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Abney K. “Containing” tuberculosis, perpetuating stigma: the materiality of N95 respirator masks. ANTHROPOLOGY SOUTHERN AFRICA 2018. [DOI: 10.1080/23323256.2018.1507675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kate Abney
- School for International Training, World Learning, Brattleboro, USA
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152
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Lynteris C. Plague Masks: The Visual Emergence of Anti-Epidemic Personal Protection Equipment. Med Anthropol 2018; 37:442-457. [DOI: 10.1080/01459740.2017.1423072] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Christos Lynteris
- Department of Social Anthropology, University of St Andrews, Fife, Scotland, United Kingdom
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153
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Preventive Effects of Vitamin D on Seasonal Influenza A in Infants: A Multicenter, Randomized, Open, Controlled Clinical Trial. Pediatr Infect Dis J 2018; 37:749-754. [PMID: 29315160 DOI: 10.1097/inf.0000000000001890] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to evaluate the clinical efficacy and safety of vitamin D for preventing influenza A in 400 infants in a multicenter, randomized, open, controlled clinical trial. METHODS The infants were randomized into low-dose and high-dose vitamin D groups, and serum calcium, inorganic phosphorus and 25-hydroxyvitamin D levels were detected thrice in 4 months. Infants infected with influenza A were monitored for symptoms including fever, cough and wheezing. Pathogen levels and safety of vitamin D treatment were also evaluated. RESULTS Of 121 cases in total, 78 and 43 cases of influenza A infection occurred in the low-dose and high-dose vitamin D groups, respectively. There was a significant difference between the groups (χ = 14.6324, P = 0.0001). Among the cases of influenza infection, the median durations for fever, cough and wheezing were shorter in the high-dose vitamin D group than in the low-dose vitamin D group. The viral loads showed a downward trend in both groups and were significantly different between the groups at the second and third detections. Additionally, the incidences of adverse events and severe adverse events were very low and not significantly different between the 2 groups. CONCLUSION High-dose vitamin D (1200 IU) is suitable for the prevention of seasonal influenza as evidenced by rapid relief from symptoms, rapid decrease in viral loads and disease recovery. In addition, high-dose vitamin D is probably safe for infants.
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Mukerji S, MacIntyre CR, Seale H, Wang Q, Yang P, Wang X, Newall AT. Cost-effectiveness analysis of N95 respirators and medical masks to protect healthcare workers in China from respiratory infections. BMC Infect Dis 2017; 17:464. [PMID: 28673259 PMCID: PMC5496227 DOI: 10.1186/s12879-017-2564-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 06/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are substantial differences between the costs of medical masks and N95 respirators. Cost-effectiveness analysis is required to assist decision-makers evaluating alternative healthcare worker (HCW) mask/respirator strategies. This study aims to compare the cost-effectiveness of N95 respirators and medical masks for protecting HCWs in Beijing, China. METHODS We developed a cost-effectiveness analysis model utilising efficacy and resource use data from two cluster randomised clinical trials assessing various mask/respirator strategies conducted in HCWs in Level 2 and 3 Beijing hospitals for the 2008-09 and 2009-10 influenza seasons. The main outcome measure was the incremental cost-effectiveness ratio (ICER) per clinical respiratory illness (CRI) case prevented. We used a societal perspective which included intervention costs, the healthcare costs of CRI in HCWs and absenteeism costs. RESULTS The incremental cost to prevent a CRI case with continuous use of N95 respirators when compared to medical masks ranged from US $490-$1230 (approx. 3000-7600 RMB). One-way sensitivity analysis indicated that the CRI attack rate and intervention effectiveness had the greatest impact on cost-effectiveness. CONCLUSIONS The determination of cost-effectiveness for mask/respirator strategies will depend on the willingness to pay to prevent a CRI case in a HCW, which will vary between countries. In the case of a highly pathogenic pandemic, respirator use in HCWs would likely be a cost-effective intervention.
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Affiliation(s)
- Shohini Mukerji
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
| | - C. Raina MacIntyre
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), University of Sydney, Westmead, NSW Australia
| | - Holly Seale
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
| | - Quanyi Wang
- The Beijing Centre for Disease Control and Prevention, Beijing, China
| | - Peng Yang
- The Beijing Centre for Disease Control and Prevention, Beijing, China
| | - Xiaoli Wang
- The Beijing Centre for Disease Control and Prevention, Beijing, China
| | - Anthony T. Newall
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
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155
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Cori A, Donnelly CA, Dorigatti I, Ferguson NM, Fraser C, Garske T, Jombart T, Nedjati-Gilani G, Nouvellet P, Riley S, Van Kerkhove MD, Mills HL, Blake IM. Key data for outbreak evaluation: building on the Ebola experience. Philos Trans R Soc Lond B Biol Sci 2017; 372:20160371. [PMID: 28396480 PMCID: PMC5394647 DOI: 10.1098/rstb.2016.0371] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 01/15/2023] Open
Abstract
Following the detection of an infectious disease outbreak, rapid epidemiological assessment is critical for guiding an effective public health response. To understand the transmission dynamics and potential impact of an outbreak, several types of data are necessary. Here we build on experience gained in the West African Ebola epidemic and prior emerging infectious disease outbreaks to set out a checklist of data needed to: (1) quantify severity and transmissibility; (2) characterize heterogeneities in transmission and their determinants; and (3) assess the effectiveness of different interventions. We differentiate data needs into individual-level data (e.g. a detailed list of reported cases), exposure data (e.g. identifying where/how cases may have been infected) and population-level data (e.g. size/demographics of the population(s) affected and when/where interventions were implemented). A remarkable amount of individual-level and exposure data was collected during the West African Ebola epidemic, which allowed the assessment of (1) and (2). However, gaps in population-level data (particularly around which interventions were applied when and where) posed challenges to the assessment of (3). Here we highlight recurrent data issues, give practical suggestions for addressing these issues and discuss priorities for improvements in data collection in future outbreaks.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.
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Affiliation(s)
- Anne Cori
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Christl A Donnelly
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Ilaria Dorigatti
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Neil M Ferguson
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Christophe Fraser
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Tini Garske
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Thibaut Jombart
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Gemma Nedjati-Gilani
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Pierre Nouvellet
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Steven Riley
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Maria D Van Kerkhove
- Centre for Global Health, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Harriet L Mills
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
- School of Veterinary Sciences, University of Bristol, Bristol BS40 5DU, UK
| | - Isobel M Blake
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
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156
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Takahashi S, Sato K, Kusaka Y, Hagihara A. Public preventive awareness and preventive behaviors during a major influenza epidemic in Fukui, Japan. J Infect Public Health 2017; 10:637-643. [PMID: 28529138 DOI: 10.1016/j.jiph.2017.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 04/12/2017] [Accepted: 04/28/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND As an influenza epidemic poses a serious public health threat, it is important for the public to adopt behaviors that effectively prevent influenza infection. METHODS In the winter of 2009, by using a structured questionnaire, we conducted an Internet survey with respect to residents (n=2788) in Fukui prefecture, Japan. The main aim is to obtain information about effective prevention, factors related to preventive awareness and behaviors during the influenza epidemic. A factor analysis and linear regression models were used in the analysis. RESULTS Three types of preventive awareness were identified by factor analysis: "avoidance of influenza infection," "awareness of the benefits of mask use," and "awareness of the need for a rapid diagnosis." Gender, age, residence, being medical person and being vaccinated were related to these preventive awareness and behaviors. Avoidance of influenza Infection was related to all preventive behavior, awareness of the benefits of mask use was related to hand disinfectant use, and awareness of the need for a rapid diagnosis was related to avoidance of face touch, gargling and attention to health care, respectively. CONCLUSION Three types of preventive awareness during the influenza epidemic were emerged, and were related to preventive behaviors against influenza infection.
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Affiliation(s)
- Shintoku Takahashi
- Division of Environmental Health, Department of International and Social Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan.
| | - Kazuhiro Sato
- Division of Environmental Health, Department of International and Social Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Yukinori Kusaka
- Division of Environmental Health, Department of International and Social Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Akihito Hagihara
- Department of Health Communication, Graduate School of Medicine, Kyushu University, Fukuoka 812-8582, Japan
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157
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Saunders-Hastings P, Crispo JAG, Sikora L, Krewski D. Effectiveness of personal protective measures in reducing pandemic influenza transmission: A systematic review and meta-analysis. Epidemics 2017; 20:1-20. [PMID: 28487207 DOI: 10.1016/j.epidem.2017.04.003] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/20/2017] [Accepted: 04/24/2017] [Indexed: 01/11/2023] Open
Abstract
The goal of this review was to examine the effectiveness of personal protective measures in preventing pandemic influenza transmission in human populations. We collected primary studies from Medline, Embase, PubMed, Cochrane Library, CINAHL and grey literature. Where appropriate, random effects meta-analyses were conducted using inverse variance statistical calculations. Meta-analyses suggest that regular hand hygiene provided a significant protective effect (OR=0.62; 95% CI 0.52-0.73; I2=0%), and facemask use provided a non-significant protective effect (OR=0.53; 95% CI 0.16-1.71; I2=48%) against 2009 pandemic influenza infection. These interventions may therefore be effective at limiting transmission during future pandemics. PROSPERO Registration: 42016039896.
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Affiliation(s)
- Patrick Saunders-Hastings
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, 850 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - James A G Crispo
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, 850 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada; University of Pennsylvania, Department of Neurology, Philadelphia, PA, United States
| | - Lindsey Sikora
- University of Ottawa, Health Sciences Library,451 Smyth Road, Ottawa, ON, Canada
| | - Daniel Krewski
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, 850 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
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158
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Reyes CG, Frey MW. Morphological traits essential to electrospun and grafted Nylon-6 nanofiber membranes for capturing submicron simulated exhaled breath aerosols. J Appl Polym Sci 2017. [DOI: 10.1002/app.44759] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Catherine G. Reyes
- Physics and Materials Science Research Unit; Université du Luxembourg; Limpertsberg L-1511 Luxembourg
| | - Margaret W. Frey
- Department of Fiber Science and Apparel Design; Cornell University; Ithaca New York 14853
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159
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Keane C. Chaos in collective health: Fractal dynamics of social learning. J Theor Biol 2016; 409:47-59. [DOI: 10.1016/j.jtbi.2016.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 08/19/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
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Ratnamohan VM, Zeng F, Donovan L, MacIntyre CR, Kok J, Dwyer DE. Phylogenetic analysis of human rhinoviruses collected over four successive years in Sydney, Australia. Influenza Other Respir Viruses 2016; 10:493-503. [PMID: 27383422 PMCID: PMC5059946 DOI: 10.1111/irv.12404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 01/09/2023] Open
Abstract
Background Human rhinoviruses (HRV) cause a wide spectrum of disease, ranging from a mild influenza‐like illness (ILI) to severe respiratory infection. Molecular epidemiological data are limited for HRV circulating in the Southern Hemisphere. Objectives To identify the species and genotypes of HRV from clinical samples collected in Sydney, Australia, from 2006 to 2009. Methods Combined nose and throat swabs or nasopharyngeal aspirates collected from individuals with ILI were tested for HRV using real‐time reverse‐transcriptase polymerase chain reaction (RT‐PCR). Sequencing data of 5′UTR and VP4/VP2 coding regions on RT‐PCR‐positive specimens were analysed. Results Human rhinoviruses were detected by real‐time PCR in 20.9% (116/555) of samples tested. Phylogenetic analysis of 5′UTR and VP4/VP2 on HRV‐positive samples was concordant in the grouping of HRV A and B species but not HRV C species. Eighty per cent (16/20) of sequences that grouped as HRV C in the VP4/VP2 tree clustered as HRV A, alongside some previously described C strains as subspecies C/A. Discordant branching was seen within HRV A group: two sequences clustering as A in the VP4/VP2 tree branched within the C/A subspecies in the 5′UTR tree, and one sequence showed identity to different HRV A strains in the two genes. The prevalence of HRV C and C/A species was greater in paediatric compared to adult patients (47.9% vs 25.5%, P = .032). Conclusion Human rhinoviruses are a common cause of respiratory infections, and HRV C is present in the Southern Hemisphere. Sequencing of multiple HRV regions may be necessary to determine exact phylogenetic relationships.
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Affiliation(s)
- Vigneswary M Ratnamohan
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Pathology West, Westmead Hospital, Westmead, NSW, Australia
| | - Frank Zeng
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Pathology West, Westmead Hospital, Westmead, NSW, Australia
| | - Linda Donovan
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Pathology West, Westmead Hospital, Westmead, NSW, Australia
| | - Chandini R MacIntyre
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Pathology West, Westmead Hospital, Westmead, NSW, Australia. .,Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Hospital, University of Sydney, Westmead, NSW, Australia. .,Centre for Research Excellence in Critical Infections, Westmead Hospital, University of Sydney, Westmead, NSW, Australia.
| | - Dominic E Dwyer
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Pathology West, Westmead Hospital, Westmead, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Hospital, University of Sydney, Westmead, NSW, Australia.,Centre for Research Excellence in Critical Infections, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
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161
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Macdonald H, Abney K, Abrams A, Truyts C. Challenges in Exploratory Methods for Tuberculosis Research in South Africa. QUALITATIVE HEALTH RESEARCH 2016; 26:1123-1136. [PMID: 26443797 DOI: 10.1177/1049732315606065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Haunted by a legacy of apartheid governance that left millions in material poverty, South Africa has among the highest tuberculosis (TB) morbidity and mortality rates in the world. Our Social Markers of TB research project shared a vision of working with ethnographic research methods to understand TB-infected persons, their families, care providers, and social networks. We argue that felt and enacted TB stigma and the related HIV-TB stigma impaired our ability to collect the necessary data for a full portrait of TB-infected persons and their lived conditions. To circumvent this limitation, each researcher improvised and augmented conventional anthropological methods with more creative, directed, and at times destabilizing methods. We present three case studies as useful illustrations of the complexities and challenges we encountered in our attempts to conduct ethically sound TB research. We discuss the implications of our call for "improvisation" for the politics of research and ethical oversight.
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Affiliation(s)
| | - Kate Abney
- University of Cape Town, Cape Town, South Africa
| | - Amber Abrams
- South African Medical Research Council, Cape Town, South Africa University of Kent, Canterbury, United Kingdom
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Lam SC, Lui AK, Lee LY, Lee JK, Wong K, Lee CN. Evaluation of the user seal check on gross leakage detection of 3 different designs of N95 filtering facepiece respirators. Am J Infect Control 2016; 44:579-86. [PMID: 26831273 PMCID: PMC7115279 DOI: 10.1016/j.ajic.2015.12.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/02/2015] [Accepted: 12/07/2015] [Indexed: 11/08/2022]
Abstract
Background The use of N95 respirators prevents spread of respiratory infectious agents, but leakage hampers its protection. Manufacturers recommend a user seal check to identify on-site gross leakage. However, no empirical evidence is provided. Therefore, this study aims to examine validity of a user seal check on gross leakage detection in commonly used types of N95 respirators. Methods A convenience sample of 638 nursing students was recruited. On the wearing of 3 different designs of N95 respirators, namely 3M-1860s, 3M-1862, and Kimberly-Clark 46827, the standardized user seal check procedure was carried out to identify gross leakage. Repeated testing of leakage was followed by the use of a quantitative fit testing (QNFT) device in performing normal breathing and deep breathing exercises. Sensitivity, specificity, predictive values, and likelihood ratios were calculated accordingly. Results As indicated by QNFT, prevalence of actual gross leakage was 31.0%-39.2% with the 3M respirators and 65.4%-65.8% with the Kimberly-Clark respirator. Sensitivity and specificity of the user seal check for identifying actual gross leakage were approximately 27.7% and 75.5% for 3M-1860s, 22.1% and 80.5% for 3M-1862, and 26.9% and 80.2% for Kimberly-Clark 46827, respectively. Likelihood ratios were close to 1 (range, 0.89-1.51) for all types of respirators. Conclusions The results did not support user seal checks in detecting any actual gross leakage in the donning of N95 respirators. However, such a check might alert health care workers that donning a tight-fitting respirator should be performed carefully.
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163
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Barasheed O, Alfelali M, Mushta S, Bokhary H, Alshehri J, Attar AA, Booy R, Rashid H. Uptake and effectiveness of facemask against respiratory infections at mass gatherings: a systematic review. Int J Infect Dis 2016; 47:105-11. [PMID: 27044522 PMCID: PMC7110449 DOI: 10.1016/j.ijid.2016.03.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/18/2016] [Accepted: 03/24/2016] [Indexed: 11/25/2022] Open
Abstract
Approximately half of the attendees of mass gatherings use facemask Facemask seems to be effective against respiratory infections at Hajj Effectiveness of facemask against specific respiratory infections is not proven
Objectives The risk of acquisition and transmission of respiratory infections is high among attendees of mass gatherings (MGs). Currently used interventions have limitations yet the role of facemask in preventing those infections at MG has not been systematically reviewed. We have conducted a systematic review to synthesise evidence about the uptake and effectiveness of facemask against respiratory infections in MGs. Methods A comprehensive literature search was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using major electronic databases such as, Medline, EMBASE, SCOPUS and CINAHL. Results Of 25 studies included, the pooled sample size was 12710 participants from 55 countries aged 11 to 89 years, 37% were female. The overall uptake of facemask ranged from 0.02% to 92.8% with an average of about 50%. Only 13 studies examined the effectiveness of facemask, and their pooled estimate revealed significant protectiveness against respiratory infections (relative risk [RR] = 0.89, 95% CI: 0.84-0.94, p < 0.01), but the study end points varied widely. Conclusion A modest proportion of attendees of MGs use facemask, the practice is more widespread among health care workers. Facemask use seems to be beneficial against certain respiratory infections at MGs but its effectiveness against specific infection remains unproven.
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Affiliation(s)
- Osamah Barasheed
- Research Center, King Abdullah Medical City (KAMC), Makkah, P.O. Box: 57657, Saudi Arabia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia.
| | - Mohammad Alfelali
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
| | | | - Hamid Bokhary
- Umm Al-Qura University Medical Center, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Jassir Alshehri
- Research Center, King Abdullah Medical City (KAMC), Makkah, P.O. Box: 57657, Saudi Arabia
| | - Ammar A Attar
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; Science and technology Unit, General Presidency for the Holy Mosque & Prophet Holy Mosque affairs, Makkah, Saudi Arabia; Department of Innovation & Corporate Integration, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Australia
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164
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Keane CR. Resilience, tipping, and hydra effects in public health: emergent collective behavior in two agent-based models. BMC Public Health 2016; 16:265. [PMID: 26975419 PMCID: PMC4791925 DOI: 10.1186/s12889-016-2938-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/08/2016] [Indexed: 01/30/2023] Open
Abstract
Background Collective health behavior often demonstrates counter-intuitive dynamics, sometimes resisting interventions designed to produce change, or even producing effects that are in the opposite direction than intended by the intervention, e.g. lowering infectivity resulting in increased infections. At other times collective health behavior exhibits sudden large-scale change in response to small interventions or change in the environment, a phenomenon often called “tipping.” I hypothesize that these seemingly very different phenomena can all be explained by the same dynamic, a type of collective resilience. Methods I compared two simple agent-based models of interactions in networks: a public health behavior game, in which individuals decide whether or not to adopt protective behavior, and a microbial-level game, in which three different strains of bacteria attack each other. I examined the type of networks and other conditions that support a dynamic balance, and determined what changes of conditions will tip the balance. Results Both models show lasting dynamic equilibrium and resilience, resulting from negative feedback that supports oscillating coexistence of diversity under a range of conditions. In the public health game, health protection is followed by free-riding defectors, followed by a rise in infection, in long-lasting cycles. In the microbial game, each of three strains takes turns dominating. In both games, the dynamic balance is tipped by lowering the level of local clustering, changing the level of benefit, or lowering infectivity or attack rate. Lowering infectivity has the surprising effect of increasing the numbers of infected individuals. We see parallel results in the microbial game of three bacterial strains, where lowering one strain’s attack rate (analogous to lowering infectivity) increases the numbers of the restrained attacker, a phenomenon captured by the phrase, “the enemy of my enemy is my friend.” Conclusions Collective behavior often shows a dynamic balance, resulting from negative feedback, supporting diversity and resisting change. Above certain threshold conditions, the dynamic balance is tipped towards uniformity of behavior. Under a certain range of conditions we see “hydra effects” in which interventions to lower attack rate or infectivity are self-defeating. Simple models of collective behavior can explain these seemingly disparate dynamics. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2938-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher Robert Keane
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA.
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165
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Protecting the frontline: designing an infection prevention platform for preventing emerging respiratory viral illnesses in healthcare personnel. Infect Control Hosp Epidemiol 2015; 36:336-45. [PMID: 25695176 DOI: 10.1017/ice.2014.52] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Healthcare personnel often find themselves on the frontlines of any epidemic, and may be at particularly high risk of acquiring respiratory viral illnesses when compared to the general population. Many aspects dictate how respiratory viruses spread both inside the hospital and out: Elements to consider include the specific type of virus being targeted for prevention, as well as environmental conditions and host factors, such as age and immune status. Due to the diverse nature of these agents, multiple modes of transmission, including contact, droplet, aerosol, and transocular, must be considered when designing an effective infection prevention program. In this review, we examine the data behind current theories of respiratory virus transmission and key elements of any respiratory illness prevention program. We also highlight other influences that may come into play, such as the cost-effectiveness of choosing one respiratory protection strategy over another.
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166
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Tsang TK, Lau LLH, Cauchemez S, Cowling BJ. Household Transmission of Influenza Virus. Trends Microbiol 2015; 24:123-133. [PMID: 26612500 PMCID: PMC4733423 DOI: 10.1016/j.tim.2015.10.012] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/05/2015] [Accepted: 10/28/2015] [Indexed: 12/13/2022]
Abstract
Human influenza viruses cause regular epidemics and occasional pandemics with a substantial public health burden. Household transmission studies have provided valuable information on the dynamics of influenza transmission. We reviewed published studies and found that once one household member is infected with influenza, the risk of infection in a household contact can be up to 38%, and the delay between onset in index and secondary cases is around 3 days. Younger age was associated with higher susceptibility. In the future, household transmission studies will provide information on transmission dynamics, including the correlation of virus shedding and symptoms with transmission, and the correlation of new measures of immunity with protection against infection. Historically, household cohort studies have provided valuable information on the incidence of respiratory infections and risk factors for infection. However, these studies require substantial resources and can provide limited information on transmission dynamics. Household transmission studies provide an efficient approach to describing the risk of influenza transmission and factors affecting transmission. In these studies, households with at least one member infected by influenza are eligible and are followed intensively for 1–2 weeks to observe secondary transmission within the household. Transmission studies also provide a model for evaluation of interventions in randomized controlled trials, and have been used to determine the efficacy of antiviral drugs for treatment and prophylaxis, and nonpharmaceutical interventions such as face masks and hand hygiene.
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Affiliation(s)
- Tim K Tsang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Lincoln L H Lau
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China.
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167
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Mukerji S, MacIntyre CR, Newall AT. Review of economic evaluations of mask and respirator use for protection against respiratory infection transmission. BMC Infect Dis 2015; 15:413. [PMID: 26462473 PMCID: PMC4605092 DOI: 10.1186/s12879-015-1167-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 09/30/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There has been increasing debate surrounding mask and respirator interventions to control respiratory infection transmission in both healthcare and community settings. As decision makers are considering the recommendations they should evaluate how to provide the most efficient protection strategies with minimum costs. The aim of this review is to identify and evaluate the existing economic evaluation literature in this area and to offer advice on how future evaluations on this topic should be conducted. METHODS We searched the Scopus database for all literature on economic evaluation of mask or respirator use to control respiratory infection transmission. Reference lists from the identified studies were also manually searched. Seven studies met our inclusion criteria from the initial 806 studies identified by the search strategy and our manual search. RESULTS Five studies considered interventions for seasonal and/or pandemic influenza, with one also considering SARS (Severe Acute Respiratory Syndrome). The other two studies focussed on tuberculosis transmission control interventions. The settings and methodologies of the studies varied greatly. No low-middle income settings were identified. Only one of the reviewed studies cited clinical evidence to inform their mask/respirator intervention effectiveness parameters. Mask and respirator interventions were generally reported by the study authors to be cost saving or cost-effective when compared to no intervention or other control measures, however the evaluations had important limitations. CONCLUSIONS Given the large cost differential between masks and respirators, there is a need for more comprehensive economic evaluations to compare the relative costs and benefits of these interventions in situations and settings where alternative options are potentially applicable. There are at present insufficient well conducted cost-effectiveness studies to inform decision-makers on the value for money of alternative mask/respirator options.
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Affiliation(s)
- Shohini Mukerji
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Anthony T Newall
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
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Abstract
Household-based interventions are the mainstay of public health policy against epidemic respiratory pathogens when vaccination is not available. Although the efficacy of these interventions has traditionally been measured by their ability to reduce the proportion of household contacts who exhibit symptoms [household secondary attack rate (hSAR)], this metric is difficult to interpret and makes only partial use of data collected by modern field studies. Here, we use Bayesian transmission model inference to analyze jointly both symptom reporting and viral shedding data from a three-armed study of influenza interventions. The reduction in hazard of infection in the increased hand hygiene intervention arm was 37.0% [8.3%, 57.8%], whereas the equivalent reduction in the other intervention arm was 27.2% [-0.46%, 52.3%] (increased hand hygiene and face masks). By imputing the presence and timing of unobserved infection, we estimated that only 61.7% [43.1%, 76.9%] of infections met the case criteria and were thus detected by the study design. An assessment of interventions using inferred infections produced more intuitively consistent attack rates when households were stratified by the speed of intervention, compared with the crude hSAR. Compared with adults, children were 2.29 [1.66, 3.23] times as infectious and 3.36 [2.31, 4.82] times as susceptible. The mean generation time was 3.39 d [3.06, 3.70]. Laboratory confirmation of infections by RT-PCR was only able to detect 79.6% [76.5%, 83.0%] of symptomatic infections, even at the peak of shedding. Our results highlight the potential use of robust inference with well-designed mechanistic transmission models to improve the design of intervention studies.
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MacIntyre CR, Seale H, Dung TC, Hien NT, Nga PT, Chughtai AA, Rahman B, Dwyer DE, Wang Q. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open 2015; 5:e006577. [PMID: 25903751 PMCID: PMC4420971 DOI: 10.1136/bmjopen-2014-006577] [Citation(s) in RCA: 254] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs). The null hypothesis is that there is no difference between medical masks and cloth masks. SETTING 14 secondary-level/tertiary-level hospitals in Hanoi, Vietnam. PARTICIPANTS 1607 hospital HCWs aged ≥18 years working full-time in selected high-risk wards. INTERVENTION Hospital wards were randomised to: medical masks, cloth masks or a control group (usual practice, which included mask wearing). Participants used the mask on every shift for 4 consecutive weeks. MAIN OUTCOME MEASURE Clinical respiratory illness (CRI), influenza-like illness (ILI) and laboratory-confirmed respiratory virus infection. RESULTS The rates of all infection outcomes were highest in the cloth mask arm, with the rate of ILI statistically significantly higher in the cloth mask arm (relative risk (RR)=13.00, 95% CI 1.69 to 100.07) compared with the medical mask arm. Cloth masks also had significantly higher rates of ILI compared with the control arm. An analysis by mask use showed ILI (RR=6.64, 95% CI 1.45 to 28.65) and laboratory-confirmed virus (RR=1.72, 95% CI 1.01 to 2.94) were significantly higher in the cloth masks group compared with the medical masks group. Penetration of cloth masks by particles was almost 97% and medical masks 44%. CONCLUSIONS This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry: ACTRN12610000887077.
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Affiliation(s)
- C Raina MacIntyre
- Faculty of Medicine, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Holly Seale
- Faculty of Medicine, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Tham Chi Dung
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Phan Thi Nga
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Abrar Ahmad Chughtai
- Faculty of Medicine, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Bayzidur Rahman
- Faculty of Medicine, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Dominic E Dwyer
- Institute for Clinical Pathology and Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Quanyi Wang
- Beijing Centers for Disease Control and Prevention, Beijing, China
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170
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Sim SW, Moey KSP, Tan NC. The use of facemasks to prevent respiratory infection: a literature review in the context of the Health Belief Model. Singapore Med J 2015; 55:160-7. [PMID: 24664384 DOI: 10.11622/smedj.2014037] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Acute respiratory infections are prevalent and pose a constant threat to society. While the use of facemasks has proven to be an effective barrier to curb the aerosol spread of such diseases, its use in the local community is uncommon, resulting in doubts being cast on its effectiveness in preventing airborne infections during epidemics. We thus aimed to conduct a literature review to determine the factors that influence the use of facemasks as a primary preventive health measure in the community. METHODS A search for publications relating to facemask usage was performed on Medline, PubMed, Google, World Health Organization and Singapore government agencies' websites, using search terms such as 'facemask', 'mask', 'influenza', 'respiratory infection', 'personal protective equipment', 'disease prevention', 'compliance' and 'adherence'. Findings were framed under five components of the Health Belief Model: perceived susceptibility, perceived benefits, perceived severity, perceived barriers and cues to action. RESULTS We found that individuals are more likely to wear facemasks due to the perceived susceptibility and perceived severity of being afflicted with life-threatening diseases. Although perceived susceptibility appeared to be the most significant factor determining compliance, perceived benefits of mask-wearing was found to have significant effects on mask-wearing compliance as well. Perceived barriers include experience or perception of personal discomfort and sense of embarrassment. Media blitz and public health promotion activities supported by government agencies provide cues to increase the public's usage of facemasks. CONCLUSION Complex interventions that use multipronged approaches targeting the five components of the Health Belief Model, especially perceived susceptibility, are needed to increase the use of facemasks in the community. Further studies are required to evaluate the effectiveness of implemented interventions.
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Affiliation(s)
- Shin Wei Sim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119228.
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171
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Matthews Pillemer F, Blendon RJ, Zaslavsky AM, Lee BY. Predicting support for non-pharmaceutical interventions during infectious outbreaks: a four region analysis. DISASTERS 2015; 39:125-45. [PMID: 25243477 PMCID: PMC4355939 DOI: 10.1111/disa.12089] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Non-pharmaceutical interventions (NPIs) are an important public health tool for responding to infectious disease outbreaks, including pandemics. However, little is known about the individual characteristics associated with support for NPIs, or whether they are consistent across regions. This study draws on survey data from four regions--Hong Kong, Singapore, Taiwan, and the United States--collected following the Severe Acute Respiratory Syndrome (SARS) outbreak of 2002-03, and employs regression techniques to estimate predictors of NPI support. It finds that characteristics associated with NPI support vary widely by region, possibly because of cultural variation and prior experience, and that minority groups tend to be less supportive of NPIs when arrest is the consequence of noncompliance. Prior experience of face-mask usage also results in increased support for future usage, as well as other NPIs. Policymakers should be attentive to local preferences and to the application of compulsory interventions. It is speculated here that some public health interventions may serve as 'gateway' exposures to future public health interventions.
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172
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Wang M, Barasheed O, Rashid H, Booy R, El Bashir H, Haworth E, Ridda I, Holmes EC, Dwyer DE, Nguyen-Van-Tam J, Memish ZA, Heron L. A cluster-randomised controlled trial to test the efficacy of facemasks in preventing respiratory viral infection among Hajj pilgrims. J Epidemiol Glob Health 2014; 5:181-9. [PMID: 25922328 PMCID: PMC7103985 DOI: 10.1016/j.jegh.2014.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/30/2014] [Accepted: 08/02/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cost-effective interventions are needed to control the transmission of viral respiratory tract infections (RTIs) in mass gatherings. Facemasks are a promising preventive measure, however, previous studies on the efficacy of facemasks have been inconclusive. This study proposes a large-scale facemask trial during the Hajj pilgrimage in Saudi Arabia and presents this protocol to illustrate its feasibility and to promote both collaboration with other research groups and additional relevant studies. METHODS/DESIGN A cluster-randomised controlled trial is being conducted to test the efficacy of standard facemasks in preventing symptomatic and proven viral RTIs among pilgrims during the Hajj season in Mina, Mecca, Saudi Arabia. The trial will compare the 'supervised use of facemasks' versus 'standard measures' among pilgrims over several Hajj seasons. Cluster-randomisation will be done by accommodation tents with a 1:1 ratio. For the intervention tents, free facemasks will be provided to be worn consistently for 7days. Data on flu-like symptoms and mask use will be recorded in diaries. Nasal samples will be collected from symptomatic recruits and tested for nucleic acid of respiratory viruses. Data obtained from questionnaires, diaries and laboratory tests will be analysed to examine whether mask use significantly reduces the frequency of laboratory-confirmed respiratory viral infection and syndromic RTI as primary outcomes. CONCLUSIONS This trial will provide valuable evidence on the efficacy of standard facemask use in preventing viral respiratory tract infections at mass gatherings. This study is registered at the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN: ACTRN12613001018707 (http://www.anzctr.org.au).
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Affiliation(s)
- Mandy Wang
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia
| | - Osamah Barasheed
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia.
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia
| | | | | | - Iman Ridda
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia
| | - Edward C Holmes
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia
| | - Dominic E Dwyer
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia; Centre for Infectious Diseases and Microbiology Laboratory Services (CIDMLS), Westmead Hospital, NSW, Australia
| | - Jonathan Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham (World Health Organization Collaborating Centre for Pandemic Influenza and Research), UK
| | - Ziad A Memish
- Ministry of Health and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Leon Heron
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia
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173
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Testing the efficacy of homemade masks: would they protect in an influenza pandemic? Disaster Med Public Health Prep 2014; 7:413-8. [PMID: 24229526 PMCID: PMC7108646 DOI: 10.1017/dmp.2013.43] [Citation(s) in RCA: 303] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study examined homemade masks as an alternative to commercial face masks. METHODS Several household materials were evaluated for the capacity to block bacterial and viral aerosols. Twenty-one healthy volunteers made their own face masks from cotton t-shirts; the masks were then tested for fit. The number of microorganisms isolated from coughs of healthy volunteers wearing their homemade mask, a surgical mask, or no mask was compared using several air-sampling techniques. RESULTS The median-fit factor of the homemade masks was one-half that of the surgical masks. Both masks significantly reduced the number of microorganisms expelled by volunteers, although the surgical mask was 3 times more effective in blocking transmission than the homemade mask. CONCLUSION Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection.
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174
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Lam W, Dawson A, Fowler C. Health promotion interventions to prevent early childhood human influenza at the household level: a realist review to identify implications for programmes in Hong Kong. J Clin Nurs 2014; 24:891-905. [PMID: 24964081 DOI: 10.1111/jocn.12646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To identify factors affecting the delivery of health promotion interventions to prevent early childhood human influenza at the household level. BACKGROUND Yearly, influenza epidemics seriously affect all age groups, particularly those with weakened immune systems, including children. Influenza is transmitted easily from person to person through droplet and direct contact. Maintaining personal hygiene, avoiding close contact with the infected person and proper hand washing are recommended as the most effective means of preventing the transmission of influenza. However, it is not clear what programme-related mechanisms and contexts are crucial to the successful delivery of interventions in the home. This study systematically reviewed published research studies to identify factors influencing the effective delivery of health promotion programmes targeting influenza in a household. DESIGN Realist review. METHODS A realist review methodology was selected to examine what interventions are effective in preventing and managing influenza at the household level and in what circumstances. A structured search of the peer-reviewed primary research literature was undertaken using a defined search protocol. RESULTS Eight studies were retrieved for the analysis. Mechanisms impacting on intervention delivery were identified, including timing of implementation, programme reach, organisational and healthcare worker involvement, mode and place of delivery, contact with infected person, health practice compliance and sustainability at home. CONCLUSION These findings suggest contextual factors that could be identified through ecological approaches to health promotion that are crucial for policymakers to consider when designing interventions. RELEVANCE TO CLINICAL PRACTICE The active involvement of community nurses through an integrated household visiting programme may help to better deliver family-based health promotion interventions to prevent illnesses such as influenza in children.
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Affiliation(s)
- Winsome Lam
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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175
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Vosseler A, Wilson GA, Wilson N. Uptake of influenza vaccination and risk reduction behaviour for respiratory infections: a survey of optometrists in New Zealand. Clin Exp Optom 2014; 97:418-21. [PMID: 24909825 DOI: 10.1111/cxo.12149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 02/11/2014] [Accepted: 02/17/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim was to determine the uptake of seasonal influenza vaccination and risk reduction behaviours among a health professional group with close patient contact, namely, optometrists. This group can have close facial proximity to patients during eye examinations. METHODS National telephone survey of optometrists in New Zealand. RESULTS Seventy per cent of registered optometrists participated (n = 450 responses). Less than one-third (29.7 per cent, 95% CI: 27.4 to 32.0) of optometrists reported having had the seasonal influenza vaccination in 2012. The major reason given for not being vaccinated was that the vaccination was considered unnecessary (47 per cent) followed by 'time constraints' (28 per cent). During their last respiratory illness, 82 per cent reported working with symptoms and only 16 per cent reported the use of a face mask. CONCLUSION There is major scope for increasing uptake of influenza vaccination and other protective behaviour for such health professional groups, especially those characterised by relatively close patient contact. Possible options include educational campaigns and government-funded vaccinators visiting the workplaces of all health-care workers.
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Affiliation(s)
- Albert Vosseler
- Department of Ophthalmology, Capital and Coast DHB, Wellington, New Zealand.
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176
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MacIntyre CR, Wang Q, Rahman B, Seale H, Ridda I, Gao Z, Yang P, Shi W, Pang X, Zhang Y, Moa A, Dwyer DE. Efficacy of face masks and respirators in preventing upper respiratory tract bacterial colonization and co-infection in hospital healthcare workers. Prev Med 2014; 62:1-7. [PMID: 24472436 PMCID: PMC7172205 DOI: 10.1016/j.ypmed.2014.01.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 12/13/2013] [Accepted: 01/15/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We compared the efficacy of medical masks (MM) and N95 respirators (N95) in preventing bacterial colonization/infection in healthcare workers (HCWs). METHODS A cluster randomized clinical trial (RCT) of 1441 hospital HCWs randomized to medical masks or N95 respirators, and compared to 481 control HCWs, was performed in Beijing, China, during the winter season of 2008-2009. Participants were followed for development of clinical respiratory illness (CRI). Symptomatic subjects were tested for Streptococcus pneumoniae, Bordetella pertussis, Chlamydia pneumoniae, Mycoplasma pneumoniae or Haemophilus influenza type B by multiplex polymerase chain reaction (PCR). RESULTS The rate of bacterial colonization was 2.8% in the N95 group (p=0.02), 5.3% among medical mask users (p<0.01) and 7.5% among the controls (p=0.16). N95 respirators were significantly protective (adjusted RR 0.34, 95% CI: 0.21-0.56) against bacterial colonization. Co-infections of two bacteria or a virus and bacteria occurred in up to 3.7% of HCWs, and were significantly lower in the N95 arm. CONCLUSIONS N95 respirators were significantly protective against bacterial colonization, co-colonization and viral-bacterial co-infection. We showed that dual respiratory virus or bacterial-viral co-infections can be reduced by the use of N95 respirators. This study has occupational health and safety implications for health workers.
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Affiliation(s)
- C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Australia; National Centre for Immunization Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia
| | - Quanyi Wang
- The Beijing Center for Disease Prevention and Control, Beijing, China
| | - Bayzidur Rahman
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Australia
| | - Iman Ridda
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Australia; National Centre for Immunization Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia
| | - Zhanhai Gao
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Australia
| | - Peng Yang
- The Beijing Center for Disease Prevention and Control, Beijing, China
| | - Weixian Shi
- The Beijing Center for Disease Prevention and Control, Beijing, China
| | - Xinghuo Pang
- The Beijing Center for Disease Prevention and Control, Beijing, China
| | - Yi Zhang
- The Beijing Center for Disease Prevention and Control, Beijing, China
| | - Aye Moa
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Australia.
| | - Dominic E Dwyer
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute for Clinical Pathology and Medical Research, Westmead Hospital and University of Sydney, Australia
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177
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Tamura E, Kishimoto K, Fukushima N. [Patients' reaction to pharmacists wearing a mask during their consultations]. YAKUGAKU ZASSHI 2014; 133:737-45. [PMID: 23728097 DOI: 10.1248/yakushi.12-00271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study sought to determine the effect of pharmacists wearing a mask on the consultation intention of patients who do not have a trusting relationship with the pharmacists. We conducted a questionnaire survey of customers at a Tokyo drugstore in August 2012. Subjects answered a questionnaire after watching two medical teaching videos, one in which the pharmacist was wearing a mask and the other in which the pharmacist was not wearing a mask. Data analysis was performed using a paired t-test and multiple logistic regression. The paired t-test revealed a significant difference in 'Maintenance Problem' between the two pharmacist situations. After excluding factors not associated with wearing a mask, multiple logistic regression analysis identified three independent variables with a significant effect on participants not wanting to consult with a pharmacist wearing a mask. Positive factors were 'active-inactive' and 'frequency mask use', a negative factor was 'age'. Our study has shown that pharmacists wearing a mask may be a factor that prevents patients from consulting with pharmacist. Those patients whose intention to consult might be affected by the pharmacists wearing a mask tended to be younger, to have no habit of wearing masks preventively themselves, and to form a negative opinion of such pharmacists. Therefore, it was estimated that pharmacists who wear masks need to provide medical education by asking questions more positively than when they do not wear a mask in order to prevent the patient worrying about oneself.
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Affiliation(s)
- Eri Tamura
- Division of Social Pharmacy, Faculty of Pharmaceutical Sciences, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
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178
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Andradóttir S, Chiu W, Goldsman D, Lee ML. Simulation of influenza propagation: Model development, parameter estimation, and mitigation strategies. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/19488300.2014.880093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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179
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Optimal design of studies of influenza transmission in households. II: comparison between cohort and case-ascertained studies. Epidemiol Infect 2013; 142:744-52. [PMID: 23830470 DOI: 10.1017/s0950268813001623] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Both case-ascertained household studies, in which households are recruited after an 'index case' is identified, and household cohort studies, where a household is enrolled before the start of the epidemic, may be used to test and estimate the protective effect of interventions used to prevent influenza transmission. A simulation approach parameterized with empirical data from household studies was used to evaluate and compare the statistical power of four study designs: a cohort study with routine virological testing of household contacts of infected index case, a cohort study where only household contacts with acute respiratory illness (ARI) are sampled for virological testing, a case-ascertained study with routine virological testing of household contacts, and a case-ascertained study where only household contacts with ARI are sampled for virological testing. We found that a case-ascertained study with ARI-triggered testing would be the most powerful design while a cohort design only testing household contacts with ARI was the least powerful. Sensitivity analysis demonstrated that these conclusions varied by model parameters including the serial interval and the risk of influenza virus infection from outside the household.
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MacIntyre CR, Wang Q, Seale H, Yang P, Shi W, Gao Z, Rahman B, Zhang Y, Wang X, Newall AT, Heywood A, Dwyer DE. A randomized clinical trial of three options for N95 respirators and medical masks in health workers. Am J Respir Crit Care Med 2013; 187:960-6. [PMID: 23413265 DOI: 10.1164/rccm.201207-1164oc] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE We compared three policy options for the use of medical masks and N95 respirators in healthcare workers (HCWs). OBJECTIVES A cluster randomized clinical trial of 1,669 hospital-based HCWs in Beijing, China in the winter of 2009-2010. METHODS Participants were randomized to medical masks, N95 respirators, or targeted use of N95 respirators while doing high-risk procedures or barrier nursing. Outcomes included clinical respiratory illness (CRI) and laboratory-confirmed respiratory pathogens in symptomatic subjects. MEASUREMENTS AND MAIN RESULTS The rate of CRI was highest in the medical mask arm (98 of 572; 17%), followed by the targeted N95 arm (61 of 516; 11.8%), and the N95 arm (42 of 581; 7.2%) (P < 0.05). Bacterial respiratory tract colonization in subjects with CRI was highest in the medical mask arm (14.7%; 84 of 572), followed by the targeted N95 arm (10.1%; 52 of 516), and lowest in the N95 arm (6.2%; 36 of 581) (P = 0.02). After adjusting for confounders, only continuous use of N95 remained significant against CRI and bacterial colonization, and for just CRI compared with targeted N95 use. Targeted N95 use was not superior to medical masks. CONCLUSIONS Continuous use of N95 respirators was more efficacious against CRI than intermittent use of N95 or medical masks. Most policies for HCWs recommend use of medical masks alone or targeted N95 respirator use. Continuous use of N95s resulted in significantly lower rates of bacterial colonization, a novel finding that points to more research on the clinical significance of bacterial infection in symptomatic HCWs. This study provides further data to inform occupational policy options for HCWs. Clinical trial registered with Australian New Zealand Clinical Trials Registry http://www.anzctr.org.au (ACTRN 12609000778280).
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Affiliation(s)
- C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia.
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Abstract
Healthy children are high transmitters of influenza and can experience poor influenza outcomes. Many questions remain about the efficacy and impect of preventive measures because most existing studies report imprecise proxies of influenza incidence, do not follow subjects throughout the entire influenza season and across multiple influenza seasons, or do not control for important factors such as timing of implementation and social contact patterns. Modeling and simulation are key methodologies to answer questions regarding influenza prevention. While vaccination may be the most efficacious existing intervention, variations in circulating strains and children's immune systems keep current vaccines from being fully protective, necessitating further clinical and economic studies and technology improvements. Hand hygiene appears to be an important adjunct but improving compliance, standardizing regimens and quantifying its impact remain challenging. Future studies should help better define the specific indications and circumstances for antiviral use and the role of nutritional supplements and nonpharmaceutical interventions.
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Affiliation(s)
- Bruce Y Lee
- Public Health Computational and Operations Research, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, PA, USA.
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182
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Wada K, Oka-Ezoe K, Smith DR. Wearing face masks in public during the influenza season may reflect other positive hygiene practices in Japan. BMC Public Health 2012; 12:1065. [PMID: 23227885 PMCID: PMC3536629 DOI: 10.1186/1471-2458-12-1065] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 12/07/2012] [Indexed: 11/22/2022] Open
Abstract
Background Although the wearing of face masks in public has not been recommended for preventing influenza, these devices are often worn in many Asian countries during the influenza season. In Japan, it is thought that such behavior may be an indicator of other positive hygiene practices. The aim of this study, therefore, was to determine if wearing a face mask in public is associated with other positive hygiene practices and health behaviors among Japanese adults. Methods We initially recruited around 3,000 Japanese individuals ranging from 20 to 69 years of age who were registered with a web survey company. Participants were asked to recall their personal hygiene practices during the influenza season of the previous year. Logistic regression analysis was then used to examine the associations between wearing a face mask in public and personal hygiene practices and health behaviors. Results A total of 3,129 persons responded to the survey, among whom 38% reported that they had worn a face mask in public during the previous influenza season. Wearing a face mask in public was associated with various self-reported hygiene practices including: frequent hand washing (adjusted Odds Ratio [OR]: 1.67; 95% Confidence Interval [95%CI]: 1.34-1.96), occasional hand washing (OR: 1.43; 95%CI: 1.10-1.75), frequently avoiding crowds (OR: 1.85; 95%CI: 1.70-1.98), occasionally avoiding crowds (OR: 1.65; 95%CI: 1.53-1.76), frequent gargling (OR: 1.68; 95%CI: 1.51-1.84), occasional gargling (OR: 1.46; 95%CI: 1.29-1.62), regularly avoiding close contact with an infected person (OR: 1.50; 95%CI: 1.33-1.67), occasionally avoiding close contact with an infected person (OR: 1.31; 95%CI: 1.16-1.46), and being vaccinated of influenza in the last season (OR: 1.31; 95%CI: 1.17-1.45). Conclusions Overall, this study suggests that wearing a face mask in public may be associated with other personal hygiene practices and health behaviors among Japanese adults. Rather than preventing influenza itself, face mask use might instead be a marker of additional, positive hygiene practices and other favorable health behaviors in the same individuals.
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Affiliation(s)
- Koji Wada
- Department of Public Health, Kitasato University School of Medicine, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan.
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Van Cauteren D, Vaux S, de Valk H, Le Strat Y, Vaillant V, Lévy-Bruhl D. Burden of influenza, healthcare seeking behaviour and hygiene measures during the A(H1N1)2009 pandemic in France: a population based study. BMC Public Health 2012; 12:947. [PMID: 23127166 PMCID: PMC3508974 DOI: 10.1186/1471-2458-12-947] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 10/29/2012] [Indexed: 12/26/2022] Open
Abstract
Background Influenza surveillance systems do not allow the identification of the true burden of illness caused by influenza in the community because they are restricted to consulting cases. A study was conducted to estimate the incidence and the burden of self-defined influenza, and to describe healthcare seeking behavior for self-defined influenza during the A(H1N1)2009 pandemic in the French population. Methods We conducted a random-based retrospective cross-sectional telephone survey between May 2009 and April 2010 among a random sample of the French population. Results For the 10 076 people included, 107 episodes of self-defined influenza were reported. The annual incidence of self-defined influenza was estimated at 13 942 cases per 100 000 inhabitants (CI95% 10 947 – 16 961), 62.1% (CI95% 50.5 – 72.5) of cases consulted a physician and 11.3% (CI95% 5.5 - 21.7) used a face mask. Following recommendations, 37.5% (CI95% 35.5 – 39.5) of people in the survey reported washing their hands more often during the pandemic season, and there was a positive association with being vaccinated against A(H1N1)2009 influenza, being a women, being a child (< 15 years) or living in a big city (≥ 100 000 inhabitants). Conclusions Self-defined influenza causes a significant burden of illness in the French population and is a frequent cause for consultation. These results allow a more accurate interpretation of influenza surveillance data and an opportunity to adapt future health education messages.
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Affiliation(s)
- Dieter Van Cauteren
- Department of infectious diseases, Institut de Veille Sanitaire (InVS) (French Institute for Public Health Surveillance), 12 rue de Val d'Osne, St Maurice Cedex, 94415, France
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Carrat F, Duval X, Tubach F, Mosnier A, Van der Werf S, Tibi A, Blanchon T, Leport C, Flahault A, Mentré F. Effect of oseltamivir, zanamivir or oseltamivir-zanamivir combination treatments on transmission of influenza in households. Antivir Ther 2012; 17:1085-90. [PMID: 22910171 DOI: 10.3851/imp2128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND The effectiveness of neuraminidase inhibitors to reduce transmission when used as treatment in influenza-infected patients remains debated. METHODS In a prespecified analysis of a blinded randomized controlled trial on the efficacy of oseltamivir-zanamivir combination therapy versus oseltamivir and zanamivir monotherapy conducted during the 2008-2009 seasonal influenza epidemic, we compared the rate of secondary illness in household contacts of influenza-positive index patients between arms. Secondary illness was defined as occurrence in contacts of fever plus cough within 7 days from randomization of index patients. Analyses were conducted according to the delay between patients' onset of symptoms and intervention. RESULTS A total of 543 household contacts of 267 index patients were included, of which 466 had follow-up assessment. A secondary illness was reported in 58 (12.5%) contacts with no significant difference between arms overall (P=0.07). When the analysis was limited to the 232 contacts of 136 index patients with first treatment intake within 24 h of onset of symptoms, a lower rate of secondary illness was reported in the combination therapy arm (2 of 56 [4%]) than in the oseltamivir arm (14 of 81 [17%]; P=0.014) and the zanamivir arm (14 of 95 [15%]; P=0.031). Multivariate analysis accounting for intra-household correlation confirmed these findings. CONCLUSIONS Our analysis suggests a greater effectiveness of the combination therapy to reduce transmissibility when given to the index patient within 24 h of onset of symptoms. As the finding was obtained from a subgroup analysis, it should be interpreted with caution.
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Affiliation(s)
- Fabrice Carrat
- APHP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France.
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185
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Godoy P, Castilla J, Delgado-Rodríguez M, Martín V, Soldevila N, Alonso J, Astray J, Baricot M, Cantón R, Castro A, González-Candelas F, Mayoral JM, Quintana JM, Pumarola T, Tamames S, Domínguez A. Effectiveness of hand hygiene and provision of information in preventing influenza cases requiring hospitalization. Prev Med 2012; 54:434-9. [PMID: 22548868 PMCID: PMC7119305 DOI: 10.1016/j.ypmed.2012.04.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/24/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The objective of the study was to investigate the effectiveness of non-pharmacological interventions in preventing cases of influenza requiring hospitalization. METHODS We performed a multicenter case-control study in 36 hospitals, in 2010 in Spain. Hospitalized influenza cases confirmed by reverse-transcription polymerase chain reaction and three matched controls (two hospital and one community control) per case were selected. The use of non-pharmacological measures seven days before the onset of symptoms (frequency of hand washing, use of alcohol-based hand sanitizers and handwashing after touching contaminated surfaces) was collected. RESULTS We studied 813 cases hospitalized for influenza and 2274 controls. The frequency of hand washing 5-10 times (adjusted odds ratio [aOR]=0.65) and >10 times (aOR=0.59) and handwashing after contact with contaminated surfaces (aOR=0.65) were protective factors and were dose-responsive (p<0.001). Alcohol-based hand sanitizers were associated with marginal benefits (aOR=0.82). CONCLUSIONS Frequent handwashing should be recommended to prevent influenza cases requiring hospitalization.
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Affiliation(s)
- Pere Godoy
- Departament de Salut, Generalitat of Catalonia, Spain.
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186
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Klick B, Nishiura H, Cowling BJ. Optimal design of intervention studies to prevent influenza in healthy cohorts. PLoS One 2012; 7:e35166. [PMID: 22514718 PMCID: PMC3325991 DOI: 10.1371/journal.pone.0035166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/13/2012] [Indexed: 11/19/2022] Open
Abstract
Background Influenza cohort studies, in which participants are monitored for infection over an epidemic period, are invaluable in assessing the effectiveness of control measures such as vaccination, antiviral prophylaxis and non-pharmaceutical interventions (NPIs). Influenza infections and illnesses can be identified through a number of approaches with different costs and logistical requirements. Methodology and Principal Findings In the context of a randomized controlled trial of an NPI with a constrained budget, we used a simulation approach to examine which approaches to measuring outcomes could provide greater statistical power to identify an effective intervention against confirmed influenza. We found that for a short epidemic season, the optimal design was to collect respiratory specimens at biweekly intervals, as well as following report of acute respiratory illness (ARI), for virologic testing by reverse transcription polymerase chain reaction (RT-PCR). Collection of respiratory specimens only from individuals reporting ARI was also an efficient design particularly for studies in settings with longer periods of influenza activity. Collection of specimens only from individuals reporting a febrile ARI was less efficient. Collection and testing of sera before and after influenza activity appeared to be inferior to collection of respiratory specimens for RT-PCR confirmation of acute infections. The performance of RT-PCR was robust to uncertainty in the costs and diagnostic performance of RT-PCR and serological tests. Conclusions and Significance Our results suggest that unless the sensitivity or specificity of serology can be increased RT-PCR will remain as the preferable outcome measure in NPI studies. Routine collection of specimens for RT-PCR testing even when study participants do not report acute respiratory illness appears to be the most cost efficient design under most scenarios.
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Affiliation(s)
- Brendan Klick
- Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
| | - Hiroshi Nishiura
- Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
- PRESTO, Japan Science and Technology Agency, Saitama, Japan
| | - Benjamin J. Cowling
- Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
- * E-mail:
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187
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Suess T, Remschmidt C, Schink SB, Schweiger B, Nitsche A, Schroeder K, Doellinger J, Milde J, Haas W, Koehler I, Krause G, Buchholz U. 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. [PMID: 22280120 PMCID: PMC3285078 DOI: 10.1186/1471-2334-12-26] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/26/2012] [Indexed: 12/08/2023] Open
Abstract
Background Previous controlled studies on the effect of non-pharmaceutical interventions (NPI) - namely the use of facemasks and intensified hand hygiene - in preventing household transmission of influenza have not produced definitive results. We aimed to investigate efficacy, acceptability, and tolerability of NPI in households with influenza index patients. Methods We conducted a cluster randomized controlled trial during the pandemic season 2009/10 and the ensuing influenza season 2010/11. We included households with an influenza positive index case in the absence of further respiratory illness within the preceding 14 days. Study arms were wearing a facemask and practicing intensified hand hygiene (MH group), wearing facemasks only (M group) and none of the two (control group). Main outcome measure was laboratory confirmed influenza infection in a household contact. We used daily questionnaires to examine adherence and tolerability of the interventions. Results We recruited 84 households (30 control, 26 M and 28 MH households) with 82, 69 and 67 household contacts, respectively. In 2009/10 all 41 index cases had a influenza A (H1N1) pdm09 infection, in 2010/11 24 had an A (H1N1) pdm09 and 20 had a B infection. The total secondary attack rate was 16% (35/218). In intention-to-treat analysis there was no statistically significant effect of the M and MH interventions on secondary infections. When analysing only households where intervention was implemented within 36 h after symptom onset of the index case, secondary infection in the pooled M and MH groups was significantly lower compared to the control group (adjusted odds ratio 0.16, 95% CI, 0.03-0.92). In a per-protocol analysis odds ratios were significantly reduced among participants of the M group (adjusted odds ratio, 0.30, 95% CI, 0.10-0.94). With the exception of MH index cases in 2010/11 adherence was good for adults and children, contacts and index cases. Conclusions Results suggest that household transmission of influenza can be reduced by the use of NPI, such as facemasks and intensified hand hygiene, when implemented early and used diligently. Concerns about acceptability and tolerability of the interventions should not be a reason against their recommendation. Trial registration The study was registered with ClinicalTrials.gov (Identifier NCT00833885).
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Affiliation(s)
- Thorsten Suess
- Department of Infectious Disease Epidemiology, Robert Koch Institute, DGZ-Ring 1, 13086 Berlin, Germany.
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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. [PMID: 22295066 PMCID: PMC3266257 DOI: 10.1371/journal.pone.0029744] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 12/02/2011] [Indexed: 11/19/2022] Open
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.
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Affiliation(s)
- Allison E Aiello
- Department of Epidemiology, University of Michigan-School of Public Health, Ann Arbor, Michigan, United States of America.
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189
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Finkelstein S, Prakash S, Nigmatulina K, McDevitt J, Larson R. A home toolkit for primary prevention of influenza by individuals and families. Disaster Med Public Health Prep 2011; 5:266-71. [PMID: 22146665 DOI: 10.1001/dmp.2011.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
An influenza pandemic can overwhelm the capacities of hospitals, clinics, nursing facilities, and emergency services. The likelihood is that most of the individuals who are stricken will be cared for at home, and there is strong evidence that in-home caregivers bear a disproportionate risk of becoming infected. We reviewed the scientific literature after 2000 to identify steps that in-home caregivers can take to reduce the chances that they and other household members will become infected in the home. Personal hygiene, common masks, and technologies including air filters and UV light each offer incremental benefits, and in combination are expected to reduce a portion of the risk that household members face when caring for a member who has become infected. In pandemics and even seasonal epidemics, seemingly small steps can literally mean the difference between life and death, especially for in-home caregivers.
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Affiliation(s)
- Stan Finkelstein
- Engineering Systems Division, Center for Engineering Systems Fundamentals, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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190
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MacIntyre CR, Ridda I, Seale H, Gao Z, Ratnamohan VM, Donovan L, Zeng F, Dwyer DE. Respiratory viruses transmission from children to adults within a household. Vaccine 2011; 30:3009-14. [PMID: 22119589 PMCID: PMC7115576 DOI: 10.1016/j.vaccine.2011.11.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 11/08/2011] [Accepted: 11/11/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study was to examine the rate of transmission of influenza and other respiratory viruses from children attending an Emergency Department to their family members in the household using active surveillance. METHODS A prospective hospital-based study was conducted over three consecutive winters (2006-2008) in children aged <1-15 years presenting with influenza-like illness (ILI). 168 children with ILI and their healthy families were recruited over three winter seasons. RESULTS Respiratory viruses were detected in 101 (60.8%) children with ILI; in 91/166 (54.8%) a single pathogen was detected, and in the remaining 10 children more than one virus was detected concurrently. Influenza was the most common virus detected (34/101), followed by rhinoviruses (22/101) and adenoviruses (14/101). Of influenza viruses, 21/34 were influenza A and 13/34 influenza B. Meeting the clinical definition of ILI did not differentiate between influenza and other viruses. Clinical ILI developed within one week of follow up in 12% (26/205) of the family members who were swabbed. Viral pathogens were detected in 42.3% (11/26) of the symptomatic family members. In 6/11 cases the same virus was detected in the adult and child. The lower estimate of the household risk of transmission of respiratory viruses, based on concordant proven infection in both child and adult, from a single sick child to adult household contacts is therefore 3% per week. CONCLUSION This study provides quantitative, prospective data on rates of household transmission of infection from children to adults.
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191
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Li X, Wu P, Gao GF, Cheng S. Carbohydrate-Functionalized Chitosan Fiber for Influenza Virus Capture. Biomacromolecules 2011; 12:3962-9. [DOI: 10.1021/bm200970x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Xuebing Li
- CAS Key Laboratory of Pathogenic
Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
| | - Peixing Wu
- Lanzhou Institute of Animal Science
and Veterinary Pharmaceutics, Chinese Academy of Agricultural Science, Lanzhou 730050, China
| | - George F. Gao
- CAS Key Laboratory of Pathogenic
Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
| | - Shuihong Cheng
- CAS Key Laboratory of Pathogenic
Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
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192
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Yang P, Seale H, MacIntyre CR, Zhang H, Zhang Z, Zhang Y, Wang X, Li X, Pang X, Wang Q. Mask-wearing and respiratory infection in healthcare workers in Beijing, China. Braz J Infect Dis 2011. [PMID: 21503394 PMCID: PMC7129448 DOI: 10.1016/s1413-8670(11)70153-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives The aim of the study was to determine rates of mask-wearing, of respiratory infection and the factors associated with mask-wearing and of respiratory infection in healthcare workers (HCWs) in Beijing during the winter of 2007/2008. Methods We conducted a survey of 400 HCWs working in eight hospitals in Beijing by face to face interview using a standardized questionnaire. Results We found that 280/400 (70.0%) of HCWs were compliant with mask-wearing while in contact with patients. Respiratory infection occurred in 238/400 (59.5%) subjects from November, 2007 through February, 2008. Respiratory infection was higher among females (odds ratio [OR], 2.00 [95% confidence interval {CI}, 1.16-3.49]) and staff working in larger hospitals (OR, 1.72 [95% CI, 1.09-2.72]), but was lower among subjects with seasonal influenza vaccination (OR, 0.46 [95% CI, 0.28-0.76]), wearing medical masks (reference: cotton-yarn; OR, 0.60 [95% CI, 0.39-0.91]) or with good mask-wearing adherence (OR, 0.60 [95% CI, 0.37-0.98]). The risk of respiratory infection of HCWs working in low risk areas was similar to that of HCWs in high risk area. Conclusion Our data suggest that female HCWs and staffs working in larger hospitals are the focus of prevention and control of respiratory infection in Beijing hospitals. Mask-wearing and seasonal influenza vaccination are protective for respiratory infection in HCWs; the protective efficacy of medical masks is better than that of cotton yarn ones; respiratory infection of HCWs working in low risk areas should also be given attention.
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Affiliation(s)
- Peng Yang
- Beijing Center for Disease Prevention and Control, Beijing, China
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193
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Abstract
An overview of available literature on the use of protective facemasks by children for protection from respiratory infectious agents reveals relatively few articles dealing specifically with the topic, despite their use during recent outbreaks (eg, severe acute respiratory syndrome, pandemic influenza). Little is known about the physiological and psychological burdens imposed by these devices and a child's ability to correctly use and tolerate them. This article focuses on the myriad issues associated with protective facemask use by children in the hope of educating public health personnel, healthcare professionals, and families on their limitations and associated risks, and in the hope of fostering much-needed research.
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Affiliation(s)
- Raymond Roberge
- Technology Research Branch, National Institute for Occupational Safety and Health, 626 Cochrans Mill Road, Pittsburgh, PA 15236, USA.
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Killingley B, Enstone J, Booy R, Hayward A, Oxford J, Ferguson N, Nguyen Van-Tam J. Potential role of human challenge studies for investigation of influenza transmission. THE LANCET. INFECTIOUS DISEASES 2011; 11:879-86. [PMID: 21798808 DOI: 10.1016/s1473-3099(11)70142-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The importance of different routes of influenza transmission (including the role of bioaerosols) and the ability of masks and hand hygiene to prevent transmission remain poorly understood. Interest in transmission of influenza has grown as the effectiveness of prevention measures implemented during the 2009 H1N1 pandemic are questioned and as plans to better prepare for the next pandemic are debated. Recent studies of naturally infected patients have encountered difficulties and have fallen short of providing definitive answers. Human challenge studies with influenza virus date back to the 1918 pandemic. In more recent decades they have been undertaken to investigate the efficacy of antiviral agents and vaccines. Could experimental challenge studies, in which volunteers are deliberately infected with influenza virus, provide an alternative approach to the study of transmission? Here, we review the latest intervention studies and discuss the potential of challenge studies to address the remaining gaps in our knowledge.
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Affiliation(s)
- Ben Killingley
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
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195
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Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al‐Ansary LA, Bawazeer GA, van Driel ML, Nair NS, Jones MA, Thorning S, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2011; 2011:CD006207. [PMID: 21735402 PMCID: PMC6993921 DOI: 10.1002/14651858.cd006207.pub4] [Citation(s) in RCA: 242] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections like influenza or severe acute respiratory syndrome pose a global threat. Antiviral drugs and vaccinations may be insufficient to prevent their spread. OBJECTIVES To review the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses. SEARCH STRATEGY We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL 2010, Issue 3), which includes the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to October 2010), OLDMEDLINE (1950 to 1965), EMBASE (1990 to October 2010), CINAHL (1982 to October 2010), LILACS (2008 to October 2010), Indian MEDLARS (2008 to October 2010) and IMSEAR (2008 to October 2010). SELECTION CRITERIA In this update, two review authors independently applied the inclusion criteria to all identified and retrieved articles and extracted data. We scanned 3775 titles, excluded 3560 and retrieved full papers of 215 studies, to include 66 papers of 67 studies. We included physical interventions (screening at entry ports, isolation, quarantine, social distancing, barriers, personal protection, hand hygiene) to prevent respiratory virus transmission. We included randomised controlled trials (RCTs), cohorts, case-controls, before-after and time series studies. DATA COLLECTION AND ANALYSIS We used a standardised form to assess trial eligibility. We assessed RCTs by randomisation method, allocation generation, concealment, blinding and follow up. We assessed non-RCTs for potential confounders and classified them as low, medium and high risk of bias. MAIN RESULTS We included 67 studies including randomised controlled trials and observational studies with a mixed risk of bias. A total number of participants is not included as the total would be made up of a heterogenous set of observations (participant people, observations on participants and countries (object of some studies)). The risk of bias for five RCTs and most cluster-RCTs was high. Observational studies were of mixed quality. Only case-control data were sufficiently homogeneous to allow meta-analysis. The highest quality cluster-RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children. Benefit from reduced transmission from children to household members is broadly supported also in other study designs where the potential for confounding is greater. Nine case-control studies suggested implementing transmission barriers, isolation and hygienic measures are effective at containing respiratory virus epidemics. Surgical masks or N95 respirators were the most consistent and comprehensive supportive measures. N95 respirators were non-inferior to simple surgical masks but more expensive, uncomfortable and irritating to skin. Adding virucidals or antiseptics to normal handwashing to decrease respiratory disease transmission remains uncertain. Global measures, such as screening at entry ports, led to a non-significant marginal delay in spread. There was limited evidence that social distancing was effective, especially if related to the risk of exposure. AUTHORS' CONCLUSIONS Simple and low-cost interventions would be useful for reducing transmission of epidemic respiratory viruses. Routine long-term implementation of some measures assessed might be difficult without the threat of an epidemic.
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Affiliation(s)
- Tom Jefferson
- University of OxfordCentre for Evidence Based MedicineOxfordUKOX2 6GG
| | - Chris B Del Mar
- Bond UniversityCentre for Research in Evidence‐Based Practice (CREBP)University DriveGold CoastQueenslandAustralia4229
| | - Liz Dooley
- Bond UniversityFaculty of Health Sciences and MedicineGold CoastQueenslandAustralia4229
| | - Eliana Ferroni
- Regional Center for Epidemiology, Veneto RegionEpidemiological System of the Veneto RegionPassaggio Gaudenzio 1PadovaItaly35131
| | - Lubna A Al‐Ansary
- World Health OrganizationDepartment of Health Metrics and MeasurementGenevaSwitzerland
| | - Ghada A Bawazeer
- King Saud UniversityDepartment of Clinical Pharmacy, College of PharmacyP.O. Box 22452RiyadhSaudi Arabia11495
| | - Mieke L van Driel
- The University of QueenslandPrimary Care Clinical Unit, Faculty of MedicineBrisbaneQueenslandAustralia4029
- Ghent UniversityDepartment of Public Health and Primary CareCampus UZ 6K3, Corneel Heymanslaan 10GhentBelgium9000
| | - N Sreekumaran Nair
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) (Institution of National Importance Under Ministry of Health and Family Welfare, Government of India)Department of Medical Biometrics & Informatics (Biostatistics)4th Floor, Administrative BlockDhanvantri NagarPuducherryIndia605006
| | - Mark A Jones
- Bond UniversityInstitute for Evidence‐Based Healthcare11 University DriveRobinaGold CoastQueenslandAustralia4226
| | - Sarah Thorning
- Gold Coast Hospital and Health ServiceGCUH LibraryLevel 1, Block E, GCUHSouthportQueenslandAustralia4215
| | - John M Conly
- Foothills Medical Centre, Room 930, North Tower1403‐29th St NWCalgaryABCanadaT2N 2T9
- WHO. Infection Prevention and Control in Health CareDepartment of Global Alert and Response ‐ Health Security and EnvironmentOffice L420, 20, Avenue AppiaGenevaSwitzerlandCH‐1211
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196
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Seale H, Dwyer DE, Cowling BJ, Wang Q, Yang P, MacIntyre CR. A review of medical masks and respirators for use during an influenza pandemic. Influenza Other Respir Viruses 2011; 3:205-6. [PMID: 19702582 PMCID: PMC4941551 DOI: 10.1111/j.1750-2659.2009.00101.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Holly Seale
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Australia
| | - Dominic E. Dwyer
- Institute for Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia
| | - Benjamin J. Cowling
- Department of Community Medicine and School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Quanyi Wang
- Institute for Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Peng Yang
- Institute for Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing, China
| | - C. Raina MacIntyre
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Australia
- National Centre for Immunization Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children’s Hospital at Westmead, Australia
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197
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Zarogoulidis P, Kouliatsis G, Papanas N, Spyratos D, Constantinidis TC, Kouroumichakis I, Steiropoulos P, Mabroudi M, Matthaios D, Kerenidi T, Courcoutsakis N, Zarogoulidis K, Maltezos E. Long-term respiratory follow-up of H1N1 infection. Virol J 2011; 8:319. [PMID: 21702977 PMCID: PMC3138433 DOI: 10.1186/1743-422x-8-319] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 06/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The first case of 2009 pandemic influenza A (H1N1) virus infection was documented in our Hospital on 10th August 2009. METHODS AND FINDINGS Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm the diagnosis. All patients were treated with oseltamivir from the first day of hospitalization. Upon admission 12/44 had local patchy shadowing in their chest x-ray and additionally antibiotic regimen was added to these patients as pneumonia was suspected based on clinical evidence. In total 44 patients were hospitalized 15/44 had asthma, 6/44 COPD, 5/44 leukemia. Lung function was evaluated with forced vital capacity, forced expiratory volume in 1 sec and diffused carbon monoxide upon discharge and every 3 months, until 6 months of observation was completed after discharge. The purpose of this retrospective cohort study was to evaluate whether influenza A (H1N1) had an impact on the respiratory capacity of the infected patients. CONCLUSIONS An improvement of pulmonary function tests was observed between the first two measurements, implicating an inflammatory pathogenesis of influenza A (H1N1) to the respiratory tract. This inflammation was not associated with the severity or clinical outcome of the patients. All patients had a mild clinical course and their respiratory capacity was stable between the second and third measurement, suggesting that the duration of respiratory inflammation was two months. Early treatment with antiviral agents and vaccination represent the mainstay of management.
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Affiliation(s)
- Paul Zarogoulidis
- Unit of Infectious Diseases, Democritus University Thrace, Dragana, 68100 Alexandroupolis, Greece.
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198
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Optimal design of studies of influenza transmission in households. I: case-ascertained studies. Epidemiol Infect 2011; 140:106-14. [PMID: 21418717 DOI: 10.1017/s0950268811000392] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Case-ascertained household transmission studies, in which households including an 'index case' are recruited and followed up, are invaluable to understanding the epidemiology of influenza. We used a simulation approach parameterized with data from household transmission studies to evaluate alternative study designs. We compared studies that relied on self-reported illness in household contacts vs. studies that used home visits to collect swab specimens for virological confirmation of secondary infections, allowing for the trade-off between sample size vs. intensity of follow-up given a fixed budget. For studies estimating the secondary attack proportion, 2-3 follow-up visits with specimens collected from all members regardless of illness were optimal. However, for studies comparing secondary attack proportions between two or more groups, such as controlled intervention studies, designs with reactive home visits following illness reports in contacts were most powerful, while a design with one home visit optimally timed also performed well.
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199
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Sensitivity and specificity of the user-seal-check in determining the fit of N95 respirators. J Hosp Infect 2011; 77:252-6. [PMID: 21236516 PMCID: PMC7114945 DOI: 10.1016/j.jhin.2010.09.034] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 09/24/2010] [Indexed: 11/23/2022]
Abstract
N95 respirators are recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to prevent the inhalation of droplets which may transmit respiratory pathogens. The reliability of N95 respirators in preventing transmission depends on their fit to the wearer. Quantitative fit testing (QNFT) is the gold standard used to determine this fit objectively. The manufacturers of the respirators also recommend performing a self-reported user-seal-check to detect for leakage. This study aims to investigate the capability of the user-seal-check in determining the fit of N95 respirators by investigating the sensitivity and specificity of the user-seal-check compared with QNFT. A prospective and cross-sectional research design was used. A total of 204 local Chinese undergraduate nursing students were recruited to test two commonly used respirator models (3M 1860S and 3M 1862). The results of the user-seal-check were compared with the results of the gold standard QNFT using the Condensation Nucleus Counter Fit Tester System. The sensitivity and specificity of the user-seal-check results obtained with the respirators were calculated. The results indicated low sensitivity, accuracy and predictive value of the user-seal-check in determining the fit of the N95 respirators. The user-seal-check was not found to be reliable as a substitute for QNFT. The results also suggested that the user-seal-check may be unreliable for detecting gross leakage. We recommend that QNFT is used to determine the fit of N95 respirators.
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200
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Forshey BM, Laguna-Torres VA, Vilcarromero S, Bazan I, Rocha C, Morrison AC, Stoddard ST, Alegre Y, Gomez J, Scott TW, Kochel TJ. Epidemiology of influenza-like illness in the Amazon Basin of Peru, 2008-2009. Influenza Other Respir Viruses 2011; 4:235-43. [PMID: 20836798 PMCID: PMC5964548 DOI: 10.1111/j.1750-2659.2010.00139.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Data addressing the incidence and epidemiology of influenza and influenza-like illness (ILI) in tropical regions of the world is scarce, particularly for the neotropics of South America. METHODS We conducted active, population-based surveillance for ILI across 45 city blocks within the Amazon Basin city of Iquitos, Peru. Demographic data and household characteristics were collected for all participants, and participating households were visited three times weekly to inquire about ILI (fever plus cough or sore throat) among household residents. Nasal and oropharyngeal swabs were collected from participants with ILI and tested for influenza virus infection. RESULTS Between May 1, 2008 and July 8, 2009, we monitored 10,341 participants for ILI for a total of 11,569.5 person-years. We detected 459 ILI episodes, with 252 (54.9%) of the participants providing specimens. Age-adjusted incidence of ILI was estimated to be 46.7 episodes/1000 person-years. Influenza A and B viruses were detected in 25 (9.9%) and 62 (24.6%) specimens of ILI patients, respectively, for an estimated age-adjusted incidence rate of 16.5 symptomatic influenza virus infections/1000 person-years. Risk factors for ILI included age, household crowding, and use of wood as cooking fuel. For influenza virus infection specifically, age and use of wood as a cooking fuel were also identified as risk factors, but no effect of household crowding was observed. CONCLUSIONS Our results represent the initial population-based description of the epidemiology of ILI in the Amazon region of Peru, which will be useful for developing region-specific strategies for reducing the burden of respiratory disease.
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Affiliation(s)
- Brett M Forshey
- US Naval Medical Research Center Detachment, Lima and Iquitos, Peru
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