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Social distancing measures may reduce the spread of Background: emerging respiratory infections however, there is little empirical data on how exposure to crowded places affects risk of acute respiratory infection. We used a case-crossover design nested in a community cohort Methods: to compare self-reported measures of activities during the week before infection onset and baseline periods. The design eliminates the effect of non-time-varying confounders. Time-varying confounders were addressed by exclusion of illnesses around the Christmas period and seasonal adjustment. 626 participants had paired data from the week before 1005 Results: illnesses and the week before baseline. Each additional day of undertaking the following activities in the prior week was associated with illness onset: Spending more than five minutes in a room with someone (other than a household member) who has a cold (Seasonally adjusted OR 1·15, p =0·003); use of underground trains (1·31,  =0·036); use of supermarkets p (1·32,  <0·001); attending a theatre, cinema or concert (1·26,  =0·032); p p eating out at a café, restaurant or canteen (1·25,  =0·003); and attending p parties (1·47,  <0·001). Undertaking the following activities at least once in p the previous week was associated with illness onset: using a bus, (aOR 1.48, p=0.049), shopping at small shops (1.9, p<0.002) attending a place of worship (1.81, p=0.005). Exposure to potentially crowded places, public transport and Conclusions: to individuals with a cold increases risk of acquiring circulating acute respiratory infections. This suggests social distancing measures can have an important impact on slowing transmission of emerging respiratory infections. 1 2 3 2,4

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Public Activities Preceding the Onset of Acute Respiratory Infection Syndromes in Adults in England - Implications for the Use of Social Distancing to Control Pandemic Respiratory Infections