There are limited data on the use of masks and
respirators to reduce transmission of
influenza. A systematic review was undertaken to help inform pandemic
influenza guidance in the United Kingdom. The initial review was performed in November 2009 and updated in June 2010 and January 2011. Inclusion criteria included randomised controlled trials and quasi-experimental and observational studies of humans published in English with an outcome of laboratory-confirmed or clinically-diagnosed
influenza and other viral
respiratory infections. There were 17 eligible studies. Six of eight randomised controlled trials found no significant differences between control and intervention groups (masks with or without
hand hygiene; N95/P2
respirators). One household trial found that mask wearing coupled with hand sanitiser use reduced secondary transmission of upper respiratory
infection/
influenza-like illness/laboratory-confirmed
influenza compared with education; hand sanitiser alone resulted in no reduction. One hospital-based trial found a lower rate of clinical respiratory illness associated with non-fit-tested
N95 respirator use compared with medical masks. Eight of nine retrospective observational studies found that mask and/or
respirator use was independently associated with a reduced risk of
severe acute respiratory syndrome (SARS). Findings, however, may not be applicable to
influenza and many studies were suboptimal. None of the studies established a conclusive relationship between mask/
respirator use and protection against
influenza infection. Some evidence suggests that mask use is best undertaken as part of a package of personal protection especially
hand hygiene. The effectiveness of masks and
respirators is likely linked to early, consistent and correct usage.