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Greenhalgh T, MacIntyre CR, Baker MG, Bhattacharjee S, Chughtai AA, Fisman D, Kunasekaran M, Kvalsvig A, Lupton D, Oliver M, Tawfiq E, Ungrin M, Vipond J. Masks and respirators for prevention of respiratory infections: a state of the science review. Clin Microbiol Rev 2024; 37:e0012423. [PMID: 38775460 PMCID: PMC11326136 DOI: 10.1128/cmr.00124-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Shovon Bhattacharjee
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - Abrar A Chughtai
- School of Population Health, University of New South Wales, Sydney, Australia
| | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amanda Kvalsvig
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah Lupton
- Centre for Social Research in Health and Social Policy Research Centre, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia
| | - Matt Oliver
- Professional Standards Advocate, Edmonton, Canada
| | - Essa Tawfiq
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Ungrin
- Faculty of Veterinary Medicine; Department of Biomedical Engineering, Schulich School of Engineering; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Joe Vipond
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Bray C, Vanberkel PT. A framework for comparing N95 and elastomeric facepiece respirators on cost and function for healthcare use during a pandemic- A literature review. Health Policy 2023; 134:104857. [PMID: 37336164 DOI: 10.1016/j.healthpol.2023.104857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 05/16/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
SARS-CoV-2 has posed implications for personal protective equipment supply. In this literature review we examine if elastomeric facepiece respirators (EFRs) are effective substitutes for N95 respirators through comparing their functionality and cost. We reviewed 30 articles which researched the advantages and disadvantages of each respirator. We compiled the reported results and found, among other things, that users favour N95 respirators for comfort but prefer EFRs for protection. EFRs are more cost effective when N95s are used as designed (single use) but mixed strategies minimize costs when N95s are reused (as practiced during shortages). Future research is needed on multicriteria analyses and to incorporate SARS-CoV-2 specific data to support future pandemic planning.
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Affiliation(s)
- Ceilidh Bray
- Dalhousie University, Industrial Engineering, PO BOX 15000, Halifax, NS B3H 4R2, Canada
| | - Peter T Vanberkel
- Dalhousie University, Industrial Engineering, PO BOX 15000, Halifax, NS B3H 4R2, Canada.
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Olry de Labry-Lima A, Bermúdez-Tamayo C, Martinez-Olmos J, Martin-Ruiz E. The use of masks to protect against respiratory infections: An umbrella review. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2021; 39:436-444. [PMID: 34446392 PMCID: PMC8382596 DOI: 10.1016/j.eimce.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/15/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The global health emergency caused by the current COVID-19 pandemic is resulting in a huge challenge at all levels. The use of masks may reduce the spread of the infection by minimising the excretion of Flügge droplets. The objective of this study was to compile the evidence available on the use of masks in relation to respiratory infections. METHODOLOGY An umbrella review (review of systematic reviews) was conducted. Two reviewers independently carried out the screening process, data extraction and data analysis. Discrepancies were resolved with a third reviewer, and the assessment of the risk of bias of the studies was carried out using the AMSTAR 2 tool. The Rayyan QCRI program was used for the screening process. RESULTS A total of eight systematic reviews were included. The studies analysed the use of masks in the general population, in long-term care facilities, in hospitals and at mass gatherings, and compared the effectiveness thereof in preventing infection. The results of this review revealed that the use of masks is associated with a protective effect against respiratory infections in healthcare facilities, in long-term care facilities and at mass gatherings. CONCLUSIONS In light of the results, it seems reasonable to recommend the use of masks to the general population, but this use should be accompanied by a training programme to improve compliance, as not using them properly may increase the risk of infection.
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Affiliation(s)
- Antonio Olry de Labry-Lima
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain,Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain,Corresponding author
| | - Clara Bermúdez-Tamayo
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain,Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
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Bagepally BS, Haridoss M, Natarajan M, Jeyashree K, Ponnaiah M. Cost-effectiveness of surgical mask, N-95 respirator, hand-hygiene and surgical mask with hand hygiene in the prevention of COVID-19: Cost effectiveness analysis from Indian context. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 10:100702. [PMID: 33558852 PMCID: PMC7859732 DOI: 10.1016/j.cegh.2021.100702] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/29/2020] [Accepted: 01/18/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION In the absence of specific treatment, preventive strategies are of paramount importance in management of coronavirus disease 2019(COVID-19) pandemic. We estimated cost-effectiveness of non-pharmacological interventions such as hand-hygiene, surgical-mask N-95 respirators and surgical mask in general population. METHODS We performed a decision tree and markov-model based economic evaluation. We estimated total costs and outcomes from public payer's perspective, based on information available through systematic literature search on relative intervention effect during early pandemic phase. We estimated outcomes as number COVID-19 prevented and Quality Adjusted life year (QALY) over one-year time-horizon with one-day cycle-length. Incremental cost effectiveness ratios (ICER) was calculated multiple sensitivity analyses were applied to assess parameter uncertainty. RESULTS Use of surgical mask with hand hygiene, fit tested N-95 respirator, surgical-mask, non-fit tested N-95 and hand-hygiene interventions prevented additional 1139, 1124, 1121, 1043 and 975 COVID-19 cases per-million as compared to using none. Additional costs incurred (in billion) were ₹29.78 ($0.40), ₹148.09 ($1.99), ₹72.51 ($0.98), ₹26.84 ($0.36) and ₹2.48 ($0.03) as well as additional QALYs gained were 357.4, 353.01, 327.95, 351.52 and 307.04 for surgical mask with hand hygiene, fit-tested N-95, non-fit-tested N-95, surgical mask and hand-hygiene respectively. ICERs with surgical with hand hygiene, hand-hygiene alone, surgical-mask alone, N-95 respirator fit and non-fit test were 83.32($1.12), 8.07($0.11), 76.36($1.03), 419.51($5.65) and 221.10 ($2.98) million ₹ ($)/QALY respectively. Results were robust on uncertainty analysis. DISCUSSION Among the non-pharmacological interventions to be considered for preventing spread of COVID-19, hand hygiene was cost-effective and avoidance of use of surgical masks and respirators by the general public could save resources.
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Affiliation(s)
| | - Madhumitha Haridoss
- Health Technology Assessment Resource Centre, ICMR- National Institute of Epidemiology, Chennai, India
| | - Meenakumari Natarajan
- Health Technology Assessment Resource Centre, ICMR- National Institute of Epidemiology, Chennai, India
| | - Kathiresan Jeyashree
- Health Technology Assessment Resource Centre, ICMR- National Institute of Epidemiology, Chennai, India
| | - Manickam Ponnaiah
- Health Technology Assessment Resource Centre, ICMR- National Institute of Epidemiology, Chennai, India
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Olry de Labry-Lima A, Bermúdez-Tamayo C, Martinez-Olmos J, Martin-Ruiz E. The use of masks to protect against respiratory infections: an umbrella review. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30262-7. [PMID: 33097294 PMCID: PMC7575638 DOI: 10.1016/j.eimc.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The global health emergency caused by the current COVID-19 pandemic is resulting in a huge challenge at all levels. The use of masks may reduce the spread of the infection by minimising the excretion of Flügge droplets. The objective of this study was to compile the evidence available on the use of masks in relation to respiratory infections. METHODOLOGY An umbrella review (review of systematic reviews) was conducted. Two reviewers independently carried out the screening process, data extraction and data analysis. Discrepancies were resolved with a third reviewer, and the assessment of the risk of bias of the studies was carried out using the AMSTAR 2 tool. The Rayyan QCRI program was used for the screening process. RESULTS A total of eight systematic reviews were included. The studies analysed the use of masks in the general population, in long-term care facilities, in hospitals and at mass gatherings, and compared the effectiveness thereof in preventing infection. The results of this review revealed that the use of masks is associated with a protective effect against respiratory infections in healthcare facilities, in long-term care facilities and at mass gatherings. CONCLUSIONS In light of the results, it seems reasonable to recommend the use of masks to the general population, but this use should be accompanied by a training programme to improve compliance, as not using them properly may increase the risk of infection.
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Affiliation(s)
- Antonio Olry de Labry-Lima
- Escuela Andaluza de Salud Pública (EASP), Granada, España; Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, España; CIBER en Epidemiología y Salud Pública (CIBERESP), España.
| | - Clara Bermúdez-Tamayo
- Escuela Andaluza de Salud Pública (EASP), Granada, España; Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, España; CIBER en Epidemiología y Salud Pública (CIBERESP), España
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6
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Hua W, Zuo Y, Wan R, Xiong L, Tang J, Zou L, Shu X, Li L. Short-term skin reactions following use of N95 respirators and medical masks. Contact Dermatitis 2020; 83:115-121. [PMID: 32406064 PMCID: PMC7272965 DOI: 10.1111/cod.13601] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 02/05/2023]
Abstract
Background In the context of the COVID‐19 pandemic, cases of adverse skin reactions related to the wearing of masks have been observed. Objectives To analyze the short‐term effects of N95 respirators and medical masks, respectively, on skin physiological properties and to report adverse skin reactions caused by the protective equipment. Methods This study used a randomized crossover design with repeated measurements. Twenty healthy Chinese volunteers were recruited. Skin parameters were measured on areas covered by the respective masks and on uncovered skin 2 and 4 hours after donning, and 0.5 and 1 hour after removing the masks, including skin hydration, transepidermal water loss (TEWL), erythema, pH, and sebum secretion. Adverse reactions were clinically assessed, and perceived discomfort and non‐compliance measured. Results Skin hydration, TEWL, and pH increased significantly with wearing the protective equipment. Erythema values increased from baseline. Sebum secretion increased both on the covered and uncovered skin with equipment‐wearing. There was no significant difference in physiological values between the two types of equipment. More adverse reactions were reported following a N95 mask use than the use of a medical mask, with a higher score of discomfort and non‐compliance. Conclusions This study demonstrates that skin biophysical characters change as a result of wearing a mask or respirator. N95 respirators were associated with more skin reactions than medical masks.
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Affiliation(s)
- Wei Hua
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China.,Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
| | - Ying Zuo
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Ruoyu Wan
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Lidan Xiong
- Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
| | - Jie Tang
- Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
| | - Lin Zou
- Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohong Shu
- Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
| | - Li Li
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China.,Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
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7
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Dalton CB, Corbett SJ, Katelaris AL. COVID-19: implementing sustainable low cost physical distancing and enhanced hygiene. Med J Aust 2020; 212:443-446.e1. [PMID: 32356573 PMCID: PMC7267378 DOI: 10.5694/mja2.50602] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Stephen J Corbett
- Centre for Population HealthWestern Sydney Local Health DistrictSydneyNSW
| | - Anthea L Katelaris
- Centre for Population HealthWestern Sydney Local Health DistrictSydneyNSW
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8
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Maintaining mask stockpiles in the COVID-19 pandemic: Taiwan as a learning model. Infect Control Hosp Epidemiol 2020; 42:244-245. [PMID: 32389156 PMCID: PMC7251288 DOI: 10.1017/ice.2020.226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lam SC, Chong ACY, Chung JYS, Lam MY, Chan LM, Shum CY, Wong EYN, Mok YM, Lam MT, Chan MM, Tong KY, Chu OL, Siu FK, Cheung JHM. Methodological Study on the Evaluation of Face Mask Use Scale among Public Adult: Cross-Language and Psychometric Testing. ACTA ACUST UNITED AC 2020. [DOI: 10.7475/kjan.2020.32.1.46] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Simon Ching Lam
- Assistant Professor, School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Andy Chun Yin Chong
- Senior Lecturer, School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong SAR
| | - Jessie Yuk Seng Chung
- Senior Lecturer, School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong SAR
| | - Ming Yee Lam
- Registered Nurse, Yan Chai Hospital, Hospital Authority, Hong Kong SAR
| | - Lai Man Chan
- Registered Nurse, Caritas Medical Center, Hospital Authority, Hong Kong SAR
| | - Cho Yee Shum
- Registered Nurse, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR
| | - Eliza Yi Ni Wong
- Registered Nurse, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR
| | - Yat Man Mok
- Registered Nurse, Ruttonjee Hospital, Hospital Authority, Hong Kong SAR
| | - Ming Tat Lam
- Registered Nurse, Queen Mary Hospital, Hospital Authority, Hong Kong SAR
| | - Man Man Chan
- Registered Nurse, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR
| | - Ka Ying Tong
- Registered Nurse, St. Paul's Hospital, Hong Kong Island, Hong Kong SAR
| | - Oi Lee Chu
- Registered Nurse, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR
| | - Fong Kiu Siu
- Registered Nurse, Caritas Medical Center, Hospital Authority, Hong Kong SAR
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Walsh K. Systematic reviews in pandemic influenza: education is needed to improve quality. Br J Hosp Med (Lond) 2019; 80:126-127. [DOI: 10.12968/hmed.2019.80.3.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kieran Walsh
- Clinical Director, BMJ, BMA House, London WC1H 9JR
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11
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Mukerji S, MacIntyre CR, Seale H, Wang Q, Yang P, Wang X, Newall AT. Cost-effectiveness analysis of N95 respirators and medical masks to protect healthcare workers in China from respiratory infections. BMC Infect Dis 2017; 17:464. [PMID: 28673259 PMCID: PMC5496227 DOI: 10.1186/s12879-017-2564-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 06/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are substantial differences between the costs of medical masks and N95 respirators. Cost-effectiveness analysis is required to assist decision-makers evaluating alternative healthcare worker (HCW) mask/respirator strategies. This study aims to compare the cost-effectiveness of N95 respirators and medical masks for protecting HCWs in Beijing, China. METHODS We developed a cost-effectiveness analysis model utilising efficacy and resource use data from two cluster randomised clinical trials assessing various mask/respirator strategies conducted in HCWs in Level 2 and 3 Beijing hospitals for the 2008-09 and 2009-10 influenza seasons. The main outcome measure was the incremental cost-effectiveness ratio (ICER) per clinical respiratory illness (CRI) case prevented. We used a societal perspective which included intervention costs, the healthcare costs of CRI in HCWs and absenteeism costs. RESULTS The incremental cost to prevent a CRI case with continuous use of N95 respirators when compared to medical masks ranged from US $490-$1230 (approx. 3000-7600 RMB). One-way sensitivity analysis indicated that the CRI attack rate and intervention effectiveness had the greatest impact on cost-effectiveness. CONCLUSIONS The determination of cost-effectiveness for mask/respirator strategies will depend on the willingness to pay to prevent a CRI case in a HCW, which will vary between countries. In the case of a highly pathogenic pandemic, respirator use in HCWs would likely be a cost-effective intervention.
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Affiliation(s)
- Shohini Mukerji
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
| | - C. Raina MacIntyre
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), University of Sydney, Westmead, NSW Australia
| | - Holly Seale
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
| | - Quanyi Wang
- The Beijing Centre for Disease Control and Prevention, Beijing, China
| | - Peng Yang
- The Beijing Centre for Disease Control and Prevention, Beijing, China
| | - Xiaoli Wang
- The Beijing Centre for Disease Control and Prevention, Beijing, China
| | - Anthony T. Newall
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
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Saunders-Hastings P, Reisman J, Krewski D. Assessing the State of Knowledge Regarding the Effectiveness of Interventions to Contain Pandemic Influenza Transmission: A Systematic Review and Narrative Synthesis. PLoS One 2016; 11:e0168262. [PMID: 27977760 PMCID: PMC5158032 DOI: 10.1371/journal.pone.0168262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/28/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Influenza pandemics occur when a novel influenza strain, to which humans are immunologically naïve, emerges to cause infection and illness on a global scale. Differences in the viral properties of pandemic strains, relative to seasonal ones, can alter the effectiveness of interventions typically implemented to control seasonal influenza burden. As a result, annual control activities may not be sufficient to contain an influenza pandemic. PURPOSE This study seeks to inform pandemic policy and planning initiatives by reviewing the effectiveness of previous interventions to reduce pandemic influenza transmission and infection. Results will inform the planning and design of more focused in-depth systematic reviews for specific types of interventions, thus providing the most comprehensive and current understanding of the potential for alternative interventions to mitigate the burden of pandemic influenza. METHODS A systematic review and narrative synthesis of existing systematic reviews and meta-analyses examining intervention effectiveness in containing pandemic influenza transmission was conducted using information collected from five databases (PubMed, Medline, Cochrane, Embase, and Cinahl/EBSCO). Two independent reviewers conducted study screening and quality assessment, extracting data related to intervention impact and effectiveness. RESULTS AND DISCUSSION Most included reviews were of moderate to high quality. Although the degree of statistical heterogeneity precluded meta-analysis, the present systematic review examines the wide variety of interventions that can impact influenza transmission in different ways. While it appears that pandemic influenza vaccination provides significant protection against infection, there was insufficient evidence to conclude that antiviral prophylaxis, seasonal influenza cross-protection, or a range of non-pharmaceutical strategies would provide appreciable protection when implemented in isolation. It is likely that an optimal intervention strategy will employ a combination of interventions in a layered approach, though more research is needed to substantiate this proposition. TRIAL REGISTRATION PROSPERO 42016039803.
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Affiliation(s)
- Patrick Saunders-Hastings
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, Ottawa, Ontario, Canada
| | - Jane Reisman
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, Ottawa, Ontario, Canada
| | - Daniel Krewski
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, Ottawa, Ontario, Canada
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