Colds and flu

Updated 11 October 2017

Tissue or handkerchief: which is better?

Winter's almost here and you'll soon be needing those tissues and hankies.

Influenza (flu) and colds are viral illnesses that occur mostly in the winter months – June to August in South Africa.

We need to understand, though, that it's not the cold weather that gives us the flu or a runny nose. The culprits are the cold and flu viruses that infect the nose, throat, sinuses, upper airways and lungs – as explained by medical virologists, Dr Jean Maritz and colleagues from Stellenbosch University.

As the weather gets colder we tend to spend more time indoors, trapping those germs and allowing them to spread from one person to the next. 

And now, with winter on the doorstep, we're starting to need those tissues or handkerchiefs to blow our runny noses and cover our mouths.

But which one is better?


Pros: The most obvious advantage of tissues is that they can be easily and immediately disposed of after use.

Tissues also trap germs, preventing them from spreading. The germs remain inside the tissue, which you then throw away. (Sneezing into your hands increases the risk of spreading the virus through e.g. hand-to-hand contact with another person.) And once the tissue is thrown into the bin, it's unlikely that someone will pick it up.

Cons: From an environmental point of view, tissues are not the best option – tissues are made from paper and paper comes from trees. Environmentalists rightly argue that trees should not be cut down unnecessarily. A Health24 article emphasises that trees are good for our health and help to decrease the incidence of respiratory diseases in humans.




Pros: As indicated above, handkerchiefs would be the environmentalist's choice because of the lower impact on the environment. It is also cheaper in the long run as hankies can be washed and used over and over again. 

Cons: Handkerchiefs tend to get damp after wiping or blowing your nose a few times. And keeping a moist piece of fabric, saturated with saliva and mucus, in your handbag or pocket for a whole day can be somewhat off-putting – as well as unhygienic.   

Besides, handkerchiefs, especially after being used a number of times, can lead to germs spreading to other surfaces or even other people – especially since most of us don't wash our hands or use hand sanitiser every time after using our handkerchief.


So, what's the verdict?

Both have pros and cons, so it's entirely up to you...

"When you blow your nose, you are putting the virus into the tissue or handkerchief," said registered independent practitioner Dr Aaseema Mugjenkar.

Keep in mind that touching your own used tissue or handkerchief won’t cause you any harm as you're already infected – but there's of course always the risk of infecting others.

"Tissues are hygienic because they can easily be disposed of; you are thereby also decreasing the chances of spreading the infection provided that no secretions have come into contact with your hands. However, if it happens, you need to wash or 'de-germ' them after blowing your nose," Dr Mugjenkar adds.

"Also keep in mind that if you use a cloth handkerchief, you are adding more virus-contaminated secretions every time you re-use it."

"Another thing you need to be aware of is that each time you handle a handkerchief and then touch an object that others come into contact with – such as a doorknob or money – you are increasing the spread of infection," said Dr Mugjenkar.

"Tissues are more hygienic, but only if you ensure that you maintain hand hygiene as well."

Read more:

Diagnosing flu

Symptoms of flu

Treating flu


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Dr Heidi van Deventer completed her MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 2004 at the University of Stellenbosch.
She has additional training in ACLS (Advanced Cardiac Life Support) and PALS (Paediatric Advanced Life Support) as well as biostatistics and epidemiology.

Dr Van Deventer is currently working as a researcher at the Desmond Tutu Tuberculosis Centre at the University of Stellenbosch.

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