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

Ram PK, DiVita MA, Khatun-e-Jannat K, Islam M, Krytus K, Cercone E, Sohel BM, Ahmed M, Rahman AM, Rahman M, Yu J, Brooks WA, Azziz-Baumgartner E, Fry AM, Luby SP - PLoS ONE (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, NY, United States of America.

ABSTRACT

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 (RRadj 5.51, 95% CI 3.43-8.85), those living with an index case-patient enrolled ≤24 hours after symptom onset (RRadj 1.91, 95% CI 1.18-3.10), and those who reported multiple daily interactions with the index case-patient (RRadj 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.

No MeSH data available.


Related in: MedlinePlus

Median per capita soap use in grams, by day of enrollment, among intervention compounds, Kishoregonj, Bangladesh, 2009–2010 (N = 191).
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pone.0125200.g003: Median per capita soap use in grams, by day of enrollment, among intervention compounds, Kishoregonj, Bangladesh, 2009–2010 (N = 191).

Mentions: We examined the presence or absence of soap and water at the handwashing station during each of the first 10 days of surveillance from 180 intervention household compounds. Soap was present at the handwashing station for at least 7 days in all 180 compounds and on all 10 days in 133 (74%). Soap and water together were present at the handwashing station for 7 or more of the first 10 days in 99% of household compounds, with water and soap observed together on all 10 days in 99 (55%) household compounds. We restricted soap use analysis to measurements of soap weight during the first 12 days of enrollment, since thereafter, data collection had stopped in 25% or more of intervention compounds based on the resolution of index case-patient symptoms. When examining the compound’s mean daily per capita soap use over the first 12 days, we found a median per capita soap consumption of 2.3 grams (interquartile range: 1.7 to 3.2 grams). Estimates of median daily per capita soap use for each day of measurement are shown in Fig 3. Maximal per capita soap use on any one of the first 12 days of enrollment was 4.6 grams and was observed on a median of the 7th day of participation (interquartile range: 5 to 9 days). We found no significant association between per capita soap use and risk of ILI transmission in the household.


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

Ram PK, DiVita MA, Khatun-e-Jannat K, Islam M, Krytus K, Cercone E, Sohel BM, Ahmed M, Rahman AM, Rahman M, Yu J, Brooks WA, Azziz-Baumgartner E, Fry AM, Luby SP - PLoS ONE (2015)

Median per capita soap use in grams, by day of enrollment, among intervention compounds, Kishoregonj, Bangladesh, 2009–2010 (N = 191).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4465839&req=5

pone.0125200.g003: Median per capita soap use in grams, by day of enrollment, among intervention compounds, Kishoregonj, Bangladesh, 2009–2010 (N = 191).
Mentions: We examined the presence or absence of soap and water at the handwashing station during each of the first 10 days of surveillance from 180 intervention household compounds. Soap was present at the handwashing station for at least 7 days in all 180 compounds and on all 10 days in 133 (74%). Soap and water together were present at the handwashing station for 7 or more of the first 10 days in 99% of household compounds, with water and soap observed together on all 10 days in 99 (55%) household compounds. We restricted soap use analysis to measurements of soap weight during the first 12 days of enrollment, since thereafter, data collection had stopped in 25% or more of intervention compounds based on the resolution of index case-patient symptoms. When examining the compound’s mean daily per capita soap use over the first 12 days, we found a median per capita soap consumption of 2.3 grams (interquartile range: 1.7 to 3.2 grams). Estimates of median daily per capita soap use for each day of measurement are shown in Fig 3. Maximal per capita soap use on any one of the first 12 days of enrollment was 4.6 grams and was observed on a median of the 7th day of participation (interquartile range: 5 to 9 days). We found no significant association between per capita soap use and risk of ILI transmission in the household.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, NY, United States of America.

ABSTRACT

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 (RRadj 5.51, 95% CI 3.43-8.85), those living with an index case-patient enrolled ≤24 hours after symptom onset (RRadj 1.91, 95% CI 1.18-3.10), and those who reported multiple daily interactions with the index case-patient (RRadj 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.

No MeSH data available.


Related in: MedlinePlus