Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis

Mingming Liang, Liang Gao, Ce Cheng, Qin Zhou, John Patrick Uy, Kurt Heiner, Chenyu Sun, Mingming Liang, Liang Gao, Ce Cheng, Qin Zhou, John Patrick Uy, Kurt Heiner, Chenyu Sun

Abstract

Background: Conflicting recommendations exist related to whether masks have a protective effect on the spread of respiratory viruses.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was consulted to report this systematic review. Relevant articles were retrieved from PubMed, Web of Science, ScienceDirect, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI), VIP (Chinese) database.

Results: A total of 21 studies met our inclusion criteria. Meta-analyses suggest that mask use provided a significant protective effect (OR = 0.35 and 95% CI = 0.24-0.51). Use of masks by healthcare workers (HCWs) and non-healthcare workers (Non-HCWs) can reduce the risk of respiratory virus infection by 80% (OR = 0.20, 95% CI = 0.11-0.37) and 47% (OR = 0.53, 95% CI = 0.36-0.79). The protective effect of wearing masks in Asia (OR = 0.31) appeared to be higher than that of Western countries (OR = 0.45). Masks had a protective effect against influenza viruses (OR = 0.55), SARS (OR = 0.26), and SARS-CoV-2 (OR = 0.04). In the subgroups based on different study designs, protective effects of wearing mask were significant in cluster randomized trials and observational studies.

Conclusions: This study adds additional evidence of the enhanced protective value of masks, we stress that the use masks serve as an adjunctive method regarding the COVID-19 outbreak.

Keywords: Facemask; Influenza; Prevention; Respiratory virus; SARS-CoV; SARS-CoV-2.

Conflict of interest statement

We declare no competing interests.

Copyright © 2020 Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Flow diagram of the study search and selection process.
Fig. 2
Fig. 2
Funnel plot of mask-wearing and risk of laboratory-confirmed respiratory viral infection.
Fig. 3
Fig. 3
Forest plot of the overall effect of mask-wearing on laboratory-confirmed respiratory viral infection.
Fig. 4
Fig. 4
Forest plot of the effect of mask-wearing on laboratory-confirmed respiratory viral infection among HCW and non-HCW.

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