【Cochrane简语概要】阻断或减少呼吸道病毒传播的物理干预方式

虽然呼吸道病毒通常只引起轻微病变，但它们可能会引起流行病（时疫）的发生。全世界每年约有10%到15%的人感染流感，在重大流行期间，发病率高达50%。全球大流行性的病毒感染多是毁灭性的。2003年，严重急性呼吸系统综合症（SARS）疫情影响到约8000人，导致780人死亡，并引发了巨大的社会和经济危机。2006年出现的新型H5N1禽流感，以及2009年爆发的新型H1N1猪流感，都引起了全球性焦虑。潜在、单一且昂贵的措施（特别是使用疫苗或抗病毒药物）可能不足以阻断病毒的传播。因此，我们旨在寻找证据，以评价简单的物理防护（如洗手或戴口罩）在减少呼吸道病毒（包括流感病毒）传播方面的有效性。

（图片来源于网络）

我们纳入了67项研究，包括随机对照试验和存在混杂偏倚的观察性研究。总受试者的人数未包括在内，因为总人数可能由各种各样的观察者构成，包括受试人群和观察受试者和国家（一些研究的对象）的研究人群。因此，任何总人群数都会产生误导。呼吸道病毒的传播可以通过卫生措施（如洗手）来控制，特别是年幼的儿童。经常洗手还可以降低儿童传染给其他家庭成员的概率。实施隔离和卫生措施（戴口罩、手套和穿防护服）等方法，可以有效地控制呼吸道病毒在医院内外的传播。我们没有找到任何证据表明，佩戴更昂贵、有刺激性的且不舒服的N95口罩优于普通的外科口罩。我们至今不明确洗手时使用杀毒剂和防腐剂比普通肥皂洗手更有效。没有足够的证据支持在入境口岸进行筛查和社交距离（感染者与未感染者之间至少一米的空间分离），是可以作为减少流行病传播的方法。

结论: 

简单和低成本的干预措施将有助于减少流行性呼吸道病毒的传播。在没有流行病威胁的情况下，长期实施这些常规干预措施来评价其效果可能会比较困难。

【Cochrane Plain Language Summary】Physical interventions to interrupt or reduce the spread of respiratory viruses

Although respiratory viruses usually only cause minor disease, they can cause epidemics. Approximately 10% to 15% of people worldwide contract influenza annually, with attack rates as high as 50% during major epidemics. Global pandemic viral infections have been devastating. In 2003 the severe acute respiratory syndrome (SARS) epidemic affected around 8000 people, killed 780 and caused an enormous social and economic crisis. In 2006 a new avian H5N1, and in 2009 a new H1N1 'swine' influenza pandemic threat, caused global anxiety. Single and potentially expensive measures (particularly the use of vaccines or antiviral drugs) may be insufficient to interrupt the spread. Therefore, we searched for evidence for the effectiveness of simple physical barriers (such as handwashing or wearing masks) in reducing the spread of respiratory viruses, including influenza viruses.

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 varied set of observations: participant people and observations on participants and countries (the object of some studies). Any total figure would therefore be misleading. Respiratory virus spread can be reduced by hygienic measures (such as handwashing), especially around younger children. Frequent handwashing can also reduce transmission from children to other household members. Implementing barriers to transmission, such as isolation, and hygienic measures (wearing masks, gloves and gowns) can be effective in containing respiratory virus epidemics or in hospital wards. We found no evidence that the more expensive, irritating and uncomfortable N95 respirators were superior to simple surgical masks. It is unclear if adding virucidals or antiseptics to normal handwashing with soap is more effective. There is insufficient evidence to support screening at entry ports and social distancing (spatial separation of at least one metre between those infected and those non-infected) as a method to reduce spread during epidemics.

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.

译者：张英英；审校：鲁春丽；编辑排版：张晓雯，北京中医药大学循证医学中心

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