There have been virtually no analyses of non-pharmaceutical interventions (NPIs) to retard the spread of influenza in the community. In the absence of enough and specific vaccines or drugs to combat epidemic or pandemic influenza, health departments are frustrated in their ability to recommend how their citizens may avoid influenza or prevent its transmission to others. We (Holmberg et al. 2006) concluded that """"""""Because of a lack of epidemiologic data, few states explicitly discuss implementing non-pharmaceutical community interventions such as voluntary self-isolation (17 states [35%]); school or other institutional closing (18 [37%]); [or] institutional or household quarantine (15 [31%])."""""""" This proposal focuses on examining whether non-pharmaceutical interventions such as keeping ill children home from school, fostering telecommuting /working from home (for those who can),and other personal measures of social/respiratory isolation during a typical influenza season make any difference in influenza incidence. The essential components of our proposal include (1) selecting intervention and nonintervention elementary school districts in North Carolina (Henderson and Haywood Counties) for special attention and comparison; (2) intervening in Henderson County (but not in nearby Haywood County) with a full range of NPIs-i.e., fostering working from home, sending sick children home from school, encouraging hand-washing/cleaning-and (3) comparing changes in measured influenza incidence (physicians and clinics in the area will be provided with rapid influenza test kits) and rates of influenza symptoms and behavioral changes from pre- and post-influenza season survey of 800 selected households in each county. RTI and the North Carolina Division of Public Health (NC DPH) are uniquely qualified to look at these issues because of (1) seminal work in influenza-like (ILI) """"""""syndromic surveillance"""""""" done in this state (NC DETECT-www.ncdetect.org); (2) a long collaborative relationship between RTI and the NC DPH- e.g., proposed RTI staff have partnered with the NC DPH and a local health department (Wake County) to implement and evaluate multicomponent, community-based interventions, Project DIRECT funded by CDC (Burrus et al 1998); (3) proposed staff-integrating epidemiologic, biologic, behavioral, and social sciences- well-versed and dedicated to this issue; and (4) some former CDC staff/ EIS officers (Drs. Holmberg and Wetterhall) who understand the mechanics and purpose of public health projects such as this and the importance of working collaboratively with CDC. We think that the data obtained from such a project will inform public health officials in making recommendations for personal and organizational steps that may be taken during inter-pandemic or pandemic influenza seasons that are practical and effective. ? ? ? ?
