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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_414"
                     title="H1N1 Vaccination Still a Good Idea, CDC Says"
                     score="0.012"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/18325?impressionId=1265761950161"
                     
      &lt;p&gt;Although pandemic H1N1 influenza activity appears to have leveled off, the CDC remains wary of what the future may hold.&lt;/p&gt;
&lt;p&gt;No states were reporting widespread influenza activity, and only six  --  Alabama, Georgia, Maine, New Jersey, New Mexico, and Virginia  --  were reporting regional activity, Anne Schuchat, MD, director of the CDC&apos;s National Center for Immunization and Respiratory Diseases, told reporters on a conference call today.&lt;/p&gt;
&lt;p&gt;Influenza-like activity remained below the baseline level for this time of year for the third straight week, Schuchat said.&lt;/p&gt;
&lt;p&gt;&quot;That&apos;s fairly similar to what we would normally see at this time of year with seasonal flu,&quot; she said.&lt;/p&gt;
&lt;p&gt;However, she said that the H1N1 virus continues to circulate, causing severe disease and death in some cases.&lt;/p&gt;
&lt;p&gt;Although total activity is down, Schuchat noted that the proportion of deaths attributed to either flu or pneumonia is higher than the epidemic threshold, and has been for the past three weeks. The reasons were unclear, but she said there are no indications that the virus has become more virulent.&lt;/p&gt;
&lt;p&gt;But, she said, &quot;H1N1 vaccination remains a good idea.&quot;&lt;/p&gt;
&lt;p&gt;The most recent results of the CDC&apos;s National H1N1 Flu Survey revealed that about 70 million people, or 23.4% of Americans, have been vaccinated so far. About 76 million doses of the vaccine have been used because of the requirement that children younger than 10 get two.&lt;/p&gt;
&lt;p&gt;About 37% of children up to age 18 have been vaccinated. For those younger than 10, 37% have received their second dose.&lt;/p&gt;
&lt;p&gt;Vaccine supply remains ample, Schuchat said, with about 124 million doses shipped around the country up to this point.&lt;/p&gt;
&lt;p&gt;Citing an &quot;unprecedented&quot; effort to monitor safety, she said there have not been any major safety concerns identified.&lt;/p&gt;
&lt;p&gt;&quot;So if safety was the reason that you were waiting, I think you can be reassured on that front.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_302"
                     title="WHO Calls H1N1 Response Imperfect"
                     score="0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/18165?impressionId=1265761950161"
                     
      &lt;p&gt;The World Health Organization says its response to the H1N1 pandemic could have been better, but was not unduly swayed by drug manufacturers.&lt;/p&gt;
&lt;p&gt;&quot;We are under no illusions that this response was the perfect response,&quot; Keiji Fukuda, MD, the agency&apos;s top flu expert, told a hearing being held by the Council of Europe&apos;s health committee.&lt;/p&gt;
&lt;p&gt;But he added, &quot;The influenza pandemic policies and responses recommended and taken by WHO were not improperly influenced by the pharmaceutical industry.&quot;&lt;/p&gt;
&lt;p&gt;The council&apos;s hearing is a response to criticism by some European politicians, as well as elements of the media, that the danger of the H1N1 pandemic was exaggerated, perhaps to allow drug companies to score multimillion-dollar contracts for vaccines and antivirals.&lt;/p&gt;
&lt;p&gt;In North America, many experts defended the response to the outbreak, which WHO last April declared a phase six pandemic  --  the highest level. The phases reflect that an infectious agent is widely spread and causing disease in the community, but they say nothing about the severity of the disease.&lt;/p&gt;
&lt;p&gt;&quot;I do not believe that the record supports the claim that health officials in the U.S. or WHO exaggerated the threat,&quot; said Andy Pavia, MD, of the University of Utah in Salt Lake City.&lt;/p&gt;
&lt;p&gt;Pavia said in an e-mail that health officials had a choice  --  to assume the threat was minor or to react strongly.&lt;/p&gt;
&lt;p&gt;&quot;The choice is obvious,&quot; Pavia said, &quot;and I would not want to be in a position of explaining to the families of victims why we planned for the mildest outcome.&quot;&lt;/p&gt;
&lt;p&gt;For the most part, illness caused by the disease has been mild, although several thousand people have died around the world and many more were sick enough to require intensive care.&lt;/p&gt;
&lt;p&gt;But the relatively low number of deaths has prompted Wolfgang Wodarg, MD, a German member of the council&apos;s Parliamentary Assembly, to dub the outbreak a &quot;false pandemic&quot; and call for this week&apos;s hearing.&lt;/p&gt;
&lt;p&gt;&quot;What we have experienced now is that millions of people have been vaccinated unnecessarily,&quot; Wodarg said. &quot;This is damage done to people, in order to earn money.&quot;&lt;/p&gt;
&lt;p&gt;Fukuda, on the other hand, said today the pandemic &quot;is a scientifically well-documented event.&quot;&lt;/p&gt;
&lt;p&gt;&quot;The labeling of the pandemic as &quot;fake&quot; is to ignore recent history and science,&quot; he said, &quot;and to trivialize the deaths of over 14,000 people and the many additional serious illnesses experienced by others.&quot;&lt;/p&gt;
&lt;p&gt;Utah&apos;s Pavia echoed that sentiment. Ask any front-line doctor if the H1N1 flu was mild, he said, &quot;and prepare to get your head handed to you.&quot;&lt;/p&gt;
&lt;p&gt;One of them was Daniel Hinthorn, MD, of the University of Kansas Medical Center in Kansas City, Kan. &quot;As a physician who saw many patients with this disease, I believe it was very serious in many people,&quot; he wrote in an e-mail. &quot;The threat was not exaggerated, at least to my mind.&quot;&lt;/p&gt;
&lt;p&gt;Even last month, as flu activity in the U.S. declined, he said his hospital treated 11 inpatients for the flu, including six in intensive care, while &quot;lots of others&quot; were being seen in emergency wards and clinics.&lt;/p&gt;
&lt;p&gt;On the other hand, to say the threat was exaggerated &quot;is merely to say the obvious,&quot; argued Philip Alcabes, PhD, of City University of New York City. By the time a vaccine was available, &quot;this outbreak was far less serious than feared,&quot; he said in an e-mail.&lt;/p&gt;
&lt;p&gt;But &quot;reality-based skepticism about swine flu&quot; doesn&apos;t mean that people would refuse immunization  --  not if an outbreak was a real public danger, caused by a &quot;highly transmissible agent, likely to be virulent, highly preventable with reliably effective vaccine.&quot;&lt;/p&gt;
&lt;p&gt;He warned that public health professionals must avoid &quot;falling in love with the most dire forecast and then pushing high-tech precautions against the worst-case scenario.&quot;&lt;/p&gt;
&lt;p&gt;When that happens, &quot;people have to be excused for wondering whether the officials, the media, and the pharmaceutical companies were in cahoots on swine flu,&quot; he said.&lt;/p&gt;
&lt;p&gt;But several experts argued that preparing for a worst-case scenario was the responsible thing to do.&lt;/p&gt;
&lt;p&gt;Sometimes, &quot;mother nature throws us a break,&quot; argued Howard Markel, MD, PhD, of the University of Michigan in Ann Arbor.&lt;/p&gt;
&lt;p&gt;&quot;We responded to a threat without knowing the future,&quot; he said in an e-mail. &quot;A far worse outcome might have occurred if we did not take the threat seriously and H1N1 turned out to be worse than we initially predicted.&quot;&lt;/p&gt;
&lt;p&gt;The public health response should be compared to the use of seat belts or auto insurance, according to Gregory Poland, MD, of the Mayo Clinic in Rochester, Minn.&lt;/p&gt;
&lt;p&gt;Every day, he said in an e-mail, he puts on his seat belt before driving. &quot;I don&apos;t finish each day and say &apos;What a waste, I didn&apos;t have an accident,&apos;&quot; he said.&lt;/p&gt;
&lt;p&gt;&quot;It is (and remains) unpredictable as to whether this virus could further mutate or change in a manner such that it could literally turn deadly within weeks,&quot; he said. &quot;If this pandemic had been deadly (and you don&apos;t know until you are into it) and we weren&apos;t prepared, the criticism would have been overwhelming.&quot; Poland said.&lt;/p&gt;
&lt;p&gt;He and others also noted that the flu season isn&apos;t over yet.&lt;/p&gt;
&lt;p&gt;&quot;This argument should be taking place at the end of the flu season in late March, not now,&quot; said Peter Katona, MD, of the University of California Los Angeles. &quot;Flu is unpredictable, and this is the heart of the argument.&quot;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_160"
                     title="CDC Says 20% of Americans Got H1N1 Flu Shot"
                     score="-0.006"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/17990?impressionId=1265761950161"
                     
      &lt;p&gt;As 2009 ended, an estimated 55 million Americans had been infected with the H1N1 pandemic flu and roughly one in five Americans had been vaccinated against the disease, the CDC said.&lt;/p&gt;
&lt;p&gt;The immunization data works out to about 61 million people, the agency said in an early release issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The proportion of people vaccinated was higher among those in priority groups, the agency said, including 29.4% of children ages 6 months through 18 years and 38% of pregnant women.&lt;/p&gt;
&lt;p&gt;At the same time, the CDC issued new estimates of the toll taken by the pandemic virus since the outbreak began last April: &lt;ul&gt; &lt;li&gt;About 55 million people had been infected up to Dec. 12, although the estimates ranged from 39 million to as high as 80 million.&lt;/li&gt; &lt;li&gt;About 246,000 needed inpatient care, although the number ranged from 173,000 to 362,000. &lt;/li&gt; &lt;li&gt;And about 11,160 died, with the estimate ranging from 7,880 to 16,460.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The vaccination findings are based on two surveys  --  the National 2009 H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System survey, which took place from Dec. 27 to Jan. 2 and from Dec. 1 to 27, respectively.&lt;/p&gt;
&lt;p&gt;Because vaccine was expected to be in short supply at the beginning, the CDC established initial target groups, including pregnant women, people living with or caring for infants under 6 months, healthcare and emergency medical services personnel, children and young adults, and adults with certain medical conditions.&lt;/p&gt;
&lt;p&gt;The CDC estimated that 27.9% of those people got vaccinated.&lt;/p&gt;
&lt;p&gt;The agency said the vaccine supply is now &quot;ample&quot; and efforts to promote general vaccination should continue.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_1420"
                     title="H1N1 (Swine) Flu Could Spread Easily Among Nations"
                     score="-0.006"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/14101?impressionId=1265761950161"
                     
      TORONTO, May 7 -- Early data on the H1N1 (swine) flu suggest it has the &quot;potential for efficient, rapid spread among countries,&quot; the CDC said.
              &lt;p&gt; 
              &lt;p&gt;And, although most cases have been uncomplicated and self-limited, there has been a &quot;substantial number of cases of severe disease and death&quot; among previously healthy children and young adults, the agency said in the May 8 issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;The snapshot of the outbreak -- up to date as of May 6 -- suggests several novel aspects:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;The percentage of patients requiring inpatient treatment seems to be higher than would be expected during a typical flu season, although the agency cautioned that many of the numbers associated with the outbreak are still not firm.
                &lt;li&gt;The age distribution of inpatients -- mostly young adults -- is different from that of seasonal influenza, where children under two, adults over 65, and people with chronic health conditions are the ones who typically need hospital care.
                &lt;li&gt;In Mexico and the U.S., the percentage of patients requiring hospital care has been particularly high among those ages 30 to 44.
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;In Mexico, where nearly 1,000 cases have laboratory confirmation, information is available on the clinical course for 22 inpatients with laboratory-confirmed illness, including seven who died, the agency said.
              &lt;p&gt; 
              &lt;p&gt;Five of the 15 surviving patients and one of the seven patients who died had underlying chronic medical conditions. Additional details on the clinical signs and symptoms of these and other patients are being collected, the CDC said.
              &lt;p&gt; 
              &lt;p&gt;The H1N1 symptoms were by and large similar to typical flu. Among patients with confirmed cases for whom information was available, 98% reported fever, 94% reported cough, 79% reported shortness of breath, 80% reported headache, and 83% reported runny nose.
              &lt;p&gt; 
              &lt;p&gt;There were minor differences in the U.S. where almost 650 confirmed cases have been reported. Among patients with confirmed disease for whom data were available, the CDC said that 90% reported fever, 84% reported cough, 61% reported sore throat, 26% reported diarrhea, and 24% reported vomiting.
              &lt;p&gt; 
              &lt;p&gt;Outside the U.S. and Mexico, the World Health Organization was reporting more than 300 laboratory-confirmed cases, the CDC said, and all but a handful were uncomplicated.
              &lt;p&gt; 
              &lt;p&gt;The vast majority of those patients reported travel to Mexico, the agency said. Of those with a travel history available, the CDC reported, 82% had recently been to Mexico and four reported traveling to the U.S. Among those who had not traveled to Mexico, 52% reported contact with a recent traveler.
              &lt;p&gt; 
              &lt;p&gt;Although there have been cases of second-generation transmission outside the U.S. and Mexico -- a healthcare worker in Germany who had cared for a patient with a confirmed infection came down with the flu -- there&apos;s no evidence of sustained community transmission in other countries, the CDC said.
              &lt;p&gt; 
              &lt;p&gt;As in North America, most cases reported from other countries have been among young adults, with a median age of 27.1 years. 
           
    </recommendedItem>
    <recommendedItem id="20090101_19_3133"
                     title="Unmasking the Surgical Mask: Does It Really Work?"
                     score="-0.006"
                     href="http://www.medpagetoday.com/InfectiousDisease/InfectionControl/tb/16278?impressionId=1265761950161"
                     
      &lt;p&gt;For a century, the surgical mask has been the symbol of a safe and sanitary medical environment. The problem: researchers don&apos;t really know if that&apos;s true.&lt;/p&gt;
&lt;p&gt;With the H1N1 influenza pandemic spreading every day, experts are still debating what type of mask to wear and how much protection that mask truly provides, particularly for those at the front lines of transmission  --  healthcare workers.&lt;/p&gt;
&lt;p&gt;Major health agencies, including the World Health Organization, the CDC, and others, have offered confusing and sometimes contradictory guidelines.&lt;/p&gt;
&lt;p&gt;Moreover, those guidelines differ for healthcare workers and ordinary citizens worried about the spread of H1N1. Even among healthcare professionals, there are different guidelines for medical wards and operating rooms.&lt;/p&gt;
&lt;p&gt;Still, most healthcare professionals have concluded that, at the very worst, a mask can&apos;t hurt, even if it may provide a false sense of safety.&lt;/p&gt;
&lt;p&gt;The notion of covering the nose and mouth for infection control actually dates back more than a century to the period when German physician Carl Fl&amp;#252;gge discovered that exhaled droplets could transmit tuberculosis.&lt;/p&gt;
&lt;p&gt;The modern surgical mask, successor to the crude gauze strips those early doctors and nurses employed, is still primarily designed to prevent the passage of relatively large particles, such as sputum droplets and hair.&lt;/p&gt;
&lt;p&gt;A high tech version  --  the so-called N95 respirator  --  seals tightly around mouth and nose and is made of material certified to block 95% of particles 0.3 &amp;#956;m or larger in diameter, roughly the size of a single virus. There&apos;s something resembling agreement that, worn properly, these do their job.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Conflicting Guidelines&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;CDC recommends surgical masks as part of the overall arsenal deployed against seasonal flu, but along with the Institute of Medicine, CDC has recommended only N95 respirators for protection against H1N1  --  in part, because animal studies suggest airborne transmission of the virus via small particles.&lt;/p&gt;
&lt;p&gt;Not so for the World Health Organization or the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, and the American College of Occupational and Environmental Medicine.&lt;/p&gt;
&lt;p&gt;They collectively recommended regular surgical masks except in high risk circumstances, such as during open suctioning of airway secretions and other procedures that could &quot;aerosolize&quot; the H1N1 virus.&lt;/p&gt;
&lt;p&gt;There&apos;s a good reason for this lack of consensus: a dearth of quality evidence in a scientific arena dominated by anecdote and laboratory experiment.&lt;/p&gt;
&lt;p&gt;&quot;Some of these practices that have been in place for decades haven&apos;t been subjected to the same strenuous investigation that, for instance, a new medicine might be subjected to,&quot; Mark Rupp, MD, president of the Society for Healthcare Epidemiology of America, told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Masks, he noted, &quot;are fairly innocuous, relatively cheap, and so people are not really very interested in going through the extensive investigation that would be required.&quot;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Conflicting Evidence&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;In the past two weeks, researchers have released results from the first two randomized clinical trials investigating efficacy of masks and respirators in protecting healthcare workers from respiratory infection.&lt;/p&gt;
&lt;p&gt;Did they settle the issue?&lt;/p&gt;
&lt;p&gt;Hardly. In fact, their conflicting results simply added fuel to the debate, according to CDC&apos;s Arjun Srinivasan, MD.&lt;/p&gt;
&lt;p&gt;The first reports came in August, during &lt;a href=&quot;http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/15518&quot; mce_href=&quot;http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/15518&quot; target=&quot;_blank&quot;&gt;IOM deliberations&lt;/a&gt; over standards for healthcare workers&apos; personal protective equipment, when C. Raina MacIntyre, MBBS, PhD, of the University of New South Wales in Sydney, Australia, presented preliminary results of her randomized clinical trial.&lt;/p&gt;
&lt;p&gt;That study involved nearly 2,000 emergency and respiratory ward nurses and physicians in Beijing who were cluster-randomized to wear surgical masks, fit-tested N95 respirators, or non-fit tested N95 respirators during all work hours for four consecutive weeks during the cold and flu season.&lt;/p&gt;
&lt;p&gt;Having been through the SARS scare in 2003, the Chinese are regarded as very serious about mask use in the hospital and outside.&lt;/p&gt;
&lt;p&gt;At the &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ICAAC/16006&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ICAAC/16006&quot; target=&quot;_blank&quot;&gt;Interscience Conference on Antimicrobial Agents and Chemotherapy&lt;/a&gt; in September, MacIntyre presented the dramatic results: Consistent use of N95 respirators prevented 75% of respiratory infections, while consistent surgical mask use was no better than low use for prevention of clinical respiratory illness (6.7% versus 9.2%, &lt;em&gt;P&lt;/em&gt;=0.159) or of influenza-like illness (0.6% versus 1.3%, &lt;em&gt;P&lt;/em&gt;=0.336).&lt;/p&gt;
&lt;p&gt;The case against old-fashioned surgical masks seemed clear.&lt;/p&gt;
&lt;p&gt;&quot;To me it would not seem justifiable to ask healthcare workers to wear surgical masks,&quot; MacIntyre said in an interview.&lt;/p&gt;
&lt;p&gt;Then another shocker. A second head-to-head study appeared, this time in the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;. It&apos;s conclusion: surgical masks &lt;em&gt;were&lt;/em&gt; just as good as N95 respirators.&lt;/p&gt;
&lt;p&gt;The 478 emergency department, medical unit, and pediatric nurses in this Canadian study who were randomized to use a surgical mask when providing care to patients with febrile respiratory illness during the flu season caught seasonal flu at about the same rate as those who wore fit-tested, N95 respirators (23.6% versus 22.9%, &lt;em&gt;P&lt;/em&gt;=0.86).&lt;/p&gt;
&lt;p&gt;For H1N1 influenza, surgical masks again met noninferiority criteria versus the N95 respirator (8.0% versus 11.9%, &lt;em&gt;P&lt;/em&gt;=0.18).&lt;/p&gt;
&lt;p&gt;Design may have accounted for the discrepancy between the trials, at least in part, suggested Srinivasan, who co-authored an editorial accompanying the &lt;em&gt;JAMA&lt;/em&gt; study with an IOM committee member colleague.&lt;/p&gt;
&lt;p&gt;&quot;These types of studies are very difficult to do,&quot; he told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The driving factor in effectiveness is how frequently and intensely the wearer is exposed to infection, he said. So one possibility is that masks may have been enough for Canadian nurses in generally lower risk settings, but not for the high-risk Chinese healthcare workers.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;In Surgery: Masks Unmasked&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Lack of evidence has also plagued surgical masks in their traditional setting, and where their use is still nearly universal: the operating room.&lt;/p&gt;
&lt;p&gt;But not for lack of study.&lt;/p&gt;
&lt;p&gt;In fact, three large, randomized controlled trials were conducted in the 1980s to determine once and for all if surgical masks actually did prevent surgical wound infection.&lt;/p&gt;
&lt;p&gt;Here, where bacteria were the major concern in wound infection, the enemy targets were larger and might not require the fine filtration necessary to keep a respiratory virus away, researchers theorized.&lt;/p&gt;
&lt;p&gt;But the trials &quot;showed absolutely no efficacy&quot; for that original purpose, MacIntyre noted.&lt;/p&gt;
&lt;p&gt;&quot;Really, the surgeon might as well wear nothing on their face,&quot; she said.&lt;/p&gt;
&lt;p&gt;Still, the CDC recommends a mask in the operating room, citing long-standing tradition and the benefits of protecting nose and mouth from splashes of blood and other bodily fluids.&lt;/p&gt;
&lt;p&gt;MacIntyre noted that a face shield is a better option against splashes because surgeons have to wear eye protection with a mask anyway.&lt;/p&gt;
&lt;p&gt;But mask wearing &quot;is so inculcated into the practice of medicine that it&apos;s going to be very hard to change,&quot; said John G. Bartlett, MD, former chief of infectious diseases at Johns Hopkins.&lt;/p&gt;
&lt;p&gt;Tradition and aesthetics play a role in the issue. Patients would not accept a surgeon who doesn&apos;t wear a mask because they are so ingrained as a symbol of a safe surgical environment, Bartlett said.&lt;/p&gt;
&lt;p&gt;And since the masks are fairly inexpensive and easy to wear, it hasn&apos;t been worth challenging the status quo, he declared.&lt;/p&gt;
&lt;p&gt;Nor are there likely to be more studies to decide the issue one way or the other, added Rupp. &quot;Those studies are difficult to do because the percentage of patients who develop a surgical site infection is very, very low. So the impact of wearing a surgical mask is difficult to demonstrate,&quot; he said.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Masks for the Masses&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Unlike the operating room, where it would be impossible to stop people from wearing masks, there are few places outside the hospital where it hasn&apos;t been hard to persuade people to put them on.&lt;/p&gt;
&lt;p&gt;One of the exceptions is Asia, which has developed has a strong culture of mask use, both in medical settings and in public venues, largely as a result of the SARS epidemic in 2003, Bartlett said.&lt;/p&gt;
&lt;p&gt;&quot;Those people did whatever they could to try to prevent SARS,&quot; he recalled. &quot;If it turned out that the H1N1 virus became more virulent and started to be a really serious disease, then people would be much more fastidious about how they used the disease prevention tools.&quot;&lt;/p&gt;
&lt;p&gt;The CDC recommends that people who are ill with suspected or confirmed H1N1 flu wear face masks when at home around family members, in healthcare settings, at school until they can be taken home, and when it&apos;s necessary for them to be out and about.&lt;/p&gt;
&lt;p&gt;However, the only high-level evidence for efficacy of masks in the community was a &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/15428&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/15428&quot; target=&quot;_blank&quot;&gt;trial from Hong Kong&lt;/a&gt; -- published online last month in the &lt;em&gt;Annals of Internal Medicine&lt;/em&gt;  --  involving flu patients who were randomized to hand hygiene alone or in combination with surgical masks.&lt;/p&gt;
&lt;p&gt;Compared with controls, employing hand hygiene alone or with face masks tended to reduce transmission of the flu to those living in the same house, but not significantly so.&lt;/p&gt;
&lt;p&gt;However, when these interventions were initiated within 36 hours of symptom onset, face masks plus hand hygiene reduced risk of transmission by a very significant 67%.&lt;/p&gt;
&lt;p&gt;Although the entire benefit can&apos;t be attributed to face masks, the results suggest masks may make a difference, MacIntyre said.&lt;/p&gt;
&lt;p&gt;Because exposure to pathogens is typically much lower for the general public than for healthcare workers, &quot;surgical masks may be enough in the community,&quot; she said.&lt;/p&gt;
&lt;p&gt;Rupp agreed, saying he takes a &quot;better safe than sorry&quot; approach. His medical center asks patients with potentially droplet-mediated infections to put on a surgical mask.&lt;/p&gt;
&lt;p&gt;&quot;There probably isn&apos;t a whole lot of extensive study on the use of this in clinical situation,&quot; Rupp said. &quot;We do think it&apos;s a pretty obvious way somebody can go about containing their secretions.&quot;&lt;/p&gt;
&lt;p&gt;N95 masks would likely provide even more protection, MacIntyre said, but there&apos;s is fairly clear consensus that they would be intolerable for someone with a respiratory illness.&lt;/p&gt;
&lt;p&gt;&quot;They are relatively difficult to breath through; they can be associated also with feelings of claustrophobia and kind of a suffocating sensation,&quot; Rupp added. &quot;It&apos;s difficult enough to get them to wear a loose fitting and relatively comfortable surgical mask.&quot;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Practical Masking&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Practical issues such as compliance and supply have been part of the argument for use of surgical masks rather than N95 respirators in most clinical settings.&lt;/p&gt;
&lt;p&gt;In a &lt;em&gt;New England Journal of Medicine&lt;/em&gt; perspective piece last week, several IOM committee members acknowledged that N95 respirators are currently in short supply.&lt;/p&gt;
&lt;p&gt;They suggested that healthcare institutions place priority on N95 respirators in the highest-risk areas, &quot;such as enclosed spaces in the respiratory care unit, patients&apos; rooms, and ambulances.&quot;&lt;/p&gt;
&lt;p&gt;While the IOM was instructed to not take these issues into consideration in its guidelines, a CDC spokesperson said that agency is making them a large factor in revision of its interim guidelines for healthcare worker respiratory protection.&lt;/p&gt;
&lt;p&gt;In the end, however, infectious disease specialists always come back to the bigger picture.&lt;/p&gt;
&lt;p&gt;Debate over the role of respiratory protection in preventing influenza transmission doesn&apos;t &quot;excuse anyone from failing to implement other measures that are known to protect patients and healthcare professionals from influenza,&quot; Srinivasan&apos;s &lt;em&gt;JAMA&lt;/em&gt; editorial concluded.&lt;/p&gt;
&lt;p&gt;&quot;Masks and respirators should be considered the &apos;last line of defense&apos; in a hierarchy of infection control measures.&quot;&lt;/p&gt;
&lt;p&gt;Handwashing, good etiquette when sneezing and coughing, and staying home when sick are still the keys to preventing spread of infectious disease, it said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Rupp reported being president of the Society for Healthcare Epidemiology of America but no other conflicts of interest.&lt;/p&gt;&lt;p&gt;MacIntyre reported receiving funding for unrelated, investigator-driven studies from GlaxoSmithKline, CSL Biotherapies, and Wyeth and having been an investigator on a Merck clinical trial.&lt;/p&gt;&lt;p&gt;Bartlett and Srinivasan reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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