This advisory summarizes new guidance from the Centers for Disease Control and Prevention (CDC), Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic. The complete CDC guidance is available at: www.pandemicflu.gov. The recommendations will be revised as new information about the use of facemasks and respirators in the setting of pandemic influenza becomes available.

Very little information is available about the effectiveness of facemasks and respirators in controlling the spread of pandemic influenza in community settings. In the absence of scientific data, the interim recommendations are based on the judgment of experts and on the historical use of facemasks and respirators in other settings.

• Wash hands often with soap and water. Use an alcohol-based hand cleaner if soap and water are not available.
• Cover the mouth and nose with a tissue or your arm when coughing and sneezing.
• Stay away from other people when you are ill.
• Avoid crowded places and large gatherings as much as possible.
• Voluntary isolation (at home or in a healthcare facility) and treatment with antiviral medications of persons with confirmed or probable influenza.
• Having members of households with confirmed or probable influenza cases voluntarily stay at home (voluntary home quarantine) for approximately 7 days.
• Dismissal of students from schools and school-based activities, and closure of childcare programs and keeping children form gathering elsewhere.

Some individuals, such as pregnant women and persons with certain underlying medical conditions (e.g., cardiopulmonary disease or immunodeficiency), are at increased risk for severe illness or complications from seasonal influenza infection, and they may likewise be at high risk during a pandemic as well. In addition to the usual risk groups, others may be at high risk for severe illness and complications during a pandemic (e.g., normally healthy children or young adults). It is especially important that all persons who are at high risk avoid crowded settings and adhere to recommended infection prevention practices.

Summary of recommendations for the public on facemask & respirator use during a flu pandemic

Neither a facemask nor a respirator will give complete protection from the flu. However, there may be times during a pandemic when individuals must be in a crowded setting or in close contact (within 6 feet) with people who might be ill. During such times, the use of a facemask or a respirator might help prevent the spread of infection. If face masks or respirators are used, they should be in addition to (not instead of) the other actions, above.

When it is absolutely necessary to enter a crowded setting or to have close contact (within 6 feet) with persons who might be infectious, the time spent in that setting should be as short as possible. If used correctly, facemasks and respirators may help prevent some exposures, but they should be used along with other preventive measures, such as social distancing and hand hygiene. When crowded settings or close contact with others cannot be avoided, the use of facemasks or respirators should be considered using the following information.

What you should know about using facemasks and respirators in community settings during a flu pandemic

Very little is known about the benefits of wearing facemasks and respirators to help control the spread of pandemic flu. In the absence of clear science, the steps below offer a “best estimate” to help guide decisions. They will be revised as new information becomes available. Whenever possible, rather than relying on the use of masks or respirators, close contact and crowded conditions should be avoided during an influenza pandemic.

Facemasks should be considered for use by individuals who enter crowded settings, both to protect the wearers’ own nose and mouth from other people's coughs and to reduce the wearers' likelihood of coughing on others. The time spent in crowded settings should be as short as possible. Consider wearing a facemask if:

• You are sick with the flu and think you might have close contact (within 6 feet) with other people.
• You live with someone who has the flu (you therefore might be in the early stages of infection) and need to be in a crowded place. Limit the amount of time you spend in these crowded places and wear a facemask while you are there.
• You are well and do not expect to be in close contact with a sick person but need to be in a crowded place. Limit the amount of time you spend in these crowded places and wear a facemask while you are there.

Respirators should be considered for use by individuals who cannot avoid close contact with an infectious person. This can include selected individuals who must care for a sick person (e.g., family member with a respiratory infection) at home. Consider wearing a respirator if:

• You are well and you expect to be in close contact with people who are known or thought to be sick with pandemic flu. Limit the amount of time you are in close contact with these people and wear a respirator during this time. These recommendations apply if you must take care of a sick person at home.

What is a facemask?

Facemasks are loose-fitting, disposable masks that cover the nose and mouth. These include products labeled as surgical, dental, medical procedure, isolation, and laser masks. Facemasks help stop droplets from being spread by the person wearing them. They also keep splashes or sprays from reaching the mouth and nose of the person wearing the facemask. They are not designed to protect you against breathing in very small particles. Facemasks should be used once and then thrown away in the trash.

What is a respirator?

A respirator (for example, an N95 or higher filtering facepiece respirator) is designed to protect you from breathing in very small particles, which might contain viruses. These types of respirators fit tightly to the face so that most air is inhaled through the filter material. To work the best way, N95 respirators must be specially fitted for each person who wears one (this is called “fit-testing” and is usually done in a workplace where respirators are used).  Most of the time, N95 respirators are used in construction and other jobs that involve dust and small particles. Some healthcare workers, such as nurses and doctors, use these types of respirators when taking care of patients with diseases that can be spread through the air. Like surgical masks, N95 respirators should be worn only once and then thrown away in the trash. IMPORTANT: If you have a heart or lung disease or other health condition, you may have trouble breathing through respirators and you should talk with your doctor before using a respirator.

Additional Information (Health care providers should carefully review the first two resources below)

• For advice on surgical mask and respirator use in healthcare settings, consult the document, Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Healthcare Settings during an Influenza Pandemic
  
  
• For information on facemask and respirator use in occupational settings (healthcare and non-healthcare), see Guidance on Preparing Workplaces for an Influenza Pandemic, prepared by the U.S. Department of Labor.
  
  
• Public Health – Seattle & King County’s pandemic influenza site with information for healthcare providers, businesses, schools and the public.
  
  
• Pandemic influenza information from Washington State Department of Health
  
  
• Comprehensive pandemic influenza information and resources from the federal government