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Efficacy of oseltamivir in reducing the duration of clinical illness, viral shedding, and transmissibility reduction within households among participants in an influenza disease burden surveillance cohort in urban Dhaka, Bangladesh

Dhaka, Bangladesh


Influenza is a disease of global importance, having caused three pandemics in the 20th Century. Although concerns persist about a new pandemic, possibly from an avian influenza A strain, more people died during the 20th Century from seasonal epidemic influenza than from any single pandemic, thus global preparedness must address both epidemic and pandemic influenza. It is generally believed that if a pandemic emerges, an efficacious vaccine will either not be either generally available or broadly protective. Additional strategies are required for effective control. Neuraminidase inhibitors, including oseltamivir, have shown efficacy in limited controlled trials against both human influenza, and have been used in avian influenza cases. Numerous questions, however, persist about the extent of their efficacy. These include whether or not they are effective if given after 48 hours post-symptom onset, whether they reduce the duration and titre of viral shedding, their effect on transmission to household contacts, and how quickly – or even if – resistance will emerge in a high endemic setting during seasonal use. Finally, clinical trials to date have used small samples sizes under controlled settings in industrialized countries. There are no data on the efficacy of neuraminidase inhibitors in over-crowded urban settings with rates of influenza and other respiratory infections, like Dhaka, Bangladesh. The findings from this study will enable better assessment of the performance of neuraminidase inhibitors under the conditions similar to those from which a global pandemic is likely to occur.

This study complements ongoing respiratory disease surveillance and intervention trials, and examines the role of influenza in overall pneumonia and respiratory disease burden, as well as the impact of interventions to reduce that burden.

Nested studies within this trial include: 1) Determination of faecal viral shedding and transmissibility; 2) Risk factors for inter and intra household transmission; 3) Impact of handwashing on influenza transmission and clinical pneumonia


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