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Impact of Intensive Handwashing Promotion on Secondary Household Influenza-Like Illness in Rural Bangladesh: Findings from a Randomized Controlled Trial

RATIONALE: There is little evidence for the efficacy of handwashing for prevention of influenza transmission in resource-poor settings. We tested the impact of intensive handwashing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh. METHODS: In 2009–10,...

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Autores principales: Ram, Pavani K., DiVita, Margaret A., Khatun-e-Jannat, Kaniz, Islam, Manoshi, Krytus, Kimberly, Cercone, Emily, Sohel, Badrul Munir, Ahmed, Makhdum, Rahman, Abid Mahmud Quaiyum, Rahman, Mustafizur, Yu, Jihnhee, Brooks, W. Abdullah, Azziz-Baumgartner, Eduardo, Fry, Alicia M., Luby, Stephen P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465839/
https://www.ncbi.nlm.nih.gov/pubmed/26066651
http://dx.doi.org/10.1371/journal.pone.0125200
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author Ram, Pavani K.
DiVita, Margaret A.
Khatun-e-Jannat, Kaniz
Islam, Manoshi
Krytus, Kimberly
Cercone, Emily
Sohel, Badrul Munir
Ahmed, Makhdum
Rahman, Abid Mahmud Quaiyum
Rahman, Mustafizur
Yu, Jihnhee
Brooks, W. Abdullah
Azziz-Baumgartner, Eduardo
Fry, Alicia M.
Luby, Stephen P.
author_facet Ram, Pavani K.
DiVita, Margaret A.
Khatun-e-Jannat, Kaniz
Islam, Manoshi
Krytus, Kimberly
Cercone, Emily
Sohel, Badrul Munir
Ahmed, Makhdum
Rahman, Abid Mahmud Quaiyum
Rahman, Mustafizur
Yu, Jihnhee
Brooks, W. Abdullah
Azziz-Baumgartner, Eduardo
Fry, Alicia M.
Luby, Stephen P.
author_sort Ram, Pavani K.
collection PubMed
description RATIONALE: There is little evidence for the efficacy of handwashing for prevention of influenza transmission in resource-poor settings. We tested the impact of intensive handwashing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh. METHODS: In 2009–10, we identified index case-patients with influenza-like illness (fever with cough or sore throat) who were the only symptomatic person in their household. Household compounds of index case-patients were randomized to control or intervention (soap and daily handwashing promotion). We conducted daily surveillance and collected oropharyngeal specimens. Secondary attack ratios (SAR) were calculated for influenza and ILI in each arm. Among controls, we investigated individual risk factors for ILI among household contacts of index case-patients. RESULTS: Among 377 index case-patients, the mean number of days between fever onset and study enrollment was 2.1 (SD 1.7) among the 184 controls and 2.6 (SD 2.9) among 193 intervention case-patients. Influenza infection was confirmed in 20% of controls and 12% of intervention index case-patients. The SAR for influenza-like illness among household contacts was 9.5% among intervention (158/1661) and 7.7% among control households (115/1498) (SAR ratio 1.24, 95% CI 0.92–1.65). The SAR ratio for influenza was 2.40 (95% CI 0.68–8.47). In the control arm, susceptible contacts <2 years old (RR(adj) 5.51, 95% CI 3.43–8.85), those living with an index case-patient enrolled ≤24 hours after symptom onset (RR(adj) 1.91, 95% CI 1.18–3.10), and those who reported multiple daily interactions with the index case-patient (RR(adj) 1.94, 95% CI 1.71–3.26) were at increased risk of influenza-like illness. DISCUSSION: Handwashing promotion initiated after illness onset in a household member did not protect against influenza-like illness or influenza. Behavior may not have changed rapidly enough to curb transmission between household members. A reactive approach to reduce household influenza transmission through handwashing promotion may be ineffective in the context of rural Bangladesh. TRIAL REGISTRATION: ClinicalTrials.gov NCT00880659
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spelling pubmed-44658392015-06-25 Impact of Intensive Handwashing Promotion on Secondary Household Influenza-Like Illness in Rural Bangladesh: Findings from a Randomized Controlled Trial Ram, Pavani K. DiVita, Margaret A. Khatun-e-Jannat, Kaniz Islam, Manoshi Krytus, Kimberly Cercone, Emily Sohel, Badrul Munir Ahmed, Makhdum Rahman, Abid Mahmud Quaiyum Rahman, Mustafizur Yu, Jihnhee Brooks, W. Abdullah Azziz-Baumgartner, Eduardo Fry, Alicia M. Luby, Stephen P. PLoS One Research Article RATIONALE: There is little evidence for the efficacy of handwashing for prevention of influenza transmission in resource-poor settings. We tested the impact of intensive handwashing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh. METHODS: In 2009–10, we identified index case-patients with influenza-like illness (fever with cough or sore throat) who were the only symptomatic person in their household. Household compounds of index case-patients were randomized to control or intervention (soap and daily handwashing promotion). We conducted daily surveillance and collected oropharyngeal specimens. Secondary attack ratios (SAR) were calculated for influenza and ILI in each arm. Among controls, we investigated individual risk factors for ILI among household contacts of index case-patients. RESULTS: Among 377 index case-patients, the mean number of days between fever onset and study enrollment was 2.1 (SD 1.7) among the 184 controls and 2.6 (SD 2.9) among 193 intervention case-patients. Influenza infection was confirmed in 20% of controls and 12% of intervention index case-patients. The SAR for influenza-like illness among household contacts was 9.5% among intervention (158/1661) and 7.7% among control households (115/1498) (SAR ratio 1.24, 95% CI 0.92–1.65). The SAR ratio for influenza was 2.40 (95% CI 0.68–8.47). In the control arm, susceptible contacts <2 years old (RR(adj) 5.51, 95% CI 3.43–8.85), those living with an index case-patient enrolled ≤24 hours after symptom onset (RR(adj) 1.91, 95% CI 1.18–3.10), and those who reported multiple daily interactions with the index case-patient (RR(adj) 1.94, 95% CI 1.71–3.26) were at increased risk of influenza-like illness. DISCUSSION: Handwashing promotion initiated after illness onset in a household member did not protect against influenza-like illness or influenza. Behavior may not have changed rapidly enough to curb transmission between household members. A reactive approach to reduce household influenza transmission through handwashing promotion may be ineffective in the context of rural Bangladesh. TRIAL REGISTRATION: ClinicalTrials.gov NCT00880659 Public Library of Science 2015-06-11 /pmc/articles/PMC4465839/ /pubmed/26066651 http://dx.doi.org/10.1371/journal.pone.0125200 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
spellingShingle Research Article
Ram, Pavani K.
DiVita, Margaret A.
Khatun-e-Jannat, Kaniz
Islam, Manoshi
Krytus, Kimberly
Cercone, Emily
Sohel, Badrul Munir
Ahmed, Makhdum
Rahman, Abid Mahmud Quaiyum
Rahman, Mustafizur
Yu, Jihnhee
Brooks, W. Abdullah
Azziz-Baumgartner, Eduardo
Fry, Alicia M.
Luby, Stephen P.
Impact of Intensive Handwashing Promotion on Secondary Household Influenza-Like Illness in Rural Bangladesh: Findings from a Randomized Controlled Trial
title Impact of Intensive Handwashing Promotion on Secondary Household Influenza-Like Illness in Rural Bangladesh: Findings from a Randomized Controlled Trial
title_full Impact of Intensive Handwashing Promotion on Secondary Household Influenza-Like Illness in Rural Bangladesh: Findings from a Randomized Controlled Trial
title_fullStr Impact of Intensive Handwashing Promotion on Secondary Household Influenza-Like Illness in Rural Bangladesh: Findings from a Randomized Controlled Trial
title_full_unstemmed Impact of Intensive Handwashing Promotion on Secondary Household Influenza-Like Illness in Rural Bangladesh: Findings from a Randomized Controlled Trial
title_short Impact of Intensive Handwashing Promotion on Secondary Household Influenza-Like Illness in Rural Bangladesh: Findings from a Randomized Controlled Trial
title_sort impact of intensive handwashing promotion on secondary household influenza-like illness in rural bangladesh: findings from a randomized controlled trial
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465839/
https://www.ncbi.nlm.nih.gov/pubmed/26066651
http://dx.doi.org/10.1371/journal.pone.0125200
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