Benjamin J. Cowling, BSc, PhD; Kwok-Hung Chan, BSc, PhD; Vicky J. Fang, BSc, MPhil; Calvin K.Y. Cheng, BSc, MMedSci; Rita O.P. Fung, BNS; Winnie Wai, BNS; Joey Sin, BNS; Wing Hong Seto, MBBS; Raymond Yung, MBBS, MPH; Daniel W.S. Chu, MBBS; Billy C.F. Chiu, MBBS; Paco W.Y. Lee, MBBS; Ming Chi Chiu, MBBS; Hoi Che Lee, MBBS; Timothy M. Uyeki, MD, MPH; Peter M. Houck, MD; J. S. Malik Peiris, MBBS, DPhil; Gabriel M. Leung, MD, MPH
Few data are available about the effectiveness of nonpharmaceutical interventions for preventing influenza virus transmission.
To investigate whether hand hygiene and use of facemasks prevents household transmission of influenza.
Cluster randomized, controlled trial. Randomization was computer generated; allocation was concealed from treating physicians and clinics and implemented by study nurses at the time of the initial household visit. Participants and personnel administering the interventions were not blinded to group assignment. (ClinicalTrials.gov registration number: NCT00425893)
Households in Hong Kong.
407 people presenting to outpatient clinics with influenza-like illness who were positive for influenza A or B virus by rapid testing (index patients) and 794 household members (contacts) in 259 households.
Lifestyle education (control) (134 households), hand hygiene (136 households), or surgical facemasks plus hand hygiene (137 households) for all household members.
Influenza virus infection in contacts, as confirmed by reverse-transcription polymerase chain reaction (RT-PCR) or diagnosed clinically after 7 days.
Sixty (8%) contacts in the 259 households had RT-PCRâ€“confirmed influenza virus infection in the 7 days after intervention. Hand hygiene with or without facemasks seemed to reduce influenza transmission, but the differences compared with the control group were not significant. In 154 households in which interventions were implemented within 36 hours of symptom onset in the index patient, transmission of RT-PCRâ€“confirmed infection seemed reduced, an effect attributable to fewer infections among participants using facemasks plus hand hygiene (adjusted odds ratio, 0.33 [95% CI, 0.13 to 0.87]). Adherence to interventions varied.
The delay from index patient symptom onset to intervention and variable adherence may have mitigated intervention effectiveness.
Hand hygiene and facemasks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset. These findings suggest that nonpharmaceutical interventions are important for mitigation of pandemic and interpandemic influenza.
Centers for Disease Control and Prevention.
Hand hygiene and use of facemasks are key elements of influenza pandemic preparedness plans, but their effects on preventing transmission of infection have not been demonstrated.
In this cluster randomized trial, hand washing and facemasks seemed to prevent influenza transmission when healthy family members started using these measures within 36 hours of symptom onset in an infected family member.
Adherence to the interventions was low.
Hand hygiene and facemasks seem to reduce influenza virus transmission when implemented early after symptom onset.
ILI = influenza-like illness; QV −ve = negative result by QuickVue Influenza A+B test; QV Flu A +ve = positive result for influenza A by QuickVue Influenza A+B test; QV Flu B +ve = positive result for influenza B by QuickVue Influenza A+B test. Top. Weekly recruitment rates, stratified by rapid test result. Middle. Local surveillance data on the weekly rate of ILI consultations per 1000 consultations among sentinel general practitioners reporting to the Centre for Health Protection. Bottom. Weekly rate of positive influenza A and B virus isolations among specimens submitted to the World Health Organization reference laboratory of Queen Mary Hospital, Hong Kong.
IQR = interquartile range; RT-PCR = reverse-transcription polymerase chain reaction.
* QuickVue Influenza A+B rapid diagnostic test (Quidel, San Diego, California).
Appendix Table 1.
Appendix Table 2.
Appendix Table 3.
Appendix Table 4.
Appendix Table 5.
Appendix Table 6.
Appendix Table 7.
Appendix Table 8.
Appendix Table 9.
Data are presented as means (95% CIs).
Appendix Table 10.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Cowling BJ, Chan K, Fang VJ, Cheng CK, Fung RO, Wai W, et al. Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households: A Cluster Randomized Trial. Ann Intern Med. 2009;151:437–446. doi: 10.7326/0003-4819-151-7-200910060-00142
Download citation file:
Published: Ann Intern Med. 2009;151(7):437-446.
Infectious Disease, Pulmonary/Critical Care.
Results provided by:
Copyright © 2018 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use