Background Three clusters of coronavirus disease 2019 (COVID-19) linked to a tour group from China, a company conference, and a church were identified in Singapore in February, 2020.Methods We gathered epidemiological and clinical data from individuals with confirmed COVID-19, via interviews and inpatient medical records, and we did field investigations to assess interactions and possible modes of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Open source reports were obtained for overseas cases. We reported the median (IQR) incubation period of SARS-CoV-2. Findings As of Feb 15, 2020, 36 cases of COVID-19 were linked epidemiologically to the first three clusters of circumscribed local transmission in Singapore. 425 close contacts were quarantined. Direct or prolonged close contact was reported among affected individuals, although indirect transmission (eg, via fomites and shared food) could not be excluded. The median incubation period of SARS-CoV-2 was 4 days (IQR 3-6). The serial interval between transmission pairs ranged between 3 days and 8 days.Interpretation SARS-CoV-2 is transmissible in community settings, and local clusters of COVID-19 are expected in countries with high travel volume from China before the lockdown of Wuhan and institution of travel restrictions. Enhanced surveillance and contact tracing is essential to minimise the risk of widespread transmission in the community.Funding None. Articles 2www.thelancet.com Published online March 16, 2020 https://doi.

This systematic review and meta-analysis quantified the protective effect of facemasks and respirators against respiratory infections among healthcare workers. Relevant articles were retrieved from Pubmed, EMBASE, and Web of Science. Meta-analyses were conducted to calculate pooled estimates. Meta-analysis of randomized controlled trials (RCTs) indicated a protective effect of masks and respirators against clinical respiratory illness (CRI) (risk ratio [RR] = 0.59; 95% confidence interval [CI]:0.46-0.77) and influenza-like illness (ILI) (RR = 0.34; 95% CI:0.14-0.82). Compared to masks, N95 respirators conferred superior protection against CRI (RR = 0.47; 95% CI: 0.36-0.62) and laboratory-confirmed bacterial (RR = 0.46; 95% CI: 0.34-0.62), but not viral infections or ILI. Meta-analysis of observational studies provided evidence of a protective effect of masks (OR = 0.13; 95% CI: 0.03-0.62) and respirators (OR = 0.12; 95% CI: 0.06-0.26) against severe acute respiratory syndrome (SARS). This systematic review and meta-analysis supports the use of respiratory protection. However, the existing evidence is sparse and findings are inconsistent within and across studies. Multicentre RCTs with standardized protocols conducted outside epidemic periods would help to clarify the circumstances under which the use of masks or respirators is most warranted.

Purpose: This systematic review and meta-analysis assessed the effectiveness of personal respiratory protective equipment, such as medical masks and respirators, in protecting healthcare workers (HCWs) from respiratory infections.Methods & Materials: The databases Pubmed, EMBASE and Web of Science were searched for relevant randomized controlled trials (RCTs) and observational studies with no language or time restrictions. We included published RCTs and observational studies assessing the effectiveness of medical masks and respirators in protecting HCWs from clinical or laboratory-confirmed respiratory outcomes. Editorials, press articles, reviews, guidelines, mathematical models, ongoing studies and non-peer-reviewed reports were excluded. Fixed-or random-effects model meta-analyses were conducted with appropriate combinations of RCTs or observational studies to calculate pooled risk ratios (RRs) or odds ratios (ORs), respectively. To facilitate an appropriate interpretation of the findings from our meta-analysis of observational studies, we calculated a range of plausible RRs for each summary OR, assuming a baseline risk of SARS-CoV infection ranging from 20% to 60%, as estimated from the available cohort studies.Results: Six RCTs and twenty-three observational studies were included into this review. Meta-analysis of RCTs indicated a protective effect of masks and respirators against clinical respiratory illness (CRI) (RR=0.59; 95%CI: 0.46 to 0.77) and influenza-like illness (ILI) (RR=0.34; 95%CI: 0.14 to 0.82), but not laboratory-confirmed viral infection (VRI). Compared to masks, N95 respirators conferred superior protection against CRI (RR= 0.47; 95%CI= 0.36 to 0.62) and laboratory-confirmed bacterial infection (RR= 0.46; 95%CI= 0.34 to 0.62), but not ILI or VRI. In the meta-analysis of observational studies, there was fairly consistent evidence of a protective effect of both N95 respirators (OR= 0.12; 95%CI: 0.06 to 0.26) and medical masks (OR= 0.13; 95%CI: 0.03 to 0.62) against SARS. Evidence for a protective effect of masks or respirators against pandemic H1N1 influenza infection was not consistent.Conclusion: Overall, this systematic review and meta-analysis supports the use of respiratory protection to prevent clinical symptoms of respiratory infection among HCWs when used consistently during non-epidemic scenarios. In addition, both N95 respirators and medical masks were effective against SARS, but not pandemic H1N1 influenza, although additional studies will be required to validate these findings.http://dx.

Knowledge and willingness to vaccinate was high in this parent population, but influenza vaccine uptake in children was low. Encouraging medical professionals to recommend vaccination of eligible children is key to improving uptake.