{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T12:31:05Z","timestamp":1793709065567,"version":"4.6.1"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:sec id=\"ab-ioi260011-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Influenza outbreaks in nursing homes (NHs) can cause high morbidity and mortality. Antiviral chemoprophylaxis with oseltamivir is recommended, yet optimal implementation strategies remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260011-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine whether initiating antiviral chemoprophylaxis for 70% or more of eligible NH residents within 2 days of influenza outbreak detection is associated with lower all-cause mortality and hospitalization at 14 and 30 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260011-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>Retrospective cohort study using a sequential cluster-randomized target trial emulation and randomize-censor-weight approach for influenza outbreaks (September 1, 2018\u2013May 31, 2022) in 12 US NH corporations. Eligibility criteria were age 18 years or older, present on the outbreak-detection day, no antiviral use in the preceding 7 days, no influenza in the past 14 days, and complete baseline data. Residents were followed up until hospitalization or death, an NH discharge to a nonacute-care location, or the end of follow-up. Data were analyzed from February 2023 to January 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260011-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Intensive antiviral chemoprophylaxis with oseltamivir (\u226570% of eligible residents within 2 days of outbreak detection) or nonintensive antiviral chemoprophylaxis (0% to &amp;amp;lt;70% of eligible residents).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260011-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Outcomes were all-cause death and hospitalizations within 14 and 30 days of outbreak detection. Discrete-time hazard models with pooled logistic regression were applied to estimate weighted risks, risk differences (RDs), and risk ratios (RRs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260011-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 404 outbreaks in 318 NHs, 35\u202f086 resident-trial observations (29\u202f683 residents; median age 78 [IQR, 68- 86] years; 60% women; 81% White; 76% vaccinated) met eligibility criteria. Intensive oseltamivir prophylaxis was randomized to 17\u202f155 observations; 17\u202f931 were randomized to nonintensive care. At 14 days, intensive prophylaxis vs nonintensive yielded an RD of \u20130.06% (95% CI, \u22120.73% to 0.93%) and an RR of 0.96 (95% CI, 0.56-1.57) for death, and an RD of \u20130.96% (95% CI, \u22121.78% to \u22120.19%) and an RR of 0.79 (95% CI, 0.64-0.96) for hospitalization. At 30 days, the hospitalization differences persisted but were less precise and there continued to be no difference in death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260011-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>Study results suggest that clinicians should initiate antiviral chemoprophylaxis for at least 70% of eligible NH residents within 2 days of outbreak detection to lower risk of hospitalization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2026.0401","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T15:30:24Z","timestamp":1774884624000},"page":"714","source":"Crossref","is-referenced-by-count":3,"title":["Prompt and Intensive Antiviral Chemoprophylaxis in Nursing Home Influenza Outbreaks"],"prefix":"10.1001","volume":"186","author":[{"given":"Joe B. 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Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew R.","family":"Zullo","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island"},{"name":"Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island"},{"name":"Providence Veterans Affairs Medical Center, Providence, Rhode Island"},{"name":"Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"6","key":"ioi260011r2","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/ciy866","article-title":"Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal 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