Eye Protection and Seasonal Influenza

At the last HICPAC meeting, Drs. Bryan Christensen and Ryan Fagan led an excellent discussion of the following question: should eye protection be included in droplet precautions for seasonal influenza and other respiratory viruses? 

Eye protection is one aspect of Standard Precautions, of course, to be used whenever there is a risk for splashes or sprays of blood and body fluids (BBF), or during aerosol-generating procedures. However, there is no recommendation for routine use of eye protection as part of Droplet Precautions—it’s an “unresolved issue”. 

Nonetheless, whenever CDC has had to issue interim guidance for new respiratory viral threats (SARS, MERS, novel influenza A viruses, etc.), they’ve included the routine use of eye protection. But seasonal influenza kills far more people annually than any of the novel threats, and there’s little reason to believe that seasonal flu strains can’t use the eye as a portal of entry (in addition to rarely causing direct ocular disease). The same applies to various of the other respiratory viruses (adeno, RSV, rhinovirus, hMPV, etc.). 

As is so often the case, we don’t have much published data to help answer this question: some work done in the 80’s suggested that eye protection was important for RSV transmission prevention, and Dr. Werner Bischoff demonstrated in an experimental system (air chamber into which live attenuated influenza vaccine virus was aerosolized) that the eyes could serve a portal of entry for influenza. So definitely wear goggles if Werner invites you to enter an airtight test chamber.

Anyway, thanks to Bryan and Ryan for their review (I will link to it when the transcript is out), and to HICPAC members for the lively discussion that followed…so what do you think? Does your center use eye protection routinely for droplet precautions for seasonal flu?