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Meta-Analysis
. 2020 Nov 20;11(11):CD006207.
doi: 10.1002/14651858.CD006207.pub5.

Physical interventions to interrupt or reduce the spread of respiratory viruses

Tom Jefferson  1 , Chris B Del Mar  2 , Liz Dooley  2 , Eliana Ferroni  3 , Lubna A Al-Ansary  4 , Ghada A Bawazeer  5 , Mieke L van Driel  6   7 , Mark A Jones  2 , Sarah Thorning  8 , Elaine M Beller  2 , Justin Clark  2 , Tammy C Hoffmann  2 , Paul P Glasziou  2 , John M Conly  9   10   11
Affiliations
Meta-Analysis

Physical interventions to interrupt or reduce the spread of respiratory viruses

Tom Jefferson et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review published in 2007, 2009, 2010, and 2011. The evidence summarised in this review does not include results from studies from the current COVID-19 pandemic.

Objectives: To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses.

Search methods: We searched CENTRAL, PubMed, Embase, CINAHL on 1 April 2020. We searched ClinicalTrials.gov, and the WHO ICTRP on 16 March 2020. We conducted a backwards and forwards citation analysis on the newly included studies.

Selection criteria: We included randomised controlled trials (RCTs) and cluster-RCTs of trials investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, and gargling) to prevent respiratory virus transmission. In previous versions of this review we also included observational studies. However, for this update, there were sufficient RCTs to address our study aims. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. Three pairs of review authors independently extracted data using a standard template applied in previous versions of this review, but which was revised to reflect our focus on RCTs and cluster-RCTs for this update. We did not contact trialists for missing data due to the urgency in completing the review. We extracted data on adverse events (harms) associated with the interventions.

Main results: We included 44 new RCTs and cluster-RCTs in this update, bringing the total number of randomised trials to 67. There were no included studies conducted during the COVID-19 pandemic. Six ongoing studies were identified, of which three evaluating masks are being conducted concurrent with the COVID pandemic, and one is completed. Many studies were conducted during non-epidemic influenza periods, but several studies were conducted during the global H1N1 influenza pandemic in 2009, and others in epidemic influenza seasons up to 2016. Thus, studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID-19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high-income countries; crowded inner city settings in low-income countries; and an immigrant neighbourhood in a high-income country. Compliance with interventions was low in many studies. The risk of bias for the RCTs and cluster-RCTs was mostly high or unclear. Medical/surgical masks compared to no masks We included nine trials (of which eight were cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and seven in the community). There is low certainty evidence from nine trials (3507 participants) that wearing a mask may make little or no difference to the outcome of influenza-like illness (ILI) compared to not wearing a mask (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.82 to 1.18. There is moderate certainty evidence that wearing a mask probably makes little or no difference to the outcome of laboratory-confirmed influenza compared to not wearing a mask (RR 0.91, 95% CI 0.66 to 1.26; 6 trials; 3005 participants). Harms were rarely measured and poorly reported. Two studies during COVID-19 plan to recruit a total of 72,000 people. One evaluates medical/surgical masks (N = 6000) (published Annals of Internal Medicine, 18 Nov 2020), and one evaluates cloth masks (N = 66,000). N95/P2 respirators compared to medical/surgical masks We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). There is uncertainty over the effects of N95/P2 respirators when compared with medical/surgical masks on the outcomes of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; very low-certainty evidence; 3 trials; 7779 participants) and ILI (RR 0.82, 95% CI 0.66 to 1.03; low-certainty evidence; 5 trials; 8407 participants). The evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirator compared to a medical/surgical mask probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; moderate-certainty evidence; 5 trials; 8407 participants). Restricting the pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies. One ongoing study recruiting 576 people compares N95/P2 respirators with medical surgical masks for healthcare workers during COVID-19. Hand hygiene compared to control Settings included schools, childcare centres, homes, and offices. In a comparison of hand hygiene interventions with control (no intervention), there was a 16% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.84, 95% CI 0.82 to 0.86; 7 trials; 44,129 participants; moderate-certainty evidence), suggesting a probable benefit. When considering the more strictly defined outcomes of ILI and laboratory-confirmed influenza, the estimates of effect for ILI (RR 0.98, 95% CI 0.85 to 1.13; 10 trials; 32,641 participants; low-certainty evidence) and laboratory-confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials; 8332 participants; low-certainty evidence) suggest the intervention made little or no difference. We pooled all 16 trials (61,372 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. The pooled data showed that hand hygiene may offer a benefit with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.84 to 0.95; low-certainty evidence), but with high heterogeneity. Few trials measured and reported harms. There are two ongoing studies of handwashing interventions in 395 children outside of COVID-19. We identified one RCT on quarantine/physical distancing. Company employees in Japan were asked to stay at home if household members had ILI symptoms. Overall fewer people in the intervention group contracted influenza compared with workers in the control group (2.75% versus 3.18%; hazard ratio 0.80, 95% CI 0.66 to 0.97). However, those who stayed at home with their infected family members were 2.17 times more likely to be infected. We found no RCTs on eye protection, gowns and gloves, or screening at entry ports.

Authors' conclusions: The high risk of bias in the trials, variation in outcome measurement, and relatively low compliance with the interventions during the studies hamper drawing firm conclusions and generalising the findings to the current COVID-19 pandemic. There is uncertainty about the effects of face masks. The low-moderate certainty of the evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of randomised trials did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks during seasonal influenza. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness. Harms associated with physical interventions were under-investigated. There is a need for large, well-designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, especially in those most at risk of ARIs.

Trial registration: ClinicalTrials.gov NCT00490633 NCT01158560 NCT01105767 NCT01339845 NCT01249625 NCT00880659 NCT00821509 NCT00833885 NCT00993759.

PubMed Disclaimer

Conflict of interest statement

Tom Jefferson: Tom Jefferson's full disclosure is available at restoringtrials.org/competing-interests-tom-jefferson/. Chris B Del Mar: a grant from WHO paid to Bond University and a grant from UK National Institute for Health Research (NIHR) to be paid to Bond University on publication of the review in the Cochrane Library. Funding from National Health and Medical Research Council (NHMRC) for research on antibiotic resistance. Liz Dooley: a grant from the World Health Organization (WHO) paid to Bond University and a grant from UK NIHR to be paid to Bond University on publication of the review in the Cochrane Library. Eliana Ferroni: none known. Lubna A Al‐Ansary: none known. Ghada A Bawazeer: none known. Mieke L van Driel: Dr van Driel has acted as a consultant for Therapeutic Guidelines Ltd and NPS Medicinewise, for which fees have been paid to her institution. Mark A Jones: a grant from WHO paid to Bond University and a grant from UK NIHR to be paid to Bond University on publication of the review in the Cochrane Library. Sarah Thorning: none known. Elaine M Beller: this review was supported in part by research grants from the NHMRC, Australia, to the Institute for Evidence‐Based Healthcare, Bond University. Justin Clark: none known. Tammy Hoffmann: a grant from WHO paid to Bond University and a grant from UK NIHR to be paid to Bond University on publication of the review in the Cochrane Library. Funding from NHMRC for research on antibiotic resistance. Paul Glasziou: none known. John M Conly: John Conly holds grants from the Canadian Institutes for Health Research on acute and primary care preparedness for COVID‐19 in Alberta, Canada and was the primary local Investigator for a Staphylococcus aureus vaccine study funded by Pfizer for which all funding was provided only to the University of Calgary. He also received support from the Centers for Disease Control and Prevention (CDC) to attend an Infection Control Think Tank Meeting.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included trials.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included trial.
1.1
1.1. Analysis
Comparison 1: Randomised trials: medical/surgical masks versus no masks, Outcome 1: Viral illness
1.2
1.2. Analysis
Comparison 1: Randomised trials: medical/surgical masks versus no masks, Outcome 2: Influenza‐like illness in healthcare workers
2.1
2.1. Analysis
Comparison 2: Randomised trials: N95 respirators compared to medical/surgical masks, Outcome 1: Viral illness
2.2
2.2. Analysis
Comparison 2: Randomised trials: N95 respirators compared to medical/surgical masks, Outcome 2: Viral illness in healthcare workers
3.1
3.1. Analysis
Comparison 3: Randomised trials: hand hygiene compared to control, Outcome 1: Viral illness
3.2
3.2. Analysis
Comparison 3: Randomised trials: hand hygiene compared to control, Outcome 2: ARI or ILI or influenza (including outcome with most events from each study)
3.3
3.3. Analysis
Comparison 3: Randomised trials: hand hygiene compared to control, Outcome 3: Influenza or ILI: sensitivity analysis including outcomes with the most precise and unequivocal definitions
3.4
3.4. Analysis
Comparison 3: Randomised trials: hand hygiene compared to control, Outcome 4: ARI or ILI or influenza: subgroup analysis
3.5
3.5. Analysis
Comparison 3: Randomised trials: hand hygiene compared to control, Outcome 5: Absenteeism
4.1
4.1. Analysis
Comparison 4: Randomised trials: hand hygiene + medical/surgical masks compared to control, Outcome 1: Viral illness
5.1
5.1. Analysis
Comparison 5: Randomised trials: hand hygiene + medical/surgical masks compared to hand hygiene, Outcome 1: Viral illness
6.1
6.1. Analysis
Comparison 6: Randomised trials: gargling compared to control, Outcome 1: Viral illness
See this image and copyright information in PMC

Update of

Comment in

References

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Savolainen‐Kopra 2012 {published data only}
    1. Savolainen-Kopra C, Haapakoski J, Peltola PA, Ziegler T, Korpela T, Anttila P, et al. Hand washing with soap and water together with behavioural recommendations prevents infections in common work environment: an open cluster-randomized trial. Trials 2012;13:10. [DOI: 10.1186/1745-6215-13-10] - DOI - PMC - PubMed
Simmerman 2011 {published data only}
    1. Simmerman JM, Suntarattiwong P, Levy J, Jarman RG, Kaewchana S, Gibbons RV, et al. Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand. Influenza and Other Respiratory Viruses 2011;5(4):256-67. [DOI: 10.1111/j.1750-2659.2011.00205.x] - DOI - PMC - PubMed
Stebbins 2011 {published data only}
    1. Stebbins S, Cummings DA, Stark JH, Vukotich C, Mitruka K, Thompson W, et al. Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: a randomized controlled trial. Pediatric Infectious Disease Journal 2011;30(11):921-6. [DOI: 10.1097/INF.0b013e3182218656] - DOI - PMC - PubMed
Suess 2012 {published data only}
    1. Suess T, Remschmidt C, Schink SB, Schweiger B, Nitsche A, Schroeder K, et al. The role of facemasks and hand hygiene in the prevention of influenza transmission in households: results from a cluster randomised trial; Berlin, Germany, 2009-2011. BMC Infectious Disease 2012;12:26. [DOI: 10.1186/1471-2334-12-26] - DOI - PMC - PubMed
Talaat 2011 {published data only}
    1. Talaat M, Afifi S, Dueger E, El-Ashry N, Marfin A, Kandeel A, et al. Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt. Emerging Infectious Diseases 2011;17(4):619-25. [DOI: 10.3201/eid1704.101353] - DOI - PMC - PubMed
Temime 2018 {published data only}16474757
    1. Temime L, Cohen N, Ait-Bouziad K, Denormandie P, Dab W, Hocine MN. Impact of a multicomponent hand hygiene-related intervention on the infectious risk in nursing homes: a cluster randomized trial. American Journal of Infection Control 2018;46(2):173-9. [DOI: 10.1016/j.ajic.2017.08.030] - DOI - PubMed
Turner 2004a {published data only}
    1. Turner RB, Biedermann KA, Morgan JM, Keswick B, Ertel KD, Barker MF. Efficacy of organic acids in hand cleansers for prevention of rhinovirus infections. Antimicrobial Agents and Chemotherapy 2004;48(7):2595-8. - PMC - PubMed
Turner 2004b {published data only}
    1. Turner RB, Biedermann KA, Morgan JM, Keswick B, Ertel KD, Barker MF. Efficacy of organic acids in hand cleansers for prevention of rhinovirus infections. Antimicrobial Agents and Chemotherapy 2004;48(7):2595-8. - PMC - PubMed
Turner 2012 {published data only}
    1. Turner RB, Fuls JL, Rodgers ND, Goldfarb HB, Lockhart LK, Aust LB. A randomized trial of the efficacy of hand disinfection for prevention of rhinovirus infection. Clinical Infectious Diseases 2012;54(10):1422-6. [DOI: 10.1093/cid/cis201] - DOI - PubMed
White 2001 {published data only}
    1. White CG, Shinder FS, Shinder AL, Dyer DL. Reduction of illness absenteeism in elementary schools using an alcohol-free instant hand sanitizer. Journal of School Nursing 2001;17(5):258-65. - PubMed
Yeung 2011 {published data only}
    1. Yeung WK, Tam WS, Wong TW. Cluster randomized controlled trial of a hand hygiene intervention involving pocket-sized containers of alcohol-based hand rub for the control of infections in long-term care facilities. Infection Control and Hospital Epidemiology 2011;32:67-76. - PubMed
Zomer 2015 {published data only}NTR3000
    1. Zomer TP, Erasmus V, Looman CW, Tjon-A-Tsien A, Van Beeck EF, De Graaf JM, et al. A hand hygiene intervention to reduce infections in child daycare: a randomized controlled trial. Epidemiology and Infection 2015;143(12):2494-502. [DOI: 10.1017/S095026881400329X] - DOI - PMC - PubMed

References to studies excluded from this review

Abou El Hassan 2004 {published data only}
    1. Abou El Hassan MA, Meulen-Muileman I, Abbas S, Kruyt FA. Conditionally replicating adenoviruses kill tumor cells via a basic apoptotic machinery-independent mechanism that resembles necrosis-like programmed cell death. Journal of Virology 2004;78(22):12243-51. - PMC - PubMed
Amirav 2005 {published data only}
    1. Amirav I, Oron A, Tal G, Cesar K, Ballin A, Houri S, et al. Aerosol delivery in respiratory syncytial virus bronchiolitis: hood or face mask? Journal of Pediatrics 2005;147(5):627-31. - PubMed
Anderson 2004 {published data only}
    1. Anderson RM, Fraser C, Ghani AC, Donnelly CA, Riley S, Ferguson NM, et al. Epidemiology, transmission dynamics and control of SARS: the 2002-2003 epidemic. Philosophical Transactions of the Royal Society of London - Series B: Biological Sciences 2004;359(1447):1091-105. - PMC - PubMed
Anonymous 2002 {published data only}
    1. Anon. Antiseptic skin cleansers may prevent rhinovirus transmission. Clinical Infectious Diseases 2002;34(3):ii.
Anonymous 2004 {published data only}
    1. Anon. Can antiviral tissues prevent the spread of colds? Consumer Reports 2004;69(12):56. - PubMed
Anonymous 2005a {published data only}
    1. Anon. Antiviral Kleenex. Medical Letter on Drugs & Therapeutics 2005;47(1199):3-4. - PubMed
Anonymous 2005b {published data only}
    1. Anon. Focusing on this year's flu...use healthy handwashing...and when soap and water aren't handy, hand gels work well, too. Child Health Alert 2005;23:1-2. - PubMed
Anonymous 2005c {published data only}
    1. How long is a cold contagious? Is there any way to prevent transmitting a cold? Johns Hopkins Medical Letter, Health After 50 2005;17(10):8. - PubMed
Apisarnthanarak 2009 {published data only}
    1. Apisarnthanarak A, Apisarnthanarak P, Cheevakumjorn B, Mundy LM. Intervention with an infection control bundle to reduce transmission of influenza-like illnesses in a Thai preschool. Infection Control and Hospital Epidemiology 2009;30(9):817-22. - PubMed
Apisarnthanarak 2010 {published data only}
    1. Apisarnthanarak A, Uyeki TM, Puthavathana P, Kitphati R, Mundy LM. Reduction of seasonal influenza transmission among healthcare workers in an intensive care unit: a 4-year intervention study in Thailand. Infection Control and Hospital Epidemiology 2010;31(10):996-1003. - PubMed
Aragon 2005 {published data only}
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Azor‐Martinez 2014 {published data only}
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Barros 1999 {published data only}
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Bauer 2009 {published data only}
    1. Bauer G, Bossi L, Santoalla M, Rodríguez S, Fariña D, Speranza AM. Impacto de un programa de prevención de infecciones respiratorias en lactantes prematuros de alto riesgo: estudio prospectivo y multicéntrico. Archivos Argentinos de Pediatria 2009;107(2):111-8. - PubMed
Bell 2004 {published data only}
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Bellissimo‐Rodrigues 2009 {published data only}
    1. Bellissimo-Rodrigues F, Bellissimo-Rodrigues WT, Viana JM, Teixeira GCA, Nicolini E, Auxiliadora-Martins M, et al. Effectiveness of oral rinse with chlorhexidine in preventing nosocomial respiratory tract infections among intensive care unit patients. Infection Control and Hospital Epidemiology 2009;30(10):952-8. - PubMed
Ben‐Abraham 2002 {published data only}
    1. Ben-Abraham R, Keller N, Szold O, Vardi A, Weinberg M, Barzilay Z, et al. Do isolation rooms reduce the rate of nosocomial infections in the pediatric intensive care unit? Journal of Critical Care 2002;17(3):176-80. - PubMed
Black 1981 {published data only}
    1. Black RE, Dykes AC, Anderson KE, Wells JG, Sinclair SP, Gary GW, et al. Handwashing to prevent diarrhea in day-care centers. American Journal of Epidemiology 1981;113(4):445-51. - PubMed
Borkow 2010 {published data only}
    1. Borkow G, Zhou SS, Page T, Gabbay J. A novel anti-influenza copper oxide containing respiratory face mask. PLOS ONE 2010;5(6):1-8. - PMC - PubMed
Bouadma 2010 {published data only}
    1. Bouadma L, Mourvillier B, Deiler V, Le Corre B, Lolom I, Régnier B, et al. A multifaceted program to prevent ventilator-associated pneumonia: impact on compliance with preventive measures. Critical Care Medicine 2010;38(3):789-96. - PubMed
Bowen 2007 {published data only}
    1. Bowen A, Ma H, Ou J, Billhimer W, Long T, Mintz E, et al. A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools. American Journal of Tropical Medicine and Hygiene 2007;76(6):1166-73. - PubMed
Breugelmans 2004 {published data only}
    1. Breugelmans JG, Zucs P, Porten K, Broll S, Niedrig M, Ammon A, et al. SARS transmission and commercial aircraft. Emerging Infectious Diseases 2004;10(8):1502-3. - PMC - PubMed
Cai 2009 {published data only}
    1. Cai W, Schweiger B, Buchholz U, Buda S, Littmann M, Heusler J, et al. Protective measures and H5N1-seroprevalence among personnel tasked with bird collection during an outbreak of avian influenza A/H5N1 in wild birds, Ruegen, Germany, 2006. BMC Infectious Diseases 2009;9:170. - PMC - PubMed
Cantagalli 2010 {published data only}
    1. Cantagalli MR, Alvim VF, Andrade EC, Leite ICG. Associação entre desnutrição energético-protéica e infecção respiratória aguda em crianças na atenção primária à saúde. Revista de APS 2010;13(1):26-33.
Carbonell‐Estrany 2008 {published data only}
    1. Carbonell-Estrany X, Bont L, Doering G, Gouyon JB, Lanari M. Clinical relevance of prevention of respiratory syncytial virus lower respiratory tract infection in preterm infants born between 33 and 35 weeks gestational age. European Journal of Clinical Microbiology and Infectious Diseases 2008;27(10):891-9. - PubMed
Carter 2002 {published data only}
    1. Carter JM. Hand washing decreases risk of colds and flu. Journal of the National Medical Association 2002;94(2):A11. - PMC - PubMed
Castillo‐Chavez 2003 {published data only}
    1. Castillo-Chavez C, Castillo-Garsow CW, Yakubu AA. Mathematical models of isolation and quarantine. JAMA 2003;290(21):2876-7. - PubMed
Cava 2005a {published data only}
    1. Cava MA, Fay KE, Beanlands HJ, McCay EA, Wignall R. Risk perception and compliance with quarantine during the SARS outbreak. Journal of Nursing Scholarship 2005;37(4):343-7. - PubMed
Cava 2005b {published data only}
    1. Cava MA, Fay KE, Beanlands HJ, McCay EA, Wignall R. The experience of quarantine for individuals affected by SARS in Toronto. Public Health Nursing 2005;22(5):398-406. - PubMed
CDC 2003a {published data only}
    1. Centers for Disease Control and Prevention. Cluster of severe acute respiratory syndrome cases among protected health-care workers - Toronto, Canada, April 2003. Morbidity & Mortality Weekly Report 2003;52(19):433-6. - PubMed
CDC 2003b {published data only}
    1. Centers for Disease Control and Prevention. Use of quarantine to prevent transmission of severe acute respiratory syndrome - Taiwan, 2003. Morbidity & Mortality Weekly Report 2003;52(29):680-3. - PubMed
Chai 2005 {published data only}
    1. Chai LY, Ng TM, Habib AG, Singh K, Kumarasinghe G, Tambyah PA. Paradoxical increase in methicillin-resistant Staphylococcus aureus acquisition rates despite barrier precautions and increased hand washing compliance during an outbreak of severe acute respiratory syndrome. Clinical Infectious Diseases 2005;40(4):623-3. - PMC - PubMed
Chami 2012 {published data only}
    1. Chami K, Gavazzi G, Bar-Hen A, Carrat F, Wazières B, Lejeune B, et al. A short-term, multicomponent infection control program in nursing homes: a cluster randomized controlled trial. Journal of the American Medical Directors Association 2012;13(6):569.e9-569.e17. - PubMed
Chaovavanich 2004 {published data only}
    1. Chaovavanich A, Wongsawat J, Dowell SF, Inthong Y, Sangsajja C, Sanguanwongse N, et al. Early containment of severe acute respiratory syndrome (SARS); experience from Bamrasnaradura Institute, Thailand. Journal of the Medical Association of Thailand 2004;87(10):1182-7. - PubMed
Chau 2003 {published data only}
    1. Chau PH, Yip PS. Monitoring the severe acute respiratory syndrome epidemic and assessing effectiveness of interventions in Hong Kong Special Administrative Region. Journal of Epidemiology and Community Health 2003;57(10):766-9. - PMC - PubMed
Chau 2008 {published data only}
    1. Chau JPC, Thompson DR, Twinn S, Lee DTF, Lopez V, Ho LSY. An evaluation of SARS and droplet infection control practices in acute and rehabilitation hospitals in Hong Kong. Hong Kong Medical Journal 2008;14(Suppl 4):44-7. - PubMed
Chen 2007 {published data only}
    1. Chen YC, Chiang LC. Effectiveness of hand-washing teaching programs for families of children in paediatric intensive care units. Journal of Clinical Nursing 2007;16(6):1173-9. - PubMed
Cheng 2010 {published data only}
    1. Cheng VCC, Tai JWM, Wong LMW, Chan JFW, Li IWS, To KKW, et al. Prevention of nosocomial transmission of swine-origin pandemic influenza virus A/H1N1 by infection control bundle. Journal of Hospital Infection 2010;74(3):271-7. - PMC - PubMed
Chia 2005 {published data only}
    1. Chia SE, Koh D, Fones C, Qian F, Ng V, Tan BH, et al. Appropriate use of personal protective equipment among healthcare workers in public sector hospitals and primary healthcare polyclinics during the SARS outbreak in Singapore. Occupational and Environmental Medicine 2005;62(7):473-7. - PMC - PubMed
Clynes 2010 {published data only}
    1. Clynes N. Surgical masks vs N95 respirators for preventing influenza. JAMA 2010;303(10):937-9. - PubMed
Cowling 2007 {published data only}
    1. Cowling BJ, Muller MP, Wong IO, Ho LM, Louie M, McGeer A, et al. Alternative methods of estimating an incubation distribution: examples from severe acute respiratory syndrome. Epidemiology 2007;18(2):253-9. - PubMed
Daniels 2010 {published data only}
    1. Daniels TL, Talbot TR. Unmasking the confusion of respiratory protection to prevent influenza-like illness in crowded community settings. Journal of Infectious Diseases 2010;201(4):483-5. - PubMed
Daugherty 2008 {published data only}
    1. Daugherty EL. Health care worker protection in mass casualty respiratory failure: infection control, decontamination, and personal protective equipment. Respiratory Care 2008;53(2):201-12; discussion 212-4. - PubMed
Davies 1994 {published data only}
    1. Davies KJ, Herbert AM, Westmoreland D, Bagg J. Seroepidemiological study of respiratory virus infections among dental surgeons. British Dental Journal 1994;176(7):262-5. - PubMed
Day 1993 {published data only}
    1. Day RA, St Arnaud S, Monsma M. Effectiveness of a handwashing program. Clinical Nursing Research 1993;2(1):24-40. - PubMed
Day 2006 {published data only}
    1. Day T, Park A, Madras N, Gumel A, Wu J. When is quarantine a useful control strategy for emerging infectious diseases? American Journal of Epidemiology 2006;163(5):479-85. - PMC - PubMed
Dell'Omodarme 2005 {published data only}
    1. Dell'Omodarme M, Prati MC. The probability of failing in detecting an infectious disease at entry points into a country. Statistics in Medicine 2005;24(17):2669-79. - PMC - PubMed
Denbak 2018 {published data only}
    1. Denbak AM, Andersen A, Bonnesen CT, Laursen B, Ersbøll AK, Due P, et al. Effect evaluation of a randomized trial to reduce infectious illness and illness-related absenteeism among schoolchildren: The Hi Five Study. Pediatric Infectious Disease Journal 2018;37(1):16-21. - PubMed
Desenclos 2004 {published data only}
    1. Desenclos JC, Werf S, Bonmarin I, Levy-Bruhl D, Yazdanpanah Y, Hoen B, et al. Introduction of SARS in France, March-April, 2003. Emerging Infectious Diseases 2004;10(2):195-200. - PMC - PubMed
DiGiovanni 2004 {published data only}
    1. DiGiovanni C, Conley J, Chiu D, Zaborski J. Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak. Biosecurity and Bioterrorism 2004;2(4):265-72. - PubMed
Doebbeling 1992 {published data only}
    1. Doebbeling BN, Stanley GL, Sheetz CT. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. New England Journal of Medicine 1992;327(2):88-92. - PubMed
Dwosh 2003 {published data only}
    1. Dwosh HA, Hong HH, Austgarden D, Herman S, Schabas R. Identification and containment of an outbreak of SARS in a community hospital. Canadian Medical Association Journal 2003;168(11):1415-20. - PMC - PubMed
Edmonds 2010 {published data only}
    1. Edmonds S, Dzyakanava V, Macinga D. Efficacy of hand hygiene products against pandemic H1N1 influenza. American Journal of Infection Control 2010;38(5):E132-3.
Fendler 2002 {published data only}
    1. Fendler EJ, Ali Y, Hammond BS, Lyons MK, Kelley MB, Vowell NA. The impact of alcohol hand sanitizer use on infection rates in an extended care facility. American Journal of Infection Control 2002;30(4):226-33. - PubMed
Flint 2003 {published data only}
    1. Flint J, Burton S, Macey JF, Deeks SL, Tam TW, King A, et al. Assessment of in-flight transmission of SARS - results of contact tracing. Canadian Communicable Disease Report 2003;29(12):105-10. - PubMed
Fung 2004 {published data only}
    1. Fung CP, Hsieh TL, Tan KH, Loh CH, Wu JS, Li CC, et al. Rapid creation of a temporary isolation ward for patients with severe acute respiratory syndrome in Taiwan. Infection Control and Hospital Epidemiology 2004;25(12):1026-32. - PubMed
Garcia 2010 {published data only}
    1. Garcia MC. The protection against influenza provided by surgical masks is not inferior to what the FFP2 (N95) respiratory protector can give. FMC Formacion Medica Continuada en Atencion Primaria 2010;17(5):365.
Gaydos 2001 {published data only}
    1. Gaydos JC. Returning to the past: respiratory illness, vaccines, and handwashing. American Journal of Preventive Medicine 2001;21(2):150-1. - PubMed
Gensini 2004 {published data only}
    1. Gensini GF, Yacoub MH, Conti AA. The concept of quarantine in history: from plague to SARS. Journal of Infection 2004;49(4):257-61. - PMC - PubMed
Girou 2002 {published data only}
    1. Girou E, Loyeau S, Legrand P, Oppein F, Brun-Buisson C. Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. BMJ 2002;325:362. - PMC - PubMed
Glass 2006 {published data only}
    1. Glass K, Becker NG. Evaluation of measures to reduce international spread of SARS. Epidemiology and Infection 2006;134(5):1092-101. - PMC - PubMed
Goel 2007 {published data only}
    1. Goel S, Gupta AK, Singh A, Lenka SR. Preparations and limitations for prevention of severe acute respiratory syndrome in a tertiary care centre of India. Journal of Hospital Infection 2007;66(2):142-7. - PMC - PubMed
Gomersall 2006 {published data only}
    1. Gomersall CD, Joynt GM, Ho OM, Ip M, Yap F, Derrick JL, et al. Transmission of SARS to healthcare workers. The experience of a Hong Kong ICU. Intensive Care Medicine 2006;32(4):564-9. - PMC - PubMed
Gore 2001 {published data only}
    1. Gore J, Lambert JA. Does use of an instant hand sanitizer reduce elementary school illness absenteeism? Journal of Family Practice 2001;50(1):64. - PubMed
Gostin 2003 {published data only}
    1. Gostin LO, Bayer R, Fairchild AL. Ethical and legal challenges posed by severe acute respiratory syndrome: implications for the control of severe infectious disease threats. JAMA 2003;290(24):3229-37. - PubMed
Gralton 2010 {published data only}
    1. Gralton J, McLaws ML. Protecting healthcare workers from pandemic influenza: N95 or surgical masks? Critical Care Medicine 2010;38(2):657-67. - PubMed
Guinan 2002 {published data only}
    1. Guinan M, McGukin M, Ali Y. The effect of a comprehensive handwashing program on absenteeism in elementary schools. American Journal of Infection Control 2002;30(4):217-20. - PubMed
Gupta 2005 {published data only}
    1. Gupta AG, Moyer CA, Stern DT. The economic impact of quarantine: SARS in Toronto as a case study. Journal of Infection 2005;50(5):386-93. - PMC - PubMed
Gwaltney 1982 {published data only}
    1. Gwaltney JM Jr, Hendley JO. Transmission of experimental rhinovirus infection by contaminated surfaces. American Journal of Epidemiology 1982;116:828-33. - PubMed
Han 2003 {published data only}
    1. Han H, Li X, Qu W, Shen T, Xu F, Gao D, et al. The building and practice of the emergency isolation radiology information system at the department of radiology in polyclinic during the epidemic outbreak stage of SARS. Beijing Da Xue Xue Bao [Journal of Peking University] 2003;35(Suppl):86-8. - PubMed
Hayden 1985 {published data only}
    1. Hayden GF, Hendley JO, Gwaltney JM Jr. The effect of placebo and virucidal paper handkerchiefs on viral contamination of the hand and transmission of experimental rhinoviral infection. Journal of Infectious Diseases 1985;152(2):403-7. - PubMed
Hendley 1988 {published data only}
    1. Hendley JO, Gwaltney JM Jr. Mechanisms of transmission of rhinovirus infections. Epidemiologic Reviews 1988;10:243-58. - PubMed
Hens 2009 {published data only}
    1. Hens N, Ayele GM, Goeyvaerts N, Aerts M, Mossong J, Edmunds JW, et al. Estimating the impact of school closure on social mixing behaviour and the transmission of close contact infections in eight European countries. BMC Infectious Diseases 2009;9:187. - PMC - PubMed
Heymann 2009 {published data only}
    1. Heymann AD, Hoch I, Valinsky L, Kokia E, Steinberg DM. School closure may be effective in reducing transmission of respiratory viruses in the community. Epidemiology and Infection 2009;137(10):1369-76. - PubMed
Hilburn 2003 {published data only}
    1. Hilburn J, Hammond BS, Fendler EJ, Groziak PA. Use of alcohol hand sanitizer as an infection control strategy in an acute care facility. American Journal of Infection Control 2003;31(2):109-16. - PubMed
Hilmarsson 2007 {published data only}
    1. Hilmarsson H, Traustason BS, Kristmundsdottir T, Thormar H. Virucidal activities of medium- and long-chain fatty alcohols and lipids against respiratory syncytial virus and parainfluenza virus type 2: comparison at different pH levels. Archives of Virology 2007;152(1):2225-36. - PubMed
Hirsch 2006 {published data only}
    1. Hirsch HH, Steffen I, Francioli P, Widmer AF. Respiratory syncytial virus infections: measures in immunocompromised patients [Respiratorisches syncytial-virus (RSV)-infektion: massnahmen beim immunsupprimierten patienten]. Praxis 2006;95(3):61-6. - PubMed
Ho 2003 {published data only}
    1. Ho AS, Sung JJ, Chan-Yeung M. An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong. Annals of Internal Medicine 2003;139(7):564-7. - PubMed
Hsieh 2007 {published data only}
    1. Hsieh YH, King CC, Chen CW, Ho MS, Hsu SB, Wu YC. Impact of quarantine on the 2003 SARS outbreak: a retrospective modeling study. Journal of Theoretical Biology 2007;244(4):729-36. - PMC - PubMed
Hugonnet 2007 {published data only}
    1. Hugonnet S, Legros D, Roth C, Pessoa-Silva CL. Nosocomial transmission of severe acute respiratory syndrome: better quality of evidence is needed. Clinical Infectious Diseases 2007;45(12):1651. - PubMed
Jiang 2003 {published data only}
    1. Jiang S, Huang L, Chen X, Wang J, Wu W, Yin S. Ventilation of wards and nosocomial outbreak of severe acute respiratory syndrome among healthcare workers. Chinese Medical Journal 2003;116(9):1293-7. - PubMed
    1. Jiang SP, Huang LW, Wang JF, Wu W, Yin SM, Chen WX. A study of the architectural factors and the infection rates of healthcare workers in isolation units for severe acute respiratory syndrome. Chung-Hua Chieh Ho Ho Hu Hsi Tsa Chih [Chinese Journal of Tuberculosis & Respiratory Diseases] 2003;26(10):594-7. - PubMed
Johnson 2009 {published data only}
    1. Johnson DF, Druce JD, Birch C, Grayson ML. A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. Clinical Infectious Diseases 2009;49(2):275-7. - PubMed
Jones 2005 {published data only}
    1. Jones EW. "Co-operation in All Human Endeavour": quarantine and immigrant disease vectors in the 1918-1919 influenza pandemic in Winnipeg. Canadian Bulletin of Medical History 2005;22(1):57-82. - PubMed
Kaydos‐Daniels 2004 {published data only}
    1. Kaydos-Daniels SC, Olowokure B, Chang HJ, Barwick RS, Deng JF, Lee ML, et al. Body temperature monitoring and SARS fever hotline, Taiwan. Emerging Infectious Diseases 2004;10(2):373-6. - PMC - PubMed
Kelso 2009 {published data only}
    1. Kelso JK, Milne GJ, Kelly H. Simulation suggests that rapid activation of social distancing can arrest epidemic development due to a novel strain of influenza. BMC Public Health 2009;9:117. - PMC - PubMed
Khaw 2008 {published data only}
    1. Khaw KS, Ngan Kee WD, Tam YH, Wong MK, Lee SW. Survey and evaluation of modified oxygen delivery devices used for suspected severe acute respiratory syndrome and other high-risk patients in Hong Kong. Hong Kong Medical Journal 2008;14(Suppl 5):27-31. - PubMed
Kilabuko 2007 {published data only}
    1. Kilabuko JH, Nakai S. Effects of cooking fuels on acute respiratory infections in children in Tanzania. International Journal of Environmental Research and Public Health 2007;4(4):283-8. - PMC - PubMed
Kosugi 2004 {published data only}
    1. Kosugi Y, Ishikawa T, Chimura Y, Annaka M, Shibazaki S, Adachi K, et al. Control of hospital infection of influenza: administration of neuraminidase inhibitor and cohort isolation of influenza patients. Kansenshogaku Zasshi [Journal of the Japanese Association for Infectious Diseases] 2004;78(12):995-9. - PubMed
Lam 2004 {published data only}
    1. Lam BC, Lee J, Lau YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics 2004;114(5):e565-71. - PubMed
Lange 2004 {published data only}
    1. Lange JH. Use of disposable face masks for public health protection against SARS. Journal of Epidemiology and Community Health 2004;58(5):434. - PMC - PubMed
Larson 2004a {published data only}
    1. Larson EL, Lin SX, Gomez-Pichardo C, Della-Latta P. Effect of antibacterial home cleaning and handwashing products on infectious disease symptoms: a randomized, double-blind trial. Annals of Internal Medicine 2004;140(5):321-9. - PMC - PubMed
Larson 2004b {published data only}
    1. Larson EL, Lin SX, Gomez-Pichardo C, Della-Latta P. Effect of antibacterial home cleaning and handwashing products on infectious disease symptoms: a randomized, double-blind trial. Annals of Internal Medicine 2004;140(5):321-9. - PMC - PubMed
Larson 2005 {published data only}
    1. Larson EL, Cimiotti J, Haas J, Parides M, Nesin M, Della-Latta P, et al. Effect of antiseptic handwashing vs alcohol sanitizer on health care-associated infections in neonatal intensive care units. Archives of Pediatrics & Adolescent Medicine 2005;159(4):377-83. - PubMed
Lau 2004 {published data only}
    1. Lau JT, Yang X, Tsui HY, Pang E. SARS related preventive and risk behaviours practised by Hong Kong-mainland China cross border travellers during the outbreak of the SARS epidemic in Hong Kong. Journal of Epidemiology and Community Health 2004;58(12):988-96. - PMC - PubMed
Lau 2005 {published data only}
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References to ongoing studies

NCT03454009 {published data only}
    1. NCT03454009. Kent State University / Price Chopper Wellness Promotion Study. clinicaltrials.gov/show/NCT03454009 (first date received March 5 2018).
NCT04267952 {published data only}
    1. NCT04267952. Hand hygiene intervention program on primary school students' health outcomes and absenteeism in school. Clinicaltrials.gov/show/NCT04267952 (first received Feb 13 2020).
NCT04296643 {published data only}
    1. NCT04296643. Medical masks vs N95 respirators for COVID-19. Clinicaltrials.gov/show/NCT04296643 (first received March 5, 2020).
NCT04337541 {published data only}
    1. NCT04337541. Reduction in COVID-19 infection using surgical facial masks outside the healthcare system. clinicaltrials.gov/show/NCT04337541 (first received 7 April 2020).
NCT04471766 {published data only}
    1. NCT04471766. Locally produced cloth face mask and COVID-19 Llke illness prevention. clinicaltrials.gov/ct2/show/NCT04471766 (first received July 15, 2020). [TRIAL REGISTRY: NCT04471766]
Wang 2015 {published data only}
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