Q. Did you hear about the new magazine for married men published by Playboy?

A. It has the same pictures month after month after month after month after month….

But I digress…….

Here is the full article about the new guidelines about screening for breast cancer.  Talk about rationing healthcare!

http://omniphysicians.com/2009/11/17/screening-for-breast-cancer/

A new drug to help with the pain in post-herpetic neuralgia.  Qutenza.  Sounds like a revolutionary from Guadalajara!

http://omniphysicians.com/2009/11/17/qutenza-for-post-herpetic-neuralgia/

New data show that when clopidogrel and omeprazole are taken together, the effectiveness of clopidogrel is reduced.  Ooops! I can hear my arteries clogging!

http://omniphysicians.com/2009/11/17/plavix-and-omeprazole-bad-combo/

You may have some immunity to H1N1 after all. 

http://omniphysicians.com/2009/11/17/immune-system-of-healthy-adults-may-be-better-prepared-than-expected-to-fight-2009-h1n1-virus/

Paul R

Link:  http://edlabor.house.gov/hearings/2009/11/protecting-employees-employers.shtml

Policies

Link:  http://healthday.com/Article.asp?AID=633012

MONDAY, Nov. 16 (HealthDay News) — While overall care of heart attack patients in the United States is good, gaps remain in the treatment of patients 80 and older, a new study suggests.

Researchers analyzed 2000-2009 data on 156,677 heart attack patients treated at 416 centers enrolled in the American Heart Association’s “Get With the Guidelines — Coronary Artery Disease” program.

The analysis revealed that 86 percent of patients aged 80 and older received early beta blocker therapy, compared with 90 percent of patients aged 64 or younger. Only 43 percent of patients 80 and older received balloon angioplasty within 90 minutes of hospital arrival, compared with 54 percent of younger patients.

Older patients had a far higher rate of in-hospital deaths (11.8 percent vs. 2.4 percent) and were less likely than younger ones to be taking statins when discharged from hospital (76 percent vs. 92 percent).

Co-existing health conditions were more common in the older patients than in the younger patients, noted Dr. Gregg C. Fonarow of the University of California, Los Angeles Medical Center and colleagues.

The study, to be presented Monday at the American Heart Association’s annual meeting in Orlando, Fla., shows there is room to improve care and outcomes in older heart attack patients, the researchers said.

More information

The American Heart Association has more about heart attack treatments.

Link:  http://www.latimes.com/news/local/la-me-stroke-centers17-2009nov17,0,4848685.story

LA Times, 11/17/09

Paramedics on Monday began transporting suspected stroke victims in Los Angeles County to the nearest certified stroke center, a change that officials hope will save lives and brings L.A. into line with other urban counties in the state.The policy shift will route patients to 10 hospitals, including one in Orange County, that have a specialized stroke neurologist available at all times.

Those facilities can run blood tests and brain scans, as well as offer rehabilitation services, said Dr. Bill Koenig, medical director at the L.A. County Emergency Medical Services Agency.

For stroke victims to benefit from the change, however, physicians say the public needs to be aware of stroke symptoms in case their co-worker or loved one starts to show them, and immediately call 911.

The five “sudden symptoms” of stroke are weakness on one side of the body, severe headache and difficulty speaking, walking or seeing.

In general, hospitals have less than three hours after the beginning of stroke symptoms to begin aggressive treatment of a blood clot in the brain.

Unfortunately, many stroke victims are either unaware that they are having a stroke or are hoping that their symptoms will go away.

If stroke victims are not within 30 minutes from a stroke center, they will be directed to the nearest hospital.

“In the past, when stroke was not really a treatable condition, it didn’t really matter which hospital you went to,” said Dr. Jeffrey Saver, who heads the stroke center at UCLA. “But now we have proven therapies . . . and we want patients to go to the right hospitals.”

Advances made over the last 15 years include medication that can dissolve a clot that blocks blood flow in the brain.

“We’re fighting for time. We’re trying to save the brain,” said Dr. Lance Lee, head of the stroke center at Glendale Adventist Medical Center. The philosophy of stroke centers, which is promoted by the American Heart Assn., is similar to the idea behind trauma centers — to designate hospitals that are better able to handle specialty care.

In 2006, L.A. County launched a system for heart attacks, in which paramedics transport victims to hospitals able to do emergency angioplasties that restore blood flow to the heart.

Hospitals now designated to handle strokes leave South Los Angeles, San Gabriel Valley and Antelope Valley underserved but, officials said, they believe that other facilities will seek certification.

Early results in Orange County, which had nine hospitals designated as stroke centers in April, have been promising.

In 2006-07 statewide, only 4% of patients with blood clots in their brain received treatment to reverse the stroke.

Between April and September in Orange County, 29% of patients with blood clots in their brain received them, said Dr. Samuel Stratton, medical director of the L.A. County Emergency Medical Services Agency.

Intro:  USA Today (11/17, Hellmich) reports, “If Americans continue to pack on pounds, obesity will cost the USA about $344 billion in medical-related expenses by 2018, eating up about 21 percent of healthcare spending,” according an analysis in the 2009 America’s Health Rankings report.

Link:  http://www.americashealthrankings.org/2009/highlights.aspx

Unhealthy Behaviors – Our Nation`s Legacy 

America`s Health RankingsTM has tracked the health of the nation for the past 20 years, providing a unique, comprehensive perspective on how the nation – and each state – measures up. The 20th anniversary edition of the Rankings suggests our nation  is  extremely adept at treating illness and disease.  However, Americans are struggling to change unhealthy behaviors such as smoking and obesity, which cause these diseases in the first place. Trends cite smoking as the greatest health challenge of the past 20 years and warn obesity is likely to be the next national health battle.

The 2009 Rankings shows the nation`s health care system has become extremely adept at treating certain illnesses and disease, such as cancer and cardiovascular disease. However, Americans are struggling in the battle to modify risk factors, such as smoking, poor eating habits and lack of exercise, which may contribute to chronic diseases in the first place. The United States currently spends more per capita than any other nation on health care, including $1.8 trillion in medical costs associated with chronic diseases, such as diabetes, heart disease and cancer. These chronic, preventable conditions all have a direct link to smoking and obesity, the nation`s two largest national risk factors.

• As we look back, smoking stands out as the greatest public health battle of the past 20 years. Despite focused efforts, nearly one in five Americans still smoke, which is only 8 million people fewer than 20 years ago. Smoking remains the leading preventable cause of disease and death in the country, leading to approximately 440,000 deaths annually. Over the past year, more than 3 million people have quit smoking, proving that smoke-free laws, smoking bans, increased cigarette taxes, access to smoking cessation programs and other interventions are beginning to make an impact. The new e-Rankings  search tool lets visitors view health determinants, such as prevalence of smoking, for the entire nation or for a specific state and/or year.
• Obesity is growing faster than any previous public health issue our nation has faced. Today, more than one in four Americans are considered obese (31 percent). If current trends continue, 103 million American adults – or 43 percent of the population – will be considered obese by 2018, making obesity the nation`s next health battle. Included as supplemental data to this year`s Rankings are estimates around the growth of health care costs over the next 10 years if obesity continues to rise at unprecedented levels. Left unchecked, obesity will add nearly $344 billion to the nation`s annual health care costs by 2018 and account for more than 21 percent of health care spending. millions. Find out what obesity is costing your state today, and if trends continue, what it may cost in the future.

The report suggests that when you place emphasis on other key issues, change happens. In fact over the past 20 years, the nation has seen significant declines in crime rates and infectious disease as a direct result of local and national initiatives.

Intro:  Even after adjusting for injury severity and comorbidities, trauma patients who did not have insurance had higher mortality rates than those who did, researchers said.  Lack of insurance increased the risk of death following traumatic injury by up to 89%, relative to individuals with commercial insurance, for various subgroups chosen to control for comorbidities, reported Heather Rosen, MD, MPH, of Children’s Hospital Boston, and colleagues.  These differences were seen in patients 18 to 30 years old, who would be expected to have few comorbidities.

Source reference:
Rosen H, et al “Downwardly mobile: The accidental cost of being uninsured” Arch Surg 2009; 144: 1006-11.

Downwardly Mobile

The Accidental Cost of Being Uninsured

Heather Rosen, MD, MPH; Fady Saleh, MD, MPH; Stuart Lipsitz, ScD; Selwyn O. Rogers Jr, MD, MPH; Atul A. Gawande, MD, MPH

Arch Surg. 2009;144(11):1006-1011.

Hypothesis  Given the pervasive evidence of disparities in screening, hospital admission, treatment, and outcomes due to insurance status, a disparity in outcomes in trauma patients (in-hospital death) among the uninsured may exist, despite preventive regulations (such as the Emergency Medical Treatment and Active Labor Act).

Design  Data were collected from the National Trauma Data Bank from January 1, 2002, through December 31, 2006 (version 7.0). We used multiple logistic regression to compare mortality rates by insurance status.

Setting  The National Trauma Data Bank contains information from 2.7 million patients admitted for traumatic injury to more than 900 US trauma centers, including demographic data, medical history, injury severity, outcomes, and charges.

Patients  Data from patients (age, >18 years; n = 687 091) with similar age, race, injury severity, sex, and injury mechanism were evaluated for differences in mortality by payer status.

Main Outcome Measure  In-hospital death after blunt or penetrating traumatic injury.

Results  Crude analysis revealed a higher mortality for uninsured patients (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.36-1.42; P < .001). Controlling for sex, race, age, Injury Severity Score, Revised Trauma Score, and injury mechanism (adjusted for clustering on hospital), uninsured patients had the highest mortality (OR, 1.80; 95% CI, 1.61-2.02; P < .001). Subgroup analysis of young patients unlikely to have comorbidities revealed higher mortality for uninsured patients (OR, 1.89; 95% CI, 1.66-2.15; P < .001), as did subgroup analyses of patients with head injuries (OR, 1.65; 95% CI, 1.42-1.90; P < .001) and patients with 1 or more comorbidities (OR, 1.52; 95% CI, 1.30-1.78; P < .001).

Conclusions  Uninsured Americans have a higher adjusted mortality rate after trauma. Treatment delay, different care (via receipt of fewer diagnostic tests), and decreased health literacy are possible mechanisms.

Link:  http://healthday.com/Article.asp?AID=633157

MONDAY, Nov. 16 (HealthDay News) — Teen girls aged 15 to 19 accounted for the largest number (409,531) of the 1.5 million reported chlamydia and gonorrhea cases in the United States in 2008, followed by women aged 20 to 24, according to an annual federal report released Monday.

The researchers also found that black females continue to have a higher rate of sexually transmitted diseases (STDs) than any other racial or ethnic group.

Last year, there were about 1.2 million reported cases of chlamydia and nearly 337,000 reported cases of gonorrhea in the United States, according to the Sexually Transmitted Disease Surveillance, 2008, report.

Among the other findings from the report:

• Gonorrhea rates among blacks were higher than any other racial or ethnic group and 20 times higher than among whites. While blacks represent 12 percent of the U.S. population, they accounted for about 71 percent of reported gonorrhea cases, 48 percent of chlamydia cases, and 49 percent of syphilis cases.
• Black females aged 15 to 19 had the highest rates of chlamydia and gonorrhea (10,513 per 100,000 and 2,934 per 100,000, respectively), followed by black women aged 20 to 24 (9,373 per 100,000 and 2,770 per 100,000, respectively).
• There were 13,500 cases of syphilis in 2008, an increase of nearly 18 percent from 2007. About 63 percent of the cases were among men who have sex with men. However, syphilis rates among women increased 36 percent from 2007 to 2008 (1.1 cases per 100,000 versus 1.5 cases per 100,000), compared with a 15 percent increase among men (6.6 cases per 100,000 versus 7.6 cases per 100,000).

“We cannot ignore the glaring racial disparities in rates of STDs, particularly when we consider the hard truth that gonorrhea rates among African-Americans are 20 times those of whites,” Dr. John M. Douglas Jr., director of the U.S. Centers for Disease Control and Prevention’s Division of STD Prevention, said in a news release.

“Research has shown that socioeconomic barriers to quality health care and higher overall prevalence of STDs within minority communities contribute to this pervasive threat. It is imperative that we improve access to effective STD prevention and treatment services in local communities for those who need them most,” he said.

Early testing, diagnosis and treatment are essential to prevent long-term health consequences of sexually transmitted diseases. Each year in the United States, untreated STDs lead to complications that cause at least 24,000 women to become infertile, according to the CDC.

Of the almost 19 million new cases of sexually transmitted diseases that occur each year in the United States, almost half are among those aged 15 to 24 years. STDs cost the nation’s health-care system as much as $15.9 billion a year, the CDC said.

More information

The U.S. National Institute of Allergy and Infectious Diseases has more about STDs.

Link:  http://healthday.com/Article.asp?AID=633048

MONDAY, Nov. 16 (HealthDay News) — If your levels of vitamin D are too low, you may be at significantly increased risk for stroke, heart disease and death, a new study suggests.

Researchers followed 27,686 people, aged 50 and older, with no history of cardiovascular disease. The participants were divided into three groups based on their vitamin D levels: normal (more than 30 nanograms per milliliter), low (15 to 30 nanograms per milliliter), or very low (less than 15 nanograms per milliliter).

After one year of follow-up, those with very low levels of vitamin D were 77 percent more likely to die, 45 percent more likely to develop coronary artery disease and 78 percent more likely to have a stroke, and twice as likely to develop heart failure compared to people with normal vitamin D levels, the researchers found.

“We concluded that among patients 50 years of age or older, even a moderate deficiency of vitamin D levels was associated with developing coronary artery disease, heart failure, stroke and death,” study co-author Heidi May, an epidemiologist with the Intermountain Medical Center in Murray, Utah, said in a news release from the center.

“This is important because vitamin D deficiency is easily treated. If increasing levels of vitamin D can decrease some risk associated with these cardiovascular diseases, it could have a significant public health impact. When you consider that cardiovascular disease is the leading cause of death in America, you understand how this research can help improve the length and quality of people’s lives,” May added.

Because this was an observational study, a definitive link between vitamin D levels and heart disease couldn’t be established, but the findings point to the need for further research, said study co-author Dr. Brent Muhlestein, director of cardiovascular research at Intermountain’s Heart Institute.

“We believe the findings are important enough to now justify randomized treatment trials of supplementation in patients with vitamin D deficiency to determine for sure whether it can reduce the risk of heart disease,” Muhlestein said in the news release.

The study was to be presented Monday at the American Heart Association’s annual meeting in Orlando, Fla.

Vitamin D is obtained from sunlight and by consuming fatty fish or fortified dairy products, including milk.

More information

The U.S. National Library of Medicine has more about vitamin D.

Link:  http://www.usatoday.com/news/health/2009-11-17-swineflublood17_ST_N.htm

Except for scattered cancellations of high school blood drives because of high absenteeism, the H1N1 pandemic doesn’t seem to have had much of an impact on the nation’s blood supply.No case of seasonal flu transmitted through a blood transfusion has ever been reported anywhere in the world, according to a draft guidance issued Friday by the Food and Drug Administration. And so far, the FDA says, the same goes for H1N1 flu.

 Studies are ongoing, though, says Jay Epstein, head of the FDA’s Office of Blood Research and Review. “There’s always a theoretical concern with a new (infectious) agent.”

 The FDA issued the H1N1 guidance “to provide clarity on expectations for how to manage donors and products,” Epstein said Monday. “The blood supply is a critical health infrastructure, and it needs to be maintained in the face of the pandemic.”

 People without flu symptoms who’ve been fever-free for at least 24 hours without taking fever-reducing medications can donate blood, according to the FDA.

 ”Absolutely the most important thing is people shouldn’t come in to donate if they’re sick,” Epstein says. While there have been no reports of flu spread through blood donations, he says, sick donors could spread it at collection sites.

 As has been the case since before H1N1, or swine flu, donors who become ill within a day or two of giving blood should notify the collection facility, says Jennifer Garfinkel, a spokeswoman for the AABB, formerly known as the American Association of Blood Banks.

 The FDA is leaving it up to collection facilities to decide whether blood from donors who become sick afterward should be discarded, Epstein says.

 Although there have been pockets of blood shortages around the country, Garfinkel says, “we’re able to move the blood where it needs to be.” Blood traditionally is in short supply during the winter months, she said.

 Since July, the American Red Cross has seen a 3% drop in blood donors scheduling appointments and giving blood, spokeswoman Stephanie Millian says.

Whether the scattered shortfalls have been because of H1N1 isn’t clear, she says. However, as donations have fallen, so has demand, partly because people are putting off elective surgeries because of the economy, she says.

Link:  http://www.annals.org/content/151/10/716.full

Intro:  The presence of J-point elevation on standard 12-lead electrocardiography has generally been viewed as an innocuous finding in healthy persons.  The data from this study challenge this concept, since J-point elevation in inferior leads was a marker of an increased risk of death from cardiac causes among middle-aged subjects. These data are partly consistent with the recent reports of a higher incidence of the early-repolarization pattern in leads other than V₁ through V₃ among subjects with idiopathic ventricular fibrillation.  In our study, J-point elevation of more than 0.2 mV in inferior leads was a stronger predictor of death from cardiac causes than other well-known electrocardiographic risk markers, such as the QTc interval and signs of left ventricular hypertrophy. Furthermore, the early-repolarization pattern remained an independent prognostic marker even after adjustment for several other risk factors.

Link:  http://content.nejm.org/cgi/content/full/NEJMoa0907589?query=TOC

Jani T. Tikkanen, B.S., Olli Anttonen, M.D., M. Juhani Junttila, M.D., Aapo L. Aro, M.D., Tuomas Kerola, M.D., Harri A. Rissanen, M.Sc., Antti Reunanen, M.D., and Heikki V. Huikuri, M.D.

Published at www.nejm.org November 16, 2009

Background Early repolarization, which is characterized by an elevation of the QRS–ST junction (J point) in leads other than V₁ through V₃ on 12-lead electrocardiography, has been associated with vulnerability to ventricular fibrillation, but little is known about the prognostic significance of this pattern in the general population.

Methods We assessed the prevalence and prognostic significance of early repolarization on 12-lead electrocardiography in a community-based general population of 10,864 middle-aged subjects (mean [±SD] age, 44±8 years). The primary end point was death from cardiac causes, and secondary end points were death from any cause and death from arrhythmia during a mean follow-up of 30±11 years. Early repolarization was stratified according to the degree of J-point elevation (>0.1 mV or >0.2 mV) in either inferior or lateral leads.

Results The early-repolarization pattern of 0.1 mV or more was present in 630 subjects (5.8%): 384 (3.5%) in inferior leads and 262 (2.4%) in lateral leads, with elevations in both leads in 16 subjects (0.1%). J-point elevation of at least 0.1 mV in inferior leads was associated with an increased risk of death from cardiac causes (adjusted relative risk, 1.28; 95% confidence interval [CI], 1.04 to 1.59; P=0.03); 36 subjects (0.3%) with J-point elevation of more than 0.2 mV in inferior leads had a markedly elevated risk of death from cardiac causes (adjusted relative risk, 2.98; 95% CI, 1.85 to 4.92; P<0.001) and from arrhythmia (adjusted relative risk, 2.92; 95% CI, 1.45 to 5.89; P=0.01). Other electrocardiographic risk markers, such as a prolonged QT interval corrected for heart rate (P=0.03) and left ventricular hypertrophy (P=0.004), were weaker predictors of the primary end point.

Conclusions An early-repolarization pattern in the inferior leads of a standard electrocardiogram is associated with an increased risk of death from cardiac causes in middle-aged subjects.

Link:  http://www3.niaid.nih.gov/news/newsreleases/2009/H1N1protection.htm

NIAID MEDIA AVAILABILITY
Immune System of Healthy Adults May Be Better Prepared Than Expected to Fight 2009 H1N1 Influenza Virus

NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

The National Institutes of Health (NIH)—The Nation’s Medical Research Agency—includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

Link:  http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm190848.htm

Clopidogrel (marketed as Plavix) and Omeprazole (marketed as

Prilosec) – Drug Interaction

Audience: Cardiovascular healthcare professionals, pharmacists

[Posted 11/17/2009] FDA notified healthcare professionals of new safety information concerning an interaction between clopidogrel (Plavix), an anti-clotting medication, and omeprazole (Prilosec/Prilosec OTC), a proton pump inhibitor (PPI) used to reduce stomach acid.  New data show that when clopidogrel and omeprazole are taken together, the effectiveness of clopidogrel is reduced. Patients at risk for heart attacks or strokes who use clopidogrel to prevent blood clots will not get the full effect of this medicine if they are also taking omeprazole. Separating the dose of clopidogrel and omeprazole in time will not reduce this drug interaction.

Other drugs that are expected to have a similar effect and should be avoided in combination with clopidogrel include: cimetidine, fluconazole, ketoconazole, voriconazole, etravirine, felbamate, fluoxetine, fluvoxamine, and ticlopidine. 

Recommendations for healthcare professionals are provided in the “Information for Healthcare Professionals” sheet.

[11/17/2009 - Information for Healthcare Professionals - FDA]
[11/17/2009 - Public Health Advisory - FDA]
[11/17/2009 - Follow-Up to January 2009 Early Communication - FDA]

Previous MedWatch Alert:

[01/26/2009] Clopidogrel bisulfate (marketed as Plavix) Early Communication

Link:  http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm191003.htm

FDA Approves New Drug Treatment for Long-Term Pain Relief after Shingles Attacks

The Food and Drug Administration (FDA) has approved the approval of Qutenza (capsaicin) 8% patch, a medicated skin patch that relieves the pain of post-herpetic neuralgia (PHN), a serious complication that can occur after a bout with shingles.

Shingles is an outbreak of rash or blisters on the skin that is caused by the same virus that causes chickenpox — the varicella-zoster virus. Anyone who once had chickenpox is at risk of shingles since the virus may become reactivated years after the initial infection.  PHN is a condition affecting nerve fibers and the skin that can cause excruciating pain for weeks, months or even years. About 10 to 15 percent of patients who have shingles experience PHN and the complication is even more common in elderly patients.

Qutenza contains capsaicin, a compound found in chili peppers. Although there are over-the-counter products with lower concentrations of capsaicin that are marketed for the treatment of PHN, Qutenza is the first pure, concentrated, synthetic capsaicin-containing prescription drug to undergo FDA review . It was approved on Nov. 16.

“This new product can provide effective pain relief for patients who suffer from PHN,” said Bob Rappaport, M.D., director of the Division of Anesthesia, Analgesia and Rheumatology Products in the FDA’s Center for Drug Evaluation and Research.

The most frequently reported adverse drug reactions included pain, swelling, itching, redness, and bumps at the application site.

Qutenza must be applied to the skin by a health care professional since placement of the patch can be quite painful, requiring use of a local topical anesthetic, as well as additional pain relief such as ice or use of opioid pain relievers. The patient must also be monitored for at least one hour since there is a risk of a significant rise in blood pressure following patch placement.

The patch is manufactured by Lohmann Therapie-Systems AD of Andernach, Germany and distributed by NeurogesX Inc. of San Mateo, Calif.

Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households: A Cluster Randomized Trial

Benjamin J. Cowling, et al

Ann Intern Med October 6, 2009 151:437-446

http://www.annals.org/content/151/7/437.abstract

Background: Few data are available about the effectiveness of nonpharmaceutical interventions for preventing influenza virus transmission.

Objective: To investigate whether hand hygiene and use of facemasks prevents household transmission of influenza.

Design: Cluster randomized, controlled trial. Randomization was computer generated; allocation was concealed from treating physicians and clinics and implemented by study nurses at the time of the initial household visit. Participants and personnel administering the interventions were not blinded to group assignment. (ClinicalTrials.gov registration number: NCT00425893)

Setting: Households in Hong Kong.

Patients: 407 people presenting to outpatient clinics with influenza-like illness who were positive for influenza A or B virus by rapid testing (index patients) and 794 household members (contacts) in 259 households.

Intervention: Lifestyle education (control) (134 households), hand hygiene (136 households), or surgical facemasks plus hand hygiene (137 households) for all household members.

Measurements: Influenza virus infection in contacts, as confirmed by reverse-transcription polymerase chain reaction (RT-PCR) or diagnosed clinically after 7 days.

Results: Sixty (8%) contacts in the 259 households had RT-PCR–confirmed influenza virus infection in the 7 days after intervention. Hand hygiene with or without facemasks seemed to reduce influenza transmission, but the differences compared with the control group were not significant. In 154 households in which interventions were implemented within 36 hours of symptom onset in the index patient, transmission of RT-PCR–confirmed infection seemed reduced, an effect attributable to fewer infections among participants using facemasks plus hand hygiene (adjusted odds ratio, 0.33 [95% CI, 0.13 to 0.87]). Adherence to interventions varied.

Limitation: The delay from index patient symptom onset to intervention and variable adherence may have mitigated intervention effectiveness.

Conclusion: Hand hygiene and facemasks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset. These findings suggest that nonpharmaceutical interventions are important for mitigation of pandemic and interpandemic influenza.