Public Health Lessons for Non-Vaccine Influenza Interventions Looking Past COVID-19 (2022) / Chapter Skim
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3 Effectiveness of Non-Vaccine Control Measures
3 Effectiveness of Non-Vaccine Control Measures
Pages 55-96
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From page 55... ...
, such as randomized controlled trials (RCTs) and systematic reviews, and on laboratory and physical modeling studies that quantify the extent to which specific interventions (e.g., masks, portable air filtration units)
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From page 56... ...
Furthermore, community transmission would be minimized without the need for future increases in physical distancing measures. An economic evaluation indicates that lockdowns and physical distancing reduce economic losses, contrary to a prevailing view that such public health pandemic-control measures necessarily undermine economic protection and recovery efforts (MacIntyre, 2021)
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. Such actions have included face masks, appropriate hand hygiene, and different physical distancing measures.
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. Authors of the rapid expert consultation acknowledge the limited real-world evidence for different types of homemade fabric masks, but laboratory evidence suggests they can reduce transmission of larger respiratory droplets, although the level of protection will be influenced by the user's behavior.
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. Moreover, according to a rapid systematic review of 19 RCTs, community-based mask use appeared effective in reducing the risk of respiratory virus infection even without appropriate hand hygiene, although the combination of measures would likely be more effective (MacIntyre and Chughtai, 2020)
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. Hand Hygiene Hand hygiene is another frequently used intervention against respiratory viruses, despite relatively little evidence of its effectiveness.
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More research is needed to assess the efficacy of interventions such as handwashing, coupled with ventilation of common facilities, such as restrooms, where handwashing takes place. Physical Distancing Measures Physical distancing reduces the risk of respiratory virus transmission by positioning people beyond the range of large, ballistic respiratory droplets and away from high concentrations of aerosol particles in a freshly emitted respiratory plume.
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. Drawing largely from observational and simulation studies, a systematic review of physical distancing measures found that they could be effective during a pandemic in terms of reducing transmission and mitigating overall impact (Fong et al., 2020)
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. Physical Strong Moderate • A systematic review of distancing measures distancing found that they could be effective in reducing transmission; protection against infection began at a distance of 1 meter and increased incrementally to 3 meters (Chu et al., 2020)
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with other interventions, such as masks, including for respiratory viruses in which contact transmission is a major factor. The evidence suggests a decline in infectious respiratory illnesses, including COVID-19, influenza, and ILIs, when hand hygiene is combined with mass masking (Aiello et al., 2010; Hsieh et al., 2020)
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• Analyze the impact of airflow, direction, duration of exposure, and masks on the effectiveness of physical distancing. EVIDENCE FOR BUILDING AND ENVIRONMENTAL CONTROLS Buildings have been associated with the spread of infectious diseases, such as of influenza and COVID-19, which has highlighted the role of building and environmental controls in reducing transmission during epidemics and pandemics.
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. In health care, office buildings, apartments, and other high-occupancy settings, routes of airflow and ventilation should be considered in strategies to mitigate risk of airborne transmission of respiratory viruses.
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. A study examining building ventilation and laboratory-confirmed acute respiratory infections was conducted in two U.S.
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. A summary of the evidence of various building and environmental control measures explored in this chapter (see Table 3-2)
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. the pathogen ° For other respiratory viruses, such as respiratory syncytial virus, with a higher risk of fomite or surface transmission, surface cleaning may have increased importance (Krilov, 2001)
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Although these controls have demonstrated effectiveness in reducing virus transmission overall, they have other potential implications that could have bearings on future influenza preparedness efforts. These measures have included travel restrictions, lockdowns, and mandates for curfew, school and business closures, testing, and quarantine.
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More on the critical importance of these various contextual factors is also discussed in Chapter 4. Travel Restrictions Many countries have enacted non-vaccine control measures related to international travel in response to the COVID-19 pandemic, such as inbound/outbound traveler screening, quarantines, and other travel restrictions.
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. A rapid review of 40 experimental, observational, and modeling studies on travel-related control measures in response to COVID-19, SARS, and MERS-CoV found a low certainty of evidence for their effectiveness based on cases detected or averted.
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. Public health measures against COVID-19, particularly border closures, may also reduce transmission of other types of respiratory viruses.
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state or local social distancing measures, including (1) large social gathering bans; (2)
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week. A decision-analytical modeling study attributed most COVID-19 cases in schools to community acquisition rather than within-school transmission.
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. The correlation between the results for rapid influenza diagnostic tests and molecular tests for H1N1 influenza is relatively poor, but the Winthrop-University Hospital Infectious Disease Division's Diagnostic Swine Influenza Triad of nonspecific laboratory indicators can
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, suggesting that testing asymptomatic individuals may have less applicability to influenza. Case Isolation and Quarantine If implemented early, isolation and contact tracing can be effective in controlling the spread of COVID-19, although these strategies may be less effective for influenza given its shorter incubation period.
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in Reducing Transmission of Respiratory Viruses Public Health Strength of Effectiveness/ Measures Evidence Efficacy Summary of Evidence (with Citation) School Moderate Low to • During the COVID-19 pandemic, sustained closures moderate school closures were not as effective at depending on preventing community spread as they are the pathogen for influenza, as children drive influenza transmission more (Bin Nafisah et al., 2018; Jackson et al., 2013; Stebbins et al., 2010)
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. Case Moderate Moderate to • A rapid review of 29 studies indicates isolation and high, depending that quarantine is effective in reducing quarantine on the pathogen COVID-19 incidence and mortality when implemented alone and even more effective in combination with other measures (Nussbaumer-Streit et al., 2020)
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EVIDENCE FOR COMBINATIONS OF MEASURES Evidence from a large-scale review and other sources suggests that combinations of non-vaccine control interventions are more effective in curbing the spread of infectious respiratory viruses than single interventions in isolation. Furthermore, U.S.
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. Similarly, a hospital in Australia reported that diagnoses of SARS-CoV-2 and other respiratory viruses plunged after travel bans in conjunction with physical distancing (Marriott et al., 2020)
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A systematic review of pandemic influenza mitigation literature reported that vaccination appears to confer significant protection against infection but evidence was insufficient to identify appreciable protection from antiviral prophylaxis, seasonal influenza cross-protection, or various non-vaccine control interventions in isolation. The authors propose that an optimal strategy would likely feature a layered combination of interventions (Saunders-Hastings et al., 2016)
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Factors such as airflow direction, duration of exposure, and use of masks and other interventions influence the efficacy of physical distancing. Building and Environmental Controls Among the types of building and environmental controls evaluated during COVID-19 that may have applicability for influenza, ventilation/ filtration systems have the most evidence of demonstrated effectiveness in reducing virus transmission.
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Since the SARS-CoV-2 virus had been spread by travelers to a number of countries before the World Health Organization recognized the novel coronavirus as a Public Health Emergency of International Concern -- and even more so, before it declared COVID-19 a pandemic -- there is little evidence that the restrictions on cross-border travel that many countries imposed were effective in reducing viral transmission during COVID-19, as is likely to be true in an influenza pandemic as well. Nonetheless, border closures -- for example, by island nations -- can be effective when imposed before community transmission is established, provided that any persons allowed to enter are quarantined, as should be true for all entrants who have recently been in countries where the virus is known to be present.
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Although the evidence is incomplete, mass testing that is not targeted to groups at highest risk has not been shown to be effective in reducing viral transmission. RECOMMENDATIONS Recommendation 3-1: The World Health Assembly should amend the International Health Regulations to allow countries to use border mea sures during a pandemic of influenza or other respiratory viruses.
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The Lancet Infectious Diseases 20(11)
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2021. International travel-related control measures to contain the COVID-19 pandemic: A rapid review.
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in a nursing home associated with aerosol transmission as a result of inadequate ventilation. Clinical Infectious Diseases ciaa1270.
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2021. Evidence of the effectiveness of travel-related measures during the early phase of the COVID-19 pandemic: A rapid systematic review.
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Emerging Infectious Diseases 27(6)
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The Lancet Infectious Diseases 20(10)
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The Lancet Infectious Diseases 21(7)
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The Lancet Infectious Diseases 21(9)
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The Lancet Infectious Diseases 21(7)
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Clinical Infectious Diseases 72(12)
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American Journal of Infection Control 49(4)
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