Impact of Intensive Handwashing Promotion on Secondary Household Influenza-Like Illness in Rural Bangladesh: Findings from a Randomized Controlled Trial

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Ram, Pavani K. ; DiVita, Margaret A. ; Khatun-e-Jannat, Kaniz ; Islam, Manoshi ; Krytus, Kimberly ; Cercone, Emily ; Sohel, Badrul Munir ; Ahmed, Makhdum ; Rahman, Abid Mahmud Quaiyum ; Rahman, Mustafizur ; Yu, Jihnhee ; Brooks, W. Abdullah ; Azziz-Baumgartner, Eduardo ; Fry, Alicia M. ; Luby, Stephen P.
• Description:
  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
  
  
• Subjects:
  Child, Preschool Family Characteristics Female Hand Disinfection Humans Infant Influenza, Human Male Oropharynx Rural Population
• Source:
  PLoS One. 10(6).
• Pubmed ID:
  26066651
• Pubmed Central ID:
  PMC4465839
• Document Type:
  Journal Article
• Funding:
  3U01CI000628/CI/NCPDCID CDC HHS/United States
• Place as Subject:
  Bangladesh
• Volume:
  10
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8a34eae5d8b5f88cca8e23e257cc772d71a7d6c3bc42860caedfe4753fc6e2aa
• Download URL:
  https://stacks.cdc.gov/view/cdc/31960/cdc_31960_DS1.pdf
• File Type:
  [PDF - 2.76 MB ]