Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: A randomized controlled trial

Samuel Stebbins, Derek A T Cummings, James H. Stark, Chuck Vukotich, Kiren Mitruka, William Thompson, Charles Rinaldo, Loren Roth, Michael Wagner, Stephen R. Wisniewski, Virginia Dato, Heather Eng, Donald S. Burke

Research output: Contribution to journalArticle

Abstract

Background: Laboratory-based evidence is lacking regarding the efficacy of nonpharmaceutical interventions (NPIs) such as alcohol-based hand sanitizer and respiratory hygiene to reduce the spread of influenza. Methods: The Pittsburgh Influenza Prevention Project was a cluster-randomized trial conducted in 10 elementary schools in Pittsburgh, PA, during the 2007 to 2008 influenza season. Children in 5 intervention schools received training in hand and respiratory hygiene, and were provided and encouraged to use hand sanitizer regularly. Children in 5 schools acted as controls. Children with influenza-like illness were tested for influenza A and B by reverse-transcriptase polymerase chain reaction. Results: A total of 3360 children participated in this study. Using reverse-transcriptase polymerase chain reaction, 54 cases of influenza A and 50 cases of influenza B were detected. We found no significant effect of the intervention on the primary study outcome of all laboratory-confirmed influenza cases (incidence rate ratio [IRR]: 0.81; 95% confidence interval [CI]: 0.54, 1.23). However, we did find statistically significant differences in protocol-specified ancillary outcomes. Children in intervention schools had significantly fewer laboratory-confirmed influenza A infections than children in control schools, with an adjusted IRR of 0.48 (95% CI: 0.26, 0.87). Total absent episodes were also significantly lower among the intervention group than among the control group; adjusted IRR 0.74 (95% CI: 0.56, 0.97). Conclusions: NPIs (respiratory hygiene education and the regular use of hand sanitizer) did not reduce total laboratory-confirmed influenza. However, the interventions did reduce school total absence episodes by 26% and laboratory-confirmed influenza A infections by 52%. Our results suggest that NPIs can be an important adjunct to influenza vaccination programs to reduce the number of influenza A infections among children.

Original languageEnglish (US)
Pages (from-to)921-926
Number of pages6
JournalPediatric Infectious Disease Journal
Volume30
Issue number11
DOIs
StatePublished - Nov 2011

Keywords

  • absence surveillance
  • hand sanitizer
  • influenza
  • laboratory testing
  • nonpharmaceutical interventions
  • randomized controlled trial
  • school-aged children

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases
  • Microbiology (medical)

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    Stebbins, S., Cummings, D. A. T., Stark, J. H., Vukotich, C., Mitruka, K., Thompson, W., Rinaldo, C., Roth, L., Wagner, M., Wisniewski, S. R., Dato, V., Eng, H., & Burke, D. S. (2011). Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: A randomized controlled trial. Pediatric Infectious Disease Journal, 30(11), 921-926. https://doi.org/10.1097/INF.0b013e3182218656