Preliminary findings of a randomized trial of non-pharmaceutical interventions to prevent influenza transmission in households.
Preliminary findings of a randomized trial of non-pharmaceutical interventions to prevent influenza transmission in households.
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DOI：
10.1371/journal.pone.0002101
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发表时间：
2008-05-07
期刊：
影响因子：
3.7
通讯作者：
Leung GM
中科院分区：
文献类型：
--
作者：
Cowling BJ;Fung RO;Cheng CK;Fang VJ;Chan KH;Seto WH;Yung R;Chiu B;Lee P;Uyeki TM;Houck PM;Peiris JS;Leung GM
关于非药物干预是否可以减少流感传播的数据很少。我们就口罩及手部卫生的可行性及成效进行研究，以减少流感在香港家庭成员之间传播。我们对家庭（至少由3名成员组成）进行了一项整群随机对照试验，其中索引受试者出现持续时间<48小时的流感样疾病。在通过QuickVue甲型流感+B快速检测确认索引病例中的流感后，将索引受试者的家庭随机分配至1）对照组或2）外科口罩组或3）手部卫生组。在36小时内以及3天、6天和9天后对住户进行了访问。在每次家庭访视时从索引受试者和所有家庭接触者中采集鼻拭子和咽拭子，并进行病毒培养检测。主要结局指标是实验室培养证实的家庭接触者流感;次要结局是临床诊断的流感（通过自我报告的症状）。我们随机分配了198个家庭，并对128个家庭进行了随访;其中122个家庭的指示病例有实验室确诊的流感。有21名与实验室确诊流感有家庭接触的人，二次发病率为6%。临床继发性发作率根据病例定义从5%到18%不等。基于实验室或临床的继发性发作比率在干预组之间没有显著差异。对干预措施的依从性是可变的。继发性发病率低于预期，也低于其他国家报告的发病率，这可能是由于不同的易感性模式、最近流行的流感病毒株缺乏显著的抗原漂移和/或与对症招募设计相关的问题。从这一试点中吸取的经验教训为2008年的主要研究提供了信息。ClinicalTrials.gov HKClinicalTrials.com HKCTR-365
There are sparse data on whether non-pharmaceutical interventions can reduce the spread of influenza. We implemented a study of the feasibility and efficacy of face masks and hand hygiene to reduce influenza transmission among Hong Kong household members. We conducted a cluster randomized controlled trial of households (composed of at least 3 members) where an index subject presented with influenza-like-illness of <48 hours duration. After influenza was confirmed in an index case by the QuickVue Influenza A+B rapid test, the household of the index subject was randomized to 1) control or 2) surgical face masks or 3) hand hygiene. Households were visited within 36 hours, and 3, 6 and 9 days later. Nose and throat swabs were collected from index subjects and all household contacts at each home visit and tested by viral culture. The primary outcome measure was laboratory culture confirmed influenza in a household contact; the secondary outcome was clinically diagnosed influenza (by self-reported symptoms). We randomized 198 households and completed follow up home visits in 128; the index cases in 122 of those households had laboratory-confirmed influenza. There were 21 household contacts with laboratory confirmed influenza corresponding to a secondary attack ratio of 6%. Clinical secondary attack ratios varied from 5% to 18% depending on case definitions. The laboratory-based or clinical secondary attack ratios did not significantly differ across the intervention arms. Adherence to interventions was variable. The secondary attack ratios were lower than anticipated, and lower than reported in other countries, perhaps due to differing patterns of susceptibility, lack of significant antigenic drift in circulating influenza virus strains recently, and/or issues related to the symptomatic recruitment design. Lessons learnt from this pilot have informed changes for the main study in 2008. ClinicalTrials.gov NCT00425893 HKClinicalTrials.com HKCTR-365
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