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.

TitleReduction 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.
Publication TypeJournal Article
Year of Publication2011
AuthorsStebbins S, Cummings DAT, Stark JH, Vukotich C, Mitruka K, Thompson W, Rinaldo C, Roth L, Wagner M, Wisniewski SR, Dato V, Eng H, Burke DS
JournalPediatr Infect Dis J
Date Published2011 Nov
KeywordsAbsenteeism, Adolescent, Case-Control Studies, Child, Child, Preschool, Cough, Female, Hand Disinfection, Humans, Hygiene, Incidence, Influenza A virus, Influenza B virus, Influenza, Human, Reverse Transcriptase Polymerase Chain Reaction, RNA, Viral, Schools, Students, United States

BACKGROUND: Laboratory-based evidence is lacking regarding the efficacy of nonpharmaceutical interventions (NPIs) 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 10 elementary schools in Pittsburgh, PA, during the 2007 to 2008 influenza season. Children in 5 intervention schools received training in hand and respiratory hygiene, and were provided and encouraged to use hand sanitizer regularly. Children in 5 schools acted as controls. Children with influenza-like illness were tested for influenza A and B by reverse-transcriptase polymerase chain reaction.RESULTS: A total of 3360 children participated in this study. Using reverse-transcriptase polymerase chain reaction, 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 (incidence rate ratio [IRR]: 0.81; 95% confidence interval [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: NPIs (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.

Alternate JournalPediatr. Infect. Dis. J.
PubMed ID21691245
PubMed Central IDPMC3470868
Grant List1U01-GM070708 / GM / NIGMS NIH HHS / United States
5UCI000435-02 / / PHS HHS / United States
U01 GM070708 / GM / NIGMS NIH HHS / United States
U54 GM088491 / GM / NIGMS NIH HHS / United States
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