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Rev Med Virol
. 2022 Feb 26;e2336.
doi: 10.1002/rmv.2336. Online ahead of print.
Comparative effectiveness of N95, surgical or medical, and non-medical facemasks in protection against respiratory virus infection: A systematic review and network meta-analysis
Min Seo Kim 1 , Dawon Seong 2 , Han Li 3 , Seo Kyoung Chung 4 , Youngjoo Park 2 , Minho Lee 2 , Seung Won Lee 5 6 , Dong Keon Yon 7 , Jae Han Kim 2 , Keum Hwa Lee 2 8 , Marco Solmi 9 10 11 12 , Elena Dragioti 13 , Ai Koyanagi 14 15 16 , Louis Jacob 14 17 , Andreas Kronbichler 18 , Kalthoum Tizaoui 19 , Sarah Cargnin 20 , Salvatore Terrazzino 20 , Sung Hwi Hong 21 , Ramy Abou Ghayda 22 , Joaquim Radua 23 24 25 , Hans Oh 26 , Karel Kostev 27 , Shuji Ogino 28 29 30 31 , I-Min Lee 29 32 , Edward Giovannucci 29 33 , Yvonne Barnett 34 , Laurie Butler 35 , Daragh McDermott 36 , Petre-Cristian Ilie 37 , Jae Il Shin 2 8 , Lee Smith 38
Affiliations
- PMID: 35218279
- DOI: 10.1002/rmv.2336
Abstract
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 The study incorporated 35 published and unpublished randomized controlled trials and observational studies investigating specific mask effectiveness against influenza virus, SARS-CoV, MERS-CoV and SARS-CoV-2.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.
Keywords: COVID-19; coronavirus; facemask; influenza virus; network meta-analysis.