Physical interventions to interrupt or reduce the spread of respiratory viruses (Review)

Jefferson, Tom, Del Mar, Chris B., Dooley, Liz, Ferroni, Eliana, Al-Ansary, Lubna A., Bawazeer, Ghada A., van Driel, Mieke L., Nair, Sreekumaran, Jones, Mark A., Thorning, Sarah and Conly, John M. (2011) Physical interventions to interrupt or reduce the spread of respiratory viruses (Review). Cochrane Database of Systematic Reviews, 7: . doi:10.1002/14651858.CD006207.pub4

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Author Jefferson, Tom
Del Mar, Chris B.
Dooley, Liz
Ferroni, Eliana
Al-Ansary, Lubna A.
Bawazeer, Ghada A.
van Driel, Mieke L.
Nair, Sreekumaran
Jones, Mark A.
Thorning, Sarah
Conly, John M.
Title Physical interventions to interrupt or reduce the spread of respiratory viruses (Review)
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2011-07-06
Year available 2011
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD006207.pub4
Open Access Status File (Publisher version)
Issue 7
Total pages 159
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Language eng
Formatted abstract
Viral epidemics or pandemics of acute respiratory infections like influenza or severe acute respiratory syndrome pose a global threat. Antiviral drugs and vaccinations may be insufficient to prevent their spread.

To review the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses.

Search strategy
We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL 2010, Issue 3), which includes the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to October 2010), OLDMEDLINE (1950 to 1965), EMBASE (1990 to October 2010), CINAHL (1982 to October 2010), LILACS (2008 to October 2010), Indian MEDLARS (2008 to October 2010) and IMSEAR (2008 to October 2010).

Selection criteria
In this update, two review authors independently applied the inclusion criteria to all identified and retrieved articles and extracted data. We scanned 3775 titles, excluded 3560 and retrieved full papers of 215 studies, to include 66 papers of 67 studies. We included physical interventions (screening at entry ports, isolation, quarantine, social distancing, barriers, personal protection, hand hygiene) to prevent respiratory virus transmission. We included randomised controlled trials (RCTs), cohorts, case-controls, before-after and time series studies.

Data collection and analysis
We used a standardised form to assess trial eligibility. We assessed RCTs by randomisation method, allocation generation, concealment, blinding and follow up. We assessed non-RCTs for potential confounders and classified them as low, medium and high risk of bias.

Main results
We included 67 studies including randomised controlled trials and observational studies with a mixed risk of bias. A total number of participants is not included as the total would be made up of a heterogenous set of observations (participant people, observations on participants and countries (object of some studies)). The risk of bias for five RCTs and most cluster-RCTs was high. Observational studies were of mixed quality. Only case-control data were sufficiently homogeneous to allow meta-analysis. The highest quality cluster-RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children. Benefit from reduced transmission from children to household members is broadly supported also in other study designs where the potential for confounding is greater. Nine case-control studies suggested implementing transmission barriers, isolation and hygienic measures are effective at containing respiratory virus epidemics. Surgical masks or N95 respirators were the most consistent and comprehensive supportive measures. N95 respirators were non-inferior to simple surgical masks but more expensive, uncomfortable and irritating to skin. Adding virucidals or antiseptics to normal handwashing to decrease respiratory disease transmission remains uncertain. Global measures, such as screening at entry ports, led to a non-significant marginal delay in spread. There was limited evidence that social distancing was effective, especially if related to the risk of exposure.

Authors' conclusions
Simple and low-cost interventions would be useful for reducing transmission of epidemic respiratory viruses. Routine long-term implementation of some measures assessed might be difficult without the threat of an epidemic.
Keyword Health-care workers
Personal protective equipment
Prevent influenza transmission
Virucidal paper handkerchiefs
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article number CD006207

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2012 Collection
School of Public Health Publications
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Citation counts: TR Web of Science Citation Count  Cited 45 times in Thomson Reuters Web of Science Article | Citations
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