THE way Australians are taught to sneeze may have fuelled the spread of deadly influenza across the country, with health experts frantically calling for people to be taught the American method of directing their spray into their elbows.
As NSW is smashed by influenza, experts have warned sick people are ignoring vital "influenza etiquette" and sneezing into hands or handkerchiefs.
The Australian Medical Association warned people have become complacent about the dangers of influenza and better public education on vaccination and hygiene is needed.
University of Sydney Associate Professor Guy Eslick said Australians need to stop sneezing the wrong way and adopt the "elbow-sneeze" like Americans in a move which almost mimics the sporting celebratory gesture known as "the dab".
"People are not seeing enough advertising campaigns in front of them about how to sneeze properly and have general good hygiene," he said.
"I haven't seen one TV commercial this season about flu prevention."
Prof Eslick said in Boston children were taught "almost every day" about sneezing into their elbow.
"It all comes back to a public education - the government should be taking a more proactive approach."
Hand Hygiene Australia director Professor Lindsay Grayson said people must learn to cough and sneeze into their elbow simply because it reduces potentially deadly influenza spreading.
"Sneezing or coughing into your elbow should be considered the new good etiquette. It's better than into hand or snotty handkerchief," he said.
"What is very clear is that previously we used to think that people caught flu by people coughing and sneezing on them.
"Of course that is one way it happens but a key means of catching it is on either hands or contact with places where people have had snot like public transport and snotty handkerchiefs.
"It's better to sneeze into tissues and throw it away and then wash your hands but what you don't want to do is sneeze straight into hands then touch something."
The move - referred to as a 'dab' or even a 'vampire' sneeze - is pictured on disease control advertising internationally including in Canada and Florida.
In Britain and NSW authorities use the slogan "catch it, bin it, kill it" during influenza season, which teaches people to sneeze into a tissue and immediately dispose of it and wash hands. NSW only recommends using your elbow when coughing if there is no tissue handy, but it's not part of the flu campaign.
American authorities even used Sesame Street character Elmo to teach children that sneezing into their elbow was "the right way to sneeze".
There is no mandatory flu education campaign in NSW schools or on public transport but principals can opt to have a poster in their school.
The campaign this year cost more than $200,000 and targeted hospitals, aged care and GPs.
"While NSW Health prefers people to use disposable tissues to cover coughs and sneezes, we agree using your elbow is the next best option," NSW Health director of communicable disease Dr Vicky Sheppeard said. "NSW Health will be evaluating the 2017 campaign at the end of the flu season before planning next year's campaign."
AMA NSW President Brad Frankum said more needed to be done to educate the public.
"In general terms we have been a bit complacent about influenza," he said
"I think we do need better education. Hand washing and covering your mouth is important but it's a highly virulent bug that's going to spread no matter what. (Education) in schools and transport helps."
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