The Effect of Mask Use on the Spread of Influenza During a Pandemic

Brienen, Nicole C. J.; Timen, Aura; Wallinga, Jacco; Steenbergen, Jim E. van; Teunis, Peter

doi:10.1111/j.1539-6924.2010.01428.x

Cited by 134 publications

(143 citation statements)

References 35 publications

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“…For example if one hypothesized that all transmission were due to aerosol particles <50 µm, and estimated a reproductive number of 1.5 for influenza (i.e. each infection generates 1.5 new infections on average at the start of the epidemic) [19], then the use of surgical masks by every infected case could reduce the reproductive number below 1 [20]. Compliance, however, would be a major limitation resulting in lower efficacy in real-world practice [21], [22].…”

Section: Discussionmentioning

confidence: 99%

Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks

et al. 2013

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The CDC recommends that healthcare settings provide influenza patients with facemasks as a means of reducing transmission to staff and other patients, and a recent report suggested that surgical masks can capture influenza virus in large droplet spray. However, there is minimal data on influenza virus aerosol shedding, the infectiousness of exhaled aerosols, and none on the impact of facemasks on viral aerosol shedding from patients with seasonal influenza.We collected samples of exhaled particles (one with and one without a facemask) in two size fractions (“coarse”>5 µm, “fine”≤5 µm) from 37 volunteers within 5 days of seasonal influenza onset, measured viral copy number using quantitative RT-PCR, and tested the fine-particle fraction for culturable virus.Fine particles contained 8.8 (95% CI 4.1 to 19) fold more viral copies than did coarse particles. Surgical masks reduced viral copy numbers in the fine fraction by 2.8 fold (95% CI 1.5 to 5.2) and in the coarse fraction by 25 fold (95% CI 3.5 to 180). Overall, masks produced a 3.4 fold (95% CI 1.8 to 6.3) reduction in viral aerosol shedding. Correlations between nasopharyngeal swab and the aerosol fraction copy numbers were weak (r = 0.17, coarse; r = 0.29, fine fraction). Copy numbers in exhaled breath declined rapidly with day after onset of illness. Two subjects with the highest copy numbers gave culture positive fine particle samples.Surgical masks worn by patients reduce aerosols shedding of virus. The abundance of viral copies in fine particle aerosols and evidence for their infectiousness suggests an important role in seasonal influenza transmission. Monitoring exhaled virus aerosols will be important for validation of experimental transmission studies in humans.

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Section: Discussionmentioning

confidence: 99%

Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks

et al. 2013

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“…Cloth masks were reportedly used by the RCT data. 101 Community masks were protective during the SARS outbreaks, and about 76% of the population used a facemask in Hong Kong. 102 There is evidence that masks have efficacy in the community setting, subject to compliance 13 and early use.…”

Section: Stat E O F T H E a Rt R Ev I E Wmentioning

confidence: 99%

Facemasks for the prevention of infection in healthcare and community settings

MacIntyre

Chughtai

2015

BMJ

281

304

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Facemasks are recommended for diseases transmitted through droplets and respirators for respiratory aerosols, yet recommendations and terminology vary between guidelines. The concepts of droplet and airborne transmission that are entrenched in clinical practice have recently been shown to be more complex than previously thought. Several randomised clinical trials of facemasks have been conducted in community and healthcare settings, using widely varying interventions, including mixed interventions (such as masks and handwashing), and diverse outcomes. Of the nine trials of facemasks identified in community settings, in all but one, facemasks were used for respiratory protection of well people. They found that facemasks and facemasks plus hand hygiene may prevent infection in community settings, subject to early use and compliance. Two trials in healthcare workers favoured respirators for clinical respiratory illness. The use of reusable cloth masks is widespread globally, particularly in Asia, which is an important region for emerging infections, but there is no clinical research to inform their use and most policies offer no guidance on them. Health economic analyses of facemasks are scarce and the few published cost effectiveness models do not use clinical efficacy data. The lack of research on facemasks and respirators is reflected in varied and sometimes conflicting policies and guidelines. Further research should focus on examining the efficacy of facemasks against specific infectious threats such as influenza and tuberculosis, assessing the efficacy of cloth masks, investigating common practices such as reuse of masks, assessing compliance, filling in policy gaps, and obtaining cost effectiveness data using clinical efficacy estimates.

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“…Human action, such as using a face mask, getting vaccinated, or avoiding contact with infectious sources (Nuño, Chowell, and Gumel, ; Brienen et al, ; Jones and Adida, ), is essential in reducing the risk of infection and controlling the spread of infectious diseases (Funk, Salathé, and Jansen, ; Jones, ; Sze‐To et al, ). Experimental research has investigated systematically how human behaviour affects the transmission of influenza (Aiello et al, ; Brienen et al, ; Jones and Adida, ; Pillemer et al, ). The findings of these studies indicate that the best way to mitigate an influenza pandemic is to reduce contact with infectious sources—a result of people's compliance with recommended protective behaviour (Funk, Salathé, and Jansen, ; Jones and Adida, ).…”

Section: Literature Review and Theoretical Frameworkmentioning

confidence: 99%

Compliance with recommended protective actions during an H7N9 emergency: a risk perception perspective

2017

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This study investigates the factors determining an individual's response to official recommended protective measures, based on the Health Belief Model and the Protective Action Decision Model, to understand the adoption of protective behaviour during an H7N9 (Avian Influenza A) emergency. A public survey involving 1,375 respondents was conducted in Anhui Province, China, during the 2013 H7N9 outbreak to test the research model and hypotheses. The results indicate that protective, stakeholder, and risk perceptions influence positively an individual's willingness to take recommended actions. Protective and stakeholder perceptions also have a positive bearing on lay people's risk perceptions. A stakeholder perception is a vital determinant of a protective perception. More importantly, the effects of protective and stakeholder perceptions on behavioural responses to recommendations are mediated in part by risk perception. These findings can help public health officials to develop messages to encourage members of the population to protect themselves effectively during an influenza crisis.

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The Effect of Mask Use on the Spread of Influenza During a Pandemic

Cited by 134 publications

References 35 publications

Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks

Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks

Facemasks for the prevention of infection in healthcare and community settings

Compliance with recommended protective actions during an H7N9 emergency: a risk perception perspective

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