CDC issues interim guidance for the use of facemasks and respirators in public settings during an influenza pandemic

The US Department of Health and Human Services (HHS) and its Centers for Disease Control and Prevention (CDC) has released interim advice to the public about the use of facemasks and respirators in certain public (non-occupational) settings during an influenza pandemic. There is very little research about the value of masks to protect people in public settings. These interim recommendations are based on the best judgment of public health experts who relied in part on information about the protective value of masks in healthcare facilities.

The CDC’s guidance stresses that during an influenza pandemic, a combination of actions will be needed, including handwashing, minimizing the likelihood of exposure by distancing people who are infected or likely to be infected with influenza away from others and treating them with antiviral medications, having people who are caring for ill family members voluntarily stay home, and encouraging people to avoid crowded places and large gatherings. When used in conjunction with such preventive steps, masks and respirators may help prevent some spread of influenza.

“Pandemic influenza remains a very real threat. We continue to look for ways to protect people and reduce the spread of disease,” Secretary Mike Leavitt said. “The guidance issued today is a good step forward in the broader, multifaceted federal effort to prepare the nation for an influenza pandemic.”

“During an influenza pandemic, we know that no single action will provide complete protection,” said Dr. Julie Gerberding, CDC director. “We also know that many people may choose to use masks for an extra margin of protection even if there is no proof of their effectiveness. If people are not able to avoid crowded places, large gatherings or are caring for people who are ill, using a facemask or a respirator correctly and consistently could help protect people and reduce the spread of pandemic influenza.”

Gerberding noted that while studies are underway in an effort to learn more about whether masks and respirators can provide protection from influenza and how people would use such devices, the CDC guidance was designed to be a “best estimate” based on what is currently known. It is designed to help guide people’s decisions regarding the use of masks.

In the guidance, the CDC recommends that:

People should consider wearing a facemask during an influenza pandemic if:

* They are sick with the ‘flu and think they might have close contact with other people (within about 6 feet).
* They live with someone who has the ‘flu symptoms (and therefore might be in the early stages of infection) or will be spending time in a crowded public place and thus may be in close contact with infected people. During a pandemic, people should limit the amount of time they spend in crowded places and consider wearing a facemask while they are there.
* They are well and do not expect to be in close contact with a sick person but need to be in a crowded place. Again, people should limit the amount of time they spend in crowded places and wear a facemask while they are there.

People should consider wearing a respirator during an influenza pandemic if:

* They are well and will be, or expect to be, in close contact (within about 6 feet) with people who are known or thought to be sick with pandemic flu. People should limit the amount of time they are in close contact with these people and wear a respirator during this time. These recommendations apply if people are taking care of a sick person at home (and if a respirator is unavailable, use of a mask should be considered).

Dr. Michael Bell, associate director for infection control in CDC’s Division of Healthcare Quality Promotion, noted that facemasks and respirators have different qualities and offer different types and levels of protection. According to Bell, the primary factor that a well person should consider before deciding whether to wear a facemask or a respirator for personal protection during a pandemic is whether they are going to be in contact with someone who has pandemic influenza.

“Facemasks are not designed to protect people from breathing in very small particles, such as viruses,” said Bell. “Rather, facemasks help stop potentially infectious droplets from being spread by the person wearing them. They also keep splashes or sprays from coughs and sneezes from reaching the mouth and nose of the person wearing the facemask. Respirators are designed to protect people from breathing in very small particles, which might contain viruses. Thus, if you’re caring for someone who is ill with pandemic flu, using a well-fitted respirator may be a reasonable choice.”

Bell stressed that neither a facemask nor a respirator will provide complete protection from a virus. To reduce the chances of becoming infected during a pandemic, people will need to practice a combination of simple actions, including: washing hands often with soap and water, staying away from other people when they are ill, and avoiding crowds and gatherings as much as possible.

For more information about respirators, see NIOSH Safety and Health Topic: Respirators (www.cdc.gov/niosh/npptl/topics/respirators/).

For more information on the proper use and removal of masks and respirators, or to learn more about these (including pictures) and other issues relating to pandemic influenza, visit http://www.pandemicflu.gov.

This guidance is now part of other community preventive measures available at www.pandemicflu.gov/plan/community/commitigation.html

Members of the public with questions about masks, respirators and pandemic influenza can also call the CDC information line, 1-800-CDC-INFO

•Date: 4th May 2007 • Region: US •Type: Article •Topic: Pandemic planning
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