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Hand Hygiene Campaigns and Influenza, Egypt | CDC EID

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Volume 17, Number 4–April 2011
Effects of Hand Hygiene Campaigns on Incidence of Laboratory-confirmed Influenza and Absenteeism in Schoolchildren, Cairo, Egypt
Maha Talaat, Salma Afifi, Erica Dueger, Nagwa El-Ashry, Anthony Marfin, Amr Kandeel, Emad Mohareb, and Nasr El-Sayed

Author affiliations: US Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt (M. Talaat, S. Afifi, E. Dueger, A. Marfin, E. Mohareb); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E. Dueger, A. Marfin); and Ministry of Health, Cairo (N. El-Ashry, A. Kandeel, N. El-Sayed)

Suggested citation for this article

To evaluate the effectiveness of an intensive hand hygiene campaign on reducing absenteeism caused by influenza-like illness (ILI), diarrhea, conjunctivitis, and laboratory-confirmed influenza, we conducted a randomized control trial in 60 elementary schools in Cairo, Egypt. Children in the intervention schools were required to wash hands twice each day, and health messages were provided through entertainment activities. Data were collected on student absenteeism and reasons for illness. School nurses collected nasal swabs from students with ILI, which were tested by using a qualitative diagnostic test for influenza A and B. Compared with results for the control group, in the intervention group, overall absences caused by ILI, diarrhea, conjunctivitis, and laboratory-confirmed influenza were reduced by 40%, 30%, 67%, and 50%, respectively (p<0.0001 for each illness). An intensive hand hygiene campaign was effective in reducing absenteeism caused by these illnesses.

Acute respiratory infections (ARIs) and diarrheal diseases cause substantial illness and death worldwide. Most of the estimated 5.5 million deaths associated with ARI and diarrhea occur in children from resource-limited countries. In these settings, where access to health services is often lacking, effective prevention methods are paramount. ARIs cause >4 million deaths annually and account for >7% of global deaths (1). Many ARIs are caused by viruses, including influenza A and B. Influenza viruses circulate in Egypt all year, peaking in winter months (2). Although influenza is generally self-limiting, each year it causes 3–5 million cases of severe illness and up to 500,000 deaths worldwide (3). The greatest number of excess deaths occur in persons >65 years of age, yet influenza greatly affects schoolage children as well. In addition, schoolchildren play a key role in transmission of influenza during community epidemics (4). Slowing or preventing transmission of influenza viruses among children may diminish the explosive transmission pattern that often characterizes annual influenza epidemics (5).

Diarrheal disease is the second leading cause of childhood illness and death and is responsible for ≈2 million deaths annually in children <5 years of age (6,7). Frequent and prolonged episodes of nonfatal diarrhea can lead to malnutrition, stunting of growth, and absenteeism in schoolage children (8,9). In Egypt, where child mortality rates have been reduced in recent years, diarrheal diseases still account for 13.9% of deaths in children <5 years of age. Much of the reduction in deaths caused by diarrheal diseases has resulted from better case management, including use of oral rehydration therapy and improved water and sanitation. Although deaths have decreased, the incidence of diarrheal diseases has remained relatively unchanged (10).

Hand hygiene is a key intervention for reducing transmission of ARI and diarrhea in community settings. Hand hygiene, using antibacterial soap or alcohol-based sanitizers, has been reported to result in notable reductions in the incidence of diarrheal diseases (11). Hand hygiene has also been specifically recommended for prevention of diseases with pandemic potential, such as severe acute respiratory syndrome and for influenza A pandemic (H1N1) 2009 (12–14). The objectives of this study were to measure the effectiveness of an intensive hand hygiene intervention campaign in reducing the incidence of absenteeism caused by illness and the incidence of laboratory-confirmed influenza in schoolchildren in Egypt.

Hand Hygiene Campaigns and Influenza, Egypt | CDC EID

Suggested Citation for this Article
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. Emerg Infect Dis [serial on the Internet]. 2011 Apr [date cited].

DOI: 10.3201/eid1704.101353

Comments to the Authors
Please use the form below to submit correspondence to the authors or contact them at the following address:

Maha Talaat, US Naval Medical Research Unit No.3, PSC 452, Box 5000 FPO AE 09835-0007, USA
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