Facemasks, hand hygiene, and influenza among young adults: a randomized intervention trial

Abstract

Limited vaccine availability and the potential for resistance to antiviral medications have led to calls for establishing the efficacy of non-pharmaceutical measures for mitigating pandemic influenza. Our objective was to examine if the use of face masks and hand hygiene reduced rates of influenza-like illness (ILI) and laboratory-confirmed influenza in the natural setting. A cluster-randomized intervention trial was designed involving 1,178 young adults living in 37 residence houses in 5 university residence halls during the 2007-2008 influenza season. Participants were assigned to face mask and hand hygiene, face mask only, or control group during the study. Discrete-time survival models using generalized estimating equations to estimate intervention effects on ILI and confirmed influenza A/B infection over a 6-week study period were examined. A significant reduction in the rate of ILI was observed in weeks 3 through 6 of the study, with a maximum reduction of 75% during the final study week (rate ratio [RR] = 0.25, [95% CI, 0.07 to 0.87]). Both intervention groups compared to the control showed cumulative reductions in rates of influenza over the study period, although results did not reach statistical significance. Generalizability limited to similar settings and age groups. Face masks and hand hygiene combined may reduce the rate of ILI and confirmed influenza in community settings. These non-pharmaceutical measures should be recommended in crowded settings at the start of an influenza pandemic.

Trial registration: [corrected] Clinicaltrials.gov NCT00490633.

Conflict of interest statement

Competing Interests: Warner Lambert provided hand sanitizer without any involvement in the study design, analysis, results, or writing of the manuscript. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1. Flow chart of participants throughout the study period.

This figure shows the enrollment, allocation, follow-up, and analysis numbers for the study.

Figure 2. Reported daily average number of hours (log transformed) of facemask use by study week.

This figure shows the daily average number of hours (log transformed) of facemask use by study week in both the face mask and hand hygiene group (solid line) and the face mask only group (dotted line). The type III fixed effects model for assessing differences over time using a week * group interaction term, was not statistically significant, F(5, 2943) = 1.30, P = 0.26.