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Meta-Analysis
. 2020 May;13(2):93-101.
doi: 10.1111/jebm.12381. Epub 2020 Mar 13.

Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis

Youlin Long  1 , Tengyue Hu  2 , Liqin Liu  2 , Rui Chen  3 , Qiong Guo  1 , Liu Yang  1 , Yifan Cheng  1 , Jin Huang  4 , Liang Du  1
Affiliations
Meta-Analysis

Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis

Youlin Long et al. J Evid Based Med. 2020 May.

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 Then we searched the latest published RCTs from the above three databases and searched ClinicalTrials.gov for unpublished RCTs.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.

Keywords: N95 respirator; influenza; masks; respiratory protective devices; respiratory tract infections; surgical mask.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Literature search and screening process
FIGURE 2
FIGURE 2
Risk of bias summary
FIGURE 3
FIGURE 3
Results of meta‐analysis to determine the effectiveness of N95 respirators versus surgical masks against laboratory‐confirmed influenza
FIGURE 4
FIGURE 4
Results of meta‐analysis to determine the effectiveness of N95 respirators versus surgical masks against laboratory‐confirmed respiratory viral infections
FIGURE 5
FIGURE 5
Results of meta‐analysis to determine the effectiveness of N95 respirators versus surgical masks against laboratory‐confirmed bacterial colonization
FIGURE 6
FIGURE 6
Results of meta‐analysis to determine the effectiveness of N95 respirators versus surgical masks against laboratory‐confirmed respiratory infection
FIGURE 7
FIGURE 7
Results of meta‐analysis to determine the effectiveness of N95 respirators versus surgical masks against influenzalike illness
See this image and copyright information in PMC

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