Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jun 13;37(2):e0012423.
doi: 10.1128/cmr.00124-23. Epub 2024 May 22.

Masks and respirators for prevention of respiratory infections: a state of the science review

Trisha Greenhalgh  1 , C Raina MacIntyre  2 , Michael G Baker  3 , Shovon Bhattacharjee  2   4 , Abrar A Chughtai  5 , David Fisman  6 , Mohana Kunasekaran  2 , Amanda Kvalsvig  3 , Deborah Lupton  7 , Matt Oliver  8 , Essa Tawfiq  2 , Mark Ungrin  9 , Joe Vipond  10
Affiliations
Review

Masks and respirators for prevention of respiratory infections: a state of the science review

Trisha Greenhalgh et al. Clin Microbiol Rev. .

Abstract

SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.

Keywords: SARS-CoV-2; infection prevention and control; masks; meta-analysis; methodology; narrative review; non-pharmaceutical interventions; respirators; respiratory infections.

PubMed Disclaimer

Conflict of interest statement

T.G. is a member of Independent SAGE, a UK-based group of scientists who engage directly with the public and produce reports and resources related to COVID-19; this role is unremunerated (see www.independentsage.org). D.F. received a grant from the Canadian Institutes for Health Research (2019 COVID-19 rapid researching funding OV4-170360); has served on advisory boards related to influenza and SARS-CoV-2 vaccines for Seqirus, Pfizer, Astrazeneca, and Sanofi-Pasteur Vaccines; and has served as a legal expert on issues related to COVID-19 epidemiology for the Elementary Teachers Federation of Ontario and the Registered Nurses Association of Ontario.

Similar articles

See all similar articles

Cited by

References

    1. Haller DA, Colwell RC. 1918. The protective qualities of the gauze face mask: experimental studies. J Am Med Assoc 71:1213–1215. doi:10.1001/jama.1918.26020410008008a - DOI
    1. Markel H, Stern A, Navarro JA, Michalsen JR. 2006. A historical assessment of nonpharmaceutical disease containment strategies employed by selected US communities during the second wave of the 1918-1920 influenza pandemic: final report: January 31, 2006. Defense Threat Reduction Agency, Advanced Systems and Concepts Office
    1. Cowling BJ, Zhou Y, Ip DKM, Leung GM, Aiello AE. 2010. Face masks to prevent transmission of influenza virus: a systematic review. Epidemiol Infect 138:449–456. doi:10.1017/S0950268809991658 - DOI - PubMed
    1. Matuschek C, Moll F, Fangerau H, Fischer JC, Zänker K, van Griensven M, Schneider M, Kindgen-Milles D, Knoefel WT, Lichtenberg A, Tamaskovics B, Djiepmo-Njanang FJ, Budach W, Corradini S, Häussinger D, Feldt T, Jensen B, Pelka R, Orth K, Peiper M, Grebe O, Maas K, Bölke E, Haussmann J. 2020. The history and value of face masks. Eur J Med Res 25:1–6. doi:10.1186/s40001-020-00423-4 - DOI - PMC - PubMed
    1. Cozza A, Maggioni G, Thiene G, Bonati MR. 2021. The 1918 influenza pandemic versus COVID-19: a historical perspective from an Italian point of view. Am J Public Health 111:1815–1823. doi:10.2105/AJPH.2021.306412 - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources