JAMA. Respiratory Protection Against Influenza

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Respiratory Protection Against Influenza, October 1, 2009, Srinivasan and Perl 0 (2009): 2009.1494 (JAMA, editorial, extract, edited)

Respiratory Protection Against Influenza

Arjun Srinivasan, MD; Trish M. Perl, MD, MSc
JAMA. 2009;302(17)doi:10.1001/jama.2009.1494).


The 2009 influenza A(H1N1) pandemic has revived debate about the role of respiratory protection in preventing the transmission of influenza to health care personnel (HCP). The Centers for Disease Control and Prevention (CDC) guidelines for preventing transmission of seasonal influenza are intended to limit exposure to large respiratory droplets and recommend the use of a medical (surgical) mask during the care of a patient with influenza as part of a comprehensive infection control strategy.1-2

However, data suggest that under certain conditions, influenza viruses can be transmitted via smaller particles that evade filtration by such masks.3 Unlike medical masks, N95 particulate respirators protect wearers from small particles when appropriately designed and worn.4 Recommendations to prevent influenza transmission take on special importance during pandemics, when there is little, if any, native immunity and vaccine is not available immediately.5

During the current pandemic, public health organizations and professional societies have reviewed information on influenza transmission and severity of the pandemic H1N1 virus and developed differing recommendations for respiratory protection. Some groups, including the World Health Organization and Society for Healthcare Epidemiology of America, recommend the use of medical masks for most patient care activities, and others, most notably the CDC, recommend N95 respirators.

Deliberations have been influenced by animal studies indicating that 2009 influenza A(H1N1) virus was transmitted via inhaled particles and replicated in the lower respiratory tract.3, 6

In September 2009, the Institute of Medicine (IOM) supported the use of N95 respirators during the care of patients infected with H1N1 influenza, although this group was instructed not to consider the available supply or comfort of N95 respirators in their decision.7

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Re: JAMA. Respiratory Protection Against Influenza

from the article . . .

. . . Unfortunately, this intense discussion over respiratory protection has distracted attention from the critical importance of implementing other strategies known to prevent the transmission of influenza in health care settings. Indeed, the use of personal protective equipment such as masks and respirators should be considered the ?last line of defense? in a hierarchy of infection control measures. . . . this study is, to our knowledge, the first and only published randomized trial assessing respiratory protection for preventing influenza transmission is a sad commentary on the state of research in this area. . .