Impact of intensive handwashing promotion on secondary household influenza-like illness in rural Bangladesh: findings from a randomized controlled trial
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RATIONALE: There is little evidence for the efficacy of handwashing for prevention of influenza transmission in resource-poor settings. We tested the impact of intensive handwashing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh. METHODS: In 2009-10, we identified index case-patients with influenza-like illness (fever with cough or sore throat) who were the only symptomatic person in their household. Household compounds of index case-patients were randomized to control or intervention (soap and daily handwashing promotion). We conducted daily surveillance and collected oropharyngeal specimens. Secondary attack ratios (SAR) were calculated for influenza and ILI in each arm. Among controls, we investigated individual risk factors for ILI among household contacts of index case-patients. RESULTS: Among 377 index case-patients, the mean number of days between fever onset and study enrollment was 2.1 (SD 1.7) among the 184 controls and 2.6 (SD 2.9) among 193 intervention case-patients. Influenza infection was confirmed in 20% of controls and 12% of intervention index case-patients. The SAR for influenza-like illness among household contacts was 9.5% among intervention (158/1661) and 7.7% among control households (115/1498) (SAR ratio 1.24, 95% CI 0.92-1.65). The SAR ratio for influenza was 2.40 (95% CI 0.68-8.47). In the control arm, susceptible contacts <2 years old (RRadj 5.51, 95% CI 3.43-8.85), those living with an index case-patient enrolled ≤24 hours after symptom onset (RRadj 1.91, 95% CI 1.18-3.10), and those who reported multiple daily interactions with the index case-patient (RRadj 1.94, 95% CI 1.71-3.26) were at increased risk of influenza-like illness. DISCUSSION: Handwashing promotion initiated after illness onset in a household member did not protect against influenza-like illness or influenza. Behavior may not have changed rapidly enough to curb transmission between household members. A reactive approach to reduce household influenza transmission through handwashing promotion may be ineffective in the context of rural Bangladesh. TRIAL REGISTRATION: ClinicalTrials.gov NCT00880659.
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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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Cites
1 retracted
Burden of influenza in healthy children and their households
Principi, N. (2004) · Archives of Disease in Childhood · doi:10.1136/adc.2003.045401 · Cited by 100 · see citing works
RetractedHealth Behavior and Health Education: Theory, Research, and Practice
(1992) · Annals of Internal Medicine · doi:10.7326/0003-4819-116-4-350_1 · Cited by 13,211 · see citing works
Murray, C. J. L., Vos, T., Lozano, R., Naghavi, M., Flaxman, A. D., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J. A., Abdalla, S., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61689-4 · Cited by 8,888 · see citing works
Nair, H., Brooks, W. A., Katz, M., Roca, A., Berkley, J. A., Madhi, S. A., Simmerman, J. M., Gordon, A. L., Sato, M., Howie, S. R. C., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)61051-9 · Cited by 1,007 · see citing works
Self-citationEffect of handwashing on child health: a randomised controlled trial
Luby, S. P., Agboatwalla, M., Feikin, D. R., Painter, J., Billhimer, W., Altaf, A., & Hoekstra, R. M. (2005) · The Lancet · doi:10.1016/s0140-6736(05)66912-7 · Cited by 748 · see citing works
Self-citationSurvival of Influenza Viruses on Environmental Surfaces
Bean, B., Moore, B. M., Sterner, B., Peterson, L. R., Gerding, D. N., & Balfour, H. H. (1982) · The Journal of Infectious Diseases · doi:10.1093/infdis/146.1.47 · Cited by 539 · see citing works
Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households
Cowling, B. J., Chan, K., Fang, V. J., Cheng, C. K. Y., Fung, R. O. P., Wai, W., Sin, J., Seto, W., Yung, R. W. H., Chu, D. W., et al. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-7-200910060-00142 · Cited by 536 · see citing works
Household Transmission of 2009 Pandemic Influenza A (H1N1) Virus in the United States
Cauchemez, S., Donnelly, C. A., Reed, C., Ghani, A. C., Fraser, C., Kent, C. K., Finelli, L., & Ferguson, N. M. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0905498 · Cited by 472 · see citing works
Aiello, A. E., Murray, G. F., Perez, V., Coulborn, R. M., Davis, B. M., Uddin, M., Shay, D. K., Waterman, S. H., & Monto, A. S. (2010) · The Journal of Infectious Diseases · doi:10.1086/650396 · Cited by 354 · see citing works
Nonpharmaceutical Interventions for Pandemic Influenza, International Measures
Bell, D., Nicoll, A., Fukuda, K., Horby, P., Monto, A. S., Hayden, F. G., Wylks, C. E., Sanders, L., & Nguyen‐Van‐Tam, J. S. (2006) · Emerging infectious diseases · doi:10.3201/eid1201.051370 · Cited by 326 · see citing works
Luby, S. P., Agboatwalla, M., Painter, J., Altaf, A., Billhimer, W. L., & Hoekstra, R. M. (2004) · JAMA · doi:10.1001/jama.291.21.2547 · Cited by 309 · cited 1× · see citing works
“In a year-long trial of handwashing promotion in Karachi, Pakistan, diarrhea rates were 50% lower in the intervention group over the course of a year of surveillance but did not differ at all during the first two months following the introduction of the intervention, suggesting that the behavior had not changed early…”
BackgroundTalaat, M., Afifi, S., Dueger, E., El-Ashry, N., Marfin, A., Kandeel, A., Mohareb, E., & El-Sayed, N. (2011) · Emerging Infectious Diseases · doi:10.3201/eid1704.101353 · Cited by 238 · see citing works
Luby, S. P., Halder, A. K., Huda, T., Unicomb, L., & Johnston, R. B. (2011) · PLoS Medicine · doi:10.1371/journal.pmed.1001052 · Cited by 217 · cited 1× · see citing works
“In Bangladesh, handwashing with soap is uncommon [11], particularly after respiratory secretion contact [12], and thus, the risk of transmission via direct contact has the potential to be high [13,14].”
BackgroundSelf-citationCowling, B. J., Fung, R. O. P., Cheng, C. K. Y., Fang, V. J., Chan, K. H., Seto, W. H., Yung, R., Chiu, B., Lee, P., Uyeki, T. M., et al. (2008) · PLoS ONE · doi:10.1371/journal.pone.0002101 · Cited by 186 · see citing works
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., et al. (2011) · Influenza and Other Respiratory Viruses · doi:10.1111/j.1750-2659.2011.00205.x · Cited by 177 · see citing works
Ram, P. K., Halder, A. K., Granger, S. P., Jones, T., Hall, P., Hitchcock, D., Wright, R. L., Nygren, B., Islam, M. S., Molyneaux, J. W., et al. (2010) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2010.09-0763 · Cited by 164 · see citing works
Self-citationStatistics notes: Sample size in cluster randomisation
Kerry, S., & Bland, J. M. (1998) · BMJ · doi:10.1136/bmj.316.7130.549 · Cited by 162 · see citing works
Impact of Non-Pharmaceutical Interventions on URIs and Influenza in Crowded, Urban Households
Larson, E., Ferng, Y., Wong‐McLoughlin, J., Wang, S., Haber, M., & Morse, S. S. (2010) · Public Health Reports · doi:10.1177/003335491012500206 · Cited by 155 · see citing works
Zaman, R. U., Alamgir, A. S. M., Rahman, M., et al. (2009) · PLoS ONE · doi:10.1371/journal.pone.0008452 · Cited by 117 · see citing works
Self-citationGurley, E. S., Salje, H., Homaira, N., Ram, P. K., Haque, R., Petri, W. A., Bresee, J., Moss, W. J., Luby, S. P., Breysse, P. N., et al. (2012) · Environmental Research · doi:10.1016/j.envres.2012.10.004 · Cited by 70 · see citing works
Self-citationImpact of influenza infection in healthy children examined as outpatients and their families
Tsolia, M. N., Logotheti, I., Papadopoulos, N. G., et al. (2006) · Vaccine · doi:10.1016/j.vaccine.2006.05.006 · Cited by 60 · see citing works
Murray, E. L., Brondi, L., Kleinbaum, D. G., McGowan, J. E., van Mels, C., Brooks, W. A., Goswami, D. R., Ryan, P. B., Klein, M. C., & Bridges, C. B. (2011) · Indoor Air · doi:10.1111/j.1600-0668.2011.00754.x · Cited by 56 · see citing works
Self-citationHousehold Air Quality Risk Factors Associated with Childhood Pneumonia in Urban Dhaka, Bangladesh
Ram, P. K., Dutt, D., Silk, B. J., Doshi, S., Rudra, C. B., Abedin, J., Goswami, D. R., Fry, A. M., Brooks, W. A., Luby, S. P., et al. (2014) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.13-0532 · Cited by 52 · see citing works
Self-citationPrevalent high-risk respiratory hygiene practices in urban and rural Bangladesh
Nasreen, S., Azziz‐Baumgartner, E., Gurley, E. S., WINCH, P. J., UNICOMB, L. E., Sharker, M. A. Y., Southern, D. L., & Luby, S. P. (2010) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2010.02531.x · Cited by 30 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Physical interventions to interrupt or reduce the spread of respiratory viruses
Jefferson, T., Dooley, L., Ferroni, E., Al-Ansary, L. A., van Driel, M. L., Bawazeer, G. A., Jones, M. A., Hoffmann, T. C., Clark, J., Beller, E. M., et al. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006207.pub6 · Cited by 291 · see citing works
Xiao, J., Shiu, E. Y. C., Gao, H., Wong, J. Y., Fong, M. W., Ryu, S., & Cowling, B. J. (2020) · Emerging Infectious Diseases · doi:10.3201/eid2605.190994 · Cited by 243 · see citing works
Ross, I., Bick, S., Ayieko, P., Dreibelbis, R., Wolf, J., Freeman, M. C., Allen, E., Brauer, M., & Cumming, O. (2023) · The Lancet · doi:10.1016/s0140-6736(23)00021-1 · Cited by 118 · see citing works
De Buck, E., Van Remoortel, H., Hannes, K., Govender, T., Naidoo, S., Avau, B., Veegaete, A. V., Musekiwa, A., Lutje, V., Cargo, M., et al. (2017) · Campbell Systematic Reviews: Better Evidence for a Better World · doi:10.4073/csr.2017.7 · Cited by 99 · see citing works
Moncion, K., Young, K., Tunis, M., Rempel, S., Stirling, R., & Zhao, L. (2019) · Canada Communicable Disease Report · doi:10.14745/ccdr.v45i01a02 · Cited by 43 · see citing works
McGuinness, S. L., Barker, S. F., O'Toole, J., Cheng, A. C., Forbes, A. B., Sinclair, M., & Leder, K. (2018) · Tropical Medicine & International Health · doi:10.1111/tmi.13080 · Cited by 36 · see citing works
- Authors
- Ram, P. K., DiVita, M. A., Khatun-e-Jannat, K., Islam, M., Krytus, K., Cercone, E., Sohel, B. M., Ahmed, M., Rahman, A. M. Q., Rahman, M., Yu, J., Brooks, W. A., Azziz-Baumgartner, E., Fry, A. M., & Luby, S. P.
- Affiliations
- University at Buffalo, State University of New York (US)
- International Centre for Diarrhoeal Disease Research (BD)
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Ram, Pavani K.
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-06-11
- Volume
- 10
- Issue
- 6
- Pages
- e0125200
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4465839
- OpenAlex
- W610695716
- Cited by
- 49
- References
- 24
- Citations by year
- 2024: 2 · 2023: 4 · 2022: 9 · 2021: 18 · 2020: 5 · 2019: 3 · 2018: 2 · 2017: 2 · 2016: 3 · 2015: 1
- FWCI
- 2.09
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- creativecommons.org/publicdomain/zero/1.0/ (vor)
- Locations
- PLoS ONE (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- International Centre for Diarrhoeal Disease Research, Bangladesh
- Centers for Disease Control and Prevention (U01CI000628, 3U01CI000628)
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Keywords
- handwashing promotion, household transmission, influenza-like illness, influenza transmission, household contacts, soap, hygiene interventions, reactive interventions, risk factors, rural Bangladesh, 2009 H1N1 pandemic, resource-limited settings
- MeSH terms
- Bangladesh, Child, Preschool, Family Characteristics, Female, Hand Disinfection, Humans, Infant, Influenza, Human, Male, Oropharynx, Rural Population
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