Impact of intensive handwashing promotion on secondary household influenza-like illness in rural Bangladesh: Findings from a randomized controlled trial

Pavani K. Ram, Margaret A. DiVita, Kaniz Khatun-e-Jannat, Manoshi Islam, Kimberly Krytus, Emily Cercone, Badrul Munir Sohel, Makhdum Ahmed, Abid Mahmud Quaiyum Rahman, Mustafizur Rahman, Jihnhee Yu, W Abdullah Brooks, Eduardo Azziz-Baumgartner, Alicia M. Fry, Stephen P. Luby

Research output: Contribution to journalArticle

Abstract

Rationale: There is little evidence for the efficacy of handwashing for prevention of influenza transmission in resource-poor settings. We tested the impact of intensive handwashing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh. Methods: In 2009-10, we identified index case-patients with influenza-like illness (fever with cough or sore throat) who were the only symptomatic person in their household. Household compounds of index case-patients were randomized to control or intervention (soap and daily handwashing promotion). We conducted daily surveillance and collected oropharyngeal specimens. Secondary attack ratios (SAR) were calculated for influenza and ILI in each arm. Among controls, we investigated individual risk factors for ILI among household contacts of index case-patients. Results: Among 377 index case-patients, the mean number of days between fever onset and study enrollment was 2.1 (SD 1.7) among the 184 controls and 2.6 (SD 2.9) among 193 intervention case-patients. Influenza infection was confirmed in 20% of controls and 12% of intervention index case-patients. The SAR for influenza-like illness among household contacts was 9.5% among intervention (158/1661) and 7.7% among control households (115/1498) (SAR ratio 1.24, 95% CI 0.92-1.65). The SAR ratio for influenza was 2.40 (95% CI 0.68-8.47). In the control arm, susceptible contacts adj 5.51, 95% CI 3.43-8.85), those living with an index case-patient enrolled 24 hours after symptom onset (RRadj 1.91, 95% CI 1.18-3.10), and those who reported multiple daily interactions with the index case-patient (RRadj 1.94, 95% CI 1.71-3.26) were at increased risk of influenza-like illness. Discussion: Handwashing promotion initiated after illness onset in a household member did not protect against influenza-like illness or influenza. Behavior may not have changed rapidly enough to curb transmission between household members. A reactive approach to reduce household influenza transmission through handwashing promotion may be ineffective in the context of rural Bangladesh. Trial Registration: ClinicalTrials.gov NCT00880659

Original languageEnglish (US)
Article numbere0125200
JournalPLoS One
Volume10
Issue number6
DOIs
StatePublished - Jun 11 2015
Externally publishedYes

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hand washing
Hand Disinfection
Bangladesh
influenza
Human Influenza
households
Randomized Controlled Trials
Curbs
Soaps (detergents)
fever
Fever
Soaps
Pharyngitis
cough
soaps
Cough
signs and symptoms (animals and humans)

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Impact of intensive handwashing promotion on secondary household influenza-like illness in rural Bangladesh : Findings from a randomized controlled trial. / Ram, Pavani K.; DiVita, Margaret A.; Khatun-e-Jannat, Kaniz; Islam, Manoshi; Krytus, Kimberly; Cercone, Emily; Sohel, Badrul Munir; Ahmed, Makhdum; Rahman, Abid Mahmud Quaiyum; Rahman, Mustafizur; Yu, Jihnhee; Brooks, W Abdullah; Azziz-Baumgartner, Eduardo; Fry, Alicia M.; Luby, Stephen P.

In: PLoS One, Vol. 10, No. 6, e0125200, 11.06.2015.

Research output: Contribution to journalArticle

Ram, PK, DiVita, MA, Khatun-e-Jannat, K, Islam, M, Krytus, K, Cercone, E, Sohel, BM, Ahmed, M, Rahman, AMQ, Rahman, M, Yu, J, Brooks, WA, Azziz-Baumgartner, E, Fry, AM & Luby, SP 2015, 'Impact of intensive handwashing promotion on secondary household influenza-like illness in rural Bangladesh: Findings from a randomized controlled trial', PLoS One, vol. 10, no. 6, e0125200. https://doi.org/10.1371/journal.pone.0125200
Ram, Pavani K. ; DiVita, Margaret A. ; Khatun-e-Jannat, Kaniz ; Islam, Manoshi ; Krytus, Kimberly ; Cercone, Emily ; Sohel, Badrul Munir ; Ahmed, Makhdum ; Rahman, Abid Mahmud Quaiyum ; Rahman, Mustafizur ; Yu, Jihnhee ; Brooks, W Abdullah ; Azziz-Baumgartner, Eduardo ; Fry, Alicia M. ; Luby, Stephen P. / Impact of intensive handwashing promotion on secondary household influenza-like illness in rural Bangladesh : Findings from a randomized controlled trial. In: PLoS One. 2015 ; Vol. 10, No. 6.
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abstract = "Rationale: There is little evidence for the efficacy of handwashing for prevention of influenza transmission in resource-poor settings. We tested the impact of intensive handwashing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh. Methods: In 2009-10, we identified index case-patients with influenza-like illness (fever with cough or sore throat) who were the only symptomatic person in their household. Household compounds of index case-patients were randomized to control or intervention (soap and daily handwashing promotion). We conducted daily surveillance and collected oropharyngeal specimens. Secondary attack ratios (SAR) were calculated for influenza and ILI in each arm. Among controls, we investigated individual risk factors for ILI among household contacts of index case-patients. Results: Among 377 index case-patients, the mean number of days between fever onset and study enrollment was 2.1 (SD 1.7) among the 184 controls and 2.6 (SD 2.9) among 193 intervention case-patients. Influenza infection was confirmed in 20{\%} of controls and 12{\%} of intervention index case-patients. The SAR for influenza-like illness among household contacts was 9.5{\%} among intervention (158/1661) and 7.7{\%} among control households (115/1498) (SAR ratio 1.24, 95{\%} CI 0.92-1.65). The SAR ratio for influenza was 2.40 (95{\%} CI 0.68-8.47). In the control arm, susceptible contacts adj 5.51, 95{\%} CI 3.43-8.85), those living with an index case-patient enrolled 24 hours after symptom onset (RRadj 1.91, 95{\%} CI 1.18-3.10), and those who reported multiple daily interactions with the index case-patient (RRadj 1.94, 95{\%} CI 1.71-3.26) were at increased risk of influenza-like illness. Discussion: Handwashing promotion initiated after illness onset in a household member did not protect against influenza-like illness or influenza. Behavior may not have changed rapidly enough to curb transmission between household members. A reactive approach to reduce household influenza transmission through handwashing promotion may be ineffective in the context of rural Bangladesh. Trial Registration: ClinicalTrials.gov NCT00880659",
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T2 - Findings from a randomized controlled trial

AU - Ram, Pavani K.

AU - DiVita, Margaret A.

AU - Khatun-e-Jannat, Kaniz

AU - Islam, Manoshi

AU - Krytus, Kimberly

AU - Cercone, Emily

AU - Sohel, Badrul Munir

AU - Ahmed, Makhdum

AU - Rahman, Abid Mahmud Quaiyum

AU - Rahman, Mustafizur

AU - Yu, Jihnhee

AU - Brooks, W Abdullah

AU - Azziz-Baumgartner, Eduardo

AU - Fry, Alicia M.

AU - Luby, Stephen P.

PY - 2015/6/11

Y1 - 2015/6/11

N2 - Rationale: There is little evidence for the efficacy of handwashing for prevention of influenza transmission in resource-poor settings. We tested the impact of intensive handwashing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh. Methods: In 2009-10, we identified index case-patients with influenza-like illness (fever with cough or sore throat) who were the only symptomatic person in their household. Household compounds of index case-patients were randomized to control or intervention (soap and daily handwashing promotion). We conducted daily surveillance and collected oropharyngeal specimens. Secondary attack ratios (SAR) were calculated for influenza and ILI in each arm. Among controls, we investigated individual risk factors for ILI among household contacts of index case-patients. Results: Among 377 index case-patients, the mean number of days between fever onset and study enrollment was 2.1 (SD 1.7) among the 184 controls and 2.6 (SD 2.9) among 193 intervention case-patients. Influenza infection was confirmed in 20% of controls and 12% of intervention index case-patients. The SAR for influenza-like illness among household contacts was 9.5% among intervention (158/1661) and 7.7% among control households (115/1498) (SAR ratio 1.24, 95% CI 0.92-1.65). The SAR ratio for influenza was 2.40 (95% CI 0.68-8.47). In the control arm, susceptible contacts adj 5.51, 95% CI 3.43-8.85), those living with an index case-patient enrolled 24 hours after symptom onset (RRadj 1.91, 95% CI 1.18-3.10), and those who reported multiple daily interactions with the index case-patient (RRadj 1.94, 95% CI 1.71-3.26) were at increased risk of influenza-like illness. Discussion: Handwashing promotion initiated after illness onset in a household member did not protect against influenza-like illness or influenza. Behavior may not have changed rapidly enough to curb transmission between household members. A reactive approach to reduce household influenza transmission through handwashing promotion may be ineffective in the context of rural Bangladesh. Trial Registration: ClinicalTrials.gov NCT00880659

AB - Rationale: There is little evidence for the efficacy of handwashing for prevention of influenza transmission in resource-poor settings. We tested the impact of intensive handwashing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh. Methods: In 2009-10, we identified index case-patients with influenza-like illness (fever with cough or sore throat) who were the only symptomatic person in their household. Household compounds of index case-patients were randomized to control or intervention (soap and daily handwashing promotion). We conducted daily surveillance and collected oropharyngeal specimens. Secondary attack ratios (SAR) were calculated for influenza and ILI in each arm. Among controls, we investigated individual risk factors for ILI among household contacts of index case-patients. Results: Among 377 index case-patients, the mean number of days between fever onset and study enrollment was 2.1 (SD 1.7) among the 184 controls and 2.6 (SD 2.9) among 193 intervention case-patients. Influenza infection was confirmed in 20% of controls and 12% of intervention index case-patients. The SAR for influenza-like illness among household contacts was 9.5% among intervention (158/1661) and 7.7% among control households (115/1498) (SAR ratio 1.24, 95% CI 0.92-1.65). The SAR ratio for influenza was 2.40 (95% CI 0.68-8.47). In the control arm, susceptible contacts adj 5.51, 95% CI 3.43-8.85), those living with an index case-patient enrolled 24 hours after symptom onset (RRadj 1.91, 95% CI 1.18-3.10), and those who reported multiple daily interactions with the index case-patient (RRadj 1.94, 95% CI 1.71-3.26) were at increased risk of influenza-like illness. Discussion: Handwashing promotion initiated after illness onset in a household member did not protect against influenza-like illness or influenza. Behavior may not have changed rapidly enough to curb transmission between household members. A reactive approach to reduce household influenza transmission through handwashing promotion may be ineffective in the context of rural Bangladesh. Trial Registration: ClinicalTrials.gov NCT00880659

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