Facemasks and intensified hand hygiene in a German household trial during the 2009/2010 influenza A(H1N1) pandemic: adherence and tolerability in children and adults

Abstract

SUMMARYNon-pharmaceutical interventions (NPI) such as facemasks and intensified hand hygiene may be effective in preventing influenza infections in households. It may be equally important that household members, especially children, can learn to use, maintain and tolerate these measures. We monitored adherence and tolerability of these NPI within a cluster-randomized trial in households with influenza index patients. We recruited 147 participants in 41 households, 39 (95 %) out of 41 index patients were children (aged <14 years). In households assigned to wear facemasks, their use peaked on day 4 after symptom onset of the index patient at 73% and at 65 % for children and adults, respectively. Mean daily frequency of hand disinfection in households assigned to intensified hand hygiene measures peaked at 7 . 7 (day 6) for children and at 10 . 1 (day 5) for adults. The majority of participants reported no problems with mask wearing. Data suggest that usage of NPI can be taught and that measures are well tolerated by adults and even sick children alike.

Transmission of Acute Gastroenteritis and Respiratory Illness From Children to Parents

“…[37][38][39] In contrast, RCTs have not shown the effectiveness of hand hygiene to prevent household transmission of ARIs, regardless of etiology. [40][41][42] However, another randomized controlled trials found no effectiveness of handwashing in influenza prevention, even with masking. [40][41][42] However, another randomized controlled trials found no effectiveness of handwashing in influenza prevention, even with masking.…”

Prevention of influenza among travellers attending at a UK travel clinic: beliefs and perceptions. A cross‐sectional study

“…Although, at least in theory, compliance with influenza prevention measures should be quite simple, 36–39 the acceptability of these measures among travellers was unknown. To our knowledge, our study is the first to evaluate the associations between determinants of intention by travellers to comply with antiviral recommendations and individual cognitive factors.…”

Assessing the State of Knowledge Regarding the Effectiveness of Interventions to Contain Pandemic Influenza Transmission: A Systematic Review and Narrative Synthesis

“…reviewed ten studies of hand hygiene and facemask use in developed countries, and obtained an insignificant estimate of risk reduction associated with hand hygiene alone (RR: 0.82; 95% CI 0.66–1.02) but a significant risk reduction when hand hygiene was practiced in conjunction with facemask use (RR: 0.73; 95% CI 0.53–0.99). However, only one of these ten studies [51] was performed in a pandemic setting, with the other nine dealing instead with seasonal influenza control. With small sample size limiting generalizability (n = 149), insignificant risk reductions associated with hand hygiene and facemask use for laboratory-confirmed influenza (RR: 0.64; 95% CI 0.32–1.29) and influenza-like illness (RR: 0.52; 95% CI 0.21–1.29) were found in the pandemic study [51].…”

“…However, only one of these ten studies [51] was performed in a pandemic setting, with the other nine dealing instead with seasonal influenza control. With small sample size limiting generalizability (n = 149), insignificant risk reductions associated with hand hygiene and facemask use for laboratory-confirmed influenza (RR: 0.64; 95% CI 0.32–1.29) and influenza-like illness (RR: 0.52; 95% CI 0.21–1.29) were found in the pandemic study [51]. Mukerji et al .…”

“…This limits the ability to evaluate the effectiveness of interventions such as school closure, facemask use, or quarantine of infected individuals, which would be inappropriate during standard seasonal influenza seasons. As a consequence, there is no conclusive evidence on the impact of these strategies: there was, in fact, substantial uncertainty about which measures to implement during the 2009 pandemic [53, 54]. Second, the assertion that seasonal influenza research remains relevant to pandemic influenza situations remains controversial [55].…”