Issue: November 2012
October 05, 2012
2 min read

Preventive behaviors during H1N1 pandemic varied worldwide

Issue: November 2012
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There were wide variations among countries in the adoption of preventive behaviors during the 2009 H1N1 influenza pandemic, recent data indicate.

People in the United Kingdom frequently reported that they did not cover their mouths or noses when coughing or sneezing, nor did they wash their hands or use hand sanitizer more frequently.

“The public’s response to this major infectious disease is dramatically different between countries, even though they all faced sizable numbers of cases,” Gillian SteelFisher, PhD, of the Harvard School of Public Health, told Infectious Disease News. “Because core strategies to reduce the impact of pandemic influenza strains require public participation, our findings suggest that even a global approach for future pandemics will need to have elements that are customized to each country.”

Gillian SteelFisher, PhD 

Gillian SteelFisher

SteelFisher and colleagues conducted telephone polls in Argentina, Japan, Mexico, the United Kingdom and the United States to obtain data on preventive behaviors. In each country, 900 participants, selected by random digit dial techniques, were surveyed.

They found that 73% of participants in the United Kingdom did not cover their mouths or nose when coughing or sneezing during the pandemic and 47% did not wash their hands or use hand sanitizer more frequently. In Mexico, 77% of participants increased efforts to cover their mouths and noses when coughing and sneezing. In Argentina, 89% of participants washed their hands more frequently.

In all countries, vaccination rates against H1N1 were low. Mexico had the highest rate of 33% and the United Kingdom had the lowest rate of 21%. Those in the United Kingdom were also less likely to approve of government policies to avoid public places or wear a mask in public.

“Despite concerns that promoting non-pharmaceutical behaviors like hand-washing would dampen public support for vaccination, our data show no evidence for this across countries,” SteelFisher said. “In every country, people who adopted the non-pharmaceutical behavior were no less likely to get vaccinated than those who didn’t adopt these behaviors. This suggests that non-pharmaceutical behaviors and vaccination are complementary behaviors and that our policy approaches to pandemic response may benefit from including both vaccination and non-pharmaceutical strategies.”

In an accompanying comment, Alison Holmes, MD, and Enrique Castro Sánchez, of Imperial College London, said providing an effective response to emerging infectious disease remains a pressing global health challenge.

“Governments and international organizations have to promptly implement feasible and proportionate health protection measures, while accepting the limitations of the scientific evidence used to underpin those measures,” they wrote. “Establishing which protective behaviors are effective is not sufficient — we need to understand how populations make sense of recommendations and adopt them.”

For more information:

SteelFisher GK. Lancet Infect Dis. 2012;doi:10.1016/S1473-3099(12)70206-2.
Holmes A. Lancet Infect Dis. 2012;doi:10.1016/S1473-3099(12)70244-X.

Disclosure: SteelFisher, Holmes and Sanchez report no relevant financial disclosures.