title: Effectiveness of public health measures in mitigating pandemic influenza spread: a prospective sero-epidemiological cohort study.
abstract: BACKGROUND
  Few studies have validated the effectiveness of public health interventions in reducing influenza spread in real‐life settings. We aim to validate these measures used during the 2009 pandemic.
  
  
  METHODS
  From 22 June to 9 October 2009, we performed a prospective observational cohort study using paired serum samples and symptom review among 3 groups of Singapore military personnel. "Normal" units were subjected to prevailing pandemic response policies. "Essential" units and health care workers had additional public health interventions (eg, enhanced surveillance with isolation, segregation, personal protective equipment). Samples were tested by hemagglutination inhibition; the principal outcome was seroconversion to 2009 influenza A(H1N1).
  
  
  RESULTS
  In total, 1015 individuals in 14 units completed the study, with 29% overall seroconversion. Seroconversion among essential units (17%) and health care workers (11%) was significantly lower than that in normal units (44%) (P = .001). Symptomatic illness attributable to influenza was also lower in essential units (5%) and health care workers (2%) than in normal units (12%) (P = .06). Adjusted for confounders, unit type was the only significant variable influencing overall seroconversion ( P < .05). From multivariate analysis within each unit, age (P < .001) and baseline antibody titer (P = .012 ) were inversely related to seroconversion risk.
  
  
  CONCLUSIONS
  Public health measures are effective in limiting influenza transmission in closed environments.
authors.affiliation: Biodefence Centre, Ministry of Defence, Department of Epidemiology and Public Health, National University of Singapore, Singapore Armed Forces, Singapore.
authors.forename: Vernon  J
authors.initials: V
authors.lastname: Lee
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yap
authors.forename: Alex R
authors.initials: AR
authors.lastname: Cook
authors.forename: Mark  I
authors.initials: M
authors.lastname: Chen
authors.forename: Joshua  K
authors.initials: J
authors.lastname: Tay
authors.forename: Ian
authors.initials: I
authors.lastname: Barr
authors.forename: Anne
authors.initials: A
authors.lastname: Kelso
authors.forename: Boon  Huan
authors.initials: B
authors.lastname: Tan
authors.forename: Jin Phang
authors.initials: JP
authors.lastname: Loh
authors.forename: Raymond
authors.initials: R
authors.lastname: Lin
authors.forename: Lin
authors.initials: L
authors.lastname: Cui
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kelly
authors.forename: Yee  Sin
authors.initials: Y
authors.lastname: Leo
authors.forename: Kee  Seng
authors.initials: K
authors.lastname: Chia
authors.forename: Wee Lee
authors.initials: WL
authors.lastname: Kang
authors.forename: Paul  A
authors.initials: P
authors.lastname: Tambyah
authors.forename: Benjamin
authors.initials: B
authors.lastname: Seet
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D015331:Cohort Studies; D003140:Communicable Disease Control / Q000379:methods*; D004196:Disease Outbreaks; D006302:Health Services Research; D006385:Hemagglutination Inhibition Tests; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control* / Q000821:virology; D008297:Male; D008889:Military Personnel; D011446:Prospective Studies; D016036:Seroepidemiologic Studies; D012846:Singapore / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral