Friday, October 05, 2012

Lancet: Public Response To The H1N1 Pandemic Of 2009



# 6610



During the opening months of the 2009 H1N1 pandemic – before a vaccine was available – about the only advice that public health departments could offer was that people practice good flu hygiene.


The CDC’s Action Steps released in September, 2009.


  1. Get your family vaccinated for seasonal flu and 2009 H1N1 flu.
  2. Cover your mouth and nose with a tissue when you cough or sneeze.  If you don’t have a tissue, cough or sneeze into your elbow or shoulder; not into your hands.
  3. Practice good hand hygiene by washing your hands often with soap and water, especially after coughing or sneezing.
  4. Stay home if you or your child is sick for at least 24 hours after there is no longer a fever or signs of a fever (without the use of fever-reducing medicine). Keeping sick students at home means that they keep their viruses to themselves rather than sharing them with others.


And variations of this advice was promoted pretty much worldwide, including this NHS promotion in the UK:




While many people did adopt these practices, many did not.  In September of 2009 I wrote of my own encounter with with an unrepentant public sneezer in a blog called  `Being A Sneeze Guard’.


And in a blog called And Yet, They Still Call It Wellington, we looked at a New Zealand study that found poor flu hygiene compliance during the 2009 pandemic.


Today, The Lancet has published a review of flu compliance that has garnered a good deal of press overnight, particularly in Britain, where compliance was less than sterling.


Public response to the 2009 influenza A H1N1 pandemic: a polling study in five countries

Dr Gillian K SteelFisher PhD , Robert J Blendon ScD , Johanna RM Ward MSc , Robyn Rapoport MA , Emily B Kahn PhD , Katrin S Kohl MD



Although the full text is behind a pay wall, the Fergus Walsh with the  BBC has a report with some of the details.


Britons 'kissed through swine flu'


Researchers at Harvard School of Public Health in Boston questioned nearly 5,000 people. Just 25% of British people surveyed said they more frequently coughed or sneezed into their elbow or shoulder during the pandemic compared with 82% in Mexico and 84% in Argentina. Some 53% of Britons said they washed their hands or used hand sanitizer more frequently, compared with 89% in Argentina, and 72% in Japan and the US.


Just 2% of Britons said they avoided hugging or kissing family or friends compared with 46% of those questioned in Mexico and 21% in the US.

(Continue . . .)



It wasn’t just the general public displaying a cavalier attitude during the pandemic - something I wrote about in Hand Hygiene Among Doctors Exposed. That concerned an observational study conducted at two scientific conferences on the hand washing habits of doctors.


The first was the 26th Meeting of the Scandinavian Society on Antimicrobial Chemotherapy (SSAC) in Tromsø, Norway, and second took place at the International Congress on Antimicrobial Agents and Chemotherapy (ICAAC) in San Francisco, CA.


Both took place in September 2009, during the height of the pandemic.


Observers stationed in the men’s and women’s restrooms kept track of the hand washing compliance among the men and women (mostly infectious disease specialists) attending these conferences.


The results, while better than others we’ve seen among the general public, were still less than comforting.


The study appeared in the  AJIC (American Journal of Infection Control) and was called:


Do as I say, not as I do: Handwashing compliance of infectious diseases experts during influenza pandemic

Anu Kantele, MD, PhD, Mari Kanerva, MD, PhD, Mikko Seppänen, MD, PhD, Jussi Sutinen, MD, PhD, Kirsi Skogberg, MD, PhD, Laura Pakarinen, MD, Iiro H.S. Jääskeläinen, MD, Inko Aho, MD, Asko Järvinen, MD, PhD, Taru Finnilä, MD Jukka Ollgren, PhD


The bottom line was that in San Francisco only 69% of the men were observed to wash with soap and water, and 86% of the women. Results from the conference in  Tromsø, Norway conference were even more disturbing, with just 38% of the men, and 84% of the women using soap and water.


You’ll find a lot more on this subject in Giving Germs A Helping Hand, which looked at low handwashing compliance among doctors and other healthcare providers.


To try to encourage better hand hygiene among health care providers, the CDC has a hand hygiene website  with  many resources, including a link to a new iPad/iPhone application called iScrub.



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