TY - JOUR
T1 - Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools
T2 - A randomized controlled trial
AU - Stebbins, Samuel
AU - Cummings, Derek A.T.
AU - Stark, James H.
AU - Vukotich, Chuck
AU - Mitruka, Kiren
AU - Thompson, William
AU - Rinaldo, Charles
AU - Roth, Loren
AU - Wagner, Michael
AU - Wisniewski, Stephen R.
AU - Dato, Virginia
AU - Eng, Heather
AU - Burke, Donald S.
N1 - Funding Information:
Supported by NIH MIDAS program (1U01-GM070708) (to D.C. and D.B.) and Cooperative Agreement number 5UCI000435–02 from the Centers for Disease Control and Prevention (CDC) . D.C. holds a Career Award at the Scientific Interface from the Burroughs Welcome Fund.
PY - 2011/11
Y1 - 2011/11
N2 - 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.
AB - 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.
KW - absence surveillance
KW - hand sanitizer
KW - influenza
KW - laboratory testing
KW - nonpharmaceutical interventions
KW - randomized controlled trial
KW - school-aged children
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U2 - 10.1097/INF.0b013e3182218656
DO - 10.1097/INF.0b013e3182218656
M3 - Article
C2 - 21691245
AN - SCOPUS:80055020538
SN - 0891-3668
VL - 30
SP - 921
EP - 926
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
IS - 11
ER -