Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand.
Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand.
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DOI：
10.1111/j.1750-2659.2011.00205.x
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发表时间：
2011-07
影响因子：
4.4
通讯作者：
Chotipitayasunondh T
中科院分区：
文献类型：
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作者：
Simmerman JM;Suntarattiwong P;Levy J;Jarman RG;Kaewchana S;Gibbons RV;Cowling BJ;Sanasuttipun W;Maloney SA;Uyeki TM;Kamimoto L;Chotipitayasunondh T
请引用这篇论文：Simmerman et al.（2011）泰国曼谷一项关于洗手和戴口罩减少流感传播的家庭随机对照试验的结果。Influenza and Other Respiratory Viruses 5（4），256-267背景证据需要证明非药物干预（NPI）减少流感传播的有效性。 方法我们研究了NPI的家庭与发热，流感阳性的孩子。 家庭被随机分配到对照组、洗手组（HW）或洗手加纸质外科口罩组（HW + FM）。 研究护士在入组后24小时内以及第3、7和21天进行家访。 从所有家庭成员中采集呼吸道拭子和血清，并通过RT-PCR或血清学检测流感。 2008年4月至2009年8月期间，5995例儿童流感样疾病患者中有991例（16.5%）检测为流感阳性。入组了1147名家庭成员的442名索引儿童，其中221名（50.0%）年龄<6岁。 397个（89.8%）家庭报告索引患者睡在父母的卧室。继发发病率为21.5%，56/345例（16.3%; 95%CI 12.4 - 20.2%）继发病例无症状。洗手受试者报告4.7次/天，HW + FM组为4.9次/天，对照组为3.9次/天（P = 0.001）。 HW组（OR = 1·20; 95% CI 0·76-1·88; P-0·442）或HW + FM组（OR = 1·16; 95% CI 0·74-1·82; P = 0·525）继发性流感感染的比值比（OR）无显著差异。 结论流感传播并没有减少干预措施，以促进洗手和口罩的使用。 这可能归因于干预前发生的传播、口罩依从性差、研究组之间洗手频率差异不大以及共享睡眠安排。一个前瞻性的研究设计和社会文化因素的仔细分析，可以改善未来的NPI研究。
Please cite this paper as: Simmerman et al. (2011) Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand. Influenza and Other Respiratory Viruses 5(4), 256–267 Background Evidence is needed on the effectiveness of non‐pharmaceutical interventions (NPIs) to reduce influenza transmission. Methodology We studied NPIs in households with a febrile, influenza‐positive child. Households were randomized to control, hand washing (HW), or hand washing plus paper surgical face masks (HW + FM) arms. Study nurses conducted home visits within 24 hours of enrollment and on days 3, 7, and 21. Respiratory swabs and serum were collected from all household members and tested for influenza by RT‐PCR or serology. Principal Findings Between April 2008 and August 2009, 991 (16·5%) of 5995 pediatric influenza‐like illness patients tested influenza positive. Four hundred and forty‐two index children with 1147 household members were enrolled, and 221 (50·0%) were aged <6 years. Three hundred and ninety‐seven (89·8%) households reported that the index patient slept in the parents’ bedroom. The secondary attack rate was 21·5%, and 56/345 (16·3%; 95% CI 12·4–20·2%) secondary cases were asymptomatic. Hand‐washing subjects reported 4·7 washing episodes/day, compared to 4·9 times/day in the HW + FM arm and 3·9 times/day in controls (P = 0·001). The odds ratios (ORs) for secondary influenza infection were not significantly different in the HW arm (OR = 1·20; 95% CI 0·76–1·88; P‐0.442), or the HW + FM arm (OR = 1·16; 95% CI .0·74–1·82; P = 0.525). Conclusions Influenza transmission was not reduced by interventions to promote hand washing and face mask use. This may be attributable to transmission that occurred before the intervention, poor facemask compliance, little difference in hand‐washing frequency between study groups, and shared sleeping arrangements. A prospective study design and a careful analysis of sociocultural factors could improve future NPI studies.