title: Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: a randomized controlled trial.
abstract: BACKGROUND
  Laboratory-based evidence is lacking regarding the efficacy of nonpharmaceutical interventions (NPIs) such as alcohol-based hand sanitizer and respiratory hygiene to reduce the spread of influenza.
  
  
  METHODS
  The Pittsburgh Influenza Prevention Project was a cluster-randomized trial conducted in 10 elementary schools in Pittsburgh, PA, during the 2007 to 2008 influenza season. Children in 5 intervention schools received training in hand and respiratory hygiene, and were provided and encouraged to use hand sanitizer regularly. Children in 5 schools acted as controls. Children with influenza-like illness were tested for influenza A and B by reverse-transcriptase polymerase chain reaction.
  
  
  RESULTS
  A total of 3360 children participated in this study. Using reverse-transcriptase polymerase chain reaction, 54 cases of influenza A and 50 cases of influenza B were detected. We found no significant effect of the intervention on the primary study outcome of all laboratory-confirmed influenza cases (incidence rate ratio [IRR]: 0.81; 95% confidence interval [CI]: 0.54, 1.23). However, we did find statistically significant differences in protocol-specified ancillary outcomes. Children in intervention schools had significantly fewer laboratory-confirmed influenza A infections than children in control schools, with an adjusted IRR of 0.48 (95% CI: 0.26, 0.87). Total absent episodes were also significantly lower among the intervention group than among the control group; adjusted IRR 0.74 (95% CI: 0.56, 0.97).
  
  
  CONCLUSIONS
  NPIs (respiratory hygiene education and the regular use of hand sanitizer) did not reduce total laboratory-confirmed influenza. However, the interventions did reduce school total absence episodes by 26% and laboratory-confirmed influenza A infections by 52%. Our results suggest that NPIs can be an important adjunct to influenza vaccination programs to reduce the number of influenza A infections among children.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA. stebbins@pitt.edu
authors.forename: Samuel
authors.initials: S
authors.lastname: Stebbins
authors.forename: Derek A T
authors.initials: DA
authors.lastname: Cummings
authors.forename: James H
authors.initials: JH
authors.lastname: Stark
authors.forename: Chuck
authors.initials: C
authors.lastname: Vukotich
authors.forename: Kiren
authors.initials: K
authors.lastname: Mitruka
authors.forename: William
authors.initials: W
authors.lastname: Thompson
authors.forename: Charles
authors.initials: C
authors.lastname: Rinaldo
authors.forename: Loren
authors.initials: L
authors.lastname: Roth
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Virginia
authors.initials: V
authors.lastname: Dato
authors.forename: Heather
authors.initials: H
authors.lastname: Eng
authors.forename: Donald S
authors.initials: DS
authors.lastname: Burke
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000517:prevention & control; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D006920:Hygiene / Q000193:education; D015994:Incidence; D009980:Influenza A virus / Q000276:immunology*; D009981:Influenza B virus / Q000276:immunology*; D007251:Influenza, Human / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D012367:RNA, Viral / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012574:Schools; D013334:Students; D014481:United States
chemical_list: D012367:RNA, Viral