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We agree that promulgating the hygiene hypothesis and related environmental issues to the public can serve to confuse, rather than to inform. The reality is however that these issues have already received widespread coverage by the media, which tends to leave the public concerned and confused about the role of hygiene and cleanliness, particularly in relation to the functioning of the immune system.

Authors reply: Prevention of the spread of infection – the need for a family-centred approach to hygiene promotion