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

Stebbins, Samuel; Cummings, Derek A. T.; Stark, James H.; Vukotich, Chuck; Mitruka, Kiren; Thompson, William; Rinaldo, Charles; Roth, Loren; Wagner, Michael; Wisniewski, Stephen R.; Dato, Virginia; Eng, Heather; Burke, Donald S.

doi:10.1097/INF.0b013e3182218656

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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

Published Date:

Nov 2011

Publisher's site:

http://dx.doi.org/10.1097/INF.0b013e3182218656 New Site Icon

Source:

Pediatr Infect Dis J. 30(11):921-926.

[PDF-920.69 KB]

Details:

Personal Authors:

Stebbins, Samuel ; Cummings, Derek A. T. ; Stark, James H. ; Vukotich, Chuck ; Mitruka, Kiren ; ... More ▼

Keywords:

[+]

Pubmed ID:

21691245

Pubmed Central ID:

PMC3470868

Description:

Background

Laboratory-based evidence is lacking regarding the efficacy of non-pharmaceutical interventions such as alcohol-based hand sanitizer and respiratory hygiene to reduce the spread of influenza.

Methods

The Pittsburgh Influenza Prevention Project was a cluster-randomized trial conducted in ten Pittsburgh, PA elementary schools during the 2007-2008 influenza season. Children in five intervention schools received training in hand and respiratory hygiene, and were provided and encouraged to use hand sanitizer regularly. Children in five schools acted as controls. Children with influenza-like illness were tested for influenza A and B by RT-PCR.

Results

3360 children participated. Using RT-PCR, 54 cases of influenza A and 50 cases of influenza B were detected. We found no significant effect of the intervention on the primary study outcome of all laboratory confirmed influenza cases (IRR 0.81 95% CI 0.54, 1.23). However, we did find statistically significant differences in protocol-specified ancillary outcomes. Children in intervention schools had significantly fewer laboratory-confirmed influenza A infections than children in control schools, with an adjusted IRR of 0.48 (95% CI 0.26, 0.87). Total absent episodes were also significantly lower among the intervention group than among the control group; adjusted IRR 0.74 (95% CI 0.56, 0.97).

Conclusions

Non-pharmaceutical interventions (respiratory hygiene education and the regular use of hand sanitizer) did not reduce total laboratory confirmed influenza. However the interventions did reduce school total absence episodes by 26% and laboratory-confirmed influenza A infections by 52%. Our results suggest that NPIs can be an important adjunct to influenza vaccination programs to reduce the number of influenza A infections among children.

Document Type:

Journal Article

Collection(s):

CDC Public Access

Funding:

UL1 TR000005/TR/NCATS NIH HHS/United States
U01 GM070708/GM/NIGMS NIH HHS/United States
1U01-GM070708/GM/NIGMS NIH HHS/United States
5UCI000435-02/PHS HHS/United States
U01 CI000435/CI/NCPDCID CDC HHS/United States

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