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采取物理介入措施以阻斷或降低呼吸道的病毒傳播

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Background

Viral epidemics or pandemics of acute respiratory infections like influenza or severe acute respiratory syndrome pose a global threat. Antiviral drugs and vaccinations may be insufficient to prevent their spread.

Objectives

To review the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses.

Search methods

We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL 2010, Issue 3), which includes the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to October 2010), OLDMEDLINE (1950 to 1965), EMBASE (1990 to October 2010), CINAHL (1982 to October 2010), LILACS (2008 to October 2010), Indian MEDLARS (2008 to October 2010) and IMSEAR (2008 to October 2010).

Selection criteria

In this update, two review authors independently applied the inclusion criteria to all identified and retrieved articles and extracted data. We scanned 3775 titles, excluded 3560 and retrieved full papers of 215 studies, to include 66 papers of 67 studies. We included physical interventions (screening at entry ports, isolation, quarantine, social distancing, barriers, personal protection, hand hygiene) to prevent respiratory virus transmission. We included randomised controlled trials (RCTs), cohorts, case‐controls, before‐after and time series studies.

Data collection and analysis

We used a standardised form to assess trial eligibility. We assessed RCTs by randomisation method, allocation generation, concealment, blinding and follow up. We assessed non‐RCTs for potential confounders and classified them as low, medium and high risk of bias.

Main results

We included 67 studies including randomised controlled trials and observational studies with a mixed risk of bias. A total number of participants is not included as the total would be made up of a heterogenous set of observations (participant people, observations on participants and countries (object of some studies)). The risk of bias for five RCTs and most cluster‐RCTs was high. Observational studies were of mixed quality. Only case‐control data were sufficiently homogeneous to allow meta‐analysis. The highest quality cluster‐RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children. Benefit from reduced transmission from children to household members is broadly supported also in other study designs where the potential for confounding is greater. Nine case‐control studies suggested implementing transmission barriers, isolation and hygienic measures are effective at containing respiratory virus epidemics. Surgical masks or N95 respirators were the most consistent and comprehensive supportive measures. N95 respirators were non‐inferior to simple surgical masks but more expensive, uncomfortable and irritating to skin. Adding virucidals or antiseptics to normal handwashing to decrease respiratory disease transmission remains uncertain. Global measures, such as screening at entry ports, led to a non‐significant marginal delay in spread. There was limited evidence that social distancing was effective, especially if related to the risk of exposure.

Authors' conclusions

Simple and low‐cost interventions would be useful for reducing transmission of epidemic respiratory viruses. Routine long‐term implementation of some measures assessed might be difficult without the threat of an epidemic.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

采取物理介入措施以阻斷或降低呼吸道的病毒傳播

雖然呼吸道病毒通常只引起輕微的疾病,但它們可能引起流行病。全球每年約有10%至15%的人感染流感,在重大流行病期間,侵襲率高達50%。全球大流行性病毒感染已具有毀滅性。2003年,嚴重急性呼吸道症候群(SARS)疫情影響約8000人,造成780人死亡,並引發巨大的社會和經濟危機。2006年出現新的禽流感病毒H5N1,2009年又出現新型流感H1N1"豬流感"大流行所帶來了威脅,引起了全球的焦慮。單一和可能昂貴的措施(特別是使用疫苗或抗病毒藥物)可能不足以阻斷傳播。因此,我們研究可以降低呼吸道病毒(包括流感病毒)傳播的方法及證據,像是一些簡單的物理屏障(如洗手或戴口罩)。

我們納入了67項研究,包含了隨機對照試驗和具有混合誤差風險的觀察性研究。參與者總人數不包括在內,因為總人數可能來自各式各樣的觀察者:包含參與者和觀察參與者與國家(某些研究的對象)的研究人群。因此,任何總人數都會產生誤導。呼吸道病毒的傳播可以透過衛生措施(如洗手)來減少,特別是在年幼的兒童身上。經常洗手也能減少兒童將病毒傳染給其他家庭成員。實施如隔離和衛生措施(戴口罩、手套和隔離衣)等方法可以有效地控制呼吸道病毒流行或在醫院傳播。我們沒有發現任何證據表明,佩戴更昂貴,有刺激性和不舒服的N95口罩優於簡單的外科口罩。目前還不清楚,在使用肥皂洗手時添加殺病毒劑或消毒液是否更為有效。沒有足夠的證據支持在入境站進行篩檢和保持社交距離(感染者與未感染者之間至少在空間上間隔一公尺)能作為減少病毒在流行病期間傳播的方法。