非药物干预措施对拥挤城市家庭中 URIs 和流感的影响。
Impact of non-pharmaceutical interventions on URIs and influenza in crowded, urban households.
机构信息
School of Nursing, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
出版信息
Public Health Rep. 2010 Mar-Apr;125(2):178-91. doi: 10.1177/003335491012500206.
OBJECTIVES
We compared the impact of three household interventions-education, education with alcohol-based hand sanitizer, and education with hand sanitizer and face masks-on incidence and secondary transmission of upper respiratory infections (URIs) and influenza, knowledge of transmission of URIs, and vaccination rates.
METHODS
A total of 509 primarily Hispanic households participated. Participants reported symptoms twice weekly, and nasal swabs were collected from those with an influenza-like illness (ILI). Households were followed for up to 19 months and home visits were made at least every two months.
RESULTS
We recorded 5034 URIs, of which 669 cases reported ILIs and 78 were laboratory-confirmed cases of influenza. Demographic factors significantly associated with infection rates included age, gender, birth location, education, and employment. The Hand Sanitizer group was significantly more likely to report that no household member had symptoms (p < 0.01), but there were no significant differences in rates of infection by intervention group in multivariate analyses. Knowledge improved significantly more in the Hand Sanitizer group (p < 0.0001). The proportion of households that reported > or = 50% of members receiving influenza vaccine increased during the study (p < 0.001). Despite the fact that compliance with mask wearing was poor, mask wearing as well as increased crowding, lower education levels of caretakers, and index cases 0-5 years of age (compared with adults) were associated with significantly lower secondary transmission rates (all p < 0.02).
CONCLUSIONS
In this population, there was no detectable additional benefit of hand sanitizer or face masks over targeted education on overall rates of URIs, but mask wearing was associated with reduced secondary transmission and should be encouraged during outbreak situations. During the study period, community concern about methicillin-resistant Staphylococcus aureus was occurring, perhaps contributing to the use of hand sanitizer in the Education control group, and diluting the intervention's measurable impact.
目的
我们比较了三种家庭干预措施（教育、含酒精的手部消毒剂教育和手部消毒剂与口罩教育）对呼吸道感染（URIs）和流感的发病率和二次传播、URIs 传播知识和疫苗接种率的影响。
方法
共有 509 个主要为西班牙裔的家庭参与。参与者每两周报告一次症状，对有流感样疾病（ILI）的人进行鼻拭子采集。对家庭进行了长达 19 个月的随访，每两个月至少进行一次家访。
结果
我们记录了 5034 例 URIs，其中 669 例报告有 ILI，78 例为实验室确诊的流感病例。与感染率显著相关的人口因素包括年龄、性别、出生地点、教育程度和就业情况。手部消毒剂组报告家中无任何成员出现症状的比例显著更高（p < 0.01），但在多变量分析中，各组间感染率无显著差异。手部消毒剂组的知识显著提高（p < 0.0001）。报告有≥50%成员接种流感疫苗的家庭比例在研究期间增加（p < 0.001）。尽管戴口罩的依从性很差，但戴口罩以及增加人群拥挤、照顾者教育程度较低以及指数病例 0-5 岁（与成人相比）与显著较低的二次传播率相关（均 p < 0.02）。
结论
在本研究人群中，手部消毒剂或口罩干预措施与总体 URIs 发病率相比，没有明显的额外益处，但戴口罩与降低二次传播有关，在暴发期间应予以鼓励。在研究期间，社区对手足口病耐药性金黄色葡萄球菌的关注可能导致教育对照组中使用手部消毒剂，从而削弱了干预措施的可衡量影响。
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