Helping hands

EHM’s Stacey Sheppard talks to Elaine Larson about the handwashing research aimed at reducing the H1N1 virus’ capacity to spread and limiting the rate of infection.

“Wash your hands as much as possible to avoid the potential of further spreading the infection”
-Elaine Larson

The H1N1 virus may not be featuring so prominently in the international news at the moment, but the maximum classification of phase 6, which the World Health Organization designates as a pandemic, remains in place. With the winter flu season rapidly approaching in many parts of the world, attention has now turned to how future outbreaks can be prevented and the effects mitigated.

Elaine Larson is Professor of Epidemiology and Director at the Center for Interdisciplinary Research on Antimicrobial Resistance at the Mailman School of Public Health at Columbia University. Her work currently focuses on determining the lifespan of the H1N1 virus.

"Believe it or not, nobody actually knows how long this virus lives on your hands or in the environment," says Larson. "We are conducting a study right now whereby we go into the homes of people who have the flu and we are getting them to cough into their hands and then we culture their hands every five minutes for 30 minutes. We're getting them to cough into a handkerchief, which we culture as well. We're also asking them to cough into their hand and touch some of the objects they regularly come into contact with such as cell phones and pillows."

Through this study Larson is hoping to shed some light on how H1N1 is spreading in real life situations. She explains that there is already a lot of literature on the topic but most of the other studies have been done under test conditions where the infection is not natural. People are given the virus and then tested, whereas Larson is actually recruiting people that are genuinely suffering from the flu. She wants to be able to assess the risks involved for people living in a household where someone is already infected.

However, the main problem that Larson is facing with regards to her study is a current lack of participants. "We'd like to finish the study as soon as possible but we need to find more people who are sick," she says. "We only have three. We're trying to spread the word and get people to call us if they have flu-like symptoms, a fever and chills."

According to Larson we are seeing extremely reduced numbers of cases in hospital emergency rooms in comparison with the figures from last spring and she believes that the lack of people who are sick at the moment can be explained by immunity. "It appears that in the places that were hit hard in the spring, like New York City, we are not seeing it so much now. So, obviously there are some people who got it in the spring who are now immune," she explains. In this case, people who have already fallen victim to H1N1 will not be infected a second time around. "Even if it mutates it's extremely likely that there will be a lot of residual immunity. I actually think that in some ways those people who got it in spring are probably lucky."

At least for those people who may be infected this winter a vaccine is on its way, but this will only help if received in sufficient time before infection takes hold. "It's terrific that the H1N1 vaccine is going to be available in months. But it takes about two weeks between the time you get the vaccine and your body developing enough antibodies. So even if you got the vaccine and then got the flu the next day, you wouldn't have much protection at all. So that's why it's important to get the vaccine out before people start getting sick," explains Larson.

In the mean time, the main piece of advice that Larson can offer is to wash your hands as much as possible to avoid the potential of further spreading the infection. But then the question arises as to what is the most effective means of washing your hands, and this is another area that Larson is investigating. "We're looking at the impact of different hand hygiene soaps. If we can determine whether the alcohol sanitizers or plain soap and water is better, then we'll know what to recommend people to use," she says.

Larson points out that a study that was published a few months ago concluded that soap and water was actually more effective than alcohol hand sanitizers, but she also clarifies that the test was carried out on artificially contaminated hands and it wasn't the real flu virus.

By gaining a better understanding of the virus, Larson hopes to be able to educate people as what they need to clean in their homes and also who should be wearing masks and for how long. Unfortunately too many questions remain unanswered for her liking and the recommendations that are coming from New York City and the Centers for Disease Control & Prevention (CDC) are somewhat different.

"For healthcare workers, the CDC is recommending N95 masks, which have a lot more filtration, and New York City is recommending just the regular surgical mask. But for the general population any regular mask will do. There was a paper published in the journal of the American Medical Association in October that basically showed that the two types of mask are equivalent in terms of protection," says Larson.

Larson's work in the area of hand hygiene also extends to the recently published WHO hand hygiene guidelines. "This has been tested now in 81 countries around the world and we were involved in some of the testing to make sure that it is actually practical. It's one thing to recommend what needs to be done in this country, but we have major resources compared to other countries," she says.

Larson has also worked on a number of smaller projects related to the meaning of hand hygiene in various religious groups and points out that the issues affecting Islamic cultures for example are somewhat different from those affecting other cultures. "In Islam it is against many fundamentalist Muslim's beliefs to even touch alcohol - it's a sin. There's lots of things that you don't consider until you start talking with people around the world.," she says.