Masks plus handwashing are most effective when their use is started at the first sign of outbreak—before the flu spreads.

From the University of Michigan

What U-M flu studies can tell us about how to deal with swine flu

Plus: Up to date information on U-M flu preparations

Allison Aiello, John G. Searle Professor of Epidemiology in the School of Public Health, led a landmark study in the University of Michigan dorms. The study evaluated the effectiveness of hand-washing and masks in preventing the spread of flu. In this Q and A, plus video, we asked Professor Aiello to explain how best to prepare for swine flu—or any flu outbreak.

Quick Time Video

Michigan Today: Can you describe the flu transmission study you did with UM students?

Allison Aiello: The overall objective of the M-FLU Study was to investigate the feasibility and effectiveness of using non-pharmaceutical interventions, specifically masks and hand hygiene, to prevent the transmission of influenza in residence hall units at the University of Michigan.

The study separated students into two groups. One wore masks and washed hands regularly. The other used masks alone.

We conducted a cluster randomized intervention trial among University of Michigan students living in university residence halls. Students were randomized into one of two intervention groups (face masks with hand hygiene; face masks alone) or a comparison (control) group. Interventions were carried out over two periods of seasonal influenza transmission (2006-2007; 2007-2008) for a six week study period. Students completed electronic surveys, reporting their health behaviors, use of the interventions (if applicable), and occurrence of influenza-like illnesses. In all selected residence halls, when illness symptoms met the criteria for influenza-like illness, specimens were collected for viral isolation.

What conclusions do you draw from the study that would be relevant to the current outbreak of swine flu—or future outbreaks of other strains?

The M-FLU study demonstrated that mask use and hand hygiene (alcohol based hand sanitizer) among university students was associated with a significant reduction in the rate of influenza-like illness of up to 50-65% over the six-week intervention periods.

Our study utilized a unique design by asking participants to begin wearing a mask and use hand sanitizer every day at the very beginning of the influenza season, just after the first case of influenza was identified on campus. This design is in contrast with household study designs that have examined the effect of mask use on secondary transmission where household members may already have been infected by the time mask use was implemented.

The study suggests that masks plus handwashing are most effective when their use is started at the first sign of outbreak—before the flu spreads.

Thus, our study provides evidence that application of masks and hand hygiene interventions prior to outbreak conditions can mitigate transmission of respiratory illness in shared living settings, such as university dorms.

Because there is little or no immunity in the human population against the novel 2009 H1N1 virus and there are currently no available vaccinations, the government has been primarily focusing on non-pharmaceutical mitigation measures to reduce transmission. For this reason, non-pharmaceutical interventions (NPIs) represent our best defense against mitigating 2009 H1N1 transmission in the US.

Do masks really make a difference?

A study conducted in the laboratory setting by van der Sande et al. assessed transmission reduction potential provided by personal respirators, surgical masks and homemade masks. Masks were worn by healthy volunteers and a simulated patient during various activities. All studied masks reduced aerosol exposure, but with a high degree of individual variation. Personal respirators were the most efficient, following by surgical and then homemade masks.

Children were less well protected, regardless of mask type. The researchers concluded that any type of general mask use is likely to decrease viral exposure and infection risk on a population level.

In a laboratory study conducted by Fabian et al., influenza virus nucleic acid was present in fine particle aerosols from influenza patients, in both tidal breathing (14-33%) and coughing (64%).

Preliminary results suggest that face masks limit the generation of influenza virus RNA contained in large droplets. Investigation of the efficacy of face masks to limit the generation of fine droplets virus particles is ongoing.

Our study did not support a significant reduction in influenza-like illness with masks only.

The mask and hand hygiene groups showed the greatest reduction in influenza-like illness, suggesting that a combination of the mitigation measures may work best at reducing transmission.

However, it is unclear whether the protection is related to reduction in aerosol fine particle droplet nuclei or reduction in contact transmission due to less contact of hands with nose and mouth while the masks were being worn by participants.

What would be key events in this or future flu epidemics that you think should trigger new actions or behaviors by ordinary people? At what point, for instance, would you suggest people begin wearing masks when they go out in public?

Sustained human-to-human transmission of disease represents a key feature necessitating behavioral change.

The key to mitigation of an influenza pandemic is adequate surveillance of disease transmission, early implementation of protective measures (i.e., face masks, hand hygiene, school closures, social distancing, quarantine, isolation) in affected communities, and travel restrictions.

Individuals should follow the current recommendations of the CDC, and recognize that peaks of pandemic activity may occur in multiple waves spread over months.

Do you have suggestions for policy makers? What are the most effective public health tools they could deploy now and if the epidemic worsens?

There are many gaps in current pandemic influenza knowledge and effectiveness of mitigation practices. The 2009 H1N1 influenza outbreak may provide a critical window to address many of the gaps in research regarding sociobehavioral response to outbreaks, compliance with NPIs, and effectiveness of NPIs. Support of additional research is essential.

Currently, plans have been developed which describe what needs to occur in the event of pandemic influenza, but they fall short of detailing how to carry out the recommendations. Policy makers must develop consistent laws specifying the authority of public health officials to implement NPI measures across county, state, or national jurisdictions and the responsibility of the federal government in terms of economic compensation for individuals, in the event of compulsory NPI measures which results in lost wages, such as staying home from work.

http://michigantoday.umich.edu/2009/05/flu.php

Flu Heads South For The Winter

Flu Heads South For The Winter

by Richard Knox       Listen Now [4 min 12 sec]

May 8, 2009

It's autumn in Brazil, and the first cases of flu in the Southern Hemisphere's annual flu season are starting to show up.

"It worries me so much," says Dr. Evelyn Eisenstein, a pediatrician in Rio de Janeiro. "Because children go to the school even when they have a cold, you know? Parents don't stay with them. There is not the prevention culture that you have in the United States."

Bracing For Swine Flu

This year, there's special reason to worry. Eisenstein has no way of knowing whether her patients will get sick with the new swine flu virus she's been hearing about up North. Or if they do, how sick they'll get.

So far, only a few cases have shown up in Central and South America — in Costa Rica, El Salvador, Guatemala and Colombia. But Dr. Jon Andrus of the Pan American Health Organization expects many, many more as the southern winter takes hold.

"The winter months provide a situation where transmission is facilitated," Andrus says. "It's very logical when people gather, as they do in the winter months, and hunker down to stay warm. Those kinds of social conditions will contribute to virus transmission."

Why Is Flu So Seasonal?

Indeed, influenza is probably the most reliably seasonal of all diseases. Every year, flu epidemics strike from November to March in the Northern Hemisphere and from May to September in the South.

Despite this ancient pattern, scientists actually know surprisingly little about why flu is so seasonal. Dr. Peter Palese of Mount Sinai School of Medicine says the conventional wisdom — that people spend more time together in confined spaces, making it easier for the flu virus to transmit — is not the whole story, or perhaps even the main explanation.

"Some people over the years have postulated that it's the crowding of schools," Palese says. "But that really turns out to be not the determining factor."

Flu Virus Spreads Faster In Colder, Drier Conditions

"What we found specifically was that cold temperatures, around 40 degrees, and low humidity — exactly the conditions in temperate zones in winter — are much more favorable for transmission of flu," Palese says. "At 75 to 80 degrees, we don't see any transmission."

That's partly because of how temperature and humidity affect flu viruses, and partly because of how the environment affects the respiratory tracts of humans and other mammals.

Palese says flu viruses are more stable in colder, drier conditions.

Equally important, the droplets of fluid that people (and guinea pigs) spray with each sneeze and cough are much smaller at lower temperatures and humidity levels. So these droplets carry much farther and stay suspended in the air longer.

The droplets also penetrate deeper into the respiratory passages and lungs when breathed in, Palese says.

"At higher humidity, the droplets become much bigger and sink to the floor," he adds.

Colder, drier air also affects mammals' respiratory tracts in a way that gives flu viruses a boost.

"The mucous is much more viscous," Palese explains. That clogs up the tiny hairs, called cilia, that continually beat in waves to clear virus-laden particles out of the breathing passages.

"It's more likely that the virus is transmitted in hallways, maybe outside of school where people are waiting," Palese says. "It may occur on the way to school, or under conditions where it's a little bit colder."

Whatever the factors, this winter will be an especially tense time for the Southern Hemisphere.

[end excerpts]

Full article at http://www.npr.org/templates/story/story.php?storyId=103910735

Related NPR Stories

Swine Flu: Your Questions AnsweredMay 5, 2009
Lesson Learned From 'The Great Influenza'

Snowy Owl

Catching Flu From Money

Catching Flu From Money

The influenza virus can survive on paper money for 10 or more days — suggesting that when we shop, spend and bank, there’s more than cash that is changing hands.

The link between flu virus and paper currency is explained this week in a story on SmartMoney.com. The findings don’t mean we should fret about handling currency — but it does illustrate why health officials repeatedly tell people to wash hands frequently. From the SmartMoney report:

Generally speaking, scientists interviewed by SmartMoney estimate the lifetime of a plain flu virus deposited on money at an hour or so. But mix in some human nasal mucus, and the potential for the virus to hang on long enough to find a victim increases, according to one of the few scientific studies done on flu transmission through cash.

In a study conducted at Switzerland’s Central Laboratory of Virology at the University Hospitals of Geneva, researchers tested to see what would happen when flu virus was placed on Swiss franc notes. In some of these tests, researchers placed flu virus mixed in with nasal secretions from children on banknotes —and saw some unexpected results.

When protected by human mucus, the flu cells were much hardier—in some cases, lasting up to 17 days on the franc notes. The virus that persisted for 17 days was a form of influenza A called H3N2. In an e-mail interview, Dr. Yves Thomas said samples of an influenza A strain called H1N1 also endured for quite a bit — in some cases, up to 10 days. That bug was similar but not identical to the virus at the center of the current swine flu outbreak, which is considered a new strain of H1N1.

more at http://well.blogs.nytimes.com/2009/05/01/catching-flu-from-money/?em

Achak

The world is full of anti-viral medicine

Hat-Tip to Crofsblog,

What's Missing From Every Media Story about H1N1 Influenza
Saturday, May 02, 2009 by: Mike Adams, the Health Ranger, NaturalNews Editor

Excerpts:

(NaturalNews) If you read the stories on H1N1 influenza written by the mainstream media, you might incorrectly think there's only one anti-viral drug in the world. It's name is Tamiflu and it's in short supply.

That's astonishing to hear because the world is full of anti-viral medicine found in tens of thousands of different plants.

Culinary herbs like thyme, sage and rosemary are anti-viral.

Berries and sprouts are anti-viral. Garlic, ginger and onions are anti-viral.

You can't walk through a grocery store without walking past a hundred or more anti-viral medicines made by Mother Nature.

And yet how many does the mainstream media mention? Zero

snip

Tamiflu comes from an herb

To live in a world that's saturated with natural anti-viral medicine and then not even acknowledge it in the media is beyond bizarre. It's Twilight Zone-like. It's like we've been teleported to an alternate universe where anti-viral plants have disappeared... or at least everyone is pretending they have.

Where do you think Tamiflu comes from, by the way?

It's extracted from the Traditional Chinese Medicine herb called Star Anis.

It's one of hundreds of different anti-viral herbs found in Chinese Medicine, not to even mention anti-viral herbs from South America, North America, Australia, Africa and other regions. 

How many stories have you read that bother to tell you Tamiflu is made from the star anise herb that's been used for over 5,000 years in Traditional Chinese Medicine? Virtually none. 

http://www.naturalnews.com/026185.html

The World is full of anti-viral.

Look Here

Snowy Owl

Pandemic, H1N1, H5N1, H3N2, Little Ice Age & Preparedness

 ‘Awareness of Humanity’

By Snowy Owl

May 6, 2009

Into shackled Labor via Perceptions,

Comes forth within our Consciousness, 
A new network of Communication.

 ‘Awareness of Humanity’,
That Transcend Beliefs, Languages,
Cultures, Traditions, Sciences and Opinions,
It is coming forth right before our Eyes

Life Itself is Inter-Dependent
We Now Perceive it more Clearly.

Indeed, the Inter-Dependence of Life,
At all Scales, Casts, Class and Layers.
At the Micro, Meso, Macro and Mega Levels
Life, in all Forms, is Inter-Dependent

It is more obvious Day by Day.

Inter-Dependence... Keeping us Aware,
Making us Humble,
More Sympathic and Empathic.

We are discovering all these Gateways between Everything, year after year.

No Solar flares from our Sun as 
Huge amount of Volcanic Ashes thrown out in Our Upper Atmosphere
Indeed means Cooler Temperature for our Earth.

Emergence of a new virus can affect all Humanity

Global Economic downfall affects all Nations

We are learning that we have to;
All together put our shoulders to the Wheel,
To reduce; conflicts, morbidity and mortality.
There are no other Ways.

Individual, Collective, National, Cultural, Scientific and Beliefs must Now,
Share their ‘Know How’ and co-ordinate the Dispatching of Resources
We are in this Together.

It’s all Understood

Snowy Owl

Teetering On The Edge Of A Flu Pandemic?
by Snowy Owl - Sun May 03, 2009
http://www.dailykos.com/story/2009/5/3/727324/-Teetering-On-The-Edge-Of-A-Flu-Pandemic

"There is a lot of misunderstanding in terms of fear and death," Margaret Chan, the United Nations public health agency’s director-general, told the Wall Street Journal Sunday. "It doesn’t mean death in big numbers is going to happen."

"We hope the virus fizzles out, because if it doesn’t we are heading for a big outbreak." But she said: "I’m not predicting the pandemic will blow up, but if I miss it and we don’t prepare, I fail. I’d rather over-prepare than not prepare."

She stressed that a likely increase to the agency’s highest "level six" pandemic alert did not necessarily mean "every country and every individual will be affected" with many more deaths.

Rather "it is a signal to public health authorities to take appropriate measures" such as intensified disease surveillance. (Financial Times)

Priorities in a global crisis

The Priority in order to reduce morbidity and mortality World Wide is to do the best we can to make sure that there are;
continuity of Humanitarian Governance,
Civil Order,
active support for Health Care Providers,
supports for the distribution of essential Services and Pruducts,
to give as much information as possible to teach people to become as much autonomous as possible and to teach them auto-treatment and finally provide them all pertinent informations on available alternatives in Medicines.

http://www.dailykos.com/story/2009/5/4/727623/-WHO-to-Declare-Level-6-Flu-Pandemic

Snowy Owl

Global Warming Alarmists Out in the Cold

IT’S snowing in April. Ice is spreading in Antarctica. The Great Barrier Reef is as healthy as ever.

And that’s just the news of the past week. Truly, it never rains but it pours - and all over our global warming alarmists.

Time’s up for this absurd scaremongering. The fears are being contradicted by the facts, and more so by the week.

Doubt it? Then here’s a test.