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, Dawon Seong, Han Li, Seo Kyoung Chung, Youngjoo Park, Minho Lee, Seung Won Lee, Dong Keon Yon, Jae Han Kim, Keum Hwa Lee, Marco Solmi, Elena Dragioti, Ai Koyanagi, Louis Jacob, Andreas Kronbichler, Kalthoum Tizaoui, Sarah Cargnin, Salvatore Terrazzino, Sung Hwi Hong, Ramy Abou Ghayda, Joaquim Radua, Hans Oh, Karel Kostev, Shuji Ogino, I-Min Lee, Edward Giovannucci, Yvonne Barnett, Laurie Butler, Daragh McDermott, Petre-Cristian Ilie, Jae Il Shin, Lee Smith
Journal: Reviews in medical virology
2022;32(5):e2336
PMID: 35218279
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 The study incorporated 35 published and unpublished randomized controlled trials and observational studies investigating specific mask effectiveness against influenza virus, SARS-CoV, MERS-CoV and SARS-CoV-2.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.
© 2022 John Wiley & Sons Ltd.
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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 Precision Medicine, Sungkyunkwan University School of medicine, Suwon, Republic of Korea.; Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea.; College of Medicine, Yonsei University, Seoul, Republic of Korea.; Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.; Department of Psychiatry, University of Ottawa, Ontario, Canada.; Department of Mental Health, The Ottawa Hospital, Ontario, Canada.; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ontario, Canada.; School of Epidemiology and Public Health, Faculty of Medicine, 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.; ICREA, Barcelona, Spain.; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain.; Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France.; 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.; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.; Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institute, Stockholm, Sweden.; 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.; Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.; Department of Nutrition, 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.
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