Volume 26, Number 5—May 2020
Policy Review
Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures
Jingyi Xiao1, Eunice Y. C. Shiu1, Huizhi Gao, Jessica Y. Wong, Min W. Fong, Sukhyun Ryu, and Benjamin J. Cowling
Table 2
Knowledge gaps for personal protective and environmental nonpharmaceutical interventions for pandemic influenza*
| Intervention | Knowledge gaps | Suggested studies |
|---|---|---|
| Hand hygiene |
There are major gaps in our knowledge of the mechanisms of person-to-person transmission of influenza, including the role of direct and indirect contact, the degree of viral contamination on hands and various types of surfaces in different settings, and the potential for contact transmission to occur in different locations and under different environmental conditions. There is little information on whether greater reductions in transmission could be possible with combinations of personal intervention (e.g., isolation away from family members as much as possible, plus using face masks and enhancing hand hygiene). |
Additional high-quality RCTs of efficacy of hand hygiene against laboratory-confirmed influenza in other nonhealthcare settings, except households and university residential halls, would be valuable. In particular, studies in school settings are needed to solve the discrepancy between the two studies from the United States and Egypt. |
| Respiratory etiquette |
There is no evidence about the quantitative effectiveness of respiratory etiquette against influenza virus. |
RCTs of interventions to demonstrate the effectiveness of respiratory etiquette in reducing influenza transmission would be valuable. |
| Face mask |
There are major gaps in our knowledge of the mechanisms of person-to-person transmission of influenza, including the importance of transmission through droplets of different sizes including small particle aerosols, and the potential for droplet and aerosol transmission to occur in different locations and with environmental conditions. |
Additional high-quality RCTs of efficacy of face masks against laboratory-confirmed influenza would be valuable. Effectiveness of face masks or respirator use to prevent influenza prevention in special subpopulation, such as immunocompromised persons, would be valuable. |
| Surface and object cleaning | The effectiveness of different cleaning products in preventing influenza transmission–in terms of cleaning frequency, cleaning dosage, cleaning time point, and cleaning targeted surface and object material–remains unknown. | RCTs of interventions to demonstrate the effectiveness of surface and object cleaning in reducing influenza transmission would be valuable. Studies that can demonstrate the reduction of environmental detection of influenza virus through cleaning of surfaces and objects would also be valuable. |
*RCT, randomized control trial.
1These first authors contributed equally to this article.
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