1
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Huguet-Torres A, Castro-Sánchez E, Capitán-Moyano L, Sánchez-Rodríguez C, Bennasar-Veny M, Yáñez AM. Personal protective measures and settings on the risk of SARS-COV-2 community transmission: a case-control study. Front Public Health 2024; 11:1327082. [PMID: 38259788 PMCID: PMC10801386 DOI: 10.3389/fpubh.2023.1327082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Background During the SARS-CoV-2 pandemic, nurses of primary health care has been an important role in Spain. Even so, the data obtained in the tracing have been scarcely used to investigate the possible mechanisms of transmission. Few studies focused on community transmission, evaluating the effectiveness of individual protective measures and exposure environment. The main aim of the study was to evaluate the association between individual protective measures and SARS-CoV-2 transmission in the community and to compare secondary attack rates in different exposure settings. Methods A case-control study from contact tracing of SARS-CoV-2 index patients. COVID-19 contact tracing was led by nurses at the COVID-19 Coordinating Centre in Majorca (Spain). During the systematic tracing, additional information for this study was collected from the index patient (social-demographic variables, symptoms, the number of close contacts). And also, the following variables from their close contacts: contact place, ventilation characteristics mask-wearing, type of mask, duration of contact, shortest distance, case-contact relationship, household members, and handwashing, the test result for SARS-CoV-2 diagnostic. Close contacts with a positive test for SARS-CoV-2 were classified as "cases" and those negative as "controls." Results A total of 1,778 close contacts from 463 index patients were identified. No significant differences were observed between the sexes but between age groups. Overall Secondary Attack Rate (SAR) was 24.0% (95% CI: 22.0-26.0%), 36.9% (95% CI: 33.2-40.6%) in closed spaces without ventilation and 50.7% (95% CI: 45.6-55.8%) in exposure time > 24 h. A total of 49.2% of infections occurred among household members. Multivariate logistic regression analysis showed that open-air setting (OR 0.43, 95% CI: 0.27-0.71), exposure for less than 1 h (OR 0.19, 95% CI: 0.11-0.32), and wearing a mask (OR 0.49, 95% CI: 0.28-0.85) had a protective effect transmission of SARS-CoV-2 in the community. Conclusion Ventilation of the space, mask-wearing and shorter exposure time were associated with a lower risk of transmission in the community. The data obtained allowed an assessment of community transmission mechanisms and could have helped to improve and streamline tracing by identifying close contacts at higher risk.
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Affiliation(s)
- Aina Huguet-Torres
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, Spain
- Research Group on Global Health, University of Balearic Islands, Palma, Spain
| | - Enrique Castro-Sánchez
- Research Group on Global Health, University of Balearic Islands, Palma, Spain
- College of Business, Arts, and Social Sciences, Brunel University London, Uxbridge, United Kingdom
- Imperial College London, London, United Kingdom
| | - Laura Capitán-Moyano
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, Spain
- Research Group on Global Health, University of Balearic Islands, Palma, Spain
| | - Cristian Sánchez-Rodríguez
- Research Group on Global Health, University of Balearic Islands, Palma, Spain
- Hospital Sant Joan de Déu, Palma, Spain
| | - Miquel Bennasar-Veny
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, Spain
- Research Group on Global Health, University of Balearic Islands, Palma, Spain
- Research Group on Global Health and Lifestyle, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Carlos III Institute of Health (ISCIII), Madrid, Spain
| | - Aina M Yáñez
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, Spain
- Research Group on Global Health, University of Balearic Islands, Palma, Spain
- Research Group on Global Health and Lifestyle, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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2
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Muchangi JM, Mturi J, Mukasa H, Kithuki K, Kosgei SJ, Kanyangi LM, Mararo R, Nankanja M. Levels of handwashing and vaccine uptake in Kenya, Uganda, and Tanzania to prevent and control COVID-19: a systematic review and meta-analysis. Front Public Health 2023; 11:1256007. [PMID: 38026286 PMCID: PMC10666047 DOI: 10.3389/fpubh.2023.1256007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Coronavirus Disease 2019 (COVID-19) presents a massive challenge in Africa due to overwhelmed and underresourced health systems, as well as the existing burden of communicable and non- communicable diseases. Self-inoculation may occur when an individual touches their mucous membrane following direct contact between their hands and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-contaminated surfaces. Therefore, handwashing can be used along with COVID-19 vaccines to reduce the spread of SARS-CoV-2 and the burden of COVID-19. We were interested in investigating the levels of handwashing and vaccine uptake to control and prevent COVID-19 in Kenya, Uganda and Tanzania using a systematic review and meta-analysis. Methods We searched PubMed, African Index Medicus and African Journals Online for studies published since inception to 31st January 2023. We included all studies that assessed: the levels of COVID-19 vaccine acceptance and hesitance as indicators of vaccine uptake; and studies on the levels of handwashing to prevent and control COVID-19 in Kenya, Uganda and Tanzania. Study findings were synthesized by meta-analysis to get the pooled effect measure. Three studies were synthesized qualitatively due to high level of heterogeneity in effect measure precluding a quantitative meta-analysis. Results Our search identified 128 articles of which 17 studies with 18,305 participants and 622 vaccination sites were reviewed with 14 of them being meta-analyzed. This systematic review and meta-analysis reports high levels of COVID-19 vaccine acceptance and handwashing in Kenya, Uganda and Tanzania at 67% (95% CI: 55, 78) and 88% (95% CI: 73, 97), respectively. Vaccine hesitance among the participants was low at 31% (95% CI: 15, 49). Discussion Despite their importance in the control and prevention of COVID-19, some countries do not implement handwashing and vaccination effectively. There is a need for public health strategies to raise awareness about the importance of handwashing and the uptake of the COVID-19 vaccine. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, PROSPERO ID CRD42023394698.
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Affiliation(s)
| | - James Mturi
- Amref Health Africa, Dar es Salaam, Tanzania
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3
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Clifford Astbury C, Lee KM, Mcleod R, Aguiar R, Atique A, Balolong M, Clarke J, Demeshko A, Labonté R, Ruckert A, Sibal P, Togño KC, Viens AM, Wiktorowicz M, Yambayamba MK, Yau A, Penney TL. Policies to prevent zoonotic spillover: a systematic scoping review of evaluative evidence. Global Health 2023; 19:82. [PMID: 37940941 PMCID: PMC10634115 DOI: 10.1186/s12992-023-00986-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Emerging infectious diseases of zoonotic origin present a critical threat to global population health. As accelerating globalisation makes epidemics and pandemics more difficult to contain, there is a need for effective preventive interventions that reduce the risk of zoonotic spillover events. Public policies can play a key role in preventing spillover events. The aim of this review is to identify and describe evaluations of public policies that target the determinants of zoonotic spillover. Our approach is informed by a One Health perspective, acknowledging the inter-connectedness of human, animal and environmental health. METHODS In this systematic scoping review, we searched Medline, SCOPUS, Web of Science and Global Health in May 2021 using search terms combining animal health and the animal-human interface, public policy, prevention and zoonoses. We screened titles and abstracts, extracted data and reported our process in line with PRISMA-ScR guidelines. We also searched relevant organisations' websites for evaluations published in the grey literature. All evaluations of public policies aiming to prevent zoonotic spillover events were eligible for inclusion. We summarised key data from each study, mapping policies along the spillover pathway. RESULTS Our review found 95 publications evaluating 111 policies. We identified 27 unique policy options including habitat protection; trade regulations; border control and quarantine procedures; farm and market biosecurity measures; public information campaigns; and vaccination programmes, as well as multi-component programmes. These were implemented by many sectors, highlighting the cross-sectoral nature of zoonotic spillover prevention. Reports emphasised the importance of surveillance data in both guiding prevention efforts and enabling policy evaluation, as well as the importance of industry and private sector actors in implementing many of these policies. Thoughtful engagement with stakeholders ranging from subsistence hunters and farmers to industrial animal agriculture operations is key for policy success in this area. CONCLUSION This review outlines the state of the evaluative evidence around policies to prevent zoonotic spillover in order to guide policy decision-making and focus research efforts. Since we found that most of the existing policy evaluations target 'downstream' determinants, additional research could focus on evaluating policies targeting 'upstream' determinants of zoonotic spillover, such as land use change, and policies impacting infection intensity and pathogen shedding in animal populations, such as those targeting animal welfare.
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Affiliation(s)
- Chloe Clifford Astbury
- School of Global Health, York University, Toronto, ON, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, ON, Canada
- Global Strategy Lab, York University, Toronto, ON, Canada
| | - Kirsten M Lee
- School of Global Health, York University, Toronto, ON, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, ON, Canada
| | - Ryan Mcleod
- School of Global Health, York University, Toronto, ON, Canada
| | - Raphael Aguiar
- Dahdaleh Institute for Global Health Research, York University, Toronto, ON, Canada
| | - Asma Atique
- School of Global Health, York University, Toronto, ON, Canada
| | - Marilen Balolong
- Applied Microbiology for Health and Environment Research Group, College of Arts and Sciences, University of the Philippines Manila, Manila, Philippines
| | - Janielle Clarke
- School of Global Health, York University, Toronto, ON, Canada
| | | | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Arne Ruckert
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Priyanka Sibal
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Kathleen Chelsea Togño
- Applied Microbiology for Health and Environment Research Group, College of Arts and Sciences, University of the Philippines Manila, Manila, Philippines
| | - A M Viens
- School of Global Health, York University, Toronto, ON, Canada
- Global Strategy Lab, York University, Toronto, ON, Canada
| | - Mary Wiktorowicz
- School of Global Health, York University, Toronto, ON, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, ON, Canada
| | - Marc K Yambayamba
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Amy Yau
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Tarra L Penney
- School of Global Health, York University, Toronto, ON, Canada.
- Dahdaleh Institute for Global Health Research, York University, Toronto, ON, Canada.
- Global Strategy Lab, York University, Toronto, ON, Canada.
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4
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Tsang TK, Wang C, Fang VJ, Perera RAPM, So HC, Ip DKM, Leung GM, Peiris JSM, Cauchemez S, Cowling BJ. Reconstructing household transmission dynamics to estimate the infectiousness of asymptomatic influenza virus infections. Proc Natl Acad Sci U S A 2023; 120:e2304750120. [PMID: 37549267 PMCID: PMC10436695 DOI: 10.1073/pnas.2304750120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/15/2023] [Indexed: 08/09/2023] Open
Abstract
There has long been controversy over the potential for asymptomatic cases of the influenza virus to have the capacity for onward transmission, but recognition of asymptomatic transmission of COVID-19 stimulates further research into this topic. Here, we develop a Bayesian methodology to analyze detailed data from a large cohort of 727 households and 2515 individuals in the 2009 pandemic influenza A(H1N1) outbreak in Hong Kong to characterize household transmission dynamics and to estimate the relative infectiousness of asymptomatic versus symptomatic influenza cases. The posterior probability that asymptomatic cases [36% of cases; 95% credible interval (CrI): 32%, 40%] are less infectious than symptomatic cases is 0.82, with estimated relative infectiousness 0.57 (95% CrI: 0.11, 1.54). More data are required to strengthen our understanding of the contribution of asymptomatic cases to the spread of influenza.
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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, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
| | - Can Wang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vicky J. Fang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ranawaka A. P. M. Perera
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- HKU-Pasteur Research Pole, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hau Chi So
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dennis K. M. Ip
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Gabriel M. Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
| | - J. S. Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, UMR2000, CNRS, 75015Paris, France
| | - Benjamin J. Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
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5
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Vickers DM, Hardie J, Eberspaecher S, Chaufan C, Pelech S. Counterfactuals of effects of vaccination and public health measures on COVID-19 cases in Canada: what could have happened? Front Public Health 2023; 11:1173673. [PMID: 37228725 PMCID: PMC10203614 DOI: 10.3389/fpubh.2023.1173673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/30/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- David M. Vickers
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Claudia Chaufan
- Health Policy and Global Health, Faculty of Health, York University, Toronto, ON, Canada
| | - Steven Pelech
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Kinexus Bioinformatics Corporation, Vancouver, BC, Canada
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6
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Coma E, Català M, Méndez-Boo L, Alonso S, Hermosilla E, Alvarez-Lacalle E, Pino D, Medina M, Asso L, Gatell A, Bassat Q, Mas A, Soriano-Arandes A, Fina Avilés F, Prats C. Unravelling the role of the mandatory use of face covering masks for the control of SARS-CoV-2 in schools: a quasi-experimental study nested in a population-based cohort in Catalonia (Spain). Arch Dis Child 2023; 108:131-136. [PMID: 35999036 DOI: 10.1136/archdischild-2022-324172] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/05/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the effectiveness of mandatory use of face covering masks (FCMs) in schools during the first term of the 2021-2022 academic year. DESIGN A retrospective population-based study. SETTING Schools in Catalonia (Spain). POPULATION 599 314 children aged 3-11 years attending preschool (3-5 years, without FCM mandate) and primary education (6-11 years, with FCM mandate). STUDY PERIOD From 13 September to 22 December 2021 (before Omicron variant). INTERVENTIONS A quasi-experimental comparison between children in the last grade of preschool (5 years old), as a control group, and children in year 1 of primary education (6 years old), as an interventional group. MAIN OUTCOME MEASURES Incidence of SARS-CoV-2, secondary attack rates (SARs) and effective reproductive number (R*). RESULTS SARS-CoV-2 incidence was significantly lower in preschool than in primary education, and an increasing trend with age was observed. Six-year-old children showed higher incidence than 5 year olds (3.54% vs 3.1%; OR 1.15 (95% CI 1.08 to 1.22)) and slightly lower but not statistically significant SAR (4.36% vs 4.59%; incidence risk ratio 0.96 (95% CI 0.82 to 1.11)) and R* (0.9 vs 0.93; OR 0.96 (95% CI 0.87 to 1.09)). Results remained consistent using a regression discontinuity design and linear regression extrapolation approaches. CONCLUSIONS We found no significant differences in SARS-CoV-2 transmission due to FCM mandates in Catalonian schools. Instead, age was the most important factor in explaining the transmission risk for children attending school.
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Affiliation(s)
- Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Martí Català
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Leonardo Méndez-Boo
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Sergio Alonso
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | - Eduardo Hermosilla
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia, Spain.,IDIAP Jordi Gol, Barcelona, Catalonia, Spain
| | - Enric Alvarez-Lacalle
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | - David Pino
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | - Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Laia Asso
- Departament de Salut, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | - Anna Gatell
- Equip Pediatria Territorial Alt Penedès-Garraf, Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigação em Saúde de Manhiça, Manhica, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues (Barcelona), Catalonia, Spain.,ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Catalonia, Spain
| | - Ariadna Mas
- Direcció Assistencial d'Atenció Primària i a la Comunitat, Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain .,Department of Infectious Diseases, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Francesc Fina Avilés
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Clara Prats
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
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7
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Clifford Astbury C, Lee KM, Aguiar R, Atique A, Balolong M, Clarke J, Labonte R, Ruckert A, Togño KC, Viens AM, Wiktorowicz M, Yau A, Penney TL. Policies to prevent zoonotic spillover: protocol for a systematic scoping review of evaluative evidence. BMJ Open 2022; 12:e058437. [PMID: 36379648 PMCID: PMC9668000 DOI: 10.1136/bmjopen-2021-058437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The increasing incidence of pathogen transmission from animals to humans (zoonotic spillover events) has been attributed to behavioural practices and ecological and socioeconomic change. As these events sometimes involve pathogens with epidemic or pandemic potential, they pose a serious threat to population health. Public policies may play a key role in preventing these events. The aim of this review is to identify evaluations of public policies that target the determinants of zoonotic spillover, examining approaches taken to evaluation, choice of outcomes measures and evidence of effectiveness. Our approach to identifying and analysing this literature will be informed by a One Health lens, acknowledging the interconnectedness of human, animal and environmental health. METHODS AND ANALYSIS A systematic scoping review methodology will be used. To identify articles, we will search Medline, SCOPUS, Web of Science and Global Health in May 2021 using search terms combining animal health and the animal-human interface, public policy, prevention and zoonoses. We will screen titles and abstracts and extract data according to published guidelines for scoping reviews. All evaluations of public policies aiming to prevent zoonotic spillover events will be eligible for inclusion. We will summarise key data from each study, mapping policies along the spillover pathway and outlining the range of policies, approaches to evaluation and outcome measures. Review findings will provide a useful reference for researchers and practitioners, outlining the state of the evaluative evidence around policies to prevent zoonotic spillover. ETHICS AND DISSEMINATION Formal ethical approval is not required, because the study does not involve primary data collection. The findings of this study will be disseminated through a peer-reviewed publication, presentations and summaries for key stakeholders.
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Affiliation(s)
- Chloe Clifford Astbury
- School of Global Health, York University, Toronto, Ontario, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, Ontario, Canada
| | - Kirsten M Lee
- School of Global Health, York University, Toronto, Ontario, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, Ontario, Canada
| | - Raphael Aguiar
- Dahdaleh Institute for Global Health Research, York University, Toronto, Ontario, Canada
| | - Asma Atique
- School of Global Health, York University, Toronto, Ontario, Canada
| | | | - Janielle Clarke
- School of Global Health, York University, Toronto, Ontario, Canada
| | | | | | | | - A M Viens
- School of Global Health, York University, Toronto, Ontario, Canada
| | - M Wiktorowicz
- School of Global Health, York University, Toronto, Ontario, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, Ontario, Canada
| | - Amy Yau
- London School of Hygiene & Tropical Medicine, London, UK
| | - Tarra L Penney
- School of Global Health, York University, Toronto, Ontario, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, Ontario, Canada
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8
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Juneau CE, Pueyo T, Bell M, Gee G, Collazzo P, Potvin L. Lessons from past pandemics: a systematic review of evidence-based, cost-effective interventions to suppress COVID-19. Syst Rev 2022; 11:90. [PMID: 35550674 PMCID: PMC9096744 DOI: 10.1186/s13643-022-01958-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/11/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In an unparalleled global response, during the COVID-19 pandemic, 90 countries asked 3.9 billion people to stay home. Yet other countries avoided lockdowns and focused on other strategies, like contact tracing. How effective and cost-effective are these strategies? We aimed to provide a comprehensive summary of the evidence on past pandemic controls, with a focus on cost-effectiveness. METHODS Following PRISMA guidelines, MEDLINE (1946 to April week 2, 2020) and EMBASE (1974 to April 17, 2020) were searched using a range of terms related to pandemic control. Articles reporting on the effectiveness or cost-effectiveness of at least one intervention were included. RESULTS We found 1653 papers; 62 were included. The effectiveness of hand-washing and face masks was supported by randomized trials. These measures were highly cost-effective. For other interventions, only observational and modelling studies were found. They suggested that (1) the most cost-effective interventions are swift contact tracing and case isolation, surveillance networks, protective equipment for healthcare workers, and early vaccination (when available); (2) home quarantines and stockpiling antivirals are less cost-effective; (3) social distancing measures like workplace and school closures are effective but costly, making them the least cost-effective options; (4) combinations are more cost-effective than single interventions; and (5) interventions are more cost-effective when adopted early. For 2009 H1N1 influenza, contact tracing was estimated to be 4363 times more cost-effective than school closure ($2260 vs. $9,860,000 per death prevented). CONCLUSIONS AND CONTRIBUTIONS For COVID-19, a cautious interpretation suggests that (1) workplace and school closures are effective but costly, especially when adopted late, and (2) scaling up as early as possible a combination of interventions that includes hand-washing, face masks, ample protective equipment for healthcare workers, and swift contact tracing and case isolation is likely to be the most cost-effective strategy.
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Affiliation(s)
- Carl-Etienne Juneau
- Direction Régionale de Santé Publique, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | | | - Matt Bell
- COVID-19 Work Group, Washington, D.C., USA
| | | | - Pablo Collazzo
- Danube University, Dr. Karl Dorrek Straße 30, 3500, Krems, Austria.
| | - Louise Potvin
- École de Santé Publique, Université de Montréal, C.P. 6128, Succursale Centre-ville, Montréal, QC, H3C 3J7, Canada
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9
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Zhao H, Jatana S, Bartoszko J, Loeb M. Nonpharmaceutical interventions to prevent viral respiratory infection in community settings: an umbrella review. ERJ Open Res 2022; 8:00650-2021. [PMID: 35651370 PMCID: PMC9149389 DOI: 10.1183/23120541.00650-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
BackgroundRespiratory viruses pose an important public health threat to most communities. Nonpharmaceutical interventions (NPIs) such as masks, hand hygiene or physical distancing, among others, are believed to play an important role in reducing transmission of respiratory viruses. In this umbrella review, we summarise the evidence of the effectiveness of NPIs for the prevention of respiratory virus transmission in the community setting.ObservationsA systematic search of PubMed, Embase, Medline and Cochrane reviews resulted in a total of 24 studies consisting of 11 systematic reviews and meta-analyses, 12 systematic reviews without meta-analyses and one standalone meta-analysis. The current evidence from these data suggests that hand hygiene is protective against respiratory viral infection. The use of hand hygiene and facemasks, facemasks alone and physical distancing were interventions with inconsistent evidence. Interventions such as school closures, oral hygiene or nasal saline rinses were shown to be effective in reducing the risk of influenza; however, the evidence is sparse and mostly of low and critically low quality.ConclusionsStudies on the effectiveness of NPIs for the prevention of respiratory viral transmission in the community vary in study design, quality and reported effectiveness. Evidence for the use of hand hygiene or facemasks is the strongest; therefore, the most reasonable suggestion is to use hand hygiene and facemasks in the community setting.
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10
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Youssef D, Berry A, Youssef J, Abou-Abbas L. Vaccination against influenza among Lebanese health care workers in the era of coronavirus disease 2019. BMC Public Health 2022; 22:120. [PMID: 35039009 PMCID: PMC8763426 DOI: 10.1186/s12889-022-12501-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022] Open
Abstract
Background Health-care workers (HCWs) are at a higher occupational risk of contracting and transmitting influenza. Annual vaccination is an essential tool to prevent seasonal influenza infection. However, HCWs vaccine hesitancy remains a leading global health threat. This study aims to evaluate the flu vaccination coverage rates among Lebanese HCWs and to assess their knowledge, attitudes, practices, perceived barriers, and benefits toward the flu vaccine during the COVID-19 pandemic. In addition, we sought to identify the factors associated with flu vaccine uptake. Methods A cross-sectional study using an online survey was conducted in Lebanon among HCWs between 14 and 28 October 2020. Multivariable logistic regression was carried out to identify the factors associated with influenza vaccine uptake. Results A total of 560 HCWs participated in the survey of whom 72.9% were females, and 53.9% were aged between 30-49 years. Regarding Flu vaccination uptake, the rate has risen from 32.1% in 2019-2020 to 80.2% in 2020-2021 flu season. The majority of HCWs had a good knowledge level and a positive attitude toward flu vaccination. Regarding their practices, less than 50% of HCW were currently promoting the importance of getting the flu vaccine. The majority (83.3%) ranked the availability of a sufficient quantity of vaccines as the most significant barrier to flu vaccination. The main perceived flu vaccination benefits were enhancing patient safety, minimizing the viral reservoir in the population, decreasing hospital admission, and avoiding influenza and COVID-19 co-infection. The odds of influenza vaccine uptake was lower in unmarried compared to married HCWs (OR = 0.527, CI (0.284-0.978). However, HCWs having received the influenza vaccine in the previous season (OR = 6.812, CI (3.045-15.239)), those with good knowledge level (OR = 3.305, CI (1.155-9.457)), low perceived barriers (OR = 4.130, CI (1.827-9.334)) and high perceived level of the benefits (OR = 6.264, CI (2.919-13.442)) of the flu vaccination were found more prone to get the flu vaccine. Conclusion Flu vaccination uptake has increased among HCWs during the 2020-2021 flu season compared with the previous one. Continuing education as well as ensuring free, equitable, and convenient access to vaccination are still required to increase the annual flu vaccination uptake among HCWs.
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Affiliation(s)
- Dalal Youssef
- Ministry of Public Health, Lebanon, Preventive Medicine Department, Ministry of Public Health, Beirut, Lebanon. .,Institut de santé publique d'épidémiologie et de développement (ISPED), Bordeaux University, France, Bordeaux, France.
| | - Atika Berry
- Ministry of Public Health, Lebanon, Preventive Medicine Department, Ministry of Public Health, Beirut, Lebanon
| | - Janet Youssef
- Al Zahraa hospital University Medical Center, Beirut, Lebanon
| | - Linda Abou-Abbas
- Neuroscience Research Center, Faculty of medical sciences, Lebanese University, Beirut, Lebanon
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11
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Ofori SK, Hung YW, Schwind JS, Diallo K, Babatunde D, Nwaobi SO, Hua X, Sullivan KL, Cowling BJ, Chowell G, Fung ICH. Economic evaluations of interventions against influenza at workplaces: systematic review. Occup Med (Lond) 2021; 72:70-80. [PMID: 34931675 DOI: 10.1093/occmed/kqab163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The burden of influenza is mostly felt by employees and employers because of increased absenteeism rates, loss of productivity and associated direct costs. Even though interventions against influenza among working adults are effective, patronage and compliance to these measures especially vaccination are low compared to other risk groups. AIMS This study was aimed to assess evidence of economic evaluations of interventions against influenza virus infection among workers or in the workplace setting. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline for systematic reviews was followed. Three databases, PubMed, Web of Science and EconLit, were searched using keywords to identify relevant articles from inception till 25 October 2020. Original peer-reviewed papers that conducted economic evaluations of influenza interventions using cost-benefit, cost-effectiveness or cost-utility analysis methods focused on working-age adults or work settings were eligible for inclusion. Two independent teams of co-authors extracted and synthesized data from identified studies. RESULTS Twenty-four articles were included: 21 were cost-benefit analyses and 3 examined cost-effectiveness analyses. Two papers also presented additional cost-utility analysis. Most of the studies were pharmaceutical interventions (n = 23) primarily focused on vaccination programs while one study was a non-pharmaceutical intervention examining the benefit of paid sick leave. All but two studies reported that interventions against influenza virus infection at the workplace were cost-saving and cost-effective regardless of the analytic approach. CONCLUSIONS Further cost-effectiveness research in non-pharmaceutical interventions against influenza in workplace settings is warranted. There is a need to develop standardized methods for reporting economic evaluation methods to ensure comparability and applicability of future research findings.
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Affiliation(s)
- S K Ofori
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Y W Hung
- Salient Advisory, Toronto, Ontario, Canada
| | - J S Schwind
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - K Diallo
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - D Babatunde
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - S O Nwaobi
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - X Hua
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - K L Sullivan
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - B J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - G Chowell
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - I C H Fung
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
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12
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Shimizu S, Ishimaru T, Nagata M, Hino A, Tateishi S, Tsuji M, Ogami A, Matsuda S, Fujino Y. Effectiveness of Infection Preventive Behaviors on COVID-19-Like Illness Symptoms During the Winter Third Wave of the Epidemic in Japan: A 2-Month Follow-up Nationwide Cohort Study. Asia Pac J Public Health 2021; 34:191-198. [PMID: 34894762 DOI: 10.1177/10105395211064437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although multilayered strategies including preventive behaviors should be adopted to mitigate coronavirus disease 2019 (COVID-19) transmission, evidence on the effectiveness of preventive behaviors against COVID-19 remains limited. This Internet-based prospective cohort study collected baseline data in November 2020 and follow-up data in February 2021, during the third wave of the epidemic in Japan. Among the 19 941 included participants, the percentages reporting that they always used a face mask, practiced hand washing/disinfection, gargling, and ensuring proper room ventilation were 85.4%, 36.0%, 51.1%, and 44.6%, respectively. Multiple logistic regression analyses revealed that less frequently practicing hand washing/disinfection (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.10-1.32), gargling (OR = 1.20, 95% CI: 1.10-1.30), and ensuring proper room ventilation (OR = 1.38, 95% CI: 1.26-1.52) were significantly associated with self-reported COVID-19-like illness (CLI). These results suggest that personal preventive behaviors may be effective in reducing CLI, even when universal masking is practiced.
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Affiliation(s)
- Shoichi Shimizu
- Department of Immunology and Parasitology, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tomohiro Ishimaru
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Masako Nagata
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Ayako Hino
- Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Seiichiro Tateishi
- Department of Occupational Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Mayumi Tsuji
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Akira Ogami
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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13
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Rivers JK, Arlette JP, DeKoven J, Guenther LC, Muhn C, Richer V, Rosen N, Tremblay JF, Wiseman MC, Zip C, Zloty D. Skin care and hygiene among healthcare professionals during and after the SARS-CoV-2 pandemic. SAGE Open Med 2021; 9:20503121211062795. [PMID: 34917384 PMCID: PMC8669117 DOI: 10.1177/20503121211062795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic has necessitated enhanced protection against viral transmission among healthcare professionals, particularly relating to handwashing and personal protective equipment. Some of these requirements may persist for years to come. They bring associated concerns around skin hygiene and general care, with damage to the face and hands now a well-documented consequence among healthcare professionals. This review assesses optimal skin care during the severe acute respiratory syndrome coronavirus 2 pandemic and in the "new normal" that will follow, identifies current knowledge gaps, and provides practical advice for the clinical setting. Regular, systematic hand cleaning with soap and water or an alcohol-based hand rub (containing 60%-90% ethanol or isopropyl alcohol) remains essential, although the optimal quantity and duration is unclear. Gloves are a useful additional barrier; further studies are needed on preferred materials. Moisturization is typically helpful and has proven benefits in mitigating damage from frequent handwashing. It may be best practiced using an alcohol-based hand rub with added moisturizer and could be particularly important among individuals with pre-existing hand dermatoses, such as psoriasis and eczema. Face moisturization immediately prior to donning a mask, and the use of dressings under the mask to reduce friction, can be helpful dermatologically, but more work is required to prove that these actions do not affect seal integrity. Nonetheless, such measures could play a role in institutional plans for mitigating the dermatologic impact of transmission control measures as we exit the pandemic.
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Affiliation(s)
- Jason K Rivers
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- Pacific Derm, Vancouver, BC, Canada
| | - John P Arlette
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joel DeKoven
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lyn C Guenther
- Division of Dermatology, Western University, London, ON, Canada
- Guenther Research Inc., London, ON, Canada
| | - Channy Muhn
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Dermetics, Burlington, ON, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- Pacific Derm, Vancouver, BC, Canada
| | | | | | - Marni C Wiseman
- Section of Dermatology, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Skinwise Dermatology, Winnipeg, MB, Canada
| | | | - David Zloty
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
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14
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Hamerman EJ, Aggarwal A, Poupis LM. Generalized self-efficacy and compliance with health behaviours related to COVID-19 in the US. Psychol Health 2021:1-18. [PMID: 34747676 DOI: 10.1080/08870446.2021.1994969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Investigate the role of generalized self-efficacy (GSE) in compliance with COVID-19 health behaviours such as wearing masks and social distancing. DESIGN Two studies conducted online in the US: 312 adults in Study 1 and 253 adults in Study 2. MAIN OUTCOME MEASURES In Study 1, participants reported compliance with four health behaviours related to COVID-19: social distancing, hand washing, avoiding non-essential travel, and wearing masks. In Study 2, participants reported expected compliance with wearing masks when it was framed as a national requirement, a state requirement, or a recommendation. RESULTS In Study 1, GSE positively affected reported compliance with COVID-19 health behaviours. This result was mediated by the perception that these behaviours would offer enhanced control. Psychological reactance negatively affected reported compliance, while trust in science-based institutions and perceived threat from COVID-19 exerted positive effects. In Study 2, requiring (vs. recommending) masks led to higher willingness to comply with COVID-19 health behaviours. This was moderated by GSE, which significantly impacted compliance only when masks were required rather than recommended. CONCLUSION Higher GSE predicted increased compliance with health behaviours related to COVID-19, such as wearing masks. This effect was strongest when these behaviours were framed as required rather than recommended.
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Affiliation(s)
- Eric J Hamerman
- LaPenta School of Business, Iona College, New Rochelle, NY, USA
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15
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Wong EY, Schachter A, Collins HN, Song L, Ta ML, Dawadi S, Neal S, Pajimula FF, Colombara DV, Johnson K, Laurent AA. Cross-Sector Monitoring and Evaluation Framework: Social, Economic, and Health Conditions Impacted During the COVID-19 Pandemic. Am J Public Health 2021; 111:S215-S223. [PMID: 34709876 DOI: 10.2105/ajph.2021.306422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Public Health 3.0 approaches are critical for monitoring disparities in economic, social, and overall health impacts following the COVID-19 pandemic and its associated policy changes to slow community spread. Timely, cross-sector data as identified using this approach help decisionmakers identify changes, track racial disparities, and address unintended consequences during a pandemic. We applied a monitoring and evaluation framework that combined policy changes with timely, relevant cross-sector data and community review. Indicators covered unemployment, basic needs, family violence, education, childcare, access to health care, and mental, physical, and behavioral health. In response to increasing COVID-19 cases, nonpharmaceutical intervention strategies were implemented in March 2020 in King County, Washington. By December 2020, 554 000 unemployment claims were filed. Social service calls increased 100%, behavioral health crisis calls increased 25%, and domestic violence calls increased 25%, with disproportionate impact on communities of color. This framework can be replicated by local jurisdictions to inform and address racial inequities in ongoing COVID-19 mitigation and recovery. Cross-sector collaboration between public health and sectors addressing the social determinants of health are an essential first step to have an impact on long-standing racial inequities. (Am J Public Health. 2021;111(S3):S215-S223. https://doi.org/10.2105/AJPH.2021.306422).
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Affiliation(s)
- Eva Y Wong
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Abigail Schachter
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Hannah N Collins
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Lin Song
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Myduc L Ta
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Shuva Dawadi
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Scott Neal
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Fel F Pajimula
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Danny V Colombara
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Kristen Johnson
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Amy A Laurent
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
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16
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Amuakwa-Mensah F, Klege RA, Adom PK, Köhlin G. COVID-19 and handwashing: Implications for water use in Sub-Saharan Africa. WATER RESOURCES AND ECONOMICS 2021; 36:100189. [PMID: 34745865 PMCID: PMC8563594 DOI: 10.1016/j.wre.2021.100189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/27/2021] [Accepted: 10/28/2021] [Indexed: 05/21/2023]
Abstract
Because the main modes of transmission of the COVID-19 virus are respiration and contact, WHO recommends frequent washing of hands with soap under running water for at least 20 s. This article investigates how the level of concern about COVID-19 affects the likelihood of washing hands frequently in sub-Saharan Africa. We discuss the implication of the findings for water-scarce environment. The study makes use of a unique survey dataset from 12 sub-Saharan African countries collected in April 2020 (first round) and May 2020 (second round) and employs an extended ordered probit model with endogenous covariate. The results show that the level of concern about the spread of the virus increases the likelihood of washing hands with soap under running water for a minimum of 20 s at least five times a day. The increase in the probability of handwashing due to concern about COVID-19, ranges from 3% for Benin to 6.3% for South Africa. The results also show heterogeneous effects across gender- and age-groups, locality and various water sources. However, in Africa, the sustainability of the handwashing protocol could be threatened by the severe water scarcity that exists in the region. To sustain frequent handwashing, sub-Saharan Africa needs an effective strategy for water management and supply.
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Affiliation(s)
- Franklin Amuakwa-Mensah
- Environment for Development, University of Gothenburg, Box 645, SE 405 30, Göteborg, Sweden
- Department of Business Administration, Technology and Social Sciences, Luleå University of Technology, 971 87, Luleå, Sweden
| | - Rebecca Afua Klege
- School of Economics, University of Cape Town, Private Bag, Rondebosch, 7701, Cape Town, South Africa
- Henry J Austin Health Center, 321 N. Warren Street, Trenton, 08618, New Jersey, USA
| | - Philip Kofi Adom
- Department of Development Policy School of Public Service, Governance Ghana Institute of Management and Public Administration GIMPA, Ghana
| | - Gunnar Köhlin
- Environment for Development, University of Gothenburg, Box 645, SE 405 30, Göteborg, Sweden
- School of Economics, University of Cape Town, Private Bag, Rondebosch, 7701, Cape Town, South Africa
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17
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Umeda M, Tominaga T, Kozuma K, Kitazawa H, Furushima D, Hibi M, Yamada H. Preventive effects of tea and tea catechins against influenza and acute upper respiratory tract infections: a systematic review and meta-analysis. Eur J Nutr 2021; 60:4189-4202. [PMID: 34550452 PMCID: PMC8456193 DOI: 10.1007/s00394-021-02681-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/11/2021] [Indexed: 01/21/2023]
Abstract
Purpose Gargling with tea has protective effects against influenza infection and upper respiratory tract infection (URTI). To evaluate if tea and tea catechin consumption has the same protective effects as gargling with tea, we performed a systematic review and meta-analysis. Methods We performed a comprehensive literature search using the PubMed, Cochrane Library, Web of Science, and Ichu-shi Web databases. The search provided six randomized controlled trials (RCTs) and four prospective cohort studies (n = 3748). The quality of each trial or study was evaluated according to the Cochrane risk-of-bias tool or Newcastle–Ottawa Scale. We collected data from publications meeting the search criteria and conducted a meta-analysis of the effect of tea gargling and tea catechin consumption for preventing URTI using a random effects model. Results Tea gargling and tea catechin consumption had significant preventive effects against URTI (risk ratio [RR] = 0.74, 95% confidence interval [CI] 0.64–0.87). In sub-analyses, a significant preventive effect was observed by study type (prospective cohort study: RR = 0.67, 95% CI 0.50–0.91; RCT: RR = 0.79, 95% CI 0.66–0.94) and disease type (influenza: RR = 0.69, 95% CI 0.58–0.84; acute URTI: RR = 0.78, 95% CI 0.62–0.98). Both gargling with tea and consuming tea catechins effectively protected against URTI (tea and tea catechins consumption: RR = 0.68, 95% CI 0.52–0.87; tea gargling: RR = 0.83, 95% CI 0.72–0.96). Conclusion Our findings suggest that tea gargling and tea catechin consumption may have preventive effects against influenza infection and URTI. The potential effectiveness of these actions as non-pharmaceutical interventions, however, requires further investigation.
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Affiliation(s)
- Mai Umeda
- Biological Science Research Laboratories, Kao Corporation, 2-1-3 Bunka, Sumida-ku, Tokyo, 131-8501, Japan.
| | - Takeichiro Tominaga
- Department of Drug Evaluation and Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, 422-8526, Japan
| | - Kazuya Kozuma
- Health and Wellness Products Research Laboratories, Kao Corporation, 2-1-3 Bunka, Sumida-ku, Tokyo, 131-8501, Japan
| | - Hidefumi Kitazawa
- Biological Science Research Laboratories, Kao Corporation, 2-1-3 Bunka, Sumida-ku, Tokyo, 131-8501, Japan
| | - Daisuke Furushima
- Department of Drug Evaluation and Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, 422-8526, Japan
| | - Masanobu Hibi
- Biological Science Research Laboratories, Kao Corporation, 2-1-3 Bunka, Sumida-ku, Tokyo, 131-8501, Japan
| | - Hiroshi Yamada
- Department of Drug Evaluation and Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, 422-8526, Japan
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18
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van Leeuwen E, Sandmann F. Augmenting contact matrices with time-use data for fine-grained intervention modelling of disease dynamics: A modelling analysis. Stat Methods Med Res 2021; 31:1704-1715. [PMID: 34468236 DOI: 10.1177/09622802211037078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Social distancing is an important public health intervention to reduce or interrupt the sustained community transmission of emerging infectious pathogens, such as severe acute respiratory syndrome-coronavirus-2 during the coronavirus disease 2019 pandemic. Contact matrices are typically used when evaluating such public health interventions to account for the heterogeneity in social mixing of individuals, but the surveys used to obtain the number of contacts often lack detailed information on the time individuals spend on daily activities. The present work addresses this problem by combining the large-scale empirical data of a social contact survey and a time-use survey to estimate contact matrices by age group (0--15, 16--24, 25-44, 45-64, 65+ years) and daily activity (work, schooling, transportation, and four leisure activities: social visits, bar/cafe/restaurant visits, park visits, and non-essential shopping). This augmentation allows exploring the impact of fewer contacts when individuals reduce the time they spend on selected daily activities as well as when lifting such restrictions again. For illustration, the derived matrices were then applied to an age-structured dynamic-transmission model of coronavirus disease 2019. Findings show how contact matrices can be successfully augmented with time-use data to inform the relative reductions in contacts by activity, which allows for more fine-grained mixing patterns and infectious disease modelling.
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Affiliation(s)
- Edwin van Leeuwen
- Statistics, Modelling and Economics Department, 371011Public Health England, UK
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- Statistics, Modelling and Economics Department, 371011Public Health England, UK
| | - Frank Sandmann
- Statistics, Modelling and Economics Department, 371011Public Health England, UK.,Department of Infectious Disease Epidemiology, 4906London School of Hygiene and Tropical Medicine, UK
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19
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Enria D, Feng Z, Fretheim A, Ihekweazu C, Ottersen T, Schuchat A, Ungchusak K, Briand S, Haldane V, Lamichhane J, Ludolph R, Mathis M, Nguyen T, Shindo N. Strengthening the evidence base for decisions on public health and social measures. Bull World Health Organ 2021; 99:610-610A. [PMID: 34475594 PMCID: PMC8381089 DOI: 10.2471/blt.21.287054] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Delia Enria
- Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui, Pergamino, Argentina
| | - Zijian Feng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | | | | | | | | | | | - Sylvie Briand
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Victoria Haldane
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Jaya Lamichhane
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ramona Ludolph
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Margaux Mathis
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Tim Nguyen
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Nahoko Shindo
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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20
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Geng Y, Li G, Zhang L. The Impact of COVID-19 Interventions on Influenza and Mycobacterium Tuberculosis Infection. Front Public Health 2021; 9:672568. [PMID: 34095074 PMCID: PMC8175651 DOI: 10.3389/fpubh.2021.672568] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/27/2021] [Indexed: 12/26/2022] Open
Abstract
A series of public health interventions have been implemented to prevent the transmission of SARS-CoV-2 in China. However, the effect of non-pharmaceutical interventions to COVID-19 on the incidence of the influenza virus and Mycobacterium tuberculosis infections is not clear. In current study, we analyzed surveillance data on influenza and Mycobacterium tuberculosis from Henan Provincial People’s Hospital in Zhengzhou, Henan province, China from 2019 to 2020. The monthly positive test rate for influenza and Mycobacterium tuberculosis to estimate transmissibility changes was calculated. The positive detection rate of influenza A declined significantly during the implementation of inventions in 2020, from a total positive rate of 17.69% in 2019 to 5.77% in 2020. Similarly, a 2.15% reduction in positive detective rate was seen for influenza B, from a total positive rate of 5.15% in 2019 to 3% in 2020. The positive rate curve of Mycobacterium tuberculosis measured by x-pert in 2020 remained above the curve in 2019 from March to June, and August, showing the rising trend under these precautions. Our study suggests that non-pharmaceutical public health interventions likely reduced influenza transmission significantly and have less effect on Mycobacterium tuberculosis transmission in 2020.
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Affiliation(s)
- Yiman Geng
- Department of Clinical Laboratory, Henan Provincial People's Hospital, Peolple's Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Li
- Department of Clinical Laboratory, Henan Provincial People's Hospital, Peolple's Hospital of Zhengzhou University, Zhengzhou, China
| | - Leiliang Zhang
- Institute of Basic Medicine, The First Affiliated Hospital of Shandong First Medical University, Shandong, China.,Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Shandong, China
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21
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Yuen E, Fried J, Salvador C, Gudis DA, Schlosser RJ, Nguyen SA, Brennan EA, Rowan NR. Nonpharmacological interventions to reduce respiratory viral transmission: an evidence-based review with recommendations. Rhinology 2021; 59:114-132. [PMID: 33760909 DOI: 10.4193/rhin20.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Viral respiratory infections are a leading cause of worldwide mortality and exert the potential to cause global socioeconomic crises. However, inexpensive, efficacious, and rapidly deployable strategies to reduce viral transmission are increasingly important in the setting of an ongoing pandemic, though not entirely understood. This article provides a comprehensive review of commonly employed nonpharmacological interventions to interrupt viral spread and provides evidence-based recommendations for their use. METHODOLOGY A systematic review of three databases was performed. Studies with defined endpoints of subjects receiving one of five interventions (nasal washing, gargling, personal protective equipment (PPE), social distancing, and hand hygiene) were included. An evidence-based review of the highest level of evidence, with recommendations, was created in accordance with a previously described, rigorous, iterative process. RESULTS Fifty-four primary studies were included. The most commonly studied intervention was hand hygiene, followed by PPE, gargling, saline nasal washing, and social distancing. CONCLUSIONS Mask use and hand hygiene are strong recommendations for prevention of viral transmission. Donning gloves, gowns, and eye protection are a recommendation in healthcare settings. Saline nasal washing and gargling are options in selected populations. Although an aggregate level of evidence is not provided, the authors recommend social distancing.
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Affiliation(s)
- E Yuen
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - J Fried
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - C Salvador
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - D A Gudis
- Columbia University Irving Medical Centre, Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
| | - R J Schlosser
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - S A Nguyen
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - E A Brennan
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - N R Rowan
- The Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, USA
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22
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Affiliation(s)
- Evgeni Magid
- Intelligent Robotics Department, Institute of Information Technologies and Intelligent Systems, Kazan Federal University, Kazan, Russian Federation
| | - Aufar Zakiev
- Intelligent Robotics Department, Institute of Information Technologies and Intelligent Systems, Kazan Federal University, Kazan, Russian Federation
| | - Tatyana Tsoy
- Intelligent Robotics Department, Institute of Information Technologies and Intelligent Systems, Kazan Federal University, Kazan, Russian Federation
| | - Roman Lavrenov
- Intelligent Robotics Department, Institute of Information Technologies and Intelligent Systems, Kazan Federal University, Kazan, Russian Federation
| | - Albert Rizvanov
- Clinical Research Center for Precision and Regenerative Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russian Federation
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23
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Abstract
INTRODUCTION The effect of non pharmacological interventions (NPIs) during an epidemic disease outbreak is well accepted dating back to historical events. NPIs involve numerous measurements like hygiene rules or contact restriction that are applied during given situations, while so far only limited quantitative data exist to rate the overall effectiveness. METHODS Using the official counts of Robert Koch Institute in Berlin/Germany, press reports and Twitter messages, the early phase of the current COVID-19/Sars-CoV2 in Bavaria is being reconstructed. RESULTS The first cases have been observed in Munich by the end of January 2020. While the initial outbreak could be sufficiently covered using isolation and quarantine measurements, the consecutive early spreading falls into three phases, starting with winter school holidays at the end of February, a number of beer festivals in the following week, and general elections on March, 15. The disaster plan on March, 16 indicates the end of the early phase. Using the official case counts, a rather coherent picture evolves although representative epidemiological studies are still missing. The epidemic started with a few cases during the winter holidays, increased exponentially afterwards including significant more cases by beer festivals and another significant excess of cases following the election that occurred in Bavaria only. Compared to other German countries, Bavaria reached the highest prevalence which could not be reversed by even the most restrictive containment measurements. CONCLUSION To be effective, NPIs need to applied early, if possible even before the beginning of the exponential phase.
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Affiliation(s)
- Matthias Wjst
- Institut für Lungenbiologie (iLBD), Helmholtz-Zentrum München, German Research Center for Environmental Health (GmbH), München-Neuherberg
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Klinikum rechts der Isar, München
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24
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Cascini F, Hoxhaj I, Zaçe D, Ferranti M, Di Pietro ML, Boccia S, Ricciardi W. How health systems approached respiratory viral pandemics over time: a systematic review. BMJ Glob Health 2020; 5:e003677. [PMID: 33380411 PMCID: PMC7780537 DOI: 10.1136/bmjgh-2020-003677] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Several healthcare systems facing respiratory viral infections outbreaks, like COVID-19, have not been prepared to manage them. Public health mitigation solutions ranging from isolation of infected or suspected cases to implementation of national lockdowns have proven their effectiveness for the outbreak's control. However, the adjustment of public health measures is crucial during transition phases to avoid new outbreaks. To address the need for designing evidence-based strategies, we performed a systematic review to identify healthcare systems interventions, experiences and recommendations that have been used to manage different respiratory viral infections outbreaks in the past. METHODS PubMed, Web of Science, Scopus and Cochrane were searched to retrieve eligible studies of any study design, published in English until 17 April 2020. Double-blinded screening process was conducted by titles/abstracts and subsequently eligible full texts were read and pertinent data were extracted. When applicable, quality assessment was conducted for the included articles. We performed a narrative synthesis of each implemented public health approaches. RESULTS We included a total of 24 articles addressing the public health approaches implemented for respiratory viral infections outbreaks for COVID-19, influenza A H1N1, MERS and severe acute respiratory syndrome . The identified approaches are ascribable to two main categories: healthcare system strategies and healthcare provider interventions. The key components of an effective response on respiratory viral outbreaks included the implementation of evidence-based contextual policies, intrahospital management actions, community healthcare facilities, non-pharmaceutical interventions, enhanced surveillance, workplace preventive measures, mental health interventions and communication plans. CONCLUSION The identified healthcare system strategies applied worldwide to face epidemics or pandemics are a useful knowledge base to inform decision-makers about control measures to be used in the transition phases of COVID-19 and beyond.
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Affiliation(s)
- Fidelia Cascini
- Public Health Section, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Ilda Hoxhaj
- Public Health Section, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Drieda Zaçe
- Public Health Section, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Margherita Ferranti
- Public Health Section, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Maria Luisa Di Pietro
- Public Health Section, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Stefania Boccia
- Public Health Section, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Walter Ricciardi
- Public Health Section, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
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25
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Alfelali M, Haworth EA, Barasheed O, Badahdah AM, Bokhary H, Tashani M, Azeem MI, Kok J, Taylor J, Barnes EH, El Bashir H, Khandaker G, Holmes EC, Dwyer DE, Heron LG, Wilson GJ, Booy R, Rashid H. Facemask against viral respiratory infections among Hajj pilgrims: A challenging cluster-randomized trial. PLoS One 2020; 15:e0240287. [PMID: 33048964 PMCID: PMC7553311 DOI: 10.1371/journal.pone.0240287] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022] Open
Abstract
Background In this large-scale cluster-randomized controlled trial (cRCT) we sought to assess the effectiveness of facemasks against viral respiratory infections. Methods and results Over three consecutive Hajj seasons (2013, 2014, 2015) pilgrims’ tents in Makkah were allocated to ‘facemask’ or ‘no facemask’ group. Fifty facemasks were offered to participants in intervention tents, to be worn over four days, and none were offered to participants in control tents. All participants recorded facemask use and respiratory symptoms in health diaries. Nasal swabs were collected from the symptomatic for virus detection by reverse transcription polymerase chain reaction. Clinical symptoms and laboratory results were analyzed by ‘intention- to-treat’ and ‘per-protocol’. A total of 7687 adult participants from 318 tents were randomized: 3864 from 149 tents to the intervention group, and 3823 from 169 tents to the control group. Participants were aged 18 to 95 (median 34, mean 37) years, with a male to female ratio of 1:1.2. Overall, respiratory viruses were detected in 277 of 650 (43%) nasal/pharyngeal swabs collected from symptomatic pilgrims. Common viruses were rhinovirus (35.1%), influenza (4.5%) and parainfluenza (1.7%). In the intervention arm, respectively 954 (24.7%) and 1842 (47.7%) participants used facemasks daily and intermittently, while in the control arm, respectively 546 (14.3%) and 1334 (34.9%) used facemasks daily and intermittently. By intention-to-treat analysis, facemask use did not seem to be effective against laboratory-confirmed viral respiratory infections (odds ratio [OR], 1.4; 95% confidence interval [CI], 0.9 to 2.1, p = 0.18) nor against clinical respiratory infection (OR, 1.1; 95% CI, 0.9 to 1.4, p = 0.40). Similarly, in a per-protocol analysis, facemask use did not seem to be effective against laboratory-confirmed viral respiratory infections (OR 1.2, 95% CI 0.9–1.7, p = 0.26) nor against clinical respiratory infection (OR 1.3, 95% CI 1.0–1.8, p = 0.06). Conclusion This trial was unable to provide conclusive evidence on facemask efficacy against viral respiratory infections most likely due to poor adherence to protocol.
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Affiliation(s)
- Mohammad Alfelali
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Osamah Barasheed
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
- Research Center, King Abdullah Medical City, Mecca, Saudi Arabia
| | - Al-Mamoon Badahdah
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hamid Bokhary
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life & Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Umm Al-Qura University, Mecca, Saudi Arabia
| | - Mohamed Tashani
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, The University of Tripoli, Ain Zara, Tripoli, Libya
| | - Mohammad I. Azeem
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
| | - Jen Kok
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life & Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
- NSW Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Janette Taylor
- NSW Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth H. Barnes
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Haitham El Bashir
- Rehabilitation Department, Al Jalila Children Specialty Hospital, Dubai, United Arab Emirates
| | - Gulam Khandaker
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Edward C. Holmes
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life & Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Dominic E. Dwyer
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life & Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
- NSW Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Leon G. Heron
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
| | - Godwin J. Wilson
- Department of Laboratory Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life & Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life & Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
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26
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Hamilton K, Smith SR, Keech JJ, Moyers SA, Hagger MS. Application of the Health Action Process Approach to Social Distancing Behavior During COVID-19. Appl Psychol Health Well Being 2020; 12:1244-1269. [PMID: 33006814 PMCID: PMC7537318 DOI: 10.1111/aphw.12231] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/15/2020] [Accepted: 08/22/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study examined the social cognition determinants of social distancing behavior during the COVID-19 pandemic in samples from Australia and the US guided by the health action process approach (HAPA). METHODS Participants (Australia: N = 495, 50.1% women; US: N = 701, 48.9% women) completed HAPA social cognition constructs at an initial time-point (T1), and one week later (T2) self-reported their social distancing behavior. RESULTS Single-indicator structural equation models that excluded and included past behavior exhibited adequate fit with the data. Intention and action control were significant predictors of social distancing behavior in both samples, and intention predicted action and coping planning in the US sample. Self-efficacy and action control were significant predictors of intention in both samples, with attitudes predicting intention in the Australia sample and risk perceptions predicting intention in the US sample. Significant indirect effects of social cognition constructs through intentions were observed. Inclusion of past behavior attenuated model effects. Multigroup analysis revealed no differences in model fit across samples, suggesting that observed variations in the parameter estimates were relatively trivial. CONCLUSION Results indicate that social distancing is a function of motivational and volitional processes. This knowledge can be used to inform messaging regarding social distancing during COVID-19 and in future pandemics.
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Affiliation(s)
| | | | - Jacob J Keech
- Griffith University, Australia.,University of the Sunshine Coast, Australia
| | | | - Martin S Hagger
- University of California, Merced, USA.,University of Jyväskylä, Finland
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27
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Asadi S, Cappa CD, Barreda S, Wexler AS, Bouvier NM, Ristenpart WD. Efficacy of masks and face coverings in controlling outward aerosol particle emission from expiratory activities. Sci Rep 2020. [PMID: 32973285 DOI: 10.1038/s414598-020-72798-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
The COVID-19 pandemic triggered a surge in demand for facemasks to protect against disease transmission. In response to shortages, many public health authorities have recommended homemade masks as acceptable alternatives to surgical masks and N95 respirators. Although mask wearing is intended, in part, to protect others from exhaled, virus-containing particles, few studies have examined particle emission by mask-wearers into the surrounding air. Here, we measured outward emissions of micron-scale aerosol particles by healthy humans performing various expiratory activities while wearing different types of medical-grade or homemade masks. Both surgical masks and unvented KN95 respirators, even without fit-testing, reduce the outward particle emission rates by 90% and 74% on average during speaking and coughing, respectively, compared to wearing no mask, corroborating their effectiveness at reducing outward emission. These masks similarly decreased the outward particle emission of a coughing superemitter, who for unclear reasons emitted up to two orders of magnitude more expiratory particles via coughing than average. In contrast, shedding of non-expiratory micron-scale particulates from friable cellulosic fibers in homemade cotton-fabric masks confounded explicit determination of their efficacy at reducing expiratory particle emission. Audio analysis of the speech and coughing intensity confirmed that people speak more loudly, but do not cough more loudly, when wearing a mask. Further work is needed to establish the efficacy of cloth masks at blocking expiratory particles for speech and coughing at varied intensity and to assess whether virus-contaminated fabrics can generate aerosolized fomites, but the results strongly corroborate the efficacy of medical-grade masks and highlight the importance of regular washing of homemade masks.
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Affiliation(s)
- Sima Asadi
- Department of Chemical Engineering, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Christopher D Cappa
- Department of Civil and Environmental Engineering, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Santiago Barreda
- Department of Linguistics, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Anthony S Wexler
- Department of Civil and Environmental Engineering, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA
- Department of Mechanical and Aerospace Engineering, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA
- Air Quality Research Center, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA
- Department of Land, Air and Water Resources, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Nicole M Bouvier
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - William D Ristenpart
- Department of Chemical Engineering, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA.
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28
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Asadi S, Cappa CD, Barreda S, Wexler AS, Bouvier NM, Ristenpart WD. Efficacy of masks and face coverings in controlling outward aerosol particle emission from expiratory activities. Sci Rep 2020; 10:15665. [PMID: 32973285 PMCID: PMC7518250 DOI: 10.1038/s41598-020-72798-7] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/23/2020] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic triggered a surge in demand for facemasks to protect against disease transmission. In response to shortages, many public health authorities have recommended homemade masks as acceptable alternatives to surgical masks and N95 respirators. Although mask wearing is intended, in part, to protect others from exhaled, virus-containing particles, few studies have examined particle emission by mask-wearers into the surrounding air. Here, we measured outward emissions of micron-scale aerosol particles by healthy humans performing various expiratory activities while wearing different types of medical-grade or homemade masks. Both surgical masks and unvented KN95 respirators, even without fit-testing, reduce the outward particle emission rates by 90% and 74% on average during speaking and coughing, respectively, compared to wearing no mask, corroborating their effectiveness at reducing outward emission. These masks similarly decreased the outward particle emission of a coughing superemitter, who for unclear reasons emitted up to two orders of magnitude more expiratory particles via coughing than average. In contrast, shedding of non-expiratory micron-scale particulates from friable cellulosic fibers in homemade cotton-fabric masks confounded explicit determination of their efficacy at reducing expiratory particle emission. Audio analysis of the speech and coughing intensity confirmed that people speak more loudly, but do not cough more loudly, when wearing a mask. Further work is needed to establish the efficacy of cloth masks at blocking expiratory particles for speech and coughing at varied intensity and to assess whether virus-contaminated fabrics can generate aerosolized fomites, but the results strongly corroborate the efficacy of medical-grade masks and highlight the importance of regular washing of homemade masks.
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Affiliation(s)
- Sima Asadi
- Department of Chemical Engineering, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Christopher D Cappa
- Department of Civil and Environmental Engineering, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Santiago Barreda
- Department of Linguistics, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Anthony S Wexler
- Department of Civil and Environmental Engineering, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA.,Department of Mechanical and Aerospace Engineering, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA.,Air Quality Research Center, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA.,Department of Land, Air and Water Resources, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Nicole M Bouvier
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.,Department of Microbiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - William D Ristenpart
- Department of Chemical Engineering, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA.
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29
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Affiliation(s)
- Eleni Mantzari
- Department of Public Health and Primary Care, Behaviour and Heath Research Unit, University of Cambridge, Cambridge, UK
| | - G James Rubin
- Department of Psychological Medicine, King's College London, London, UK
| | - Theresa M Marteau
- Department of Public Health and Primary Care, Behaviour and Heath Research Unit, University of Cambridge, Cambridge, UK
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30
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Udow-Phillips M, Lantz PM. Trust in Public Health Is Essential Amid the COVID-19 Pandemic. J Hosp Med 2020; 15:431-433. [PMID: 32584250 DOI: 10.12788/jhm.3474] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/21/2020] [Indexed: 11/20/2022]
Affiliation(s)
| | - Paula M Lantz
- Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan
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31
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Stutt ROJH, Retkute R, Bradley M, Gilligan CA, Colvin J. A modelling framework to assess the likely effectiveness of facemasks in combination with 'lock-down' in managing the COVID-19 pandemic. Proc Math Phys Eng Sci 2020; 476:20200376. [PMID: 32821237 PMCID: PMC7428039 DOI: 10.1098/rspa.2020.0376] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023] Open
Abstract
COVID-19 is characterized by an infectious pre-symptomatic period, when newly infected individuals can unwittingly infect others. We are interested in what benefits facemasks could offer as a non-pharmaceutical intervention, especially in the settings where high-technology interventions, such as contact tracing using mobile apps or rapid case detection via molecular tests, are not sustainable. Here, we report the results of two mathematical models and show that facemask use by the public could make a major contribution to reducing the impact of the COVID-19 pandemic. Our intention is to provide a simple modelling framework to examine the dynamics of COVID-19 epidemics when facemasks are worn by the public, with or without imposed 'lock-down' periods. Our results are illustrated for a number of plausible values for parameter ranges describing epidemiological processes and mechanistic properties of facemasks, in the absence of current measurements for these values. We show that, when facemasks are used by the public all the time (not just from when symptoms first appear), the effective reproduction number, Re , can be decreased below 1, leading to the mitigation of epidemic spread. Under certain conditions, when lock-down periods are implemented in combination with 100% facemask use, there is vastly less disease spread, secondary and tertiary waves are flattened and the epidemic is brought under control. The effect occurs even when it is assumed that facemasks are only 50% effective at capturing exhaled virus inoculum with an equal or lower efficiency on inhalation. Facemask use by the public has been suggested to be ineffective because wearers may touch their faces more often, thus increasing the probability of contracting COVID-19. For completeness, our models show that facemask adoption provides population-level benefits, even in circumstances where wearers are placed at increased risk. At the time of writing, facemask use by the public has not been recommended in many countries, but a recommendation for wearing face-coverings has just been announced for Scotland. Even if facemask use began after the start of the first lock-down period, our results show that benefits could still accrue by reducing the risk of the occurrence of further COVID-19 waves. We examine the effects of different rates of facemask adoption without lock-down periods and show that, even at lower levels of adoption, benefits accrue to the facemask wearers. These analyses may explain why some countries, where adoption of facemask use by the public is around 100%, have experienced significantly lower rates of COVID-19 spread and associated deaths. We conclude that facemask use by the public, when used in combination with physical distancing or periods of lock-down, may provide an acceptable way of managing the COVID-19 pandemic and re-opening economic activity. These results are relevant to the developed as well as the developing world, where large numbers of people are resource poor, but fabrication of home-made, effective facemasks is possible. A key message from our analyses to aid the widespread adoption of facemasks would be: 'my mask protects you, your mask protects me'.
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Affiliation(s)
- Richard O. J. H. Stutt
- Epidemiology and Modelling Group, Department of Plant Sciences, University of Cambridge, Downing Street, Cambridge CB2 3EA, UK
| | - Renata Retkute
- Epidemiology and Modelling Group, Department of Plant Sciences, University of Cambridge, Downing Street, Cambridge CB2 3EA, UK
| | - Michael Bradley
- The Wolfson Centre for Bulk Solids Handling Technology, University of Greenwich, Chatham Maritime ME4 4TB, UK
| | - Christopher A. Gilligan
- Epidemiology and Modelling Group, Department of Plant Sciences, University of Cambridge, Downing Street, Cambridge CB2 3EA, UK
| | - John Colvin
- Natural Resources Institute, University of Greenwich, Chatham Maritime ME4 4TB, UK
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Brauer M, Zhao JT, Bennitt FB, Stanaway JD. Global Access to Handwashing: Implications for COVID-19 Control in Low-Income Countries. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:57005. [PMID: 32438824 PMCID: PMC7263456 DOI: 10.1289/ehp7200] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND Low-income countries have reduced health care system capacity and are therefore at risk of substantially higher COVID-19 case fatality rates than those currently seen in high-income countries. Handwashing is a key component of guidance to reduce transmission of the SARS-CoV-2 virus, responsible for the COVID-19 pandemic. Prior systematic reviews have indicated the effectiveness of handwashing to reduce transmission of respiratory viruses. In low-income countries, reduction of transmission is of paramount importance, but social distancing is challenged by high population densities and access to handwashing facilities with soap and water is limited. OBJECTIVES Our objective was to estimate global access to handwashing with soap and water to inform use of handwashing in the prevention of COVID-19 transmission. METHODS We utilized observational surveys and spatiotemporal Gaussian process regression modeling in the context of the Global Burden of Diseases, Injuries, and Risk Factors Study to estimate access to a handwashing station with available soap and water for 1,062 locations from 1990 to 2019. RESULTS Despite overall improvements from 1990 {33.6% [95% uncertainty interval (UI): 31.5, 35.6] without access} to 2019, globally in 2019, 2.02 (95% UI: 1.91, 2.14) billion people, 26.1% (95% UI: 24.7, 27.7) of the global population, lacked access to handwashing with available soap and water. More than 50% of the population in sub-Saharan Africa and Oceania were without access to handwashing in 2019, and in eight countries, 50 million or more persons lacked access. DISCUSSION For populations without handwashing access, immediate improvements in access or alternative strategies are urgently needed, and disparities in handwashing access should be incorporated into COVID-19 forecasting models when applied to low-income countries. https://doi.org/10.1289/EHP7200.
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Affiliation(s)
- Michael Brauer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeff T Zhao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Fiona B Bennitt
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Jeffrey D Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Lam SC, Chong ACY, Chung JYS, Lam MY, Chan LM, Shum CY, Wong EYN, Mok YM, Lam MT, Chan MM, Tong KY, Chu OL, Siu FK, Cheung JHM. Methodological Study on the Evaluation of Face Mask Use Scale among Public Adult: Cross-Language and Psychometric Testing. ACTA ACUST UNITED AC 2020. [DOI: 10.7475/kjan.2020.32.1.46] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Simon Ching Lam
- Assistant Professor, School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Andy Chun Yin Chong
- Senior Lecturer, School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong SAR
| | - Jessie Yuk Seng Chung
- Senior Lecturer, School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong SAR
| | - Ming Yee Lam
- Registered Nurse, Yan Chai Hospital, Hospital Authority, Hong Kong SAR
| | - Lai Man Chan
- Registered Nurse, Caritas Medical Center, Hospital Authority, Hong Kong SAR
| | - Cho Yee Shum
- Registered Nurse, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR
| | - Eliza Yi Ni Wong
- Registered Nurse, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR
| | - Yat Man Mok
- Registered Nurse, Ruttonjee Hospital, Hospital Authority, Hong Kong SAR
| | - Ming Tat Lam
- Registered Nurse, Queen Mary Hospital, Hospital Authority, Hong Kong SAR
| | - Man Man Chan
- Registered Nurse, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR
| | - Ka Ying Tong
- Registered Nurse, St. Paul's Hospital, Hong Kong Island, Hong Kong SAR
| | - Oi Lee Chu
- Registered Nurse, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR
| | - Fong Kiu Siu
- Registered Nurse, Caritas Medical Center, Hospital Authority, Hong Kong SAR
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Pogreba-Brown K, Austhof E, Okello A, Weiss J, Lira R, Ernst K. Public perceptions of non-pharmaceutical interventions for influenza and mosquito-borne illnesses - a statewide survey in Arizona. Perspect Public Health 2019; 140:214-221. [PMID: 31755813 DOI: 10.1177/1757913919886605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS We conducted a statewide online survey to understand public knowledge, attitudes, and practices (KAP) related to non-pharmaceutical interventions (NPIs) for mosquito-borne diseases and influenza in Arizona. METHODS The survey included knowledge of diseases, major health concerns, and sources of health information and KAP of NPIs for influenza and mosquito-borne diseases. Our team worked with Qualtrics®, an online survey company, to recruit a representative sample of 1500 adults in Arizona. RESULTS Of the 1531 respondents who completed the survey, most indicated that chronic conditions were their primary health concern (48%), with the other half split between infectious diseases (25%) and health effects of environmental conditions (26%). The majority (88%) of respondents indicated that they use the Internet to get their health information. Approximately one in eight people reported not emptying standing water and reducing potential mosquito habitats, despite respondents citing them as being the most effective factors in reducing mosquitoes. Regarding specific diseases, about half of the respondents were concerned about West Nile virus and/or Zika virus. Most (85%) people knew the signs and symptoms of influenza and 63% of people reported being likely to get the influenza shot. Those who did not vaccinate (n = 285) reported concerns that the vaccine would make them sick (41%), was ineffective (37%), or others indicated, 'I don't want to' (37%). CONCLUSIONS Overall, respondents were most concerned with chronic conditions and received their information from the Internet. Knowledge about mosquito-borne diseases was low. There were high levels of acceptance and self-reported uptake of the influenza vaccine.
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Affiliation(s)
- K Pogreba-Brown
- Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave., A220, P.O. Box 245211, Tucson, AZ 85724, USA
| | - E Austhof
- Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - A Okello
- Ohio Colleges of Medicine Government Resource Center, Columbus, OH, USA
| | - J Weiss
- Arizona Department of Health Services, Phoenix, AZ, USA
| | - R Lira
- Arizona Department of Health Services, Phoenix, AZ, USA
| | - K Ernst
- Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
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Sansone M, Wiman Å, Karlberg ML, Brytting M, Bohlin L, Andersson LM, Westin J, Nordén R. Molecular characterization of a nosocomial outbreak of influenza B virus in an acute care hospital setting. J Hosp Infect 2018; 101:30-37. [PMID: 29909095 PMCID: PMC7114871 DOI: 10.1016/j.jhin.2018.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/04/2018] [Indexed: 01/21/2023]
Abstract
Aim To describe a hospital outbreak of influenza B virus (InfB) infection during season 2015/2016 by combining clinical and epidemiological data with molecular methods. Methods Twenty patients diagnosed with InfB from a hospital outbreak over a four-week-period were included. Nasopharyngeal samples (NPS) positive for InfB by multiplex real-time polymerase chain reaction were sent for lineage typing and whole genome sequencing (WGS). Medical records were reviewed retrospectively for data regarding patient characteristics, localization, exposure and outcome, and assembled into a timeline. In order to find possible connections to the hospital outbreak, all patients with a positive NPS for influenza from the region over an extended time period were also reviewed. Findings All 20 cases of InfB were of subtype B/Yamagata, and 17 of 20 patients could be linked to each other by either shared room or shared ward. WGS was successful or partially successful for 15 of the 17 viral isolates, and corroborated the epidemiological link supporting a close relationship. In the main affected ward, 19 of 75 inpatients were infected with InfB during the outbreak period, resulting in an attack rate of 25%. One probable case of influenza-related death was identified. Conclusion InfB may spread within an acute care hospital, and advanced molecular methods may facilitate assessment of the source and extent of the outbreak. A multi-faceted approach, including rapid diagnosis, early recognition of outbreak situations, simple rules for patient management and the use of regular infection control measures, may prevent nosocomial transmission of influenza virus.
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Affiliation(s)
- M Sansone
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Å Wiman
- Public Health Agency of Sweden, Solna, Sweden
| | | | - M Brytting
- Public Health Agency of Sweden, Solna, Sweden
| | - L Bohlin
- Department of Internal Medicine, Kungalv Hospital, Kungalv, Sweden
| | - L-M Andersson
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Westin
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - R Nordén
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Chan TC, Hu TH, Hwang JS. Estimating the Risk of Influenza-Like Illness Transmission Through Social Contacts: Web-Based Participatory Cohort Study. JMIR Public Health Surveill 2018; 4:e40. [PMID: 29631987 PMCID: PMC5913573 DOI: 10.2196/publichealth.8874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/26/2018] [Accepted: 02/11/2018] [Indexed: 12/20/2022] Open
Abstract
Background Epidemiological studies on influenza have focused mostly on enhancing vaccination coverage or promoting personal hygiene behavior. Few studies have investigated potential effects of personal health behaviors and social contacts on the risk of getting influenza-like illness (ILI). Objective Taking advantage of an online participatory cohort, this study aimed to estimate the increased risk of getting ILI after contact with infected persons and examine how personal health behaviors, weather, and air pollution affect the probability of getting ILI. Methods A Web-based platform was designed for participants to record daily health behaviors and social contacts during the influenza season of October 1, 2015 to March 31, 2016, in Taiwan. Data on sleep, diet, physical activity, self-reported ILI, and contact with infected persons were retrieved from the diaries. Measurements of weather and air pollutants were used for calculating environmental exposure levels for the participants. We fitted a mixed-effects logistic regression model to the daily measurements of the diary keepers to estimate the effects of these variables on the risk of getting ILI. Results During the influenza season, 160 participants provided 14,317 health diaries and recorded 124,222 face-to-face contacts. The model estimated odds ratio of getting ILI was 1.87 (95% CI 1.40-2.50) when a person had contact with others having ILI in the previous 3 days. Longer duration of physical exercise and eating more fruits, beans, and dairy products were associated with lower risk of getting ILI. However, staying up late was linked to an elevated risk of getting ILI. Higher variation of ambient temperature and worse air quality were associated with increased risk of developing ILI. Conclusions Developing a healthier lifestyle, avoiding contact with persons having ILI symptoms, and staying alert with respect to temperature changes and air quality can reduce the risk of getting ILI.
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Affiliation(s)
- Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei City, Taiwan
| | - Tsuey-Hwa Hu
- Institute of Statistical Science, Academia Sinica, Taipei City, Taiwan
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, Taipei City, Taiwan
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High vaccination coverage is associated with low epidemic level of seasonal influenza in elementary schools: an observational study in Matsumoto City, Japan. BMC Infect Dis 2018. [PMID: 29534676 PMCID: PMC5851075 DOI: 10.1186/s12879-018-3025-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Influenza virus transmission may be prevented by infection control measures, including vaccination, wearing a mask, gargling with water, and hand washing. It is unclear, however, whether these measures affect influenza epidemics in school settings. Methods A prospective epidemiological survey in all public elementary schools in Matsumoto City, Japan, during the 2014/2015 season evaluated the number of diagnosed patients in each school and calculated the reproduction number of schoolchildren. At the end of the prospective survey, a cross-sectional survey evaluated the implementation of infection control measures in these schools. Both results were combined and associations among infection control measures including vaccination, mask wearing, hand washing, water gargling, and epidemic level were evaluated. Results Of the 13,217 schoolchildren in 29 schools, 2548 were diagnosed with seasonal influenza. A significant negative association was observed between vaccination coverage and reproduction number at each school, but not between other infection control measures and the reproduction number. A regression curve with exponential function was most predictive. At 0% vaccination, the reproduction number was estimated to be 1.39. Conclusion These findings provide evidence that high vaccination coverage was associated with reduced epidemic levels in schools and suggest the need for increased vaccination of schoolchildren.
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Abstract
Influenza is an acute viral respiratory disease that affects persons of all ages and is associated with millions of medical visits, hundreds of thousands of hospitalizations, and thousands of deaths during annual winter epidemics of variable severity in the United States. Elderly persons have the highest influenza-associated hospitalization and mortality rates. The primary method of prevention is annual vaccination. Early antiviral treatment has the greatest clinical benefit; otherwise, management includes adherence to recommended infection prevention and control measures as well as supportive care of complications.
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Affiliation(s)
- Timothy M Uyeki
- From the Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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Smith TA, Disler RT, Jenkins CR, Ingham JM, Davidson PM. Perspectives on advance care planning among patients recently requiring non-invasive ventilation for acute respiratory failure: A qualitative study using thematic analysis. Palliat Med 2017; 31:566-574. [PMID: 28440124 DOI: 10.1177/0269216316670286] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Patients requiring non-invasive ventilation for acute-on-chronic respiratory failure due to chronic obstructive pulmonary disease or heart failure exacerbations may have a poor prognosis underscoring the importance of advance care planning. AIM We aimed to describe attitudes to, and experiences of, discussing the future among patients recently treated with non-invasive ventilation. DESIGN Qualitative research using thematic analysis. SETTINGS AND PARTICIPANTS Tertiary teaching hospital. Patients with acute hypercapnic respiratory failure requiring non-invasive ventilation. RESULTS Individuals recently treated with non-invasive ventilation describe feeling the future is beyond their control and instead controlled by their illness. Participants often recognised their poor prognosis but avoided discussing some difficult topics. The majority preferred not to undergo cardiopulmonary resuscitation but most had not discussed this with healthcare professionals. When participants voiced concerns about their future health to family members, they were met with polarised responses. Some encountered willingness for further discussion, while others met deflection, deterring further conversation. An overarching narrative of 'Looking through my illness to an uncertain but concerning future' unites these themes. CONCLUSION This study suggests opportunities and barriers for advance care planning in individuals with chronic disease. Patients' understanding of their prognosis and their attitudes to cardiopulmonary resuscitation suggests an opportunity for advance care planning. Structuring discussions around patients' preferences for care during future exacerbations may foster a sense of control over the future despite illness. The diversity of familial responses to patients' concerns about their future health has implications for advance care planning. These findings have the potential to improve care for patients with respiratory failure and suggest an important ongoing research agenda.
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Affiliation(s)
- Tracy A Smith
- 1 St Vincent's Clinical School, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia.,2 Department of Respiratory & Sleep Medicine, Westmead Hospital, Wentworthville, NSW, Australia
| | - Rebecca T Disler
- 3 Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.,4 ImPaCCT (Improving Palliative Care through Clinical Trials) NSW Palliative Care Collaborative Clinical Trials Group, Liverpool, NSW, Australia
| | - Christine R Jenkins
- 5 Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia.,6 The George Institute, Sydney, NSW, Australia
| | - Jane M Ingham
- 1 St Vincent's Clinical School, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia.,7 St Vincent's Health Network, Sydney, NSW, Australia
| | - Patricia M Davidson
- 3 Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.,8 Department of Acute and Chronic Care, Johns Hopkins University, Baltimore, MD, USA
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Uchida M, Kaneko M, Hidaka Y, Yamamoto H, Honda T, Takeuchi S, Saito M, Kawa S. Effectiveness of vaccination and wearing masks on seasonal influenza in Matsumoto City, Japan, in the 2014/2015 season: An observational study among all elementary schoolchildren. Prev Med Rep 2017; 5:86-91. [PMID: 27981021 PMCID: PMC5153448 DOI: 10.1016/j.pmedr.2016.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 11/28/2016] [Accepted: 12/04/2016] [Indexed: 11/25/2022] Open
Abstract
Measures of seasonal influenza control are generally divided into two categories: pharmaceutical and non-pharmaceutical interventions. The effectiveness of these measures remains unclear, because of insufficient study sample size and/or differences in study settings. This observational epidemiological study involved all elementary schoolchildren in Matsumoto City, Japan, with seasonal influenza during the 2014/2015 season. Questionnaires, including experiences with influenza diagnosis and socio-demographic factors, were distributed to all 29 public elementary schools, involving 13,217 children, at the end of February 2015. Data were obtained from 10,524 children and analyzed with multivariate logistic regression analysis. The result showed that vaccination (odds ratio 0.866, 95% confidence interval 0.786-0.954) and wearing masks (0.859, 0.778-0.949) had significant protective association. Hand washing (1.447, 1.274-1.644) and gargling (1.319, 1.183-1.471), however, were not associated with protection. In the natural setting, hand washing and gargling showed a negative association, which may have been due to inappropriate infection control measures or aggregating infected and non-infected children to conduct those measures. These results may indicate a pathway for influenza transmission and explain why seasonal influenza control remains difficult in school settings. The overall effectiveness of vaccination and mask wearing was 9.9% and 8.6%, respectively. After dividing children into higher (grades 4-6) and lower (grade 1-3) grade groups, the effectiveness of vaccination became greater in the lower grade group, and the effectiveness of wearing masks became greater in the higher grade group. These results may provide valuable information about designing infection control measures that allocate resources among children.
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Affiliation(s)
- Mitsuo Uchida
- Center for Health, Safety and Environment Management, Shinshu University, Matsumoto, Nagano, Japan
| | - Minoru Kaneko
- Center for Health, Safety and Environment Management, Shinshu University, Matsumoto, Nagano, Japan
| | - Yoshihiko Hidaka
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroshi Yamamoto
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takayuki Honda
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shouhei Takeuchi
- Department of Public Health, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Masaya Saito
- Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan
| | - Shigeyuki Kawa
- Center for Health, Safety and Environment Management, Shinshu University, Matsumoto, Nagano, Japan
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Michail KA, Ioannidou C, Galanis P, Tsoumakas K, Pavlopoulou ID. Promotion of Preventive Measures in Public Nursery Schools: Lessons From the H1N1 Pandemic. Health Promot Pract 2016; 18:636-644. [PMID: 27807196 DOI: 10.1177/1524839916676073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nursery schools serve as reservoirs of transmission of infectious diseases, and teachers should be able to implement and monitor hygiene measures to prevent them. The aim of the present study was to assess the compliance of nursery school teachers on promoting preventive interventions and to identify associated factors, during the novel H1N1 influenza pandemic. A secondary objective was to evaluate their knowledge and vaccination status regarding the novel virus. A cross-sectional study was performed, with the use of a predesigned anonymous, questionnaire, and distributed to all public nursery teachers of Athens, Greece. General etiquette practices were highly acceptable to over 92% of teachers. Those with longer teaching experience promoted simple preventive measures, such as hand washing and use of hand sanitizer, more often while older children were more likely to familiarize with them. However, teachers presented inadequate knowledge concerning the novel virus and their vaccination rates with the pandemic vaccine were unacceptably low (1.1%). Our study showed that promotion of simple preventive measures is feasible and may contribute to the prevention of outbreaks in nursery schools, although knowledge gaps and fear concerning the pandemic vaccine highlight communication issues.
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Lee P, Leung CC, Restrepo MI, Takahashi K, Song Y, Porcel JM. Year in review 2015: Lung cancer, pleural diseases, respiratory infections, bronchiectasis and tuberculosis, bronchoscopic intervention and imaging. Respirology 2016; 21:961-7. [PMID: 26998678 DOI: 10.1111/resp.12779] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/23/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Pyng Lee
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore
| | - Chi Chiu Leung
- Department of Health, TB and Chest Service, Hong Kong, China
| | - Marcos I Restrepo
- South Texas Veterans Health Care System ALMD, San Antonio, Texas, USA
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - José M Porcel
- Pleural Medicine Unit, Arnau de Vilanova University Hospital, Lleida, Spain
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Sanchez JL, Cooper MJ, Myers CA, Cummings JF, Vest KG, Russell KL, Sanchez JL, Hiser MJ, Gaydos CA. Respiratory Infections in the U.S. Military: Recent Experience and Control. Clin Microbiol Rev 2015; 28:743-800. [PMID: 26085551 PMCID: PMC4475643 DOI: 10.1128/cmr.00039-14] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This comprehensive review outlines the impact of military-relevant respiratory infections, with special attention to recruit training environments, influenza pandemics in 1918 to 1919 and 2009 to 2010, and peacetime operations and conflicts in the past 25 years. Outbreaks and epidemiologic investigations of viral and bacterial infections among high-risk groups are presented, including (i) experience by recruits at training centers, (ii) impact on advanced trainees in special settings, (iii) morbidity sustained by shipboard personnel at sea, and (iv) experience of deployed personnel. Utilizing a pathogen-by-pathogen approach, we examine (i) epidemiology, (ii) impact in terms of morbidity and operational readiness, (iii) clinical presentation and outbreak potential, (iv) diagnostic modalities, (v) treatment approaches, and (vi) vaccine and other control measures. We also outline military-specific initiatives in (i) surveillance, (ii) vaccine development and policy, (iii) novel influenza and coronavirus diagnostic test development and surveillance methods, (iv) influenza virus transmission and severity prediction modeling efforts, and (v) evaluation and implementation of nonvaccine, nonpharmacologic interventions.
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Affiliation(s)
- Jose L Sanchez
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Michael J Cooper
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | | | - James F Cummings
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Joyce L Sanchez
- Mayo Clinic, Division of General Internal Medicine, Rochester, Minnesota, USA
| | - Michelle J Hiser
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA Oak Ridge Institute for Science and Education, Postgraduate Research Participation Program, U.S. Army Public Health Command, Aberdeen Proving Ground, Aberdeen, Maryland, USA
| | - Charlotte A Gaydos
- International STD, Respiratory, and Biothreat Research Laboratory, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
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