Effectiveness of Surgical Face Masks in Reducing Acute Respiratory Infections in Non-Healthcare Settings: A Systematic Review and Meta-Analysis

Abstract

Background: Acute respiratory illnesses (ARIs) are the most common respiratory infectious diseases among humans globally. Surgical mask (SM) wearing has been shown to be effective in reducing ARI among healthcare workers. However, the effectiveness of SM in reducing ARI in the non-healthcare settings remains unclear. This review aims to summarize and assess the association between SM wearing and ARI incidence, from existing interventional and observational studies conducted in non-healthcare settings. Methods: Systematic literature searches conducted in PubMed, Cochrane Library, and Embase databases identified 503 unique studies. After screening, 15 studies (5 randomized controlled trials and 10 observational studies) were assessed for reporting and methodological qualities. Proportions of ARI episodes in each group and adjusted summary statistics with their relevant 95% CIs were extracted. Data from 10 observational studies were pooled using the generic inverse variance method. Results: A total of 23,892 participants between 7 and 89 years old involved across 15 studies from 11 countries were involved. Key settings identified were Hajj, schools, and in-flight settings. A modest but non-significant protective effect of SM on ARI incidence was observed (pooled OR 0.96, 95% CI 0.8-1.15). Subgroup analysis according to age group, outcome ascertainment and different non-healthcare settings also revealed no significant associations between SM use and ARI incidence. Conclusion: Surgical mask wearing among individuals in non-healthcare settings is not significantly associated with reduction in ARI incidence in this meta-review.

Cotton and Surgical Face Masks in Community Settings: Bacterial Contamination and Face Mask Hygiene

“…Since masks were not recommended public health measures most of the population did not wear face masks during this clinical trial. These results were also supported by another recent meta-analysis (19). In general, masks seem less effective in protecting the wearer from being infected (20), but they could reduce the risk of virus transmission when worn consistently (10,21,22).…”

“…During the current coronavirus disease 2019 (COVID- 19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the use of protective face masks has become increasingly recommended or even mandatory in community settings outside hospitals and care facilities (1,2). Surgical or cotton masks are most often used to prevent respiratory droplet transmission and reduce transmission from people infected with respiratory viruses to non-infected people (3,4).…”

Universal Use of Face Masks and Related Challenges During COVID-19 in Developing Countries

“… 18 Another literature review study involving a total of 23,892 participants across 15 studies from 11 countries shows varying effectiveness surgical masks against acute respiratory infection but larger reduction was observed among consistent users. 19 The effectiveness of face masks against COVID-19 was proven without significant protective effect of N95 respirator and surgical masks. 20 , 21 Use of face masks is highly recommended at a community setting to prevent corona virus and other respiratory infections.…”

Face masks and COVID-19: don’t let perfect be the enemy of good

“…In this issue of Eurosurveillance, Brainard et al reviewed 12 randomised trials and 21 observational studies of the effectiveness of face mask use against respiratory virus transmission [17]. The meta-analysis of randomised trials has similar findings to a number of earlier Cochrane reviews [18][19][20][21] and published systematic reviews and meta-analyses [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], namely that face mask interventions could probably reduce transmission by a small margin but not a large margin in the community. Brainard et al estimate that masks reduce the risk of infection by around 6% to 15% [17].…”