Comparative effectiveness of N95, surgical or medical, and non-medical facemasks in protection against respiratory virus infection: A systematic review and network meta-analysis.
Journal: Reviews in medical virology
Volume: 32
Issue: 5
Year of Publication: 2022
Affiliated Institutions:
Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea.
College of Medicine, Yonsei University, Seoul, Republic of Korea.
College of Medicine, University of Florida, Gainesville, Florida, USA.
College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea.
Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
Department of Psychiatry, University of Ottawa, Ontario, Canada.
Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain.
Department of Medicine, University of Cambridge, Cambridge, UK.
Department of Basic Sciences, Medicine Faculty of Tunis, Tunis El Manar University, Tunis, Tunisia.
Department of Pharmaceutical Sciences, Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale, Novara, Italy.
Severance Hospital, Yonsei University Health Systems, Seoul, Republic of Korea.
Urology Institute, University Hospitals System, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center, CIBERSAM, Barcelona, Spain.
School of Social Work, University of Southern California, California, USA.
University Clinic of Marburg, Marburg, Germany.
Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, East Road, Cambridge, UK.
Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK.
NTU Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK.
Queen Elizabeth Hospital Foundation Trust, King's Lynn, UK.
Center for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK.
Abstract summary
The aim of this systematic review and network meta-analysis is to evaluate the comparative effectiveness of N95, surgical/medical and non-medical facemasks as personal protective equipment against respiratory virus infection. The study incorporated 35 published and unpublished randomized controlled trials and observational studies investigating specific mask effectiveness against influenza virus, SARS-CoV, MERS-CoV and SARS-CoV-2. We searched PubMed, Google Scholar and medRxiv databases for studies published up to 5 February 2021 (PROSPERO registration: CRD42020214729). The primary outcome of interest was the rate of respiratory viral infection. The quality of evidence was estimated using the GRADE approach. High compliance to mask-wearing conferred a significantly better protection (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.23-0.82) than low compliance. N95 or equivalent masks were the most effective in providing protection against coronavirus infections (OR, 0.30; CI, 0.20-0.44) consistently across subgroup analyses of causative viruses and clinical settings. Evidence supporting the use of medical or surgical masks against influenza or coronavirus infections (SARS, MERS and COVID-19) was weak. Our study confirmed that the use of facemasks provides protection against respiratory viral infections in general; however, the effectiveness may vary according to the type of facemask used. Our findings encourage the use of N95 respirators or their equivalents (e.g., P2) for best personal protection in healthcare settings until more evidence on surgical and medical masks is accrued. This study highlights a substantial lack of evidence on the comparative effectiveness of mask types in community settings.
Authors & Co-authors:
Kim Min Seo MS
Seong Dawon D
Li Han H
Chung Seo Kyoung SK
Park Youngjoo Y
Lee Minho M
Lee Seung Won SW
Yon Dong Keon DK
Kim Jae Han JH
Lee Keum Hwa KH
Solmi Marco M
Dragioti Elena E
Koyanagi Ai A
Jacob Louis L
Kronbichler Andreas A
Tizaoui Kalthoum K
Cargnin Sarah S
Terrazzino Salvatore S
Hong Sung Hwi SH
Abou Ghayda Ramy R
Radua Joaquim J
Oh Hans H
Kostev Karel K
Ogino Shuji S
Lee I-Min IM
Giovannucci Edward E
Barnett Yvonne Y
Butler Laurie L
McDermott Daragh D
Ilie Petre-Cristian PC
Shin Jae Il JI
Smith Lee L
Study Outcome
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