Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households A Cluster Randomized Trial
Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households A Cluster Randomized Trial
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DOI：
10.7326/0003-4819-151-7-200910060-00142
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发表时间：
2009-10-06
影响因子：
39.2
通讯作者：
Leung, Gabriel M.
中科院分区：
文献类型：
--
作者：
Cowling, Benjamin J.;Chan, Kwok-Hung;Leung, Gabriel M.
背景资料：关于非药物干预预防流感病毒transmission.Objective的有效性的数据很少：要调查是否手卫生和使用口罩防止家庭transmissionofinfluenza.Design：群集随机对照试验。随机化由计算机生成;分配对治疗医生和诊所保密，并由研究护士在首次家庭访视时实施。参与者和管理干预措施的人员不对组分配设盲。（Clinical-Trials.gov注册号：NCT 00425893）研究对象：香港家庭。患者：407名因流感样疾病到门诊就诊的患者（索引患者）和259个家庭的794名家庭成员（接触者），这些患者通过快速检测对甲型或B型流感病毒呈阳性。干预措施：生活方式教育（对照）（134户）、手卫生（136户）或外科口罩加手卫生（137户）。测量：通过逆转录聚合酶链反应（RT-PCR）确诊或7天后临床确诊的接触者流感病毒感染。干预后7天内，259个家庭中有60名（8%）接触者出现RT-PCR确认的流感病毒感染。戴口罩或不戴口罩的手卫生似乎可以减少流感传播，但与对照组相比差异不显著。在154个家庭中，在指标患者出现症状的36小时内实施干预措施，RT-PCR证实的感染传播似乎减少，这一效果归因于使用口罩加手部卫生的参与者中感染较少（调整后的比值比为0.33 [95%CI，0.13至0.87]）。坚持干预varied.Limitation：从指数患者症状发作的延迟干预和变量的坚持可能减轻了干预effectiveness.Conclusion：手卫生和口罩似乎可以防止家庭传播流感病毒时，在36小时内实施的指数患者症状发作。这些研究结果表明，非药物干预措施对缓解大流行和大流行间流感非常重要。
Background: Few data are available about the effectiveness of nonpharmaceutical interventions for preventing influenza virus transmission.Objective: To investigate whether hand hygiene and use of facemasks prevents household transmission of influenza.Design: Cluster randomized, controlled trial. Randomization was computer generated; allocation was concealed from treating physicians and clinics and implemented by study nurses at the time of the initial household visit. Participants and personnel administering the interventions were not blinded to group assignment. (Clinical-Trials.gov registration number: NCT00425893)Setting: Households in Hong Kong.Patients: 407 people presenting to outpatient clinics with influenza-like illness who were positive for influenza A or B virus by rapid testing (index patients) and 794 household members (contacts) in 259 households.Intervention: Lifestyle education (control) (134 households), hand hygiene (136 households), or surgical facemasks plus hand hygiene (137 households) for all household members.Measurements: Influenza virus infection in contacts, as confirmed by reverse-transcription polymerase chain reaction (RT-PCR) or diagnosed clinically after 7 days.Results: Sixty (8%) contacts in the 259 households had RT-PCR-confirmed influenza virus infection in the 7 days after intervention. Hand hygiene with or without facemasks seemed to reduce influenza transmission, but the differences compared with the control group were not significant. In 154 households in which interventions were implemented within 36 hours of symptom onset in the index patient, transmission of RT-PCR-confirmed infection seemed reduced, an effect attributable to fewer infections among participants using facemasks plus hand hygiene (adjusted odds ratio, 0.33 [95% CI, 0.13 to 0.87]). Adherence to interventions varied.Limitation: The delay from index patient symptom onset to intervention and variable adherence may have mitigated intervention effectiveness.Conclusion: Hand hygiene and facemasks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset. These findings suggest that nonpharmaceutical interventions are important for mitigation of pandemic and interpandemic influenza.