Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-International Travel-Related Measures

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Emerg Infect Dis. 2020 May 17;26(5). doi: 10.3201/eid2605.190993. [Epub ahead of print] Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-International Travel-Related Measures.

Ryu S, Gao H, Wong JY, Shiu EYC, Xiao J, Fong MW, Cowling BJ.
Abstract

International travel-related nonpharmaceutical interventions (NPIs), which can include traveler screening, travel restrictions, and border closures, often are included in national influenza pandemic preparedness plans. We performed systematic reviews to identify evidence for their effectiveness. We found 15 studies in total. Some studies reported that NPIs could delay the introduction of influenza virus. However, no available evidence indicated that screening of inbound travelers would have a substantial effect on preventing spread of pandemic influenza, and no studies examining exit screening were found. Some studies reported that travel restrictions could delay the start of local transmission and slow international spread, and 1 study indicated that small Pacific islands were able to prevent importation of pandemic influenza during 1918-19 through complete border closure. This limited evidence base indicates that international travel-related NPIs would have limited effectiveness in controlling pandemic influenza and that these measures require considerable resources to implement.


KEYWORDS:

border closure; entry screening; influenza; nonpharmaceutical interventions; pandemic; public health; quarantine; respiratory diseases; travel restrictions; vaccine-preventable diseases; viruses

PMID: 32027587 DOI: 10.3201/eid2605.190993
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Emerg Infect Dis. 2020 May 17;26(5). doi: 10.3201/eid2605.190994. [Epub ahead of print] Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-Personal Protective and Environmental Measures.

Xiao J, Shiu EYC, Gao H, Wong JY, Fong MW, Ryu S, Cowling BJ.
Abstract

There were 3 influenza pandemics in the 20th century, and there has been 1 so far in the 21st century. Local, national, and international health authorities regularly update their plans for mitigating the next influenza pandemic in light of the latest available evidence on the effectiveness of various control measures in reducing transmission. Here, we review the evidence base on the effectiveness of nonpharmaceutical personal protective measures and environmental hygiene measures in nonhealthcare settings and discuss their potential inclusion in pandemic plans. Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza. We similarly found limited evidence on the effectiveness of improved hygiene and environmental cleaning. We identified several major knowledge gaps requiring further research, most fundamentally an improved characterization of the modes of person-to-person transmission.


KEYWORDS:

environmental measures; influenza; influenza virus; meta-analysis; nonhealthcare settings; nonpharmaceutical measures; pandemic influenza; personal protective measures; public health; respiratory infections; viruses

PMID: 32027586 DOI: 10.3201/eid2605.190994
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Emerg Infect Dis. 2020 May 17;26(5). doi: 10.3201/eid2605.190995. [Epub ahead of print] Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-Social Distancing Measures.

Fong MW, Gao H, Wong JY, Xiao J, Shiu EYC, Ryu S, Cowling BJ.
Abstract

Influenza virus infections are believed to spread mostly by close contact in the community. Social distancing measures are essential components of the public health response to influenza pandemics. The objective of these mitigation measures is to reduce transmission, thereby delaying the epidemic peak, reducing the size of the epidemic peak, and spreading cases over a longer time to relieve pressure on the healthcare system. We conducted systematic reviews of the evidence base for effectiveness of multiple mitigation measures: isolating ill persons, contact tracing, quarantining exposed persons, school closures, workplace measures/closures, and avoiding crowding. Evidence supporting the effectiveness of these measures was obtained largely from observational studies and simulation studies. Voluntary isolation at home might be a more feasible social distancing measure, and pandemic plans should consider how to facilitate this measure. More drastic social distancing measures might be reserved for severe pandemics.


KEYWORDS:

influenza; influenza viruses; nonhealthcare settings; nonpharmaceutical measures; pandemic; pandemic influenza; public health; respiratory infections; social distancing measures; viruses

PMID: 32027585 DOI: 10.3201/eid2605.190995
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