Implementation of non-pharmaceutical interventions by New York City public schools to prevent 2009 influenza A

How College Students Used Information From Institutions of Higher Education in the United States During COVID-19: Web-Based Cross-Sectional Survey Study

BACKGROUND

The start of the COVID-19 pandemic resulted in the implementation of nonpharmaceutical interventions by US institutions of higher education at an unprecedented level. During the backdrop of an emerging pandemic, younger adults (eg, college students) had an overall lower risk for severe outcomes for SARS-CoV-2, making this population a potential source of transmission for age groups with high susceptibility and negative health outcomes. We examine how college students' level of concern for COVID-19 was influenced by different sources of information, their living status, income level, and other demographic identifiers and its association with prevention behavior change.

OBJECTIVE

We sought to examine the level of concern, defined as the extent to which the participant would take corrective action to mitigate contracting or spreading the virus (to family or friends) by using personal protective equipment such as a face mask, practicing social distancing, and following other public health recommendations, among college students during the COVID-19 pandemic.

METHODS

A cross-sectional, web-based survey was conducted in 2021 among 185 college students aged 18-41 years, with most living in New York City and the United States (n=134, 72.4%). Out of 185 college students, 94 provided their zip codes, with 51 of those college students indicating they lived in New York City areas. The participants completed the survey via a QR code. Study participants who did not complete the full survey or were not college students in any US college or university were excluded. Analyses were conducted using R (version 4.2.2; R Foundation for Statistical Computing).

RESULTS

Of 185 respondents participated in the study, 25 (13.5.%) used emails from their schools, 51 (27.6%) used mainstream media, and 109 (58.9%) used social media and other sources to obtain information about COVID-19. Of the 109 participants who learned about the pandemic from social media, 91 (83.5%) were concerned; however, only 63% (32/51) and 60% (15/25) of the participants who sourced information from mainstream media and their schools' email, respectively, were concerned. Further, the participants who received information from social media and other sources were about 3 times more likely to be concerned about COVID-19 than participants who received information from the university via email (P=.036; OR=3.07, 95% CI: 1.06-8.83)..

CONCLUSIONS

College students who received information from social media and other sources were more likely to be concerned about COVID-19 than students who received information from their school via emails.

Respiratory pandemics, urban planning and design: A multidisciplinary rapid review of the literature

COVID-19 is the most recent respiratory pandemic to necessitate better knowledge about city planning and design. The complex connections between cities and pandemics, however challenge traditional approaches to reviewing literature. In this article we adopted a rapid review methodology. We review the historical literature on respiratory pandemics and their documented connections to urban planning and design (both broadly defined as being concerned with cities as complex systems). Our systematic search across multidisciplinary databases returned a total of 1323 sources, with 92 articles included in the final review. Findings showed that the literature represents the multi-scalar nature of cities and pandemics - pandemics are global phenomena spread through an interconnected world, but require regional, city, local and individual responses. We characterise the literature under ten themes: scale (global to local); built environment; governance; modelling; non-pharmaceutical interventions; socioeconomic factors; system preparedness; system responses; underserved and vulnerable populations; and future-proofing urban planning and design. We conclude that the historical literature captures how city planning and design intersects with a public health response to respiratory pandemics. Our thematic framework provides parameters for future research and policy responses to the varied connections between cities and respiratory pandemics.

Six Cs of pandemic emergency management: A case study of Taiwan's initial response to the COVID-19 pandemic

A review of the disaster literature indicates that emergency responses to pandemics are often understudied; the current COVID-19 crisis provides an important opportunity to improve awareness and understanding about this and other contagious and disruptive diseases. With this in mind, this study examines Taiwan's response to COVID-19 because it was successful in spite of a high probability of contagion. The paper first explores the assertion that cognition, communication, collaboration, and control are vital for effective disaster response; it then indicates the need to consider two additional Cs: confidence (trust of government's competency) and coproduction (public participation in disaster transmission prevention). The paper also conducts a qualitative descriptive study of the Taiwan government's response timeline with examples of each of these concepts in action. To further illustrate the need for the two additional Cs, survey data illustrate how public confidence serves as a pivot between government's COVID-19 response and citizen coproduction in COVID-19 transmission prevention.

Effectiveness of a Hand Hygiene Program at Child Care Centers: A Cluster Randomized Trial

OBJECTIVES

Respiratory infections (RIs) are an important cause of morbidity and excessive antibiotic prescriptions in children attending day care centers (DCCs). We aimed to assess the effectiveness of an educational and hand hygiene program in DCCs and homes in reducing RI incidence and antibiotic prescriptions in children.

METHODS

A cluster, randomized, controlled, and open study of 911 children aged 0 to 3 years attending 24 DCCs in Almería (Spain) with an 8-month follow-up. Two intervention groups of DCC families performed educational and hand hygiene measures, 1 with soap and water (SWG; n = 274), another with hand sanitizer (HSG; n = 339), and the control group (CG; n = 298) followed usual hand-washing procedures. RI episode rates were compared through multilevel Poisson regression models. The percentage of days missed were compared with Poisson exact tests.

RESULTS

There were 5211 RI episodes registered. Children in the HSG had less risk of RI episodes (incidence rate ratio [IRR]: 0.77; 95% confidence interval [CI]: 0.68-0.88) and antibiotic prescriptions (IRR: 0.69; 95% CI: 0.57-0.84) compared with the those in the CG. Children in the SWG had a higher risk of RI episodes (IRR: 1.21; 95% CI: 1.06-1.39) and antibiotic prescriptions (IRR: 1.31; 95% CI: 1.08-1.56) than those in the HSG. Pupils missed 5186 DCC days because of RIs, and the percentage of days absent was significantly lower in the HSG compared with the CG (P < .001) and the SWG (P < .001).

CONCLUSIONS

Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents, reduce absent days, RIs, and antibiotic prescriptions for these infections in children at DCCs.

A review of documents prepared by international organizations about influenza pandemics, including the 2009 pandemic: a bibliometric analysis

Background

World Health Organization (WHO), the World Bank, UN System Influenza Coordination (UNSIC) and other international organizations released a series of documents to fight against the influenza pandemic. Those documents have great significance on guiding influenza pandemic preparedness and responses and providing a multilevel, multi-directional influenza pandemic prevention and control network for their member countries. This study focuses on the above-mentioned influenza pandemic preparedness guidelines with the aim of exploring the roles of the society, defining the relationship of different interventions and evaluating the planning on influenza pandemic preparedness.

Methods

Documents about pandemic influenza preparedness were retrieved from the official websites of the following three international organizations, World Health Organization (WHO), the World Bank, UN System Influenza Coordination (UNSIC) with the key words ‘pandemic’, ‘influenza’ and the Boolean combinations of these words as the retrieval strategy. Guidelines, research study and meeting reports were included in the study. The categories of the ministries/departments involved and their roles/responsibilities in pandemic influenza preparedness were summarized. Word frequency of selected vocabularies about pandemic influenza preventive measures were collected from the documents and the correlations between the word frequency of these measures were analyzed. Ochiai coefficient was employed to show the correlation between the word vocabularies.

Results

A total of 38 records on the topic of pandemic influenza preparedness were included. The responsibilities of the whole-of-society mentioned in the international organizations’ documents varied across the 2009 influenza pandemic period. Meanwhile, it had been emphasized that a comprehensive influenza prevention and control plan in every sector should be developed and evaluated. Because various measures were emphasized in the guidelines after 2009 pandemic influenza, the correlations between the word frequencies of the various influenza preventive measures became stronger after the pandemic influenza.

Conclusions

Responsibilities of ministries of education, ministries of energy, ministries of agriculture and animal health, ministries of communication and the business sector in the pandemic influenza preparedness were described more comprehensively in the international organizations’ documents in 2017. Better understanding the variations of the guidelines delivered by international organizations would be useful for the member countries to strengthen their influenza control network.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3286-3) contains supplementary material, which is available to authorized users.

Tuning in and catching on? Examining the relationship between pandemic communication and awareness and knowledge of MERS in the USA

Background

Large-scale influenza outbreaks over the last decade, such as SARS and H1N1, have brought to global attention the importance of emergency risk communication and prompted the international community to develop communication responses. Since pandemic outbreaks are relatively infrequent, there is a dearth of evidence addressing the following questions: (i) Have the resources invested in strategic and routine communication for past pandemic outbreaks yielded public health preparedness benefits? (ii) Have past efforts sensitized people to pay attention to new pandemic threats? The Middle East Respiratory Syndrome (MERS) that was followed closely by major media outlets in the USA provides an opportunity to examine the relationship between exposure to public communication about epidemics and public awareness and knowledge about new risks.

Methods

In December, 2013, we surveyed a nationally representative sample of 627 American adults and examined the associations between people's awareness to prior pandemics and their awareness of and knowledge about MERS.

Results

Awareness of prior pandemics was significantly associated with awareness and knowledge of MERS. The most common sources from which people first heard about MERS were also identified.

Conclusions

Communication inequalities were observed between racial/ethnic and socioeconomic positions, suggesting a need for more effective pandemic communication.

Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017

When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).

Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017

When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).

Hand Hygiene Program Decreases School Absenteeism Due to Upper Respiratory Infections

BACKGROUND

We assessed the effectiveness of a handwashing program using hand sanitizer to prevent school absenteeism due to upper respiratory infections (URIs).

METHODS

This was a randomized, controlled, and open study on a sample of 1341 children 4-12 years old, attending 5 state schools in Almería (Spain), with an 8-month follow-up. The experimental group (EG) washed their hands with soap and water, together with using hand sanitizer, and the control group followed their usual handwashing procedures. Absenteeism rates due to URIs were compared between the 2 groups through a multivariate Poisson regression analysis. The percent of days missed in both groups were compared with a z test.

RESULTS

Overall, 1271 cases of school absenteeism due to URIs were registered. Schoolchildren from the EG had a 38% lower risk of absenteeism due to URIs, incidence rate ratio: 0.62, 95% confidence interval: 0.55-0.70, and a decrease in absenteeism of 0.45 episodes/child/academic year, p < .001. Pupils missed 2734 school days due to URIs and the percentage of days absent was significantly lower in the EG, p < .001.

CONCLUSIONS

Use of hand sanitizer plus handwashing with soap accompanied by educational support is an effective measure to reduce absenteeism due to URIs.

Promotion of Preventive Measures in Public Nursery Schools: Lessons From the H1N1 Pandemic

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.

Online Work Force Analyzes Social Media to Identify Consequences of an Unplanned School Closure - Using Technology to Prepare for the Next Pandemic

Background

During an influenza pandemic, the United States Centers for Disease Control and Prevention (CDC) may recommend school closures. These closures could have unintended consequences for students and their families. Publicly available social media could be analyzed to identify the consequences of an unplanned school closure.

Methods

As a proxy for an unplanned, pandemic-related school closure, we used the district-wide school closure due to the September 10–18, 2012 teachers’ strike in Chicago, Illinois. We captured social media posts about the school closure using the Radian6 social media-monitoring platform. An online workforce from Amazon Mechanical Turk categorized each post into one of two groups. The first group included relevant posts that described the impact of the closure on students and their families. The second group included irrelevant posts that described the political aspects of the strike or topics unrelated to the school closure. All relevant posts were further categorized as expressing a positive, negative, or neutral sentiment. We analyzed patterns of relevant posts and sentiment over time and compared our findings to household surveys conducted after other unplanned school closures.

Results

We captured 4,546 social media posts about the district-wide school closure using our search criteria. Of these, 930 (20%) were categorized as relevant by the online workforce. Of the relevant posts, 619 (67%) expressed a negative sentiment, 51 (5%) expressed a positive sentiment, and 260 (28%) were neutral. The number of relevant posts, and especially those with a negative sentiment, peaked on day 1 of the strike. Negative sentiment expressed concerns about childcare, missed school lunches, and the lack of class time for students. This was consistent with findings from previously conducted household surveys.

Conclusion

Social media are publicly available and can readily provide information on the impact of an unplanned school closure on students and their families. Using social media to assess the impact of an unplanned school closure due to a public health event would be informative. An online workforce can effectively assist with the review process.

Adoption of Preventive Measures and Attitudes Toward the H1N1 Influenza Pandemic in Schools

BACKGROUND

This study describes the perceived impact of H1N1 influenza and the adoption of the recommended measures to address the pandemic in schools.

METHODS

A cross-sectional self-reported survey was conducted in 433 schools in Barcelona addressed to the school principal or the H1N1 influenza designated person. A descriptive analysis was performed, stratifying by educational level and type of school. A logistic regression analysis also was conducted.

RESULTS

Around 70% of the respondents reported that there had been H1N1 influenza cases among students, being this percentage significantly higher among those schools offering primary education (74.4%) (p < .05). The main measures (single-use paper towels, availability of sanitizer solutions and 15 minutes ventilation per day of enclosed spaces) were implemented in most of the centers. However, the correct adoption of the main measures took place in around 30% of the schools, being the percentage lower in those offering only secondary education (Odds ratio [OR]: 0.518; 95% confidence interval [CI]:0.272-0.986) and those located in medium (OR: 0.438, 95% CI: 0.234-0.811) or low socioeconomic status (SES) districts (OR: 0.321, 95% CI: 0.159-0.649).

CONCLUSIONS

Despite the climate of social alarm, the perceived impact of H1N1 influenza in most schools was moderate. In future potential threats, the educational level and the SES of the school should be considered, especially when measures requiring purchasing any product are recommended but not provided.

Media use and communication inequalities in a public health emergency: a case study of 2009-2010 pandemic influenza A virus subtype H1N1

OBJECTIVES

Studies have shown that differences among individuals and social groups in accessing and using information on health and specific threats have an impact on their knowledge and behaviors. These differences, characterized as communication inequalities, may hamper the strength of a society's response to a public health emergency. Such inequalities not only make vulnerable populations subject to a disproportionate burden of adversity, but also compromise the public health system's efforts to prevent and respond to pandemic influenza outbreaks. We investigated the effect of socioeconomic status (SES) and health communication behaviors (including barriers) on people's knowledge and misconceptions about pandemic influenza A(H1N1) (pH1N1) and adoption of prevention behaviors.

METHODS

The data for this study came from a survey of 1,569 respondents drawn from a nationally representative sample of American adults during pH1N1. We conducted logistic regression analyses when appropriate.

RESULTS

We found that (1) SES has a significant association with barriers to information access and processing, levels of pH1N1-related knowledge, and misconceptions; (2) levels of pH1N1-related knowledge are associated positively with the adoption of recommended prevention measures and negatively with the adoption of incorrect protective behaviors; and (3) people with higher SES, higher news exposure, and higher levels of pH1N1-related knowledge, as well as those who actively seek information, are less likely than their counterparts to adopt incorrect prevention behaviors.

CONCLUSION

Strategic public health communication efforts in public health preparedness and during emergencies should take into account potential communication inequalities and develop campaigns that reach across different social groups.

Knowledge, attitudes, and practices of nonpharmaceutical interventions following school dismissals during the 2009 Influenza A H1N1 pandemic in Michigan, United States

Background

Many schools throughout the United States reported an increase in dismissals due to the 2009 influenza A H1N1 pandemic (pH1N1). During the fall months of 2009, more than 567 school dismissals were reported from the state of Michigan. In December 2009, the Michigan Department of Community Health, in collaboration with the United States Centers for Disease Control and Prevention, conducted a survey to describe the knowledge, attitudes, and practices (KAPs) of households with school-aged children and classroom teachers regarding the recommended use of nonpharmaceutical interventions (NPIs) to slow the spread of influenza.

Methods

A random sample of eight elementary schools (kindergarten through 5^th grade) was selected from each of the eight public health preparedness regions in the state. Within each selected school, a single classroom was randomly identified from each grade (K-5), and household caregivers of the classroom students and their respective teachers were asked to participate in the survey.

Results

In total, 26% (2,188/8,280) of household caregivers and 45% (163/360) of teachers from 48 schools (of the 64 sampled) responded to the survey. Of the 48 participating schools, 27% (13) experienced a school dismissal during the 2009 fall term. Eighty-seven percent (1,806/2,082) of caregivers and 80% (122/152) of teachers thought that the 2009 influenza A H1N1 pandemic was severe, and >90% of both groups indicated that they told their children/students to use NPIs, such as washing hands more often and covering coughs with tissues, to prevent infection with influenza.

Conclusions

Knowledge and instruction on the use of NPIs appeared to be high among household caregivers and teachers responding to the survey. Nevertheless, public health officials should continue to explain the public health rationale for NPIs to reduce pandemic influenza. Ensuring this information is communicated to household caregivers and teachers through trusted sources is essential.