Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-Personal Protective and Environmental Measures

Jingyi Xiao, Eunice Y C Shiu, Huizhi Gao, Jessica Y Wong, Min W Fong, Sukhyun Ryu, Benjamin J Cowling, Jingyi Xiao, Eunice Y C Shiu, Huizhi Gao, Jessica Y Wong, Min W Fong, Sukhyun Ryu, Benjamin J Cowling

Abstract

There were 3 influenza pandemics in the 20th century, and there has been 1 so far in the 21st century. Local, national, and international health authorities regularly update their plans for mitigating the next influenza pandemic in light of the latest available evidence on the effectiveness of various control measures in reducing transmission. Here, we review the evidence base on the effectiveness of nonpharmaceutical personal protective measures and environmental hygiene measures in nonhealthcare settings and discuss their potential inclusion in pandemic plans. Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza. We similarly found limited evidence on the effectiveness of improved hygiene and environmental cleaning. We identified several major knowledge gaps requiring further research, most fundamentally an improved characterization of the modes of person-to-person transmission.

Keywords: environmental measures; influenza; influenza virus; meta-analysis; nonhealthcare settings; nonpharmaceutical measures; pandemic influenza; personal protective measures; public health; respiratory infections; viruses.

Figures

Figure 1
Figure 1
Meta-analysis of risk ratios for the effect of hand hygiene with or without face mask use on laboratory-confirmed influenza from 10 randomized controlled trials with >11,000 participants. A) Hand hygiene alone; B) hand hygiene and face mask; C) hand hygiene with or without face mask. Pooled estimates were not made if there was high heterogeneity (I2 >75%). Squares indicate risk ratio for each of the included studies, horizontal lines indicate 95% CIs, dashed vertical line indicates pooled estimation of risk ratio, and diamond indicates pooled estimation of risk ratio. Diamond width corresponds to the 95% CI.
Figure 2
Figure 2
Meta-analysis of risk ratios for the effect of face mask use with or without enhanced hand hygiene on laboratory-confirmed influenza from 10 randomized controlled trials with >6,500 participants. A) Face mask use alone; B) face mask and hand hygiene; C) face mask with or without hand hygiene. Pooled estimates were not made if there was high heterogeneity (I2 >75%). Squares indicate risk ratio for each of the included studies, horizontal lines indicate 95% CIs, dashed vertical lines indicate pooled estimation of risk ratio, and diamonds indicate pooled estimation of risk ratio. Diamond width corresponds to the 95% CI.

References

    1. Uyeki TM, Katz JM, Jernigan DB. Novel influenza A viruses and pandemic threats. Lancet. 2017;389:2172–4. 10.1016/S0140-6736(17)31274-6
    1. Bean B, Moore BM, Sterner B, Peterson LR, Gerding DN, Balfour HH Jr. Survival of influenza viruses on environmental surfaces. J Infect Dis. 1982;146:47–51. 10.1093/infdis/146.1.47
    1. Tellier R. Aerosol transmission of influenza A virus: a review of new studies. J R Soc Interface. 2009;6(Suppl 6):S783–90. 10.1098/rsif.2009.0302.focus
    1. Siegel JD, Rhinehart E, Jackson M, Chiarello L; Health Care Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings: Atlanta: Centers for Disease Control and Prevention; 2007.
    1. World Health Organization. Comparative analysis of national pandemic influenza preparedness plans, 2011. [cited 2019 Jun 25].
    1. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al.; GRADE Working Group. GRADE guidelines: 7. Rating the quality of evidence—inconsistency. J Clin Epidemiol. 2011;64:1294–302. 10.1016/j.jclinepi.2011.03.017
    1. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64:383–94. 10.1016/j.jclinepi.2010.04.026
    1. Wong VW, Cowling BJ, Aiello AE. Hand hygiene and risk of influenza virus infections in the community: a systematic review and meta-analysis. Epidemiol Infect. 2014;142:922–32. 10.1017/S095026881400003X
    1. Aiello AE, Murray GF, Perez V, Coulborn RM, Davis BM, Uddin M, et al. Mask use, hand hygiene, and seasonal influenza-like illness among young adults: a randomized intervention trial. J Infect Dis. 2010;201:491–8. 10.1086/650396
    1. Aiello AE, Perez V, Coulborn RM, Davis BM, Uddin M, Monto AS. Facemasks, hand hygiene, and influenza among young adults: a randomized intervention trial. PLoS One. 2012;7:e29744. 10.1371/journal.pone.0029744
    1. Cowling BJ, Chan KH, Fang VJ, Cheng CK, Fung RO, Wai W, et al. Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. Ann Intern Med. 2009;151:437–46. 10.7326/0003-4819-151-7-200910060-00142
    1. Cowling BJ, Fung RO, Cheng CK, Fang VJ, Chan KH, Seto WH, et al. Preliminary findings of a randomized trial of non-pharmaceutical interventions to prevent influenza transmission in households. PLoS One. 2008;3:e2101. 10.1371/journal.pone.0002101
    1. Larson EL, Ferng YH, Wong-McLoughlin J, Wang S, Haber M, Morse SS. Impact of non-pharmaceutical interventions on URIs and influenza in crowded, urban households. Public Health Rep. 2010;125:178–91. 10.1177/003335491012500206
    1. Ram PK, DiVita MA, Khatun-e-Jannat K, Islam M, Krytus K, Cercone E, et al. Impact of intensive handwashing promotion on secondary household influenza-like illness in rural bangladesh: findings from a randomized controlled trial. PLoS One. 2015;10:e0125200. 10.1371/journal.pone.0125200
    1. Simmerman JM, Suntarattiwong P, Levy J, Jarman RG, Kaewchana S, Gibbons RV, et al. Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand. Influenza Other Respir Viruses. 2011;5:256–67. 10.1111/j.1750-2659.2011.00205.x
    1. Stebbins S, Cummings DA, Stark JH, Vukotich C, Mitruka K, Thompson W, et al. Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: a randomized controlled trial. Pediatr Infect Dis J. 2011;30:921–6. 10.1097/INF.0b013e3182218656
    1. Suess T, Remschmidt C, Schink SB, Schweiger B, Nitsche A, Schroeder K, et al. The role of facemasks and hand hygiene in the prevention of influenza transmission in households: results from a cluster randomised trial; Berlin, Germany, 2009-2011. BMC Infect Dis. 2012;12:26. 10.1186/1471-2334-12-26
    1. Talaat M, Afifi S, Dueger E, El-Ashry N, Marfin A, Kandeel A, et al. Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt. Emerg Infect Dis. 2011;17:619–25. 10.3201/eid1704.101353
    1. Azman AS, Stark JH, Althouse BM, Vukotich CJ Jr, Stebbins S, Burke DS, et al. Household transmission of influenza A and B in a school-based study of non-pharmaceutical interventions. Epidemics. 2013;5:181–6. 10.1016/j.epidem.2013.09.001
    1. Levy JW, Suntarattiwong P, Simmerman JM, Jarman RG, Johnson K, Olsen SJ, et al. Increased hand washing reduces influenza virus surface contamination in Bangkok households, 2009-2010. Influenza Other Respir Viruses. 2014;8:13–6. 10.1111/irv.12204
    1. Mukherjee DV, Cohen B, Bovino ME, Desai S, Whittier S, Larson EL. Survival of influenza virus on hands and fomites in community and laboratory settings. Am J Infect Control. 2012;40:590–4. 10.1016/j.ajic.2011.09.006
    1. Macias AE, de la Torre A, Moreno-Espinosa S, Leal PE, Bourlon MT, Ruiz-Palacios GM. Controlling the novel A (H1N1) influenza virus: don’t touch your face! J Hosp Infect. 2009;73:280–1. 10.1016/j.jhin.2009.06.017
    1. Simmerman JM, Suntarattiwong P, Levy J, Gibbons RV, Cruz C, Shaman J, et al. Influenza virus contamination of common household surfaces during the 2009 influenza A (H1N1) pandemic in Bangkok, Thailand: implications for contact transmission. Clin Infect Dis. 2010;51:1053–61. 10.1086/656581
    1. Grayson ML, Melvani S, Druce J, Barr IG, Ballard SA, Johnson PD, et al. Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers. Clin Infect Dis. 2009;48:285–91. 10.1086/595845
    1. Larson EL, Cohen B, Baxter KA. Analysis of alcohol-based hand sanitizer delivery systems: efficacy of foam, gel, and wipes against influenza A (H1N1) virus on hands. Am J Infect Control. 2012;40:806–9. 10.1016/j.ajic.2011.10.016
    1. Aiello AE, Coulborn RM, Perez V, Larson EL. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health. 2008;98:1372–81. 10.2105/AJPH.2007.124610
    1. Löffler H, Kampf G. Hand disinfection: how irritant are alcohols? J Hosp Infect. 2008;70(Suppl 1):44–8. 10.1016/S0195-6701(08)60010-9
    1. Ahmed QA, Memish ZA, Allegranzi B, Pittet D, Global Patient Safety Challenge WHO; WHO Global Patient Safety Challenge. Muslim health-care workers and alcohol-based handrubs. Lancet. 2006;367:1025–7. 10.1016/S0140-6736(06)68431-6
    1. Pittet D. Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis. 2001;7:234–40. 10.3201/eid0702.010217
    1. Centers for Disease Control and Prevention. Respiratory hygiene/cough etiquette in healthcare settings, 2009. [cited 2019 Jul 8].
    1. Zayas G, Chiang MC, Wong E, MacDonald F, Lange CF, Senthilselvan A, et al. Effectiveness of cough etiquette maneuvers in disrupting the chain of transmission of infectious respiratory diseases. BMC Public Health. 2013;13:811. 10.1186/1471-2458-13-811
    1. Balaban V, Stauffer WM, Hammad A, Afgarshe M, Abd-Alla M, Ahmed Q, et al. Protective practices and respiratory illness among US travelers to the 2009 Hajj. J Travel Med. 2012;19:163–8. 10.1111/j.1708-8305.2012.00602.x
    1. Barasheed O, Almasri N, Badahdah AM, Heron L, Taylor J, McPhee K, et al.; Hajj Research Team. Pilot randomised controlled trial to test effectiveness of facemasks in preventing influenza-like illness transmission among Australian Hajj pilgrims in 2011. Infect Disord Drug Targets. 2014;14:110–6. 10.2174/1871526514666141021112855
    1. MacIntyre CR, Cauchemez S, Dwyer DE, Seale H, Cheung P, Browne G, et al. Face mask use and control of respiratory virus transmission in households. Emerg Infect Dis. 2009;15:233–41. 10.3201/eid1502.081166
    1. MacIntyre CR, Zhang Y, Chughtai AA, Seale H, Zhang D, Chu Y, et al. Cluster randomised controlled trial to examine medical mask use as source control for people with respiratory illness. BMJ Open. 2016;6:e012330. 10.1136/bmjopen-2016-012330
    1. US Food and Drug Administration. Masks and N95 respirators, 2018. [cited 2019 Jul 10].
    1. Centers for Disease Control and Prevention. Respirator fact sheet, 2012. [cited 2019 Jul 10].
    1. Chughtai AA, Seale H, MacIntyre CR. Use of cloth masks in the practice of infection control—evidence and policy gaps. Int J Infect Control. 2013;9:1–12. 10.3396/IJIC.v9i3.020.13
    1. World Health Organization. Advice on the use of masks in the community setting in Influenza A (H1N1) outbreaks, 2009. [cited 2019 Jul 10].
    1. Casas L, Espinosa A, Borràs-Santos A, Jacobs J, Krop E, Heederik D, et al. Domestic use of bleach and infections in children: a multicentre cross-sectional study. Occup Environ Med. 2015;72:602–4. 10.1136/oemed-2014-102701
    1. Ibfelt T, Engelund EH, Schultz AC, Andersen LP. Effect of cleaning and disinfection of toys on infectious diseases and micro-organisms in daycare nurseries. J Hosp Infect. 2015;89:109–15. 10.1016/j.jhin.2014.10.007
    1. Sandora TJ, Shih MC, Goldmann DA. Reducing absenteeism from gastrointestinal and respiratory illness in elementary school students: a randomized, controlled trial of an infection-control intervention. Pediatrics. 2008;121:e1555–62. 10.1542/peds.2007-2597
    1. Oxford J, Berezin EN, Courvalin P, Dwyer DE, Exner M, Jana LA, et al. The survival of influenza A(H1N1)pdm09 virus on 4 household surfaces. Am J Infect Control. 2014;42:423–5. 10.1016/j.ajic.2013.10.016
    1. Tuladhar E, Hazeleger WC, Koopmans M, Zwietering MH, Beumer RR, Duizer E. Residual viral and bacterial contamination of surfaces after cleaning and disinfection. Appl Environ Microbiol. 2012;78:7769–75. 10.1128/AEM.02144-12
    1. Zhang N, Li Y. Transmission of influenza A in a student office based on realistic person-to-person contact and surface touch behaviour. Int J Environ Res Public Health. 2018;15:E1699. 10.3390/ijerph15081699
    1. Shiu EYC, Leung NHL, Cowling BJ. Controversy around airborne versus droplet transmission of respiratory viruses: implication for infection prevention. Curr Opin Infect Dis. 2019;32:372–9. 10.1097/QCO.0000000000000563
    1. Marr LC, Tang JW, Van Mullekom J, Lakdawala SS. Mechanistic insights into the effect of humidity on airborne influenza virus survival, transmission and incidence. J R Soc Interface. 2019;16:20180298. 10.1098/rsif.2018.0298
    1. Reiman JM, Das B, Sindberg GM, Urban MD, Hammerlund MEM, Lee HB, et al. Humidity as a non-pharmaceutical intervention for influenza A. PLoS One. 2018;13:e0204337. 10.1371/journal.pone.0204337
    1. Gao X, Wei J, Cowling BJ, Li Y. Potential impact of a ventilation intervention for influenza in the context of a dense indoor contact network in Hong Kong. Sci Total Environ. 2016;569-570:373–81. 10.1016/j.scitotenv.2016.06.179
    1. McDevitt JJ, Rudnick SN, Radonovich LJ. Aerosol susceptibility of influenza virus to UV-C light. Appl Environ Microbiol. 2012;78:1666–9. 10.1128/AEM.06960-11

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