Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand
Open accessAbstract
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.
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Two of the three influenza studies assessed interventions delivered to household members of a confirmed influenza case, and were probably delivered too late to prevent domestic transmission.
“Two of these studies 47,48 assessed interventions delivered to household members of a confirmed influenza case, and were probably delivered too late to prevent domestic transmission.”
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- Authors
- Simmerman, J. M., Suntarattiwong, P., Levy, J., Jarman, R. G., Kaewchana, S., Gibbons, R. V., Cowling, B. J., Sanasuttipun, W., Maloney, S. A., Uyeki, T. M., Kamimoto, L., & Chotipitayasunondh, T.
- Affiliations
- Ministry of Public Health (TH)
- Queen Sirikit National Institute of Child Health (TH)
- Armed Forces Research Institute of Medical Science (TH)
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Simmerman, James M.
- ORCID
- Venue
- Influenza and Other Respiratory Viruses
- Publisher
- Wiley
- Published
- 2011-02-17
- Volume
- 5
- Issue
- 4
- Pages
- 256-267
- ISSN
- 1750-2640 (ISSN-L)
- PMC
- PMC4634545
- OpenAlex
- W1910874260
- Cited by
- 177
- References
- 29
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 5 · 2023: 7 · 2022: 22 · 2021: 30 · 2020: 37 · 2019: 6 · 2018: 6 · 2017: 4 · 2016: 7 · 2015: 13 · 2014: 10 · 2013: 7 · 2012: 11
- FWCI
- 7.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Influenza and Other Respiratory Viruses (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Funders
- U.S. Department of Defense
- Amylin Pharmaceuticals
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Keywords
- influenza transmission, hand washing, face masks, non-pharmaceutical interventions, household transmission, secondary attack rate, asymptomatic transmission, pediatric influenza, co-sleeping
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Antibodies, Viral, Child, Child, Preschool, Enzyme-Linked Immunosorbent Assay, Family Characteristics, Female, Hand Disinfection, Humans, Infant, Infant, Newborn, Influenza, Human, Male, Masks, Middle Aged, Nasopharynx, Orthomyxoviridae, RNA, Viral, Thailand, Disease Transmission, Infectious, Reverse Transcriptase Polymerase Chain Reaction, Serum, Young Adult
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