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Influenza Other Respir Viruses. 2013 May;7(3):418-25. doi: 10.1111/j.1750-2659.2012.00407.x. Epub 2012 Jul 16.

Preventable and non-preventable risk factors for influenza transmission and hygiene behavior in German influenza households, pandemic season (H1N1) 2009/2010.

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Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.



To date, little is known about the role of behavioral risk factors for influenza transmission as well as hygiene behavior in the household setting during the influenza pandemic (H1N1) 2009. In a household-based study conducted during 2008/2009, we identified several behavioral risk factors for influenza transmission; 30% of index patients and 30% of household contacts reported increased hand cleaning frequency in the week after symptom onset of the index patient. We conducted another household-based study during the pandemic season 2009/2010.


We identified index patients with laboratory confirmed influenza infection and interviewed household members after illness day 8 of the index patient. Outcome was influenza-like illness (ILI) in a household contact.


We included 108 households. Overall secondary attack rate was 10·1% (27/267) and decreased with increasing age. Apart from being in close daily proximity with the index patient for at least 9 hours, no other behavioral risk factor was associated with secondary ILI. Of all index patients and household contacts, 49% and 55%, respectively, cleaned their hands more often in the week after symptom onset of the index patient (in comparison with 2008/2009 P-value for both <0·01).


While the study was hampered by its relatively limited size, data suggest that a significantly larger proportion of influenza households practiced good hand hygiene compared to the last pre-pandemic season. This may have led to a different risk factor profile and a delay of the time threshold necessary for transmission among household members with close contact.

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