Smith Sheree M S, Sonego Sandra, Wallen Gwenyth R, Waterer Grant, Cheng Allen C, Thompson Philip
School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia.
Centre for Pharmacology and Therapeutics, Imperial College, Chelsea and Westminster Campus, London, UK.
Respirology. 2015 Aug;20(6):896-903. doi: 10.1111/resp.12541. Epub 2015 Apr 14.
During seasonal influenza epidemics and pandemics, virus transmission causes significant public health concern. Reduction of viral transmission by non-pharmaceutical interventions (NPI) has a significant appeal and is often recommended. However, the efficacy of such interventions is unclear. A systematic literature review was undertaken to identify and evaluate the published literature on NPI efficacy to prevent human transmission of influenza virus in adults. Reviewers assessed the quality of eligible studies utilizing the Critical Appraisal Skills Programme for bias and the Scottish Intercollegiate Guidelines Network for methodological quality. Studies were assessed for risk of bias domains of random sequence generation, allocation concealment, attribution bias, selective reporting and blinding. Relevant citations of 2247 were reduced to 100 for full-text evaluation. Only seven met all selection criteria and pooled analysis was not feasible. Of the seven studies, two were randomized controlled trials (RCT) and five were cluster RCT. The main NPI studied were disinfection and hygiene; barriers; and combined NPI. However, these seven RCT had significant design flaws. Only two studies used laboratory confirmed influenza and poor statistical power was a major problem. Positive significant interventions included professional oral hygiene intervention in the elderly and hand washing. Despite the potential for NPI in preventing influenza transmission, there is very limited data available. Hand washing and dental hygiene may be useful, but other interventions have not been fully assessed. Properly designed studies evaluating large populations including 'at risk' patients and in a variety of communities are needed.
在季节性流感流行和大流行期间，病毒传播引起了重大的公共卫生关注。通过非药物干预措施（NPI）减少病毒传播具有重大吸引力，并且经常被推荐。然而，此类干预措施的效果尚不清楚。进行了一项系统的文献综述，以识别和评估已发表的关于NPI预防成人流感病毒人际传播效果的文献。评审人员利用批判性评估技能计划评估合格研究的偏倚质量，并利用苏格兰跨学院指南网络评估方法学质量。对研究的随机序列生成、分配隐藏、归因偏倚、选择性报告和盲法等偏倚领域进行了评估。2247条相关引文经筛选后，有100条进入全文评估。只有7项研究符合所有入选标准，因此无法进行汇总分析。在这7项研究中，2项为随机对照试验（RCT），5项为整群RCT。所研究的主要NPI包括消毒与卫生；屏障；以及联合NPI。然而，这7项RCT存在显著的设计缺陷。只有2项研究使用了实验室确诊的流感病例，而且统计效能不足是一个主要问题。积极有效的干预措施包括对老年人进行专业口腔卫生干预和洗手。尽管NPI在预防流感传播方面具有潜力，但可用数据非常有限。洗手和口腔卫生可能有用，但其他干预措施尚未得到充分评估。需要开展设计合理的研究，评估包括“高危”患者在内的大量人群以及各种社区中的情况。
