Flu SAFE: Flu SMS Alerts to Freeze Exposure

问题：流感感染导致约3100万门诊就诊，55，000至974，200 住院治疗，3,000至49,000人死亡。其他人患有流感的家庭成员 是感染流感的主要危险因素。家庭二次发病率（SAR）高达19% 基于实验室确诊的流感，30%基于症状。非药物预防 包括教育在内的措施可能在减少传播方面发挥作用，但只有开始才有效 在索引病例中症状发作后36小时内。然而，大多数干预措施之所以被推迟， 在寻求护理之前，我们在一个主要是拉丁裔的城市社区样本中证明， 消息传递可用于在早期快速识别患有流感样疾病（ILI）的社区成员， 病这种早期识别将使教育干预的实施，在最佳的 减少流感传播的时间表。在短信中提供教育是一个被证明是成功的 影响行为的策略。短信本身是可扩展的，低成本的，可以在低文化水平的人群中使用 人口。然而，使用基于短信的监视来触发实时短信行为， 尚未评估减少家庭流感传播的教育干预措施。 目的：评估通过短信传递的教育干预对传播的影响 家庭内的流感 探索性目的：比较一个研究中不同亚组的ILI/ARI短信监测的收益。 多样的社区样本 方法：我们将招募400个家庭（n=~1500人），从4个家庭招募≥1名儿童。 在纽约市的相邻社区。我们将按社区1：1对家庭进行随机分组， 仅接受监控（无短信教育）vs.监控加短信教育 干预对于症状监测，两组家庭将在治疗期间每周收到3次短信， 每个流感季节（11月至3月），并报告家中是否有人出现ILI症状。为 在教育干预组中，当报告ILI/ARI时， 将与减少家庭传播的信息一起发送。两组将获得一个自拭子， 指数病例，以及指数发病后第3天和第5天所有其他家庭成员的自我拭子。以识别 呼吸道病原体，拭子将使用RT-PCR进行分析。 结局：主要结局为实验室确认流感的SAR。其次，我们将 根据ILI/ARI症状和非流感病毒评估SAR。将比较答复率 组间差异和人口统计学因素（年龄、教育、种族/民族）。

Problem: Influenza infection results in an estimated 31 million outpatient visits, 55,000 to 974,200 hospitalizations, and 3,000 to 49,000 deaths. Membership in household in which someone else has influenza is the major risk factor for contracting influenza. The household secondary attack rate (SAR) is as high as 19% based on laboratory-confirmed influenza and 30% based on symptoms. Non-pharmaceutical preventive measures, including education, may play a role in decreasing transmission, but are only effective if started within 36 hours of symptom onset in index cases. Yet, most interventions are delayed because they are not initiated until care is sought. We have demonstrated in one primarily Latino, urban community sample, that text messaging can be used to rapidly identify community members with influenza-like illness (ILI) early in an illness. This early identification would enable implementation of an educational intervention in the optimal timeframe to reduce influenza transmission. Providing education within a text message is a proven successful strategy to influence behavior. Text messaging itself is scalable, low-cost, and can be used in low literacy populations. However, using text-message based surveillance to trigger a real-time text-message behavioral educational intervention to decrease household influenza transmission has not been assessed. Aim: To assess the impact of an educational intervention delivered by text messaging on transmission of influenza within households Exploratory Aim: To compare the yield of text message ILI/ARI surveillance among subgroups in a diverse, community sample Methods: We will enroll 400 households (n=~1500 individuals) with ≥1 child recruited from four contiguous communities in New York City. We will randomize households stratified by community 1:1 to receive surveillance-only (no text message education) vs. surveillance plus text message educational intervention. For symptom surveillance, households in both arms will receive text messages 3x/week during each influenza season (November-March) and report if someone in the household has ILI symptoms. For those in the educational intervention arm, when an ILI/ARI is reported, a series of educational text messages will be sent with information to decrease household transmission. Both arms will obtain one self-swab of the index case, and self-swabs of all other household members on days 3 and 5 from index onset. To identify respiratory tract pathogens, swabs will be analyzed using RT-PCR. Outcomes: The primary outcome will be SAR of laboratory-confirmed influenza. Secondarily, we will assess SAR based on ILI/ARI symptoms, and of non-influenza viruses. Response rates will be compared between arms and by demographic factors (age, education, race/ethnicity).