workers exposed to poultry during five simultaneous avian influenza (At) H5N1 outbreaks in poultry farms in southern Israel in March 2006, as well as the efficiency of the distribution system of oseltamivir in the community. Design: Epidemiological investigation identified 201 workers exposed to poultry during At outbreaks. They were interviewed by a public health nurse regarding adherence with recommended OP, symptoms, and possible side effects. Data were collected on type of exposure, age, sex, rate of adherence with OP, and reasons for non-adherence. For eight workers, paired sera were drawn for the determination of antibodies to H5. Data were collected on the efficiency of the distribution of oseltamivir tablets to workers in the community. Results: High adherence with OP (87.6%) was found among poultry workers during outbreaks of At, with no difference by type of exposure, age, or sex. There was a low rate of side effects of OP (1.5%). No exposed workers developed At and none of the eight who had paired sera drawn showed seroconversion. The distribution of OP in the community was inefficient, with 27.7% of the tablets 'lost' or returned unusable. Conclusions: These data emphasize the importance of developing efficient targeted distribution systems in the community for OR in order to prevent human infection during Al outbreaks. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.