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Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis.
J Evid Based Med. 2020 May; 13(2):93-101.JE

Abstract

OBJECTIVE

Previous meta-analyses concluded that there was insufficient evidence to determine the effect of N95 respirators. We aimed to assess the effectiveness of N95 respirators versus surgical masks for prevention of influenza by collecting randomized controlled trials (RCTs).

METHODS

We searched PubMed, EMbase and The Cochrane Library from the inception to January 27, 2020 to identify relevant systematic reviews. The RCTs included in systematic reviews were identified. Then we searched the latest published RCTs from the above three databases and searched ClinicalTrials.gov for unpublished RCTs. Two reviewers independently extracted the data and assessed risk of bias. Meta-analyses were conducted to calculate pooled estimates by using RevMan 5.3 software.

RESULTS

A total of six RCTs involving 9 171 participants were included. There were no statistically significant differences in preventing laboratory-confirmed influenza (RR = 1.09, 95% CI 0.92-1.28, P > .05), laboratory-confirmed respiratory viral infections (RR = 0.89, 95% CI 0.70-1.11), laboratory-confirmed respiratory infection (RR = 0.74, 95% CI 0.42-1.29) and influenzalike illness (RR = 0.61, 95% CI 0.33-1.14) using N95 respirators and surgical masks. Meta-analysis indicated a protective effect of N95 respirators against laboratory-confirmed bacterial colonization (RR = 0.58, 95% CI 0.43-0.78).

CONCLUSION

The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza. It suggests that N95 respirators should not be recommended for general public and nonhigh-risk medical staff those are not in close contact with influenza patients or suspected patients.

Authors+Show Affiliations

Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China.West China School of Medicine, Sichuan University, Chengdu, P.R. China.West China School of Medicine, Sichuan University, Chengdu, P.R. China.School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. China.Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China.Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China.Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China.West China Hospital, Sichuan University, Chengdu, P.R. China.Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32167245

Citation

Long, Youlin, et al. "Effectiveness of N95 Respirators Versus Surgical Masks Against Influenza: a Systematic Review and Meta-analysis." Journal of Evidence-based Medicine, vol. 13, no. 2, 2020, pp. 93-101.
Long Y, Hu T, Liu L, et al. Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis. J Evid Based Med. 2020;13(2):93-101.
Long, Y., Hu, T., Liu, L., Chen, R., Guo, Q., Yang, L., Cheng, Y., Huang, J., & Du, L. (2020). Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis. Journal of Evidence-based Medicine, 13(2), 93-101. https://doi.org/10.1111/jebm.12381
Long Y, et al. Effectiveness of N95 Respirators Versus Surgical Masks Against Influenza: a Systematic Review and Meta-analysis. J Evid Based Med. 2020;13(2):93-101. PubMed PMID: 32167245.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis. AU - Long,Youlin, AU - Hu,Tengyue, AU - Liu,Liqin, AU - Chen,Rui, AU - Guo,Qiong, AU - Yang,Liu, AU - Cheng,Yifan, AU - Huang,Jin, AU - Du,Liang, Y1 - 2020/03/13/ PY - 2020/02/03/received PY - 2020/02/12/accepted PY - 2020/3/14/pubmed PY - 2020/6/10/medline PY - 2020/3/14/entrez KW - N95 respirator KW - influenza KW - masks KW - respiratory protective devices KW - respiratory tract infections KW - surgical mask SP - 93 EP - 101 JF - Journal of evidence-based medicine JO - J Evid Based Med VL - 13 IS - 2 N2 - OBJECTIVE: Previous meta-analyses concluded that there was insufficient evidence to determine the effect of N95 respirators. We aimed to assess the effectiveness of N95 respirators versus surgical masks for prevention of influenza by collecting randomized controlled trials (RCTs). METHODS: We searched PubMed, EMbase and The Cochrane Library from the inception to January 27, 2020 to identify relevant systematic reviews. The RCTs included in systematic reviews were identified. Then we searched the latest published RCTs from the above three databases and searched ClinicalTrials.gov for unpublished RCTs. Two reviewers independently extracted the data and assessed risk of bias. Meta-analyses were conducted to calculate pooled estimates by using RevMan 5.3 software. RESULTS: A total of six RCTs involving 9 171 participants were included. There were no statistically significant differences in preventing laboratory-confirmed influenza (RR = 1.09, 95% CI 0.92-1.28, P > .05), laboratory-confirmed respiratory viral infections (RR = 0.89, 95% CI 0.70-1.11), laboratory-confirmed respiratory infection (RR = 0.74, 95% CI 0.42-1.29) and influenzalike illness (RR = 0.61, 95% CI 0.33-1.14) using N95 respirators and surgical masks. Meta-analysis indicated a protective effect of N95 respirators against laboratory-confirmed bacterial colonization (RR = 0.58, 95% CI 0.43-0.78). CONCLUSION: The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza. It suggests that N95 respirators should not be recommended for general public and nonhigh-risk medical staff those are not in close contact with influenza patients or suspected patients. SN - 1756-5391 UR - https://www.unboundmedicine.com/medline/citation/32167245/Effectiveness_of_N95_respirators_versus_surgical_masks_against_influenza:_A_systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1111/jebm.12381 DB - PRIME DP - Unbound Medicine ER -