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Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: A randomized controlled trial

Stebbins, S and Cummings, DAT and Stark, JH and Vukotich, C and Mitruka, K and Thompson, W and Rinaldo, C and Roth, L and Wagner, M and Wisniewski, SR and Dato, V and Eng, H and Burke, DS (2011) Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: A randomized controlled trial. Pediatric Infectious Disease Journal, 30 (11). 921 - 926. ISSN 0891-3668

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Background: Laboratory-based evidence is lacking regarding the efficacy of nonpharmaceutical interventions (NPIs) such as alcohol-based hand sanitizer and respiratory hygiene to reduce the spread of influenza. Methods: The Pittsburgh Influenza Prevention Project was a cluster-randomized trial conducted in 10 elementary schools in Pittsburgh, PA, during the 2007 to 2008 influenza season. Children in 5 intervention schools received training in hand and respiratory hygiene, and were provided and encouraged to use hand sanitizer regularly. Children in 5 schools acted as controls. Children with influenza-like illness were tested for influenza A and B by reverse-transcriptase polymerase chain reaction. Results: A total of 3360 children participated in this study. Using reverse-transcriptase polymerase chain reaction, 54 cases of influenza A and 50 cases of influenza B were detected. We found no significant effect of the intervention on the primary study outcome of all laboratory-confirmed influenza cases (incidence rate ratio [IRR]: 0.81; 95% confidence interval [CI]: 0.54, 1.23). However, we did find statistically significant differences in protocol-specified ancillary outcomes. Children in intervention schools had significantly fewer laboratory-confirmed influenza A infections than children in control schools, with an adjusted IRR of 0.48 (95% CI: 0.26, 0.87). Total absent episodes were also significantly lower among the intervention group than among the control group; adjusted IRR 0.74 (95% CI: 0.56, 0.97). Conclusions: NPIs (respiratory hygiene education and the regular use of hand sanitizer) did not reduce total laboratory-confirmed influenza. However, the interventions did reduce school total absence episodes by 26% and laboratory-confirmed influenza A infections by 52%. Our results suggest that NPIs can be an important adjunct to influenza vaccination programs to reduce the number of influenza A infections among children. © 2011 by Lippincott Williams & Wilkins.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Stebbins, S
Cummings, DAT
Stark, JH
Vukotich, C
Mitruka, K
Thompson, W
Rinaldo, CRINALDO@pitt.eduRINALDO
Roth, L
Wagner, M
Wisniewski, SRSTEVEWIS@pitt.eduSTEVEWIS
Dato, Vvmd11@pitt.eduVMD11
Eng, HHENG@pitt.eduHENG
Burke, DSdonburke@pitt.eduDONBURKE
Centers: Other Centers, Institutes, Offices, or Units > Center for Public Health Practice
Other Centers, Institutes, Offices, or Units > Center for Vaccine Research
Date: 1 January 2011
Date Type: Publication
Journal or Publication Title: Pediatric Infectious Disease Journal
Volume: 30
Number: 11
Page Range: 921 - 926
DOI or Unique Handle: 10.1097/inf.0b013e3182218656
Schools and Programs: Graduate School of Public Health > Epidemiology
Graduate School of Public Health > Infectious Diseases and Microbiology
Refereed: Yes
ISSN: 0891-3668
Date Deposited: 07 May 2015 20:03
Last Modified: 18 May 2020 13:56


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