title: Influenza virus contamination of common household surfaces during the 2009 influenza A (H1N1) pandemic in Bangkok, Thailand: implications for contact transmission.
abstract: BACKGROUND
  Rational infection control guidance requires an improved understanding of influenza transmission. We studied households with an influenza-infected child to measure the prevalence of influenza contamination, the effect of hand washing, and associations with humidity and temperature.
  
  
  METHODS
  We identified children with influenza and randomly assigned their households to hand washing and control arms. Six common household surfaces and the fingertips of the index patient and symptomatic family members were swabbed. Specimens were tested by real-time reverse-transcription polymerase chain reaction (rRT-PCR), and specimens with positive results were placed on cell culture. A handheld psychrometer measured meteorological data.
  
  
  RESULTS
  Sixteen (17.8%) of 90 households had influenza A-positive surfaces by rRT-PCR, but no viruses could be cultured. The fingertips of 15 (16.6%) of the index patients had results positive for influenza A, and 1 virus was cultured. Index patients with seasonal influenza infections shed more virus than did patients with pandemic influenza infection. Control households had a higher prevalence of surface contamination (11 [24.4%] of 45) than did hand washing households (5 [11.1%] of 45); prevalence risk difference (PRD), 13.3%; [95% confidence interval {CI}, −2.2% to 28.9%]; P = .09). Households in which the age of the index patient was ≤8 years had a significantly higher prevalence of contamination (PRD ,19.1%; 95% CI, 5.3% -32.9%; P = .02). Within the strata of households with secondary infections, an effect of lower absolute humidity is suggested (P = .07).
  
  
  CONCLUSIONS
  We documented influenza virus RNA contamination on household surfaces and on the fingertips of ill children. Homes with younger children were more likely than homes of older children to have contaminated surfaces. Lower absolute humidity favors surface contamination in households with multiple infections. Increased hand washing can reduce influenza contamination in the home.
authors.affiliation: Influenza Division, International Emerging Infections Program, Thailand Ministry of Public Health, US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand. marksimmerman@hotmail.com
authors.forename: James Mark
authors.initials: JM
authors.lastname: Simmerman
authors.forename: Piyarat
authors.initials: P
authors.lastname: Suntarattiwong
authors.forename: Jens
authors.initials: J
authors.lastname: Levy
authors.forename: Robert V
authors.initials: RV
authors.lastname: Gibbons
authors.forename: Christina
authors.initials: C
authors.lastname: Cruz
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Shaman
authors.forename: Richard G
authors.initials: RG
authors.lastname: Jarman
authors.forename: Tawee
authors.initials: T
authors.lastname: Chotpitayasunondh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004783:Environmental Microbiology; D005191:Family Characteristics; D005260:Female; D006225:Hand / Q000821:virology; D006235:Hand Disinfection; D006801:Humans; D006813:Humidity; D007223:Infant; D017053:Infection Control / Q000379:methods*; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000635:transmission / Q000821:virology*; D008297:Male; D058873:Pandemics; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D013696:Temperature; D013785:Thailand
chemical_list: D012367:RNA, Viral