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Respirology. 2015 Aug;20(6):896-903. doi: 10.1111/resp.12541. Epub 2015 Apr 14.

Use of non-pharmaceutical interventions to reduce the transmission of influenza in adults: A systematic review.

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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.
National Institutes of Health, Clinical Center, Bethesda, Maryland, USA.
School of Medicine and Pharmacology, Royal Perth Unit, University of Western Australia, Perth, Western Australia, Australia.
Infectious Diseases Unit, Department of Epidemiology and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
School of Medicine and Pharmacology, Queen Elizabeth II Unit, University of Western Australia, Perth, Western Australia, Australia.
The Lung Health Clinic, Hollywood Hospital, Perth, Western Australia, Australia.
Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.


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.


epidemic; influenza; non-pharmaceutical; pandemic; seasonal

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