Skip to main content
    • Aa
    • Aa

Face masks to prevent transmission of influenza virus: a systematic review

  • B. J. COWLING (a1), Y. ZHOU (a1), D. K. M. IP (a1), G. M. LEUNG (a1) and A. E. AIELLO (a2)...

Influenza viruses circulate around the world every year. From time to time new strains emerge and cause global pandemics. Many national and international health agencies recommended the use of face masks during the 2009 influenza A (H1N1) pandemic. We reviewed the English-language literature on this subject to inform public health preparedness. There is some evidence to support the wearing of masks or respirators during illness to protect others, and public health emphasis on mask wearing during illness may help to reduce influenza virus transmission. There are fewer data to support the use of masks or respirators to prevent becoming infected. Further studies in controlled settings and studies of natural infections in healthcare and community settings are required to better define the effectiveness of face masks and respirators in preventing influenza virus transmission.

Corresponding author
*Author for correspondence: Dr B. J. Cowling, School of Public Health, The University of Hong Kong, Units 624-7, Cyberport 3, Pokfulam, Hong Kong. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.C Fraser , Pandemic potential of a strain of influenza A (H1N1): early findings. Science 2009; 324: 15571561.

3.World Health Organization (WHO) Writing Group. Nonpharmaceutical interventions for pandemic influenza, international measures. Emerging Infectious Diseases 2006; 12: 8187.

4.World Health Organization (WHO) Writing Group. Nonpharmaceutical interventions for pandemic influenza, national and community measures. Emerging Infectious Diseases 2006; 12: 8894.

5.T Jefferson , Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. British Medical Journal 2008; 336: 7780.

6.D Moher , Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. British Medical Journal 2009; 339: b2535.

7.DF Johnson , A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. Clinical Infectious Diseases 2009; 49: 275277.

8.M Loeb , Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. Journal of the American Medical Association 2009; 302: 18651871.

9.JL Jacobs , Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: a randomized controlled trial. American Journal of Infection Control 2009; 37: 417419.

11.S Al-Asmary , Acute respiratory tract infections among Hajj medical mission personnel, Saudi Arabia. International Journal of Infectious Diseases 2007; 11: 268272.

12.K Davies , Seroepidemiological study of respiratory virus infections among dental surgeons. British Dental Journal 1994; 176: 262265.

14.BJ Cowling , Facemasks and hand hygiene to prevent influenza transmission in households: a randomized trial. Annals of Internal Medicine 2009; 151: 437446.

15.BJ Cowling , Preliminary findings of a randomized trial of non-pharmaceutical interventions to prevent influenza transmission in households. PLoS One 2008; 3: e2101.

16.CR MacIntyre , Face mask use and control of respiratory virus transmission in households. Emerging Infectious Diseases 2009; 15: 233241.

18.J Lo , Respiratory infections during SARS outbreak, Hong Kong, 2003. Emerging Infectious Diseases 2005; 11: 17381741.

20.G Brankston , Transmission of influenza A in human beings. Lancet Infectious Diseases 2007; 7: 257265.

21.R Tellier . Review of aerosol transmission of influenza A virus. Emerging Infectious Diseases 2006; 12: 16571662.

22.R Tellier . Aerosol transmission of influenza A virus: a review of new studies. Journal of the Royal Society Interface 2009; 6 (Suppl. 6): S783790.

23.TP Weber , NI Stilianakis . Inactivation of influenza A viruses in the environment and modes of transmission: a critical review. Journal of Infection 2008; 57: 361373.

24.H Blumenfeld , Studies on influenza in the pandemic of 1957–1958. I. An epidemiologic, clinical and serologic investigation of an intrahospital epidemic, with a note on vaccination efficacy. Journal of Clinical Investigation 1959; 38: 199.

25.N Awofeso , Influenza outbreak in a correctional facility. Australian and New Zealand Journal of Public Health 2001; 25: 443446.

26.D Morens , V Rash . Lessons from a nursing home outbreak of influenza A. Infection Control and Hospital Epidemiology 1995; 16: 275.

27.K Han , Lack of airborne transmission during outbreak of pandemic (H1N1) 2009 among tour group members, China, June 2009. Emerging Infectious Diseases 2009; 15: 15781581.

28.AC Lowen , High temperature (30 degrees C) blocks aerosol but not contact transmission of influenza virus. Journal of Virology 2008; 82: 56505652.

29.MM Weiss , Disrupting the transmission of influenza a: face masks and ultraviolet light as control measures. American Journal of Public Health 2007; 97 (Suppl. 1): S3237.

30.A Rengasamy , Z Zhuang , R Berryann . Respiratory protection against bioaerosols: literature review and research needs. American Journal of Infection Control 2004; 32: 345354.

32.M Beck , Wearing masks in a pediatric hospital: developing practical guidelines. Canadian Journal of Public Health 2004; 95: 256257.

33.Y Li , Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations. International Archives of Occupational and Environmental Health 2005; 78: 501509.

34.EC Lim , Headaches and the N95 face-mask amongst healthcare providers. Acta Neurologica Scandinavica 2006; 113: 199202.

35.H Seale , A review of medical masks and respirators for use during an influenza pandemic. Influenza and Other Respiratory Viruses 2009; 3: 205206.

36.YT Lu , Viral load and outcome in SARS infection: the role of personal protective equipment in the emergency department. Journal of Emerging Medicine 2006; 30: 715.

37.L Casanova , Methods for the recovery of a model virus from healthcare personal protective equipment. Journal of Applied Microbiology 2009; 106: 12441251.

39.S Stebbins , JS Downs , CJ Vukotich Jr.. Using nonpharmaceutical interventions to prevent influenza transmission in elementary school children: parent and teacher perspectives. Journal of Public Health Management and Practice 2009; 15: 112117.

41.World Health Organization. Advice on the use of masks in the community setting in Influenza A (H1N1) outbreaks. Interim guidance (3 May 2009), 2009. ( Accessed 11 August 2009.

42.Centers for Disease Control and Prevention. Interim public health guidance for the use of facemasks and respirators in non-occupational community settings during an influenza pandemic, 2009. ( Accessed 30 August 2009.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *