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Comparative effectiveness of N95 respirators and surgical/face masks in preventing airborne infections in the era of SARS-CoV2 pandemic: A meta-analysis of randomized trials.
PLoS One. 2020; 15(12):e0242901.Plos

Abstract

BACKGROUND

Recently, several randomized controlled trials (RCTs) have evaluated the effect of N95 respirators compared with medical masks to protect against acute respiratory infections. However, these studies are limited by modest sample sizes and inconclusive results. Therefore, the goal of the present study was to review the relevant and available published RCTs with the aid of the increased power of meta-analytic methods in order to assess the effectiveness of medical masks and N95 respirators in reducing the risk of respiratory infections.

METHODS

This meta-analysis follows the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for conducting and reporting results. We searched PubMed, Web of Science, Embase, and Cochrane databases from inception through April 1, 2020 to identify potentially relevant studies. Two authors (LS and JS) independently searched the titles and abstracts of the potentially eligible articles. They independently retrieved required data from the eligible trials; the data were initially tabulated for statistical analysis. Two authors (JRL and LS) independently assessed the methodological quality of the included RCTs using the Cochrane Collaboration's tool for assessing risk of bias.

RESULTS

Six articles met the inclusion criteria. The pooled analysis showed that N95 respirators did not reduce the risk of infection with respiratory viruses compared with medical/surgical masks (5.7% vs. 7.9%; RR = 1.12; 95% CI: 0.88-1.41; p = 0.36); however, there was no statistically significant difference in laboratory-confirmed influenza between N95 and medical masks (RR = 0.91; 95% CI: 0.77-1.07; p = 0.26). Medical masks provided similar protection against other viruses, including coronavirus (RR = 0.74; 95% CI: 0.32-1.73; p = 0.49). Respiratory illness, as well as influenza-like illness were less frequently observed with N95 respirators.

CONCLUSIONS

Our meta-analysis suggests that there are insufficient data to definitively determine whether N95 respirators are superior to medical masks in protection against transmissible acute respiratory infections. Further randomized trials are necessary to compare the above methods of respiratory protection in the context of COVID-19 incidence.

Authors+Show Affiliations

Polish Society of Disaster Medicine, Warsaw, Poland.Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland.First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland.Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.Clinic of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland.Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33320847

Citation

Barycka, Katarzyna, et al. "Comparative Effectiveness of N95 Respirators and Surgical/face Masks in Preventing Airborne Infections in the Era of SARS-CoV2 Pandemic: a Meta-analysis of Randomized Trials." PloS One, vol. 15, no. 12, 2020, pp. e0242901.
Barycka K, Szarpak L, Filipiak KJ, et al. Comparative effectiveness of N95 respirators and surgical/face masks in preventing airborne infections in the era of SARS-CoV2 pandemic: A meta-analysis of randomized trials. PLoS One. 2020;15(12):e0242901.
Barycka, K., Szarpak, L., Filipiak, K. J., Jaguszewski, M., Smereka, J., Ladny, J. R., & Turan, O. (2020). Comparative effectiveness of N95 respirators and surgical/face masks in preventing airborne infections in the era of SARS-CoV2 pandemic: A meta-analysis of randomized trials. PloS One, 15(12), e0242901. https://doi.org/10.1371/journal.pone.0242901
Barycka K, et al. Comparative Effectiveness of N95 Respirators and Surgical/face Masks in Preventing Airborne Infections in the Era of SARS-CoV2 Pandemic: a Meta-analysis of Randomized Trials. PLoS One. 2020;15(12):e0242901. PubMed PMID: 33320847.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative effectiveness of N95 respirators and surgical/face masks in preventing airborne infections in the era of SARS-CoV2 pandemic: A meta-analysis of randomized trials. AU - Barycka,Katarzyna, AU - Szarpak,Lukasz, AU - Filipiak,Krzysztof Jerzy, AU - Jaguszewski,Milosz, AU - Smereka,Jacek, AU - Ladny,Jerzy Robert, AU - Turan,Oguz, Y1 - 2020/12/15/ PY - 2020/04/20/received PY - 2020/11/11/accepted PY - 2020/12/15/entrez PY - 2020/12/16/pubmed PY - 2020/12/23/medline SP - e0242901 EP - e0242901 JF - PloS one JO - PLoS One VL - 15 IS - 12 N2 - BACKGROUND: Recently, several randomized controlled trials (RCTs) have evaluated the effect of N95 respirators compared with medical masks to protect against acute respiratory infections. However, these studies are limited by modest sample sizes and inconclusive results. Therefore, the goal of the present study was to review the relevant and available published RCTs with the aid of the increased power of meta-analytic methods in order to assess the effectiveness of medical masks and N95 respirators in reducing the risk of respiratory infections. METHODS: This meta-analysis follows the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for conducting and reporting results. We searched PubMed, Web of Science, Embase, and Cochrane databases from inception through April 1, 2020 to identify potentially relevant studies. Two authors (LS and JS) independently searched the titles and abstracts of the potentially eligible articles. They independently retrieved required data from the eligible trials; the data were initially tabulated for statistical analysis. Two authors (JRL and LS) independently assessed the methodological quality of the included RCTs using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS: Six articles met the inclusion criteria. The pooled analysis showed that N95 respirators did not reduce the risk of infection with respiratory viruses compared with medical/surgical masks (5.7% vs. 7.9%; RR = 1.12; 95% CI: 0.88-1.41; p = 0.36); however, there was no statistically significant difference in laboratory-confirmed influenza between N95 and medical masks (RR = 0.91; 95% CI: 0.77-1.07; p = 0.26). Medical masks provided similar protection against other viruses, including coronavirus (RR = 0.74; 95% CI: 0.32-1.73; p = 0.49). Respiratory illness, as well as influenza-like illness were less frequently observed with N95 respirators. CONCLUSIONS: Our meta-analysis suggests that there are insufficient data to definitively determine whether N95 respirators are superior to medical masks in protection against transmissible acute respiratory infections. Further randomized trials are necessary to compare the above methods of respiratory protection in the context of COVID-19 incidence. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/33320847/Comparative_effectiveness_of_N95_respirators_and_surgical/face_masks_in_preventing_airborne_infections_in_the_era_of_SARS_CoV2_pandemic:_A_meta_analysis_of_randomized_trials_ L2 - https://dx.plos.org/10.1371/journal.pone.0242901 DB - PRIME DP - Unbound Medicine ER -